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New IOM report may help officials link payment to quality JCAHO worries about underreporting to its Sentinel Event Database 8,500 patients *not* dead at Michigan hospital

Patient Safety Monitor Alert, January 14, 2003

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NEW IOM REPORT MAY HELP OFFICIALS LINK PAYMENT TO QUALITY

Wondering where to start your quality improvement efforts? The Institute of Medicine (IOM) released a list of possibilities last week that hospital staff will want to keep an eye on--for more reasons than one. These 20 priority areas for quality improvement "could set the stage for linking payment incentives to the quality of care," Harvey Fineberg, MD, PhD, president of the IOM wrote in the forward of the report, "Priority Areas for National Action: Transforming Health Care Quality," which published the list. The following are some of the issues included on the list:

- Care coordination - Appropriate management of early diabetes
- Child and adult immunization
- Preventing and surveying nosocomial infections
- Treatment for adult tobacco dependence

Organizations such as the Agency for Healthcare Research and Quality should develop data collection and measurement systems to assess the effectiveness of quality improvement efforts, develop standard quality measures, make key information available to the public, and update the list every few years, recommended the IOM committee that developed the list. The committee also recommends that legislators provide funding support for the initiative, as well as for more scientific research on quality measures.

The report, produced in response to recommendations in the 2001 report, "Crossing the Quality Chasm," focuses on chronic conditions, but also includes acute, preventative, and palliative care--as well as interventions that cut across the systems. Go to www.iom.edu to view a copy, which includes the entire list of priority areas.

JCAHO WORRIES ABOUT UNDERREPORTING TO ITS SENTINEL EVENT DATABASE

The JCAHO's voluntary Sentinel Event Database may not be as accurate as the organization once thought due to underreporting, according to a letter sent to health care providers earlier this month. The organization has recently become concerned that it has received a "disproportionately low volume of reports" on unanticipated deaths or permanent loss of function that
- are apparently nosocomial infection-related
- long-term care services report to federal and state agencies in the Minimum Data Set
- home care services report to federal and state agencies as part of the OASIS requirements

In the letter, the Joint Commission's president, Dennis O'Leary, MD, encouraged providers to report on these issues and reminded them that the information helps the JCAHO create Sentinel Event Alerts and the annual National Patient Safety Goals.

8,500 PATIENTS *NOT* DEAD AT MICHIGAN HOSPITAL

Patient safety staff that notice an extraordinary spike in patient deaths at their organizations may not always have cause to panic--at least not if their situation is similar to the one at Saint Mary's Mercy Medical Center in Grand Rapids, MI. Saint Mary's staff recently discovered that the bills for 8,500 patients were incorrectly coded as "deceased" rather than "discharged to home," according to the Associated Press (AP).

An employee helping a patient with a billing problem discovered the discrepancy when she compared the bill--which said the patient had died--to the very live person standing in front of her. The hospital is currently working with Medicare officials to correct the problem, which could take months, hospital officials told the AP.

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