"Quality is never an accident; it is always the result of intelligent effort"

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Kaitlyn Dmyterko, staff writer

Like John Ruskin, English social thinker, poet and artist once said, Quality is never an accident; it is always the result of intelligent effort. Currently in the medical industry, there is much focus on the public reporting of quality-performance measures and a greater emphasis on disclosing both top-notch and below-average care, not only just in hopes to improve care, but to also create a system of greater transparency.

In this week’s news, a perspective in the New England Journal of Medicine weighs the pros and cons of publicly reporting outcomes of CABG procedures. While reporting the 11 quality measures that include medical therapy, risk-adjusted mortality post-CABG, rates of infections and stroke, among others, may help improve patient care, Ferris and Torchiana question whether the disclosures assist patients in “discriminating among sites of care.”

Using a three-star scale, facilities were ranked as either outliers—above or below—or equal to the national performance range. Of 221 sites reporting, only five ranked below the national average, alluding to the fact that reporting these outcomes may lead to a better quality of care.

Similarly, another study published Sept. 2 in the NEJM stated that healthcare facilities should disclose medical mistakes and adverse events that affect a multitude of patients despite whether or not patients were harmed by the event.

These events, incompletely sterilizing equipment and device malfunction, among others, can affect thousands of patients and researchers from the University of Washington, Seattle, recommended that there should be increased disclosure, better communication with the public, better patient follow-up and an institutional policy for disclosure.

To bolster this, the FDA announced this week that it has established a performance monitoring program—FDA-TRACK— that will monitor over 100 FDA offices by use of performance measures to create transparency.

According to the FDA, the program will increase transparency, accountability and credibility when dealing with new devices or drugs.

Likewise, a study published in the Annals of Internal Medicine  investigated cardiologist and patient perceptions of PCI, finding many discrepancies that exist. Alicia Fernandez, MD, told Cardiovascular Business News that there are some major flaws within the patient informed consent process that may lead to these discrepancies and misjudgements and that the system should be reworked.

Fernandez said that reinventing the reimbursement system could help align quality care and reimbursement, as currently there is little incentive for physicians to discourage patients from undergoing a PCI intervention. A better system to weigh both the benefits and risks of a procedure, particularly PCI, could lead to better care and outcomes.

Focusing policy on publicly reporting data may help with outcomes and lead to better patient care, but also set a standard of competition for hospitals striving to set care above the national average.

On these topics, or others please feel free to contact me.

Kaitlyn Dmyterko