News Briefs
August 1, 1999 3 minutes read
News Briefs
AMA’s quality chief takes helm at MGMA
Former vice president for quality and managed care at the American Medical Association, William F. Jessee, MD, who was instrumental in crafting a physician accreditation program, became president and CEO of the Medical Group Management Association (MGMA) in Englewood, CO, in July. "MGMA is widely regarded as an extremely valuable repository of expertise on how to run a high-quality efficient practice. I want to build on that," says Jessee.
Outcomes measurement and quality improvement are increasingly important components of good practice management, he notes.
Jessee points to a neurosurgery practice in Denver that used health status and patient satisfaction data to demonstrate success to managed care plans. "They got better contracts from managed care plans because they had data to show they were providing better value."
CONQUEST offers ways to find QI measures
Medical groups looking for quality improvement tools can tap into an expanded version of the CONQUEST (Computerized Needs- Oriented Quality Measurement Evaluation System) database. Developed by the federal Agency for Health Care Policy and Research (AHCPR) in Rockville, MD, the database encompasses measurement sets and individual indicators. The Conditions database covers 57 medical conditions, including cancer, cataracts, hypertension, and pregnancy. The Clinical Performance Measures database includes specifications for almost 1,200 measures, such as patients with pneumonia who receive correct antibiotics.
The CONQUEST 2.0 database, User’s Guide, and Quick Start guide can be downloaded from AHCPR’s Web site (http://www.ahcpr.gov/ qual/conquest.htm). Disk versions of the database (No. 99-DP01), User’s Guide (No. 99-0011), and Quick Start guide (No. 99-015) are available free of charge from the AHCPR Publications Clearing-house, P.O. Box 8547, Silver Spring, MD 20907. Telephone: (800) 358-9295.
Next year, AHCPR hopes to launch CONQUEST as an interactive, Internet-based database. For more information on the database and its capabilities, contact Marge Keyes, AHCPR project officer at (301) 594-1824. E-mail: mkeyes@ ahcpr.gov.
Web site posts ratings for most U.S. hospitals
A free Internet site is offering ratings of hospitals on specialties such as orthopedic joint replacement and cardiac surgery, cardiology, neurology, neurosurgery, and pulmonary/respiratory care. Created by Lakewood, CO-based Healthcare Report Cards Inc. (HRCI), the site has registered over 6 million hits since its launch on Oct. 27, 1998. The address (www.healthcarereportcards.com) is not case-sensitive.
HealthcareReportCards.com rates hospitals from best to poor. Five-star hospitals represent the top 10% of all U.S. medical facilities as graded by HRCI. Grades posted on HealthcareReport Cards.com reflect both the quality of care delivered by the hospital’s staff and by the physicians involved in the cases. The ratings in each specialty cover 1,000 to 4,000 facilities, depending on how many offer each type of care. The raw data, the Medicare Provider Analysis and Review, are purchased from the Health Care Financing Administration and risk-adjusted by HRCI.
What’s the best way to promote guidelines?
A recent study confirms what you probably already know: The publication of practice guidelines fails to get voluntary compliance by practioner's. What's more interesting is that academic detailing (AD) is more effective than continuous quality improvement (CQI) teams in changing clinical procedures. But neither method produces the full-fledged adoption of guidelines you may seek.
To study the matter, a randomized controlled trial compared the two methods of increasing guidelines' compliance in ambulatory settings. Tested were national guidelines for the primary care treatment of hypertension and depression. The AD intervention is modeled on the methods of pharmaceutical sales representatives. Physicians or pharmacists offer providers brief, one-on-one educational sessions. The CQI intervention involves multidisciplinary teams empowered to target improvement opportunities, set goals, and map and collect data on process changes.
Of their rather gloomy conclusions, the investigators write, "The AD techniques and the CQI teams evaluated were generally ineffective in improving guideline compliance and clinical outcomes regarding the primary care of hypertension and depression." Both techniques, they add, are socially complex interventions sensitive to organizational culture and the personalities involved. The strengths and shortcomings of the techniques bear more study.
Meanwhile, however, they note that CQI teams might be better suited to implementing process changes already proven effective. AD programs seem most effective when applied to conditions that are obviously ripe for better treatment regimens.
[For more information, see Goldberg HI, Wagner EH, Fihn SD, et al, A randomized controlled trial of CQI teams and academic detailing: Can they alter compliance with guidelines? Jt Comm J Qual Improv 1998; (24)3:130-142.]
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