Quality Improvement Summit 2016: Shared Decision Making and Prostate Cancer Screening.

INTRODUCTION: The American Urological Association Quality Improvement Summit occurs regularly to provide education and promote dialogue around the issues of quality improvement and patient safety. Nearly all prostate cancer screening guidelines recommend shared decision making strategies when determining whether prostate specific antigen testing is right for a specific patient. This summit, held in partnership with the Society for Medical Decision Making, focused on techniques to identify and understand patient values in relation to prostate cancer screening and treatment, and to promote incorporation of shared decision making into prostate cancer screening discussions. METHODS: Information presented at the Quality Improvement Summit was provided by physicians and leading experts in the field of shared decision making. The open forum of this summit encouraged contributions from participants about their personal experiences with shared decision making and their thoughts on the tools presented during the day. RESULTS: Shared decision making supports collaboration between physician and patient in situations where there are multiple preference sensitive options. CONCLUSIONS: Practitioners should include formal shared decision making procedures surrounding prostate specific antigen testing in their practices to ensure that testing is in accordance with patient values and desired outcomes. Tools and strategies like those reviewed in this Quality Improvement Summit are invaluable for alleviating potential burden on providers, ensuring communication and improving quality of care.

Emergency care and the national quality strategy: highlights from the Centers for Medicare & Medicaid Services.

The Centers for Medicare & Medicaid Services (CMS) of the US Department of Health and Human Services seeks to optimize health outcomes by leading clinical quality improvement and health system transformation through a variety of activities, including quality measure alignment, prioritization, and implementation. CMS manages more than 20 federal quality measurement and public reporting programs that cover the gamut of health care providers and facilities, including both hospital-based emergency departments (EDs) and individual emergency physicians. With more than 130 million annual visits, and as the primary portal of hospital admission, US hospital-based EDs deliver a substantial portion of acute care to Medicare beneficiaries. Given the position of emergency care across clinical conditions and between multiple settings of care, the ED plays a critical role in fulfilling all 6 priorities of the National Quality Strategy. We outline current CMS initiatives and future opportunities for emergency physicians and EDs to effect each of these priorities and help CMS achieve the triple aim of better health, better health care, and lower costs.

Opportunities for quality measurement to improve the value of care for patients with multiple chronic conditions.

Quality measurement efforts have not historically focused on patients with multiple chronic conditions (MCCs), despite them comprising one quarter of the population and two thirds of health care spending. The Patient Protection and Affordable Care Act (ACA) creates several mechanisms for the Centers for Medicare & Medicaid Services (CMS) to transform quality measurement into an organized enterprise designed to support clinicians caring for this vulnerable population. This article highlights 3 emerging policy opportunities for CMS to guide public and private quality measurement efforts for patients with MCCs. First, it discusses infusing an MCC framework into measure development to promote patient-centered, as opposed to single-disease-specific, performance measurement. Second, it describes the importance of using common performance measures for individual clinicians, hospitals, and communities to accelerate meaningful improvement in the prevention and management of chronic conditions across local populations. Finally, the need for longitudinal measurement as a foundation for sustained quality improvement is presented. The ACA's expansion of insurance access and portability necessitates collaborative alignment of chronic condition quality measurement efforts between public and private programs to develop a high-value lifelong health system.

Hospitalist utilization and hospital performance on 6 publicly reported patient outcomes.

BACKGROUND: The increase in hospitalist-provided inpatient care may be accompanied by an expectation of improvement on patient outcomes. To date, the association between utilization of hospitalists and the publicly reported patient outcomes is unknown. OBJECTIVE: Assess the relationship between hospitalist utilization and performance on 6 publicly reported patient outcomes. DESIGN: Cross-sectional study. PARTICIPANTS: Representatives of 598 hospitals in the United States with direct knowledge of inpatient service models. INTERVENTION: Survey of hospital personnel with knowledge of hospitalist use and hospitalist programs. MEASUREMENTS: Six publicly reported quality outcome measures across 3 medical conditions: acute myocardial infarction (AMI), congestive heart failure (HF), and pneumonia. Using multivariable regression models, we assessed the relationship between presence of hospitalists and performance on each outcome measure; we further assessed the relationship between the percentage of patients admitted by hospitalists and each outcome measure. RESULTS: Of 598 respondents, 429 (72%) reported the use of hospitalist services. In the comparison of hospitals with and without hospitalists, there was no statistically significant difference on any of the mortality or readmissions measures with the exception of the risk-stratified readmission rate for heart failure. For hospitals that used hospitalists, there was no significant change in any of the outcome measures with increasing percentage of patients admitted by hospitalists. CONCLUSIONS: The presence of hospitalists is not an independent predictor of performance on publicly reported mortality and readmissions measures for AMI, HF, or pneumonia. It is likely that broader system or organizational interventions are required to improve performance on patient outcomes.

Patient-centered care categorization of U.S. health care expenditures.

OBJECTIVE: To categorize national medical expenditures into patient-centered categories. DATA SOURCES: The 2007 Medical Expenditure Panel Survey (MEPS), a nationally representative annual survey of the civilian noninstitutionalized population. STUDY DESIGN: Descriptive statistics categorizing expenditures into seven patient-centered care categories: chronic conditions, acute illness, trauma/injury or poisoning, dental, pregnancy/birth-related, routine preventative health care, and other. DATA COLLECTION METHODS: MEPS cohort. PRINCIPAL FINDINGS: Nearly half of expenditures were for chronic conditions. The remaining expenditures were as follows: acute illness (25 percent), trauma/poisoning (8 percent), dental (7 percent), routine preventative health care (6 percent), pregnancy/birth-related (4 percent), and other (3 percent). Hospital-based expenditures accounted for the majority for acute illness, trauma/injury, and pregnancy/birth and over a third for chronic conditions. CONCLUSIONS: This patient-centered viewpoint may complement other methods to examine health care expenditures and may better represent how patients interact with the health care system and expend resources.