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1.
Am J Manag Care ; 29(5): 220-226, 2023 05.
Artigo em Inglês | MEDLINE | ID: mdl-37229781

RESUMO

OBJECTIVES: The study examined a commercial accountable care organization (ACO) population and then assessed the impact of an integrated care management program on medical spending and clinical event rates. STUDY DESIGN: Retrospective cohort study of high-risk individuals (n = 487) in a population of 365,413 individuals aged 18 to 64 years within the Mass General Brigham health system who were part of commercial ACO contracts with 3 large insurers between 2015 and 2019. METHODS: Using medical spending claims and other enrollment data, the study assessed the demographic and clinical characteristics, medical spending, and clinical event rates of patients in the ACO and its high-risk care management program. The study then examined the impact of the program using a staggered difference-in-difference design with individual-level fixed effects and compared outcomes of those who had entered the program with those of similar patients who had not entered. RESULTS: The commercially insured ACO population was healthy on average but included several hundred high-risk patients (n = 487). After adjustment, patients within the ACO's integrated care management program for high-risk patients had lower monthly medical spending (by $1361 per person per month) as well as lower emergency department visit and hospitalization rates compared with similar patients who had yet to start the program. Accounting for early ACO departure decreased the magnitude of the program effects as expected. CONCLUSIONS: Commercial ACO populations may be healthy on average but still include some high-risk patients. Identifying which patients might benefit from more intensive care management could be critical for reaping the potential savings.


Assuntos
Organizações de Assistência Responsáveis , Medicare , Estados Unidos , Humanos , Estudos Retrospectivos , Assistência Médica , Hospitalização , Redução de Custos
2.
Am J Manag Care ; 29(4): e104-e110, 2023 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-37104836

RESUMO

OBJECTIVES: Commercial accountable care organization (ACO) contracts attempt to mitigate spending growth, but past evaluations have been limited to continuously enrolled ACO members in health maintenance organization (HMO) plans, excluding many members. The objective of this study was to examine the magnitude of turnover and leakage within a commercial ACO. STUDY DESIGN: A historical cohort study using detailed information from multiple commercial ACO contracts within a large health care system between 2015 and 2019. METHODS: Individuals insured through 1 of the 3 largest commercial ACO contracts during the study period, 2015-2019, were included. We examined patterns of entry and exit and the characteristics that predicted remaining in the ACO compared with leaving the ACO. We also examined predictors of the amount of care delivered in the ACO compared with outside the ACO. RESULTS: Among the 453,573 commercially insured individuals in the ACO, approximately half left the ACO within the initial 24 months after entry. Approximately one-third of spending was for care occurring outside the ACO. Patients who remained in the ACO differed from those who left earlier, including being older, having a non-HMO plan, having lower predicted spending at entry, and having more medical spending for care performed within the ACO during the initial quarter of membership. CONCLUSIONS: Both turnover and leakage hamper the ability of ACOs to manage spending. Modifications that address potentially intrinsic vs avoidable sources of population turnover and increase patient incentives for care within vs outside of ACOs could help address medical spending growth within commercial ACO programs.


Assuntos
Organizações de Assistência Responsáveis , Medicare , Estados Unidos , Humanos , Estudos de Coortes , Sistemas Pré-Pagos de Saúde
3.
J Racial Ethn Health Disparities ; 10(2): 593-602, 2023 04.
Artigo em Inglês | MEDLINE | ID: mdl-35199327

RESUMO

OBJECTIVE: The COVID-19 pandemic has disproportionately impacted minority communities, yet little data exists regarding whether disparities have improved at a health system level. This study examined whether sociodemographic disparities in hospitalization and clinical outcomes changed between two temporal waves of hospitalized COVID-19 patients. METHODS: This is a retrospective cohort study of primary care patients at Mass General Brigham (a large northeastern health system serving 1.27 million primary care patients) hospitalized in-system with COVID-19 between March 1, 2020, and March 1, 2021, categorized into two 6-month "wave" periods. We used chi-square tests to compare demographics between waves, and regression analysis to characterize the association of race/ethnicity and language with in-hospital severe outcomes (death, hospice discharge, intensive unit care need). RESULTS: Hispanic/Latino, Black, and non-English-speaking patients constituted 30.3%, 12.5%, and 29.7% of COVID-19 admissions in wave 1 (N = 5844) and 22.2%, 9.0%, and 22.7% in wave 2 (N = 4007), compared to 2019 general admission proportions of 8.8%, 6.3%, and 7.7%, respectively. Admissions from highly socially vulnerable census tracts decreased between waves. Non-English speakers had significantly higher odds of severe illness during wave 1 (OR 1.35; 95% CI: 1.10, 1.66) compared to English speakers; this association was non-significant during wave 2 (OR 1.01; 95% CI: 0.76, 1.36). CONCLUSIONS: Comparing two COVID-19 temporal waves, significant sociodemographic disparities in COVID-19 admissions improved between waves but continued to persist over a year, demonstrating the need for ongoing interventions to truly close equity gaps. Non-English-speaking language status independently predicted worse hospitalization outcomes in wave 1, underscoring the importance of targeted and effective in-hospital supports for non-English speakers.


Assuntos
COVID-19 , Pandemias , Humanos , Estudos Retrospectivos , COVID-19/terapia , Hospitalização , Hospitais
5.
Am J Manag Care ; 27(3): 123-128, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33720669

RESUMO

The coronavirus disease 2019 (COVID-19) pandemic has fundamentally changed how health care systems deliver services and revealed the tenuousness of care delivery based on face-to-face office visits and fee-for-service reimbursement models. Robust population health management, fostered by value-based contract participation, integrates analytics and agile clinical programs and is adaptable to optimize outcomes and reduce risk during population-level crises. In this article, we describe how mature population health programs in a learning health system have been rapidly leveraged to address the challenges of the pandemic. Population-level data and care management have facilitated identification of demographic-based disparities and community outreach. Telemedicine and integrated behavioral health have ensured critical primary care and specialty access, and mobile health and postacute interventions have shifted site of care and optimized hospital utilization. Beyond the pandemic, population health can lead as a cornerstone of a resilient health system, better prepared to improve public health and mitigate risk in a value-based paradigm.


Assuntos
Atenção à Saúde/organização & administração , Sistema de Aprendizagem em Saúde/organização & administração , Saúde da População , COVID-19/prevenção & controle
6.
Nurs Adm Q ; 45(2): 102-108, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33570876

RESUMO

As hospitals across the world realized their surge capacity would not be enough to care for patients with coronavirus disease-2019 (COVID-19) infection, an urgent need to open field hospitals prevailed. In this article the authors describe the implementation process of opening a Boston field hospital including the development of a culture unique to this crisis and the local community needs. Through first-person accounts, readers will learn (1) about Boston Hope, (2) how leaders managed and collaborated, (3) how the close proximity of the care environment impacted decision-making and management style, and (4) the characteristics of leaders under pressure as observed by the team.


Assuntos
COVID-19/epidemiologia , Fortalecimento Institucional/organização & administração , Arquitetura Hospitalar/métodos , Unidades Móveis de Saúde/organização & administração , Boston , Feminino , Humanos , Liderança , Masculino , Unidades Móveis de Saúde/estatística & dados numéricos , Pandemias , SARS-CoV-2 , Incerteza
7.
JAMA Netw Open ; 3(4): e202764, 2020 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-32286657

RESUMO

Importance: The collection of patient-reported outcomes (PROs) has garnered intense interest, but dissemination of PRO programs has been limited, as have analyses of the factors associated with successful programs. Objective: To identify factors associated with improving PRO collection rates within a large health care system using a centralized PRO infrastructure. Design, Setting, and Participants: This cohort study included 205 medical and surgical clinics in the Partners Healthcare system in Massachusetts that implemented a PRO program between March 15, 2014, and December 31, 2018, using a standardized centralized infrastructure. Data were analyzed from March to April 2019. Exposures: Relevant clinical characteristics were recorded for each clinic launching a PRO program. Main Outcomes and Measures: The primary outcome was the mean PRO collection rate during each clinic's most recent 6 months of collection prior to January 2019. Data were analyzed using a linear regression model with the 6-month PRO collection rate as the dependent variable and clinic characteristics as independent variables. Secondary analysis used a logistic regression model to assess clinical factors associated with successful clinics, defined as those that collected PROs at a rate greater than 50%. Results: Between March 2014 and December 2018, 205 Partners Healthcare clinics were available for analysis, and 4 061 205 PRO measures from 745 028 encounters were collected. Among these, 103 clinics (50.2%) collected at a rate greater than 50%. Increased collection rates were associated with more than 50% of physicians in a clinic trained on PROs (change, 19.6% [95% CI, 9.9%-29.4%]; P < .001), routine administrative oversight of collection rates (change, 16.0% [95% CI, 6.6%-25.5%]; P = .001), previous collection of PROs on paper (change, 12.5% [95% CI, 4.7%-20.3%]; P = .002), presence of a clinical champion (change, 11.2% [95% CI, 2.5%-20.0%]; P = .01) and payer incentive (change, 10.5% [95% CI, 2.0%-18.9%]; P = .02). Conclusions and Relevance: These findings suggest that training physicians on the use of PROs, administrative surveillance of collection rates, and the presence of a local clinical champion may be promising interventions for increasing PRO collection. Clinics that have previously collected PROs may have greater success in increasing collections. Payer incentive for collection was associated with improved collections, but not associated with successful programs.


Assuntos
Coleta de Dados/estatística & dados numéricos , Atenção à Saúde/estatística & dados numéricos , Medidas de Resultados Relatados pelo Paciente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Humanos , Masculino , Massachusetts , Pessoa de Meia-Idade , Inquéritos e Questionários
8.
PLoS One ; 14(6): e0217353, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31216286

RESUMO

BACKGROUND: Across countries, a small group of patients accounts for the majority of health care spending. These patients are more likely than other patients to experience problems with quality and safety in their care, suggesting that efforts targeting efficiency and quality among this population might have significant payoffs for health systems. Better understanding of similarities and differences in patient characteristics and health care use in different countries may ultimately inform further efforts to improve care for HNHC patients in these health systems. METHODS: We conducted a cross-sectional descriptive study using one year of patient-level data on high-cost patients in seven high-income OECD member countries. Countries were selected based on availability of detailed information (large enough samples of claims, administrative, and survey data of high-cost patients). We studied concentration of spending among high-cost patients, characteristics of high-cost patients, and per capita spending on high-cost patients. FINDINGS: Cost-concentration of the top 5% of patients varied across countries, from 41% in Japan to 60% in Canada, driven primarily by variation in the top 1% of spenders. In general, high-cost patients were more likely to be female (57.7% on average), had a significant number of multi-morbidities (up to on average 10 major diagnostic categories (ICD chapters), and had a lower socioeconomic status. Characteristics of high-cost patients varied as well: median age ranged from 62 in the Netherlands to 75 in Germany and the difference in socioeconomic status is particularly stark in the US. Lastly, utilization, particularly for inpatient care, varied with an average number of inpatient days ranging from 6.6 nights (US) to 97.7 nights in Japan. INTERPRETATION: In this descriptive study, there is substantial variation in the cost concentration, characteristics, and per capita spending on high-cost patient populations across high-income countries. Differences in the way that health systems are structured likely explains some of this variation, which suggests the potential of cross-system learning opportunities. Our findings highlight the need for further studies including comparable performance metrics and institutional analysis.


Assuntos
Atenção à Saúde/economia , Qualidade da Assistência à Saúde/economia , Idoso , Custos e Análise de Custo , Estudos Transversais , Feminino , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Espanha
9.
Jt Comm J Qual Patient Saf ; 44(10): 583-589, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30064961

RESUMO

BACKGROUND: In the United States, regulatory bodies, state licensing boards, hospital accreditation organizations, and medical specialty boards have increased their demands for data, public reporting, and improvement. Survey research suggests that as much as $15 billion is spent on reporting quality measures, but those costs, as well as those associated with improvement, have not been sufficiently characterized. A study was conducted to examine, in detail, the costs incurred by one health care organization-an academic health center (AHC) with employed physicians-in responding to quality and safety requirements. METHODS: To identify annual costs associated with an AHC's quality and safety infrastructure, a conceptual model was developed for organizing costs into four domains-Measurement and Reporting, Safety, Quality Improvement, and Training and Communication. In an inventory approach, a purpose-specific instrument was used to aggregate and sort costs; clinicians and administrators were asked to identify all domain activities and the associated full-time equivalents and other direct costs (labor and nonlabor) allocated to each activity. RESULTS: For this AHC, nearly $30 million of direct costs-more than 1.1% of net patient service revenue-were incurred to maintain the quality infrastructure. Approximately 81.6% of the costs were associated with mandates by regulators, accreditors, and payers-49.8% of which supported required public reporting. CONCLUSION: Indisputable good for patients and providers has resulted from organizational investments in quality and safety. But policy makers must be cognizant of potential trade-offs and explicitly recognize the incremental costs of additional measurement, improvement, and mandated reporting in their decision making.


Assuntos
Centros Médicos Acadêmicos/economia , Segurança do Paciente/economia , Qualidade da Assistência à Saúde/economia , Acreditação/economia , Comunicação , Custos e Análise de Custo , Humanos , Capacitação em Serviço/economia , Avaliação de Processos e Resultados em Cuidados de Saúde/economia , Melhoria de Qualidade/economia , Estados Unidos
10.
BMJ Qual Saf ; 27(12): 1019-1026, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30018115

RESUMO

In 2009, the National Patient Safety Foundation's Lucian Leape Institute (LLI) published a paper identifying five areas of healthcare that require system-level attention and action to advance patient safety.The authors argued that to truly transform the safety of healthcare, there was a need to address medical education reform; care integration; restoring joy and meaning in work and ensuring the safety of the healthcare workforce; consumer engagement in healthcare and transparency across the continuum of care. In the ensuing years, the LLI convened a series of expert roundtables to address each concept, look at obstacles to implementation, assess potential for improvement, identify potential implementation partners and issue recommendations for action. Reports of these activities were published between 2010 and 2015. While all five areas have seen encouraging developments, multiple challenges remain. In this paper, the current members of the LLI (now based at the Institute for Healthcare Improvement) assess progress made in the USA since 2009 and identify ongoing challenges.


Assuntos
Educação Médica/organização & administração , Erros Médicos/prevenção & controle , Segurança do Paciente , Melhoria de Qualidade , Gestão da Segurança/organização & administração , Humanos , Liderança , Erros Médicos/estatística & dados numéricos , Cultura Organizacional , Relatório de Pesquisa , Estados Unidos
11.
J Gen Intern Med ; 32(6): 626-631, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28150098

RESUMO

BACKGROUND: Numerical ratings and narrative comments about physicians are increasingly available online. These physician rating websites include independent websites reporting crowd-sourced data from online users and health systems reporting data from their internal patient experience surveys. OBJECTIVE: To assess patient and physician views on physician rating websites. DESIGN: Cross-sectional physician (electronic) and patient (paper) surveys conducted in August 2015. PARTICIPANTS: Eight hundred twenty-eight physicians (response rate 43%) affiliated with one of four hospitals in a large accountable care organization in eastern Massachusetts; 494 adult patients (response rate 34%) who received care in this system in May 2015. MAIN MEASURES: Use and perceptions of physician rating websites. KEY RESULTS: Fifty-three percent of physicians and 39% of patients reported visiting a physician rating website at least once. Physicians reported higher levels of agreement with the accuracy of numerical data (53%) and narrative comments (62%) from health system patient experience surveys compared to numerical data (36%) and narrative comments (36%) on independent websites. Patients reported higher levels of agreement with trusting the accuracy of data obtained from independent websites (57%) compared to health system patient experience surveys (45%). Twenty-one percent of physicians and 51% of patients supported posting narrative comments online for all consumers. The majority (78%) of physicians believed that posting narrative comments online would increase physician job stress; smaller proportions perceived a negative effect on the physician-patient relationship (46%), health care overuse (34%), and patient-reported experiences of care (33%). Over one-fourth of patients (29%) believed that posting narrative comments would cause them to be less open. CONCLUSIONS: Physicians and patients have different views on whether independent or health system physician rating websites are the more reliable source of information. Their views on whether such data should be shared on public websites are also discordant.


Assuntos
Internet , Satisfação do Paciente , Indicadores de Qualidade em Assistência à Saúde/estatística & dados numéricos , Idoso , Informática Aplicada à Saúde dos Consumidores , Estudos Transversais , Feminino , Humanos , Comportamento de Busca de Informação , Masculino , Massachusetts , Pessoa de Meia-Idade , Percepção , Relações Médico-Paciente
12.
Ann Intern Med ; 164(2): 114-9, 2016 Jan 19.
Artigo em Inglês | MEDLINE | ID: mdl-26595370

RESUMO

Behavioral economics provides insights about the development of effective incentives for physicians to deliver high-value care. It suggests that the structure and delivery of incentives can shape behavior, as can thoughtful design of the decision-making environment. This article discusses several principles of behavioral economics, including inertia, loss aversion, choice overload, and relative social ranking. Whereas these principles have been applied to motivate personal health decisions, retirement planning, and savings behavior, they have been largely ignored in the design of physician incentive programs. Applying these principles to physician incentives can improve their effectiveness through better alignment with performance goals. Anecdotal examples of successful incentive programs that apply behavioral economics principles are provided, even as the authors recognize that its application to the design of physician incentives is largely untested, and many outstanding questions exist. Application and rigorous evaluation of infrastructure changes and incentives are needed to design payment systems that incentivize high-quality, cost-conscious care.


Assuntos
Atenção à Saúde/economia , Atenção à Saúde/normas , Economia Comportamental , Planos de Incentivos Médicos , Humanos , Estados Unidos
13.
BMJ Qual Saf ; 24(2): 162-6, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25411320

RESUMO

The opening keynote session of the 16th Annual National Patient Safety Foundation Patient Safety Congress, held 14-16 May 2014, featured a debate addressing the merits and challenges of accountability with respect to key issues in patient safety. The specific resolution debated was: Certain safety practices should be inviolable, and transgressions should result in penalties, potentially including fines, suspensions, and firing. The themes discussed in the debate are issues that healthcare professionals and leaders commonly struggle with in their day-to-day work. How do we draw a line between systems problems and personal failings? When should clinicians and staff be penalised for failing to follow a known safety protocol? The majority of those who listened to the live debate agreed that it is time to begin holding health professionals accountable when they wilfully or repeatedly violate policies or protocols put in place by their institutions to protect the safety of patients. This article summarises the debate as well as the questions and discussion generated by each side. A video of the original debate can be found at http://bit.ly/Npsf_debate.


Assuntos
Segurança do Paciente , Congressos como Assunto , Humanos , Erros Médicos/prevenção & controle , Segurança do Paciente/normas
14.
J Ambul Care Manage ; 37(3): 219-25, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24887523

RESUMO

We predict self-care will become the new principal source of care. People living with diverse chronic conditions spend more time on self-management than with their providers. The increasing burden of chronic disease and costs coupled with value-based payments and innovative care models will generate a shift away from expensive specialized care toward high-value self-care facilitated by information technology, social support, and clinical expertise. This predicted shift in the value stream carries with it risks and uncertainties but will likely prevail as society seeks to confer "agency" by enabling people to make decisions and engage effectively in care coproduction.


Assuntos
Doença Crônica/terapia , Segurança do Paciente , Atenção Primária à Saúde/normas , Autocuidado/normas , Doença Crônica/economia , Gastos em Saúde/tendências , Humanos , Atenção Primária à Saúde/economia , Atenção Primária à Saúde/tendências , Autocuidado/economia , Autocuidado/tendências , Apoio Social , Fatores de Tempo , Aquisição Baseada em Valor/normas , Aquisição Baseada em Valor/tendências
15.
Acad Med ; 89(1): 94-106, 2014 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-24280849

RESUMO

PURPOSE: To quantify the role of teaching hospitals in direct patient care, the authors compared characteristics of patients served by hospitals of varying teaching intensity. METHOD: The authors studied Medicare beneficiaries ≥ 66 years old, hospitalized in 2009-2010 for acute myocardial infarction, heart failure, or pneumonia. They categorized hospitals as nonteaching, teaching, or Council of Teaching Hospitals and Health Systems (COTH) members and performed secondary analyses using intern and resident-to-bed ratios. The authors used descriptive statistics, adjusted odds ratios, and linear propensity scores to compare patient characteristics among teaching intensity levels. They supplemented Medicare mortality model variables with race, transfer status, and distance traveled. RESULTS: Adjusted for comorbidities, black patients had 2.44 (95% confidence interval [CI] 2.36-2.52), 2.56 (95% CI 2.51-2.60), and 2.58 (95% CI 2.51-2.65) times the odds of COTH hospital admission compared with white patients for acute myocardial infarction, heart failure, and pneumonia, respectively. For patients transferred from another hospital's inpatient setting, the corresponding adjusted odds ratios of COTH hospital admission were 3.99 (95% CI 3.85-4.13), 4.60 (95% CI 4.34-4.88), and 4.62 (95% CI 4.16-5.12). Using national data, distributions of propensity scores (probability of admission to a COTH hospital) varied markedly among teaching intensity levels. Data from Massachusetts and California illustrated between-state heterogeneity in COTH utilization. CONCLUSIONS: Major teaching hospitals are significantly more likely to provide care for minorities and patients requiring transfer from other institutions for advanced care.Both are essential to an equitable and high-quality regional health care system.


Assuntos
Insuficiência Cardíaca/terapia , Hospitais de Ensino , Infarto do Miocárdio/terapia , Avaliação de Resultados em Cuidados de Saúde , Pneumonia/terapia , Padrões de Prática Médica/estatística & dados numéricos , Idoso , Comorbidade , Feminino , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/etnologia , Hospitais , Humanos , Masculino , Medicare , Infarto do Miocárdio/epidemiologia , Infarto do Miocárdio/etnologia , Admissão do Paciente/estatística & dados numéricos , Transferência de Pacientes/estatística & dados numéricos , Pneumonia/epidemiologia , Pneumonia/etnologia , Pontuação de Propensão , Estados Unidos/epidemiologia
16.
Med Care ; 52(1): 38-46, 2014 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-24322988

RESUMO

BACKGROUND: Under the Affordable Care Act, health care reimbursement will increasingly be linked to quality and costs. In this environment, teaching hospitals will be closely scrutinized, as their care is often more expensive. Furthermore, although they serve vital roles in education, research, management of complex diseases, and care of vulnerable populations, debate continues as to whether teaching hospitals deliver better outcomes for common conditions. OBJECTIVE: To determine the association between risk-standardized mortality and teaching intensity for 3 common conditions. RESEARCH DESIGN: Using CMS models, 30-day risk-standardized mortality rates were compared among US hospitals classified as Council of Teaching Hospital (COTH) members, non-COTH teaching hospitals, or nonteaching hospitals. These analyses were repeated using ratios of interns and residents to beds to classify teaching intensity. SUBJECTS: The study cohort included Medicare fee-for-service beneficiaries aged 66 years or older hospitalized in acute care hospitals during 2009-2010 for acute myocardial infarction (N = 342,145), heart failure (N = 647,081), or pneumonia (N = 598,366). OUTCOME MEASURE: The 30-day risk-standardized mortality rates for each condition, stratified by teaching intensity. RESULTS: For each diagnosis, compared with nonteaching hospitals there was a 10% relative reduction in the adjusted odds of mortality for patients admitted to COTH hospitals and a 6%-7% relative reduction for patients admitted to non-COTH teaching hospitals. These findings were insensitive to the method of classifying teaching intensity and only partially explained by higher teaching hospital volumes. CONCLUSIONS: Health care reimbursement strategies designed to increase value should consider not only the costs but also the superior clinical outcomes at teaching hospitals for certain common conditions.


Assuntos
Insuficiência Cardíaca/mortalidade , Hospitais de Ensino/estatística & dados numéricos , Infarto do Miocárdio/mortalidade , Pneumonia/mortalidade , Idoso , Idoso de 80 Anos ou mais , Feminino , Mortalidade Hospitalar , Humanos , Internato e Residência/estatística & dados numéricos , Masculino , Medicare/estatística & dados numéricos , Transferência de Pacientes/estatística & dados numéricos , Estados Unidos/epidemiologia
17.
Health Aff (Millwood) ; 32(10): 1748-56, 2013 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-24101064

RESUMO

Physicians are increasingly becoming salaried employees of hospitals or large physician groups. Yet few published reports have evaluated provider-driven quality incentive programs for salaried physicians. In 2006 the Massachusetts General Physicians Organization began a quality incentive program for its salaried physicians. Eligible physicians were given performance targets for three quality measures every six months. The incentive payments could be as much as 2 percent of a physician's annual income. Over thirteen six-month terms, the program used 130 different quality measures. Although quality-of-care improvements and cost reductions were difficult to calculate, anecdotal evidence points to multiple successes. For example, the program helped physicians meet many federal health information technology meaningful-use criteria and produced $15.5 million in incentive payments. The program also facilitated the adoption of an electronic health record, improved hand hygiene compliance, increased efficiency in radiology and the cancer center, and decreased emergency department use. The program demonstrated that even small incentives tied to carefully structured metrics, priority setting, and clear communication can help change salaried physicians' behavior in ways that improve the quality and safety of health care and ease the physicians' sense of administrative burden.


Assuntos
Clínicos Gerais , Corpo Clínico Hospitalar , Planos de Incentivos Médicos , Garantia da Qualidade dos Cuidados de Saúde/economia , Hospitais Gerais , Humanos , Massachusetts , Indicadores de Qualidade em Assistência à Saúde
18.
Acad Med ; 88(8): 1099-104, 2013 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-23807111

RESUMO

Hospitals are continually challenged to provide safer and higher-quality patient care despite resource constraints. With an ever-increasing range of quality and safety targets at the national, state, and local levels, prioritization is crucial in effective institutional quality goal setting and resource allocation.Organizational goal-setting theory is a performance improvement methodology with strong results across many industries. The authors describe a structured goal-setting process they have established at Massachusetts General Hospital for setting annual institutional quality and safety goals. Begun in 2008, this process has been conducted on an annual basis. Quality and safety data are gathered from many sources, both internal and external to the hospital. These data are collated and classified, and multiple approaches are used to identify the most pressing quality issues facing the institution. The conclusions are subject to stringent internal review, and then the top quality goals of the institution are chosen. Specific tactical initiatives and executive owners are assigned to each goal, and metrics are selected to track performance. A reporting tool based on these tactics and metrics is used to deliver progress updates to senior hospital leadership.The hospital has experienced excellent results and strong organizational buy-in using this effective, low-cost, and replicable goal-setting process. It has led to improvements in structural, process, and outcomes aspects of quality.


Assuntos
Centros Médicos Acadêmicos/organização & administração , Liderança , Administração dos Cuidados ao Paciente/normas , Qualidade da Assistência à Saúde/normas , Segurança/normas , Centros Médicos Acadêmicos/normas , Humanos , Massachusetts , Objetivos Organizacionais , Gestão da Segurança/métodos
20.
BMJ Qual Saf ; 22(3): 187-93, 2013 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-23204514

RESUMO

The management literature reveals that many successful organisations have strategic plans that include a bold 'stretch-goal' to stimulate progress over a ten-to-thirty-year period. A stretch goal is clear, compelling and easily understood. It serves as a unifying focal point for organisational efforts. The ambitiousness of such goals has been emphasised with the phrase Big Hairy Audacious Goal ('BHAG'). President Kennedy's proclamation in 1961 that 'this Nation should commit itself to achieving the goal, before this decade is out, of landing a man on the moon and returning him safely to earth' provides a famous example. This goal energised the US National Aeronautics and Space Administration, and it captured the attention of the American public and resulted in one of the largest accomplishments of any organisation. The goal set by Sony, a small, cash-strapped electronics company in the 1950s, to change the poor image of Japanese products around the world represents a classic BHAG. Few examples of quality goals that conform to the BHAG definition exist in the healthcare literature. However, the concept may provide a useful framework for organisations seeking to transform the quality of care they deliver. This review examines the merits and cautions of setting overarching quality goals to catalyse quality improvement efforts, and assists healthcare organisations with determining whether to adopt these goals.


Assuntos
Atenção à Saúde/organização & administração , Objetivos Organizacionais , Segurança do Paciente , Garantia da Qualidade dos Cuidados de Saúde/métodos , Difusão de Inovações , Objetivos , Humanos , Modelos Organizacionais , Inovação Organizacional , Técnicas de Planejamento , Garantia da Qualidade dos Cuidados de Saúde/normas , Estados Unidos
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