Innovations in Healthcare

An RIV poster presented at HM15 highlights a common problem hospitalists face: morning hyperglycemia in hospitalized patients, including patients not previously diagnosed with diabetes.¹ Lead author Regina Heyl DePietro, BA, now a medical student at Stony Brook (N.Y.) School of Medicine, working with colleagues including David O. Meltzer, MD, PhD, MHM, and Vineet Arora, MD, MAPP, FHM, at the University of Chicago, gathered data to analyze the connections among sleep deprivation, diabetes, and hyperglycemia of hospitalization.

Prior epidemiologic and laboratory research has shown a correlation between hyperglycemia and impaired sleep, DePietro says, but she is not aware of any inpatient cohort study done on this subject. Although diabetic patients have worse morning fasting glucose measures, the correlation between poor quality and quantity of sleep and higher blood glucose levels is also present in patients not previously diagnosed with diabetes.

In her study, participating patients reported their sleep quality prior to hospitalization, while wrist actigraphy measured the duration and efficiency of their sleep in the hospital. Every hour of inpatient sleep loss raised the odds of elevated subsequent morning blood glucose rates by 17%.

“Sleep helps healing,” DePietro says. “Sleep deprivation is a preventable patient quality metric that we have shown affects a health measure.”

Based on additional research, hospitals could take behavioral and/or design measures to help ameliorate this problem.

Reference

1. DePietro RH, Spampinato LM, Knutson KL, Cauter EV, Meltzer DO, Arora VM. Hyperglycemia of hospitalization: side effect of sleep deprivation? [abstract] Society of Hospital Medicine Annual Meeting 2015. Accessed September 12, 2015.

An RIV poster presented at HM15 highlights a common problem hospitalists face: morning hyperglycemia in hospitalized patients, including patients not previously diagnosed with diabetes.¹ Lead author Regina Heyl DePietro, BA, now a medical student at Stony Brook (N.Y.) School of Medicine, working with colleagues including David O. Meltzer, MD, PhD, MHM, and Vineet Arora, MD, MAPP, FHM, at the University of Chicago, gathered data to analyze the connections among sleep deprivation, diabetes, and hyperglycemia of hospitalization.

Prior epidemiologic and laboratory research has shown a correlation between hyperglycemia and impaired sleep, DePietro says, but she is not aware of any inpatient cohort study done on this subject. Although diabetic patients have worse morning fasting glucose measures, the correlation between poor quality and quantity of sleep and higher blood glucose levels is also present in patients not previously diagnosed with diabetes.

In her study, participating patients reported their sleep quality prior to hospitalization, while wrist actigraphy measured the duration and efficiency of their sleep in the hospital. Every hour of inpatient sleep loss raised the odds of elevated subsequent morning blood glucose rates by 17%.

“Sleep helps healing,” DePietro says. “Sleep deprivation is a preventable patient quality metric that we have shown affects a health measure.”

Based on additional research, hospitals could take behavioral and/or design measures to help ameliorate this problem.

Reference

1. DePietro RH, Spampinato LM, Knutson KL, Cauter EV, Meltzer DO, Arora VM. Hyperglycemia of hospitalization: side effect of sleep deprivation? [abstract] Society of Hospital Medicine Annual Meeting 2015. Accessed September 12, 2015.

An RIV poster presented at HM15 highlights a common problem hospitalists face: morning hyperglycemia in hospitalized patients, including patients not previously diagnosed with diabetes.¹ Lead author Regina Heyl DePietro, BA, now a medical student at Stony Brook (N.Y.) School of Medicine, working with colleagues including David O. Meltzer, MD, PhD, MHM, and Vineet Arora, MD, MAPP, FHM, at the University of Chicago, gathered data to analyze the connections among sleep deprivation, diabetes, and hyperglycemia of hospitalization.

Prior epidemiologic and laboratory research has shown a correlation between hyperglycemia and impaired sleep, DePietro says, but she is not aware of any inpatient cohort study done on this subject. Although diabetic patients have worse morning fasting glucose measures, the correlation between poor quality and quantity of sleep and higher blood glucose levels is also present in patients not previously diagnosed with diabetes.

In her study, participating patients reported their sleep quality prior to hospitalization, while wrist actigraphy measured the duration and efficiency of their sleep in the hospital. Every hour of inpatient sleep loss raised the odds of elevated subsequent morning blood glucose rates by 17%.

“Sleep helps healing,” DePietro says. “Sleep deprivation is a preventable patient quality metric that we have shown affects a health measure.”

Based on additional research, hospitals could take behavioral and/or design measures to help ameliorate this problem.

Reference

1. DePietro RH, Spampinato LM, Knutson KL, Cauter EV, Meltzer DO, Arora VM. Hyperglycemia of hospitalization: side effect of sleep deprivation? [abstract] Society of Hospital Medicine Annual Meeting 2015. Accessed September 12, 2015.

Three pediatric hospitalists – Dr. Ricardo Quiñonez of San Antonio Children’s Hospital, Dr. Shawn Ralston of Dartmouth-Hitchcock, and Dr. Alan Schroeder of Santa Clara Valley Medical Center – talk about the concept of “right care” in hospital medicine, and their participation in the Lown Institute’s Right Care movement.

Three pediatric hospitalists – Dr. Ricardo Quiñonez of San Antonio Children’s Hospital, Dr. Shawn Ralston of Dartmouth-Hitchcock, and Dr. Alan Schroeder of Santa Clara Valley Medical Center – talk about the concept of “right care” in hospital medicine, and their participation in the Lown Institute’s Right Care movement.

Three pediatric hospitalists – Dr. Ricardo Quiñonez of San Antonio Children’s Hospital, Dr. Shawn Ralston of Dartmouth-Hitchcock, and Dr. Alan Schroeder of Santa Clara Valley Medical Center – talk about the concept of “right care” in hospital medicine, and their participation in the Lown Institute’s Right Care movement.

Hospitalists who presented RIV posters at HM15 talk about their projects. Dr. Brian Poustinchian worked on a bedside rounding study at Midwestern University in Illinois, and Dr. Jennifer Pascoe worked on a poster about patients leaving the hospital against medical advice, focusing on a case of her own at the University of Rochester.

Hospitalists who presented RIV posters at HM15 talk about their projects. Dr. Brian Poustinchian worked on a bedside rounding study at Midwestern University in Illinois, and Dr. Jennifer Pascoe worked on a poster about patients leaving the hospital against medical advice, focusing on a case of her own at the University of Rochester.

Hospitalists who presented RIV posters at HM15 talk about their projects. Dr. Brian Poustinchian worked on a bedside rounding study at Midwestern University in Illinois, and Dr. Jennifer Pascoe worked on a poster about patients leaving the hospital against medical advice, focusing on a case of her own at the University of Rochester.

Presenters: Dr. Patrick Brady, Dr. Michele Saysana, Dr. Christine White, and Dr. Mark Shen.

Session analysis:

QI is about making positive changes in the delivery of healthcare. Multiple QI interventions are been implemented daily throughout our hospitals. Some of those interventions result in positive changes and affect specific outcomes the way we want. It is our job, as hospitalists, to share them with our colleagues so patients can benefit from them.

Some of the barriers to publishing QI as identified by the group are: lack of time, resources available and administrative support, lack of mentorship, and unrecognized value of QI in the academic world. The group also identified some strategies to be successful at writing and publishing QI, including: blocking time in the schedule and labeling it "writing days," joining a collaborative, reaching out to Journal editors and becoming familiar with the SQUIRE guidelines. Some key points as discussed by the experts that will aid during the process of writing QI are:

1. A specific goal/aim statement needs to be identified,
2. The measurement needs to match your goal/aim,
3. Always start with writing your methods since you know exactly what you did,
4. Plot data over time using a run chart, and
5. Keep a notebook with documentation of dates all interventions started.

It is also important for everyone to know there are multiple quality and safety journals willing to review QI manuscripts for publication.

Presenters: Dr. Patrick Brady, Dr. Michele Saysana, Dr. Christine White, and Dr. Mark Shen.

Session analysis:

QI is about making positive changes in the delivery of healthcare. Multiple QI interventions are been implemented daily throughout our hospitals. Some of those interventions result in positive changes and affect specific outcomes the way we want. It is our job, as hospitalists, to share them with our colleagues so patients can benefit from them.

Some of the barriers to publishing QI as identified by the group are: lack of time, resources available and administrative support, lack of mentorship, and unrecognized value of QI in the academic world. The group also identified some strategies to be successful at writing and publishing QI, including: blocking time in the schedule and labeling it "writing days," joining a collaborative, reaching out to Journal editors and becoming familiar with the SQUIRE guidelines. Some key points as discussed by the experts that will aid during the process of writing QI are:

1. A specific goal/aim statement needs to be identified,
2. The measurement needs to match your goal/aim,
3. Always start with writing your methods since you know exactly what you did,
4. Plot data over time using a run chart, and
5. Keep a notebook with documentation of dates all interventions started.

It is also important for everyone to know there are multiple quality and safety journals willing to review QI manuscripts for publication.

Presenters: Dr. Patrick Brady, Dr. Michele Saysana, Dr. Christine White, and Dr. Mark Shen.

Session analysis:

QI is about making positive changes in the delivery of healthcare. Multiple QI interventions are been implemented daily throughout our hospitals. Some of those interventions result in positive changes and affect specific outcomes the way we want. It is our job, as hospitalists, to share them with our colleagues so patients can benefit from them.

Some of the barriers to publishing QI as identified by the group are: lack of time, resources available and administrative support, lack of mentorship, and unrecognized value of QI in the academic world. The group also identified some strategies to be successful at writing and publishing QI, including: blocking time in the schedule and labeling it "writing days," joining a collaborative, reaching out to Journal editors and becoming familiar with the SQUIRE guidelines. Some key points as discussed by the experts that will aid during the process of writing QI are:

1. A specific goal/aim statement needs to be identified,
2. The measurement needs to match your goal/aim,
3. Always start with writing your methods since you know exactly what you did,
4. Plot data over time using a run chart, and
5. Keep a notebook with documentation of dates all interventions started.

It is also important for everyone to know there are multiple quality and safety journals willing to review QI manuscripts for publication.

An Australian team conducted a literature review of expected deaths in the hospital—where the majority of deaths in the developed world occur—and identified elements of end-of-life care that are important to patients and families.¹ Published in the British journal Palliative Medicine, the review of nine electronic data bases and 1859 articles released between 1990 and 2014 identified eight quantitative studies that met inclusion criteria.

The authors, led by Claudia Virdun, RN, of the faculty of health at the University of Technology in Sydney, found four end-of-life domains that were most important to both patients and families:

• Effective communication and shared decision-making;
• Expert care;
• Respectful and compassionate care; and
• Trust and confidence in clinicians.

Not all patients dying in hospitals receive best evidence-based palliative care, the authors note, adding that the “challenge for healthcare services is to act on this evidence, reconfigure care systems accordingly and ensure universal access to optimal end-of-life care within hospitals.”

Reference

1. Virdun C, Luckett T, Davidson PM, Phillips J. Dying in the hospital setting: A systematic review of quantitative studies identifying the elements of end-of-life care that patients and their families rank as being most important [published online ahead of print April 28, 2015]. Palliat Med.

An Australian team conducted a literature review of expected deaths in the hospital—where the majority of deaths in the developed world occur—and identified elements of end-of-life care that are important to patients and families.¹ Published in the British journal Palliative Medicine, the review of nine electronic data bases and 1859 articles released between 1990 and 2014 identified eight quantitative studies that met inclusion criteria.

The authors, led by Claudia Virdun, RN, of the faculty of health at the University of Technology in Sydney, found four end-of-life domains that were most important to both patients and families:

• Effective communication and shared decision-making;
• Expert care;
• Respectful and compassionate care; and
• Trust and confidence in clinicians.

Not all patients dying in hospitals receive best evidence-based palliative care, the authors note, adding that the “challenge for healthcare services is to act on this evidence, reconfigure care systems accordingly and ensure universal access to optimal end-of-life care within hospitals.”

Reference

1. Virdun C, Luckett T, Davidson PM, Phillips J. Dying in the hospital setting: A systematic review of quantitative studies identifying the elements of end-of-life care that patients and their families rank as being most important [published online ahead of print April 28, 2015]. Palliat Med.

An Australian team conducted a literature review of expected deaths in the hospital—where the majority of deaths in the developed world occur—and identified elements of end-of-life care that are important to patients and families.¹ Published in the British journal Palliative Medicine, the review of nine electronic data bases and 1859 articles released between 1990 and 2014 identified eight quantitative studies that met inclusion criteria.

The authors, led by Claudia Virdun, RN, of the faculty of health at the University of Technology in Sydney, found four end-of-life domains that were most important to both patients and families:

• Effective communication and shared decision-making;
• Expert care;
• Respectful and compassionate care; and
• Trust and confidence in clinicians.

Not all patients dying in hospitals receive best evidence-based palliative care, the authors note, adding that the “challenge for healthcare services is to act on this evidence, reconfigure care systems accordingly and ensure universal access to optimal end-of-life care within hospitals.”

Reference

1. Virdun C, Luckett T, Davidson PM, Phillips J. Dying in the hospital setting: A systematic review of quantitative studies identifying the elements of end-of-life care that patients and their families rank as being most important [published online ahead of print April 28, 2015]. Palliat Med.

A new book by three leading hospital medicine advocates for maximizing efficiency and outcomes while managing costs and avoiding waste in healthcare—also known as value-based healthcare—offers a primer filled with practical advice for doctors and other clinicians.¹ The hospitalist authors of Understanding Value-Based Healthcare, Christopher Moriates, MD, of the University of California-San Francisco, Vineet Arora, MD, MAPP, of the University of Chicago, and Neel Shah, MD, MPP, of Harvard Medical School, all have leadership positions in Costs of Care, a nonprofit organization formed in 2009 to help empower patients and their caregivers to deflate medical bills.

In a recent op-ed piece at MedPage Today, the book’s authors emphasize the harms for patients when doctors fail to consider the impact of medical bills or screen patients for financial harm.² Doctors should help their patients navigate tradeoffs of lower-cost treatment options. The authors hope to embed principles of value-based care into the apprenticeship of health professional education through initiatives such as Costs of Care’s “Teaching Value & Choosing Wisely Challenge,” which received 80 submissions from medical students and faculty from across the United States and Canada presenting bright ideas and innovations for integrating value into education.

References

1. Moriates C, Arora V, Shah N. Understanding Value-Based Healthcare. New York City: McGraw Hill Education; 2015.
2. Moriates C, Arora V, Shah N. Op-ed: how to rein in out-of-control healthcare costs. May 5, 2015. MedPage Today. Accessed July 2, 2015.

A new book by three leading hospital medicine advocates for maximizing efficiency and outcomes while managing costs and avoiding waste in healthcare—also known as value-based healthcare—offers a primer filled with practical advice for doctors and other clinicians.¹ The hospitalist authors of Understanding Value-Based Healthcare, Christopher Moriates, MD, of the University of California-San Francisco, Vineet Arora, MD, MAPP, of the University of Chicago, and Neel Shah, MD, MPP, of Harvard Medical School, all have leadership positions in Costs of Care, a nonprofit organization formed in 2009 to help empower patients and their caregivers to deflate medical bills.

In a recent op-ed piece at MedPage Today, the book’s authors emphasize the harms for patients when doctors fail to consider the impact of medical bills or screen patients for financial harm.² Doctors should help their patients navigate tradeoffs of lower-cost treatment options. The authors hope to embed principles of value-based care into the apprenticeship of health professional education through initiatives such as Costs of Care’s “Teaching Value & Choosing Wisely Challenge,” which received 80 submissions from medical students and faculty from across the United States and Canada presenting bright ideas and innovations for integrating value into education.

References

1. Moriates C, Arora V, Shah N. Understanding Value-Based Healthcare. New York City: McGraw Hill Education; 2015.
2. Moriates C, Arora V, Shah N. Op-ed: how to rein in out-of-control healthcare costs. May 5, 2015. MedPage Today. Accessed July 2, 2015.

A new book by three leading hospital medicine advocates for maximizing efficiency and outcomes while managing costs and avoiding waste in healthcare—also known as value-based healthcare—offers a primer filled with practical advice for doctors and other clinicians.¹ The hospitalist authors of Understanding Value-Based Healthcare, Christopher Moriates, MD, of the University of California-San Francisco, Vineet Arora, MD, MAPP, of the University of Chicago, and Neel Shah, MD, MPP, of Harvard Medical School, all have leadership positions in Costs of Care, a nonprofit organization formed in 2009 to help empower patients and their caregivers to deflate medical bills.

In a recent op-ed piece at MedPage Today, the book’s authors emphasize the harms for patients when doctors fail to consider the impact of medical bills or screen patients for financial harm.² Doctors should help their patients navigate tradeoffs of lower-cost treatment options. The authors hope to embed principles of value-based care into the apprenticeship of health professional education through initiatives such as Costs of Care’s “Teaching Value & Choosing Wisely Challenge,” which received 80 submissions from medical students and faculty from across the United States and Canada presenting bright ideas and innovations for integrating value into education.

References

1. Moriates C, Arora V, Shah N. Understanding Value-Based Healthcare. New York City: McGraw Hill Education; 2015.
2. Moriates C, Arora V, Shah N. Op-ed: how to rein in out-of-control healthcare costs. May 5, 2015. MedPage Today. Accessed July 2, 2015.

In a May 12 JAMA “Viewpoint” article, Mark Chassin, MD, FACP, MPP, MPH, The Joint Commission’s president and CEO, and David Baker, MD, FACP, MPH, The Joint Commission’s vice president for healthcare quality evaluation, called on American physicians to acquire the necessary skills to take on new responsibilities to become leaders for QI and patient safety in an increasingly complex healthcare environment.¹

The Joint Commission, they said, has embraced the tools, methods, and science of QI used in other industries, including Lean Six Sigma and change management, for all of its internal improvement functions and for its Center for Transforming Healthcare. They urge physicians to do the same or risk jeopardizing medicine’s long-standing self-governance status because of societal concerns about patient safety.

Drs. Chassin and Baker note that medicine has too often tolerated problematic behaviors and is viewed by some stakeholders as failing to address poor quality of care and safety, lack of access, and high costs of care.

“Physicians could make a much stronger case for continued self-government if they took a more visible and vigorous leadership role in efforts that led to major improvement in the quality and safety of patient care,” they said.

Reference

1. Chassin MR, Baker DW. Aiming higher to enhance professionalism: beyond accreditation and certification. JAMA. 2015;313(18):1795-1796.

In a May 12 JAMA “Viewpoint” article, Mark Chassin, MD, FACP, MPP, MPH, The Joint Commission’s president and CEO, and David Baker, MD, FACP, MPH, The Joint Commission’s vice president for healthcare quality evaluation, called on American physicians to acquire the necessary skills to take on new responsibilities to become leaders for QI and patient safety in an increasingly complex healthcare environment.¹

The Joint Commission, they said, has embraced the tools, methods, and science of QI used in other industries, including Lean Six Sigma and change management, for all of its internal improvement functions and for its Center for Transforming Healthcare. They urge physicians to do the same or risk jeopardizing medicine’s long-standing self-governance status because of societal concerns about patient safety.

Drs. Chassin and Baker note that medicine has too often tolerated problematic behaviors and is viewed by some stakeholders as failing to address poor quality of care and safety, lack of access, and high costs of care.

“Physicians could make a much stronger case for continued self-government if they took a more visible and vigorous leadership role in efforts that led to major improvement in the quality and safety of patient care,” they said.

Reference

1. Chassin MR, Baker DW. Aiming higher to enhance professionalism: beyond accreditation and certification. JAMA. 2015;313(18):1795-1796.

In a May 12 JAMA “Viewpoint” article, Mark Chassin, MD, FACP, MPP, MPH, The Joint Commission’s president and CEO, and David Baker, MD, FACP, MPH, The Joint Commission’s vice president for healthcare quality evaluation, called on American physicians to acquire the necessary skills to take on new responsibilities to become leaders for QI and patient safety in an increasingly complex healthcare environment.¹

The Joint Commission, they said, has embraced the tools, methods, and science of QI used in other industries, including Lean Six Sigma and change management, for all of its internal improvement functions and for its Center for Transforming Healthcare. They urge physicians to do the same or risk jeopardizing medicine’s long-standing self-governance status because of societal concerns about patient safety.

Drs. Chassin and Baker note that medicine has too often tolerated problematic behaviors and is viewed by some stakeholders as failing to address poor quality of care and safety, lack of access, and high costs of care.

“Physicians could make a much stronger case for continued self-government if they took a more visible and vigorous leadership role in efforts that led to major improvement in the quality and safety of patient care,” they said.

Reference

1. Chassin MR, Baker DW. Aiming higher to enhance professionalism: beyond accreditation and certification. JAMA. 2015;313(18):1795-1796.

Fantasy sports, hospital medicine, and quality metrics. Those were the unique elements of an RIV poster presented by Noppon Setji, MD, medical director of the Duke University Medical Center’s hospital medicine program in Durham, N.C., at HM15.

Dr. Setji, who participates in a fantasy football league for physicians, says he aimed to apply the approaches of fantasy sports leagues to hospitalist quality metrics.¹ Dr. Setji wanted to find a way to recognize high-performing hospitalists in his group on a regular basis, beyond the group metrics that had been reported to faculty members—and to create greater accountability and evaluate physicians’ performance over time.

A team developed a survey instrument compiling common clinical process and outcome measures for hospitalists, and faculty members were asked to rate how important the various metrics were to them individually as indicators of physician performance. Their responses were combined into a weighted, composite hospital medicine provider performance score, which reflects the relative value practicing hospitalists assign to available performance measures. Results are easily tabulated on an Excel spreadsheet, Dr. Setji says.

Every three months—or football quarter—the top overall performer is awarded two bottles of wine and possession of the traveling trophy.

“We’re always looking for ways to measure our performance,” Dr. Setji says, “and we all want to know how we’re doing relative to our peers.”

Reference

1. Setji NP, Bae JG, Griffith BC, Daley C. Fantasy physician leagues? Introducing the physician equivalent of the Qbr (Quarterly Metric-Based Rating) [abstract]. J Hosp Med. 2015;10(suppl 2).

Fantasy sports, hospital medicine, and quality metrics. Those were the unique elements of an RIV poster presented by Noppon Setji, MD, medical director of the Duke University Medical Center’s hospital medicine program in Durham, N.C., at HM15.

Dr. Setji, who participates in a fantasy football league for physicians, says he aimed to apply the approaches of fantasy sports leagues to hospitalist quality metrics.¹ Dr. Setji wanted to find a way to recognize high-performing hospitalists in his group on a regular basis, beyond the group metrics that had been reported to faculty members—and to create greater accountability and evaluate physicians’ performance over time.

A team developed a survey instrument compiling common clinical process and outcome measures for hospitalists, and faculty members were asked to rate how important the various metrics were to them individually as indicators of physician performance. Their responses were combined into a weighted, composite hospital medicine provider performance score, which reflects the relative value practicing hospitalists assign to available performance measures. Results are easily tabulated on an Excel spreadsheet, Dr. Setji says.

Every three months—or football quarter—the top overall performer is awarded two bottles of wine and possession of the traveling trophy.

“We’re always looking for ways to measure our performance,” Dr. Setji says, “and we all want to know how we’re doing relative to our peers.”

Reference

1. Setji NP, Bae JG, Griffith BC, Daley C. Fantasy physician leagues? Introducing the physician equivalent of the Qbr (Quarterly Metric-Based Rating) [abstract]. J Hosp Med. 2015;10(suppl 2).

Fantasy sports, hospital medicine, and quality metrics. Those were the unique elements of an RIV poster presented by Noppon Setji, MD, medical director of the Duke University Medical Center’s hospital medicine program in Durham, N.C., at HM15.

Dr. Setji, who participates in a fantasy football league for physicians, says he aimed to apply the approaches of fantasy sports leagues to hospitalist quality metrics.¹ Dr. Setji wanted to find a way to recognize high-performing hospitalists in his group on a regular basis, beyond the group metrics that had been reported to faculty members—and to create greater accountability and evaluate physicians’ performance over time.

A team developed a survey instrument compiling common clinical process and outcome measures for hospitalists, and faculty members were asked to rate how important the various metrics were to them individually as indicators of physician performance. Their responses were combined into a weighted, composite hospital medicine provider performance score, which reflects the relative value practicing hospitalists assign to available performance measures. Results are easily tabulated on an Excel spreadsheet, Dr. Setji says.

Every three months—or football quarter—the top overall performer is awarded two bottles of wine and possession of the traveling trophy.

“We’re always looking for ways to measure our performance,” Dr. Setji says, “and we all want to know how we’re doing relative to our peers.”

Reference

1. Setji NP, Bae JG, Griffith BC, Daley C. Fantasy physician leagues? Introducing the physician equivalent of the Qbr (Quarterly Metric-Based Rating) [abstract]. J Hosp Med. 2015;10(suppl 2).

The newly developed Pediatric All-Cause Harm Measurement Tool (PACHMT) improved detection of harms in pediatric inpatients in a recent pilot study.

Using the tool, researchers found a rate of 40 harms per 100 patients admitted, and at least one harm in nearly a quarter of the children in the study. Close to half of the events were potentially or definitely preventable.

"Safety is measured inconsistently in health care, and the only way to make progress to improving these rates of harm is to understand how our patients are impacted by the care they receive," says Dr. David C. Stockwell, of George Washington University and Children's National Medical Center in Washington, D.C. "Therefore, we would like to see wider adoption of active surveillance of safety events with an approach like the PACHMT.

“While not replacing voluntarily reported events, it would greatly augment the understanding of all-cause harm." TH

—Reuters Health

The newly developed Pediatric All-Cause Harm Measurement Tool (PACHMT) improved detection of harms in pediatric inpatients in a recent pilot study.

Using the tool, researchers found a rate of 40 harms per 100 patients admitted, and at least one harm in nearly a quarter of the children in the study. Close to half of the events were potentially or definitely preventable.

"Safety is measured inconsistently in health care, and the only way to make progress to improving these rates of harm is to understand how our patients are impacted by the care they receive," says Dr. David C. Stockwell, of George Washington University and Children's National Medical Center in Washington, D.C. "Therefore, we would like to see wider adoption of active surveillance of safety events with an approach like the PACHMT.

“While not replacing voluntarily reported events, it would greatly augment the understanding of all-cause harm." TH

—Reuters Health

The newly developed Pediatric All-Cause Harm Measurement Tool (PACHMT) improved detection of harms in pediatric inpatients in a recent pilot study.

Using the tool, researchers found a rate of 40 harms per 100 patients admitted, and at least one harm in nearly a quarter of the children in the study. Close to half of the events were potentially or definitely preventable.

"Safety is measured inconsistently in health care, and the only way to make progress to improving these rates of harm is to understand how our patients are impacted by the care they receive," says Dr. David C. Stockwell, of George Washington University and Children's National Medical Center in Washington, D.C. "Therefore, we would like to see wider adoption of active surveillance of safety events with an approach like the PACHMT.

“While not replacing voluntarily reported events, it would greatly augment the understanding of all-cause harm." TH

—Reuters Health

For Robert Fogerty, MD, MPH, it’s more than just a story. It’s a nightmare that he only narrowly avoided.

Now a hospitalist at Yale University School of Medicine in New Haven, Conn., Dr. Fogerty was an economics major in his senior year of college when he was diagnosed with metastatic testicular cancer. Early in the course of his treatment, amid multiple rounds of chemotherapy and before a major surgery, his insurance company informed him that his benefits had been exhausted. Even with family resources, the remaining bills would have been crippling. Luckily, he went to college in Massachusetts, where a state law allowed him to enroll in an individual insurance plan by exempting him from the normal pre-existing condition exclusion. Two years later, he got his life back in order and enrolled in medical school.

“What stuck with me is, yes, I was sick, and yes, I lost all my hair, and yes, I went to my final exams bald with my nausea medicine and my steroids in my pocket and all of those things,” he says. “But after that was all gone, after my hair grew back, and I had my last chemo and my surgery, and I was really starting to get my life back on track, the financial implications of that disease were still there. The financial impact of my illness outlasted the pathological impact of my illness, and the financial burdens could easily have been just as life-altering as a permanent disability.”

Although he was “unbelievably lucky” to escape with manageable medical bills, Dr. Fogerty says, other patients haven’t been as fortunate. That lesson is why he identifies so much with his patients. It’s why he posted his own story to the Costs of Care website, which stresses the importance of cost awareness in healthcare. And it’s why he has committed himself to helping other medical students and residents “remove the blinders” to understand healthcare’s often devastating financial impact.

“When I was going through my residency, I learned a lot about low sodium, and I learned a lot about bloodstream infections and what to do when someone can’t breathe and how to do a skin exam, and all of these things,” Dr. Fogerty says. “But all of these other components that were so devastating to me as a patient weren’t really a main portion of the education that we’re providing tomorrow’s doctors. I thought that was an opportunity to really change things."

By combining his clinical and economics expertise, Dr. Fogerty helped to develop a program called the Interactive Cost-Awareness Resident Exercise, or I-CARE. Launched in 2011, I-CARE seeks to make the abstract problem of healthcare costs—including unnecessary ones—more accessible to trainees. The concept is deceptively simple: Residents compete to see who can reach the correct diagnosis for a given case using the fewest possible resources.

By talking through each case, both trainees and faculty can discuss concepts like waste prevention and financial stewardship in a safe environment. Giving young doctors that “basic set of vocabulary,” Dr. Fogerty says, may help them engage in real decisions later on about a group or health system’s financial pressures and obligations.

The program has since spread to other medical centers, and what began as a cost-awareness exercise has blossomed into a broader discussion about minimizing the cost and burden to patients while maximizing safety and good medicine. TH

For Robert Fogerty, MD, MPH, it’s more than just a story. It’s a nightmare that he only narrowly avoided.

Now a hospitalist at Yale University School of Medicine in New Haven, Conn., Dr. Fogerty was an economics major in his senior year of college when he was diagnosed with metastatic testicular cancer. Early in the course of his treatment, amid multiple rounds of chemotherapy and before a major surgery, his insurance company informed him that his benefits had been exhausted. Even with family resources, the remaining bills would have been crippling. Luckily, he went to college in Massachusetts, where a state law allowed him to enroll in an individual insurance plan by exempting him from the normal pre-existing condition exclusion. Two years later, he got his life back in order and enrolled in medical school.

“What stuck with me is, yes, I was sick, and yes, I lost all my hair, and yes, I went to my final exams bald with my nausea medicine and my steroids in my pocket and all of those things,” he says. “But after that was all gone, after my hair grew back, and I had my last chemo and my surgery, and I was really starting to get my life back on track, the financial implications of that disease were still there. The financial impact of my illness outlasted the pathological impact of my illness, and the financial burdens could easily have been just as life-altering as a permanent disability.”

Although he was “unbelievably lucky” to escape with manageable medical bills, Dr. Fogerty says, other patients haven’t been as fortunate. That lesson is why he identifies so much with his patients. It’s why he posted his own story to the Costs of Care website, which stresses the importance of cost awareness in healthcare. And it’s why he has committed himself to helping other medical students and residents “remove the blinders” to understand healthcare’s often devastating financial impact.

“When I was going through my residency, I learned a lot about low sodium, and I learned a lot about bloodstream infections and what to do when someone can’t breathe and how to do a skin exam, and all of these things,” Dr. Fogerty says. “But all of these other components that were so devastating to me as a patient weren’t really a main portion of the education that we’re providing tomorrow’s doctors. I thought that was an opportunity to really change things."

By combining his clinical and economics expertise, Dr. Fogerty helped to develop a program called the Interactive Cost-Awareness Resident Exercise, or I-CARE. Launched in 2011, I-CARE seeks to make the abstract problem of healthcare costs—including unnecessary ones—more accessible to trainees. The concept is deceptively simple: Residents compete to see who can reach the correct diagnosis for a given case using the fewest possible resources.

By talking through each case, both trainees and faculty can discuss concepts like waste prevention and financial stewardship in a safe environment. Giving young doctors that “basic set of vocabulary,” Dr. Fogerty says, may help them engage in real decisions later on about a group or health system’s financial pressures and obligations.

The program has since spread to other medical centers, and what began as a cost-awareness exercise has blossomed into a broader discussion about minimizing the cost and burden to patients while maximizing safety and good medicine. TH

For Robert Fogerty, MD, MPH, it’s more than just a story. It’s a nightmare that he only narrowly avoided.

Now a hospitalist at Yale University School of Medicine in New Haven, Conn., Dr. Fogerty was an economics major in his senior year of college when he was diagnosed with metastatic testicular cancer. Early in the course of his treatment, amid multiple rounds of chemotherapy and before a major surgery, his insurance company informed him that his benefits had been exhausted. Even with family resources, the remaining bills would have been crippling. Luckily, he went to college in Massachusetts, where a state law allowed him to enroll in an individual insurance plan by exempting him from the normal pre-existing condition exclusion. Two years later, he got his life back in order and enrolled in medical school.

“What stuck with me is, yes, I was sick, and yes, I lost all my hair, and yes, I went to my final exams bald with my nausea medicine and my steroids in my pocket and all of those things,” he says. “But after that was all gone, after my hair grew back, and I had my last chemo and my surgery, and I was really starting to get my life back on track, the financial implications of that disease were still there. The financial impact of my illness outlasted the pathological impact of my illness, and the financial burdens could easily have been just as life-altering as a permanent disability.”

Although he was “unbelievably lucky” to escape with manageable medical bills, Dr. Fogerty says, other patients haven’t been as fortunate. That lesson is why he identifies so much with his patients. It’s why he posted his own story to the Costs of Care website, which stresses the importance of cost awareness in healthcare. And it’s why he has committed himself to helping other medical students and residents “remove the blinders” to understand healthcare’s often devastating financial impact.

“When I was going through my residency, I learned a lot about low sodium, and I learned a lot about bloodstream infections and what to do when someone can’t breathe and how to do a skin exam, and all of these things,” Dr. Fogerty says. “But all of these other components that were so devastating to me as a patient weren’t really a main portion of the education that we’re providing tomorrow’s doctors. I thought that was an opportunity to really change things."

By combining his clinical and economics expertise, Dr. Fogerty helped to develop a program called the Interactive Cost-Awareness Resident Exercise, or I-CARE. Launched in 2011, I-CARE seeks to make the abstract problem of healthcare costs—including unnecessary ones—more accessible to trainees. The concept is deceptively simple: Residents compete to see who can reach the correct diagnosis for a given case using the fewest possible resources.

By talking through each case, both trainees and faculty can discuss concepts like waste prevention and financial stewardship in a safe environment. Giving young doctors that “basic set of vocabulary,” Dr. Fogerty says, may help them engage in real decisions later on about a group or health system’s financial pressures and obligations.

The program has since spread to other medical centers, and what began as a cost-awareness exercise has blossomed into a broader discussion about minimizing the cost and burden to patients while maximizing safety and good medicine. TH