health care quality

RECENT POSTS

Moms Speak Out: On Improving Childbirth In Boston-Area Hospitals

When we opened up the “lines” for an online chat about quality and childbirth, moms dove in with comments and questions about induction, malpractice and worse results for black women as compared to whites.

We had help answering questions from:
Gene Declercq, a Boston University School of Public Health professor who has studied childbirth practices for more than 20 years.
Dr Jeff Ecker, an OB/GYN at Massachusetts General Hospital and a member of the Massachusetts Perinatal Quality Collaborative Advisory Committee.
Betsy Deitte, a mom from Needham who had her third child, a boy, in September.
And Rebecca Loveys of Watertown, who delivered her second son in August.

Livechat

First question, from Agnes…
Is there a way we can improve these measures of childbirth by focusing not just on the labor-and-delivery part, whose benchmarks mostly are set by hospital birth, but on childbearing? On a woman’s experience of her pregnancy and not just the outcome?

Dr. Jeff Ecker responds…
I think it would be difficult to do so, as they are such different experiences. A woman can have a perfectly healthy pregnancy, and have a difficult delivery. One does not necessarily affect the other experience.

I agree that it would be ideal to focus on the whole experience of pregnancy, childbirth and post-delivery care. We have, to date, focused mostly on the process of labor and delivery because that is the point at which we most reliably collect data (think: birth certificate). Increasingly we are turning to evaluate patient satisfaction. But I need to tell you that in my experience, much of satisfaction is driven by outcome.

Question from Katie…
To what extent does the fear of medical malpractice dictate a woman’s birth experience?

Gene Declercq responds…
The research on the effects of fear of malpractice on obstetrician’s behavior is somewhat mixed. In terms of whether things like malpractice premiums are directly related to, say cesarean rates, there is not much support for that link. However, in terms of perception of malpractice concerns on obstetrician attitudes it continues to have an impact since the widespread feeling exists that interventions like cesareans are more easily defensible in court.

Cara responds…
As a labor and delivery RN I know that the fear of lawsuit is a huge driving force in the care we provide. I can’t tell you how often I hear docs and midwives say “Well I really should do (insert intervention) because how would it ‘look’ if we didn’t”…..”look” being the operative word and it means when the lawyers review the chart if a lawsuit did happen.

Ecker responds…
Cara, you’re right. Those on labor and delivery spend much time (too much time) talking about lawyers and how they might spin our care. But research is split about how such concerns actually affect care and outcomes. It turns out to be difficult, for example, to demonstrate that a recent malpractice settlement drives care in any particular direction. Don’t get me wrong: I’m no fan of lawyers second guessing good care after the fact but they’re not the only things driving cesarean rates up.

Question from Sarah…
How do doctors decide when during a woman’s labor to recommend a Cesarean section? Do most doctors have their own formula or threshold for deciding when the woman is not making progress that will lead to a vaginal delivery?

Dr. Ecker responds…
There’s no one formula for determining when progress isn’t being made and cesarean delivery is best recommended. Continue reading

Better Hospital Shopping: Try Healthcare Savvy’s New Quality Map

WBUR’s Healthcare Savvy has just launched an important project: An interactive map of local hospitals that uses official public data to help you, the potential patient, try to find the best place to get the care you need. The photo above gives only a taste of the data; be sure to check out the full Savvy display here.

From the introduction by WBUR’s Martha Bebinger:

Hospitals say they are making great strides in gathering quality information. That’s great, but turning it into information we, consumers, can use still has a long way to go. And figuring out which doctors do a better job than their colleagues is nearly impossible to determine, except by word of mouth.

We’re hoping to kick off a broad discussion about where to find the best care, starting with this snapshot of hospital quality in Massachusetts. The scores and ratings you see on the map and bar chart below are not new. This is all public data, collected by private, state or federal agents and posted online somewhere else. We’re pooling a range of quality measures here to offer you a glimpse of how much quality varies from one hospital to the next and to give you a place to ask your questions about what the health care system will and won’t tell you about quality and why.

If you don’t find what you’re looking for here, let us know. We are putting readers on notice: this is the quality information that is available. We don’t think it’s good enough. Many hospitals agree. We all need to push for more. In the meantime, tell us what other quality information you’re looking for. We’ll see if we can help or let you know why we can’t.

Your input is deeply welcome — and it could help others, as well as yourself. Again, the full project is here.

Commentary: What We Learned From Cutting Colon Surgery Infections

costs of  complications

(Courtesy of MH)

By Matthew Hutter, MD
Guest Contributor

Dr. Matthew Hutter is director of the Codman Center for Clinical Effectiveness in Surgery, and a surgeon at Massachusetts General Hospital. This post is adapted from a talk he just gave at the American College of Surgeons’ Surgical Health Care Quality Forum in Boston.

Surgery to remove part of the colon is prone to nasty complications nearly one-third of the time. Even though the colon can be rinsed, it is never really “clean,” and so the procedure is prone to infection that can lead to open wounds. Other complications include abscess, bowel obstruction, pneumonia and worse. Sometimes, people die.

Dr. Matthew Hutter

Dr. Matthew Hutter

This high rate of complications is one reason why our quality consortium – five Partners Healthcare hospitals – chose partial colectomy as our first target for improving patient outcomes. Although our collective 29-percent complications rate was lower than the national average, we thought it could get still better.

It did. Over one year, we cut our complication rate by a dramatic 23 percent. How? Please read on for the lessons we learned about how to improve quality and save money at the same time — lessons we think may be broadly applied across surgery. Continue reading

Report Finds 40% Differences In Mass. Primary Docs’ Quality

A view of the Massachusetts Health Quality Partners tool for checking primary care quality

Attention, primary care patients, which means just about all of us. A new study from Massachusetts Health Quality Partners finds that the state remains a great place to be a patient, and it’s getting even better. But there are some major disparities among medical groups in performance as measured by MHQP’s quality indicators, from testing for strep throat before prescribing antibiotics to using scans to diagnose lower back pain.

The Massachusetts quality numbers come out just as national attention to the need for more careful and effective care has been rising. On Wednesday, nine medical specialty groups released recommendations that 45 common tests be performed less frequently. (See local specialists’ useful comments in “Tests You Don’t Need” in The Boston Globe.)

Massachusetts Health Quality Partners has been tracking the state’s doctors’ performance on 24 “process measures” — does the practice adhere to the recommended guidelines? — for eight years now, including asthma management, well-child visits, antidepressant prescriptions, cholesterol control and more. The new data summarize care quality among about 150 medical groups and 4,000 medical staffers. Check out the full report — and possibly your own doctor’s performance — here. Some press release excerpts, skipping the good news about our generally high quality and getting right to the gaps:

But not all health care in Massachusetts is the same. There is high variation in how pediatricians across the state perform. For the same strep throat measure, some pediatricians gave the recommended care 100 percent of the time, while others did so only 60 percent of the time. A variation of 40 percentage points shows the differences in care a child could receive depending on where they go for care. Continue reading