News

NQF Endorses Clinician-Level Consensus Standards for Ambulatory and Hospital Care

The National Quality Forum (NQF) announces the endorsement of additional clinician-level national voluntary consensus standards for ambulatory and hospital care for a two-year period of time. The 35 consensus standards expand NQF’s ongoing activities to endorse standardized measures for gauging and publicly reporting the quality of care provided by clinicians in the ambulatory and hospital settings.

Twenty-nine of the measures were recently developed by the American Medical Association Physician Consortium for Performance Improvement (AMA PCPI) and the National Committee for Quality Assurance (NCQA) under a contract from the Centers for Medicare and Medicaid Services (CMS) and have not undergone significant field-testing. The NQF board of directors recently approved an endorsement designation to allow for “time limited” endorsement for measures that satisfy all NQF criteria, but have not been adequately field tested. Once the field testing has been completed and measures have been demonstrated to produce valid and reliable results, NQF would remove the time limitation on the endorsement designation.

The action represents the formal consensus of more than 350 healthcare providers, consumer groups, professional associations, purchasers, federal agencies, and research and quality improvement organizations. All of these standards were vetted through NQF’s formal Consensus Development Process, with multiple stakeholder input, to achieve special legal standing as voluntary consensus standards. Each measure was evaluated against NQF-endorsed measure evaluation criteria of importance, scientific soundness, feasibility, and usability.

NQF has previously endorsed 86 clinician-level measures for ambulatory care. These 35 measures bringing to 121 the total number of NQF-endorsed voluntary consensus standards for clinician- level performance.

The 35 measures approved for time-limited endorsement fall under the following categories: bone and joint conditions, eye care, diabetes care, geriatrics, incontinence, emergency care, cardiac surgery, perioperative care, stroke or intracranial hemorrhage. Additionally, NQF endorsed nine research recommendations for further development of clinician-level performance measures.

Study Finds Gap Between Practice, Attitudes Toward Medical Errors

When it comes to disclosing medical errors to patients, there is a gap between physicians’ attitudes and their real-world experiences admitting such errors, according to a University of Iowa study. From a survey of physicians and medical students, researchers found that while nearly all respondents indicated that they would disclose a hypothetical error, less than half reported having disclosed an actual minor or major medical error. The survey results are published in the online version of the Journal of General Internal Medicine.

“Our goal was to learn more about clinicians’ attitudes but also what they actually have, and have not, done,” says the study’s lead author Lauris Kaldjian, MD, PhD, associate professor of internal medicine in the UI Roy J. and Lucille A. Carver College of Medicine and director of the college’s Program in Biomedical Ethics and Medical Humanities. “We were interested in what factors or beliefs might be motivating physicians who are more likely to disclose errors to their patients.”

Ninety-seven percent of the faculty and resident physicians surveyed indicated that they would disclose the hypothetical medical error that resulted in minor medical harm (resulting in prolonged treatment or discomfort) to a patient, and 93 percent responded that they would disclose the error if it caused major harm (disability or death) to a patient. However, only 41 percent of faculty and resident physicians reported actually having disclosed a minor medical error, and only 5 percent responded as having disclosed a major error. Moreover, 19 percent acknowledged having made a minor medical error and not disclosing it; 4 percent indicated having made and not disclosing a major error.

Taken at face value, the responses would imply that more than half of the physicians surveyed have never made a medical error in their careers. This is striking, Kaldjian notes. “It seems fair to assume that all of us have made at least a minor error, if not a major error, sometime in our careers,” he says.

Fear of malpractice has been cited as a reason why doctors do not disclose medical errors, but the study authors report that their survey found that physicians who had been exposed to malpractice litigation were not less inclined to disclose errors. The researchers also found differences among the survey respondents based on training level. Physicians with more experience were more willing to disclose medical errors, suggesting that with increased clinical competence and confidence, doctors become more comfortable with error disclosure, according to the study.

Healthcare Industry Embracing Sustainability, Green Building

NEW YORK — McGraw-Hill Construction, in conjunction with Turner Construction Company, the U.S. Green Building Council, and Johns Manville, has released core findings of its study on green building in the healthcare construction sector. The major findings listed in the study included:

• Green healthcare facilities reduce energy use, thus reducing green house gasses and improving air quality 
• 47 percent of respondents said that patient recovery time is reduced in green buildings 
• Other benefits include lower operating costs, greater innovation and public relations benefits 

The survey shows that there is an increasing trend toward building green healthcare facilities; of the survey respondents, 19 percent said they expect that their organization will be significantly involved with green building in 2008 — more than triple the level for 2007.

“The numbers are encouraging,” says Harvey M. Bernstein, McGraw-Hill Construction vice president of Industry Analytics, Alliances and Strategic Initiatives. “Despite the obstacles, 60 percent of respondents see green building as transforming the healthcare construction sector, and by next year, one-fifth of the survey respondents expect that they will be highly dedicated (more than 30 percent of their projects) to building green healthcare facilities.”

The study also found that benefits to patient health and recovery times are an essential part of a healthcare facility’s decision to go green. “It’s clear that the perceived additional cost premium obstacle will be eroded by the overwhelming benefits of green,” says Bernstein. “When 91 percent of a sample tell you patient well-being is an important reason to build green, 58 percent tell you it’s the most important reason, and 47 percent say that patients recover faster in green buildings, it is clear that improved well-being is an important finding that the market cannot afford to ignore if we are going to accelerate green building in this sector.”

The survey of senior healthcare and hospital administrators was collected online from January to February 2007, with a total of 95 respondents. Survey respondents were geographically diverse, with nearly equal numbers urban, suburban and rural. Twenty-eight percent were C-level executives.