"No matter where patients were cared for, when they received quality care...it actually did result in lower cost," Denise Remus, vice president of clinical informatics at the Premier Inc. healthcare alliance, which is a co-sponsor of the pilot project and also conducted the study, told United Press International.

At hospitals participating in the project, a portion of what they are paid for services is based on whether they complete specific tasks that are indicated for all patients with certain conditions.

For patients with pneumonia, for example, the steps include smoking cessation counseling, flu vaccination and timely doses of antibiotics.

The study examined whether 33 steps were followed in the treatment of patients with pneumonia, coronary artery bypass graft, acute myocardial infarction, hip and knee replacement and heart failure.

For all the conditions except heart failure, patients who received more than 75 percent of the recommended care reported fewer complications and fewer readmissions, significantly lower hospital costs, significantly shorter length of stay, and, for coronary artery bypass graft patients, significantly lower mortality rates.

Medicare payment information on the patients also revealed that the total cost of their care was consistently hundreds or thousands of dollars less.

"As the first real-world test of these quality measures, this project represents an important step forward in our understanding of the impact of process improvement on patient outcomes," said Maureen Bisognano, executive vice president and chief operating officer of the Institute for Healthcare Improvement. "This analysis clearly identifies the positive results for patients when providers reliably implement a set of evidence-based care practices."

Furthermore, according to the analysis, if all pneumonia, heart bypass, heart attack and hip and knee replacement patients nationally received most or all of the same steps of care in 2004, it could have resulted in nearly 5,700 fewer deaths, 8,100 fewer complications, 10,000 fewer readmissions and 750,000 fewer days in the hospital. In addition, hospital costs could have been as much as $1.35 billion lower.

The finding also bodes well for the implementation of a requirement by Congress requiring a performance-based payment system for all of Medicare by fiscal year 2009, Remus said. "It can be done. Hospitals do provide all of eligible care, but not consistently yet."

Pay-for-performance is an important incentive for encouraging hospitals to adopt measures that improve quality, Remus said. Standing order sets for doctors can "make it easy to do the right thing."

One hospital has even had considerable success in improving quality with signs on operating suite doors, Remus said.

"We believe (pay-for-performance) is expediting change," she said. "It's been an incentive and it's provided the opportunity for learning."

However, it is not clear that the same relationship between improved quality and cost savings will be true for all conditions. In the case of heart failure patients, the study results were somewhat inconclusive, indicating that good care for that condition is actually more expensive.

"It may be that after further research, we find the best care for heart patients is a longer length of stay, for example," Remus said.

Community
Email This Article
Comment On This Article

Related Links
Hospital and Medical News at InternDaily.com
Hospital and Medical News at InternDaily.com

Memory Foam Mattress Review

SPACE MEDIA NETWORK PROMOTIONS Solar Energy Solutions Tempur-Pedic Mattress Comparison ... Newsletters :: SpaceDaily :: SpaceWar :: TerraDaily :: Energy Daily XML Feeds :: Space News :: Earth News :: War News :: Solar Energy News