The Centers for Disease Control and Prevention, which has lately been under attack for mishandling infectious disease samples, got a vote of confidence from patient safety experts.
At a July 17 hearing of the Primary Health and Aging Subcommittee of the Senate Health, Education, Labor and Pensions Committee, patient safety advocates and physicians called on Congress to get the CDC more involved in tracking and reporting on all forms of preventable harm that occur in the hospital.
Dr. Ashish Jha
The agency already monitors and reports on health care–associated infections such as catheter-associated urinary tract infections and surgical site infections. But the CDC also should be enlisted to help hospitals in other areas where they currently lack a good surveillance system, including venous thromboembolism and medication errors, experts testified.
"We need to expand the efforts of the CDC," said Dr. Ashish Jha, professor of health policy and management at the Harvard School of Public Health. "There is no reason to think that what they have been able to do around health care associated infections, they can’t do in other areas."
As many as 440,000 patients die of preventable errors in U.S. hospitals, according to most recent estimates (J. Pat. Safety 2013;9:122-8 [doi: 10.1097/PTS.0b013e3182948a69]).
About 180,000 Medicare patients likely die each year from preventable adverse events in the hospital, according to a 2010 report from the U.S. Department of Health & Human Services.
Those numbers may seem daunting, but the experts testified that there are plenty of policy steps the government can take to aid physicians and hospitals in tackling the problem.
Creating standards for reporting health care quality and cost measures, similar to the standards for the financial industry created under the Security and Exchange Act, would be a good place to start, said Dr. Peter Pronovost, senior vice president for patient safety and quality at Johns Hopkins Medicine in Baltimore.
"Right now we have no guarantee that the measures that we’re reporting are accurate," said Dr. Pronovost, who spearheaded a checklist protocol that led has resulted in significantly lower rates of central line associated bloodstream infections. "Johns Hopkins Hospital was both congratulated and criticized for its performance on the exact same measure for the exact same time period for bloodstream infections. And when we looked, the one we’re paid on, using administrative data, got it right 13% of the time."
Billing data isn’t adequate for this type of reporting, he said.
Experts at the hearing also called on Congress to help make safety a priority for hospitals by beefing up penalties for errors.
Lisa McGiffert, director of the Safe Patient Project at Consumers Union, said Medicare needs to put more financial pressure on hospitals. Under Medicare’s Hospital-Acquired Conditions payment program, the government withholds payment for hospitalizations in which certain preventable errors occur. But Ms. McGiffert said that policy doesn’t go far enough. The hospital should be responsible for the full range of follow-up care that results from the original adverse event, including physician visits, rehospitalizations, and medications, she said.
Dr. Pronovost said Medicare and the Joint Commission could also use their existing authority to sanction hospitals that have infection rates that are consistently above the national average. But he cautioned that regulators should only exercise this authority in areas where there is good data and validated measures, such as central line associated bloodstream infections.
CEO compensation also plays a role, said Dr. Jha, who has researched this issue among nonprofit hospitals. Right now, patient safety is typically not one of the factors influencing how CEOs at nonprofit hospital are paid, he said.
"Until we get to a point where the CEO of the hospital is lying awake at night worrying about patient safety, I don’t think we’re going to really meaningfully move the needle," Dr. Jha said.
mschneider@frontlinemedcom.com
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