Let Us Be Part of a Culture of Health Care Quality Improvement

May 28, 2009

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By David Z. Wang, DO, FAHA, Member, AAN Quality Measurement & Reporting Subcommittee and Stroke Section Executive Committee

In his inaugural address, President Obama said, "Health care reform cannot wait, it must not wait, and it will not wait another year." Under this newly intensified national interest in health care reform, the American Medical Association (AMA)-convened Physician Consortium for Performance Improvement (PCPI) held a meeting in Chicago in March 2009. The PCPI consists of more than 100 national medical specialty and state medical societies. The organization is committed to enhancing quality of care and patient safety by taking the lead in development, testing, and maintenance of evidence-based clinical performance measures and measurement resources for physicians. The PCPI aims to be a leading voice in national health care reform efforts.

Toward a Culture of Quality Improvement

The March conference's theme was to "Mobilize a Culture of Quality Improvement." Bernard Rosof, MD, MACP, Chair of PCPI, reiterated the President's principles of health care reform:

  • Decrease the rate of growth of health insurance claims
  • Increase access to health care
  • Implement information technology more broadly
  • Improve patient safety
  • Decrease administrative costs
  • Resolve end-of-life issues

The Institute of Medicine estimates that nearly a trillion dollars are wasted annually in health care either from overuse or care provided without benefit. The current health care system still rewards volume rather than value and quality. While we need to standardize quality measurements and reporting, physicians lack information about quality:

  • Only about one-third of physicians receive data on performance
  • Less than one-fifth receive any clinical outcome data
  • Less than one-seventh of solo practitioners receive any quality data

How do we "save lives and save dollars" at the same time? The PCPI recognizes that quality care is a local issue. It may include helping physicians improve their delivery of quality care to patients, engaging them to become better practitioners, reducing inequality of care, and identifying gaps of care and strategies for improvement. Health care providers also need to focus on the roles nurses may play.

Currently there are organizations that deliver quality care without higher costs. They can serve as models for others to follow. PCPI invited three speakers to share their experiences on instilling a culture of quality improvement within their health care systems.

Michael J. Dowling, President and CEO of the North Shore/LIJ Health System in New York, shared nine key concepts on assuring quality care:

  1. Priority from the top—it should be an initiative at the administration level
  2. Quality is everybody's business
  3. Present a clear and concise message
  4. Pick leaders and staff carefully
  5. Embrace transparencies of operation
  6. Tie quality measures with compensation
  7. Shift focus onto patients and families
  8. Balance the accountability and blame
  9. Avoid a "finish-line" philosophy—quality improvement is an ongoing process

Lee B. Sacks, MD, Executive Vice President and Chief Medical Officer of Advocate Health Care and President, Advocate Physician Partners, stated that his organization’s primary goal was to optimize outcomes. They worked toward this goal by having targeted programs, offering financial incentives, and mandating provider education on quality issues.

Finally, William Conway, MD, Henry Ford Health System, presented a case study of mortality reduction at Henry Ford Hospital and Henry Ford Medical Group. His organization has set up quality and safety objectives that include a "No-Harm Campaign," care coordination across the continuum, prevention and disease management bundles, an E-Care Spread, and adoption of the Baldridge Criteria for Performance Excellence.

Academy's Position on Quality Improvement

Where does the AAN stand in the quality improvement arena? We have positioned ourselves well in this culture of change. We monitor quality initiatives by participating in national alliances. In addition to being a voting member of PCPI, we are a member of National Quality Forum (NQF) and AQA Alliance (AQA). Read more about Academy collaborations on the Quality Alliances page.

The Academy is also proactive. We led the development of the stroke care measurements that were adopted by the Centers for Medicare & Medicaid Services (CMS) for its Physician Quality Reporting Initiative program. The AAN's Quality Measurement & Reporting (QMR) Subcommittee continues to develop additional quality measures for neurologic conditions. Performance measurement sets for Epilepsy and Parkinson's disease should be completed before the end of 2009. Future topics will include dementia, headache, safety, and multiple sclerosis. AAN members who would like to nominate a topic may complete the topic nomination form.

Health care reform is one of the main goals on the Obama administration's agenda. Quality is a central component. AAN.com offers many resources to help members understand and participate in quality programs and develop strategies for enhancing patient safety. However, surveys at previous Annual Meetings have revealed that members did not prioritize quality improvement. For instance, fewer than ten percent of Stroke Section members participated in the 2007 PQRI program. There is indeed much work to be done if we are to bring our members up to date on these issues.

With the expansion of PQRI measures and increase in PQRI bonuses for participating physicians, it's clear that quality programs are not going away. Neurologists need to become familiar with quality measures and quality improvement/pay-for-reporting programs. They are likely to become increasingly important and will directly impact every practicing neurologist soon.

If you have questions or would like to participate in the AAN's quality efforts, please contact Rebecca Swain-Eng, MS, Program Manager, Performance Measurement, at rswaineng@aan.com or (651) 695-2808.

Author Disclosure

Within the past 24 months, Dr. Wang received personal compensation for participating in speaker's bureaus for Bristol-Myers Squibb, Sanofi-Aventis, and Biogen Idec. In addition, he served as editor for the Journal of Stroke & Cerebrovascular Diseases in an uncompensated capacity. Dr. Wang has also received research support in the form of a grant from Genentech within the last five years.