Little Progress on Eliminating Health Care-Associated Infections and Patient Safety
Health care-associated infections (HAIs) have been identified as a complication that can be avoided with proper care and procedures. To put pressure on hospitals to reduce if not eliminate HAIs, Medicare has included some infections on its list of never events, that is complicatoins that could reasonably have been prevented. As a never event, Medicare will not pay the extra costs of treatment when acquired in the hospital. Nonetheless, according to the 2009 National Healthcare Quality Report (NHQR) and National Healthcare Disparities Report (NHDR) issued April 13, 2010 by the U.S. Department of Health and Human Services' Agency for Healthcare Research and Quality (AHRQ) very little progress has been made on eliminating HAIs. For example, of the five types of HAIs in adult patients who are tracked in the reports: Rates of postoperative sepsis, or bloodstream infections, increased by 8 percent. Postoperative catheter-associated urinary tract infections increased by 3.6 percent. Rates of selected infections due to medical care increased by 1.6 percent. There was no change in the number of bloodstream infections associated with central venous catheter placements, which are tubes placed in a large vein in the patient's neck, chest, or groin to give medication or fluids or to collect blood samples. However, rates of postoperative pneumonia improved by 12 percent. In addition, although rates are improving incrementally, blacks, Hispanics, Asians, and American Indians are less likely than whites to receive preventive antibiotics before surgery in a timely manner. Other positive news is that over 100 participating hospital intensive care units in Michigan have been able to keep the rates of central line-associated bloodstream infections to near zero, 3 years after adopting standardized procedures. The project involved the use of a comprehensive unit-based safety program to reduce these potentially lethal infections. AHRQ issues annual quality and disparities reports mandated by Congress. The data are based on more than 200 health care measures categorized in four areas of quality: effectiveness, patient safety, timeliness, and patient-centeredness. The 2009 NHQR emphasizes three themes to accelerate progress if the Nation is to achieve higher quality health care in the near future: 1. Health care quality needs to be improved, particularly for uninsured individuals, who are less likely to get recommended care. 2. Some areas merit urgent attention, including patient safety and health care-associated infections (HAIs). 3. Quality is improving, but the pace is slow, especially for preventive care and chronic disease management. Three key themes in the 2009 NHDR are: 1. Disparities are common and uninsurance is an important contributor. 2. Many disparities are not decreasing. 3. Some disparities merit particular attention, especially care for cancer, heart failure, and pneumonia. The report states that in hospitals patient safety remains a significant problem. It noted that measures of hospital care improve more quickly than measures of outpatient care, and measures of acute treatment improve more quickly than measures of preventive care and chronic disease management. The 2009 reports include a new section on lifestyle modifications, because preventing or reducing obesity is a crucial goal for many Americans and an important task for health care providers. The reports found: One-third of obese adults have never received advice from their doctor about exercise. Obese adults who are black, Hispanic, poor or have less than a high school education are less likely to receive diet advice from their doctor. Most overweight children and one-third of obese adults report that they have not been told by their doctor that they are overweight. Most American children have never received counseling from their health care provider about exercise, and almost half have never received counseling about healthy eating. The reports indicate that the lack of health insurance slows improvement in health care quality and reduction of disparities. For many services, not having insurance is the single strongest predictor of poor quality care, exceeding the effects of race, ethnicity, income or education. Examples of disparities of care given in the reports include whether colonoscopies, mammograms, and PAP smears. Concluding, the NHQR states: It makes a difference in peoples lives when breast cancer is diagnosed early with timely mammography; when a patient suffering from a heart attack is given the correct lifesaving treatment in a timely fashion; when medications are correctly administered; and when doctors listen to their patients and their families, show them respect, and answer their questions. 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