Physicians Must Have a Voice National focus on patient safety and quality

by Susan McBride, RN, Vice president, DFW Hospital Council,Data Initiative

Healthcare professionals are concerned about the recent flood of media reports regarding patient safety and quality. Opinions are mixed regarding the validity of research substantiating these reports. The question has become how best to measure quality and patient safety. Numerous national initiatives are pushing to produce the best set of measures that will result in the ultimate quality and patient safety report.

Quality indicators are defined as quantitative data from which quality is inferred, assessed, evaluated, or judged. Approaches to deriving these measures have implications for the practicing physician. The fundamental challenge in every initiative is capturing the data necessary to make valid and reliable interpretations and, ultimately, decisions based on those interpretations.

Documentation is critical
A physician’s documentation always is important to the care of the patient, but the necessity to document risk factors, clinical history, and other clinical information that might influence these measures has implications for how the organization will appear to the public. Additionally, the physician may be asked to participate in initiatives to collect and record this data in “real-time” during the process of care rather than after the fact. In a real-time data collection mode, the physician might be asked to document against a standing order sheet. When the physician deviates from the protocol, the reason also is documented. This is important to note because this same information will be used to identify cases that should be excluded from the measured population.

Physician report cards
Currently, the physician’s name is not available in the Texas Health Care Information Council public domain data file, but Consumer’s Union and various business groups are suggesting that it should be. Should this occur, public reports most likely would be produced at a physician level with physician names on reports that might include mortality rates, complication rates, length of stay reports, and utilization reports on many key patient populations and surgical procedures. The Dallas-Fort Worth Business Group on Health is publishing quality reports on a Web site for use by employees, encouraging them to use the information to talk with their providers about selecting a hospital. This same group is heavily promoting patient safety public reporting and the physician name disclosure in future public releases of state data. The data in the THCIC data is administrative billing data—patient demographic information and ICD9 coding data that is used to derive numerous measures. Measures getting a great deal of attention in Texas are those distributed by the Agency for Health Care Research and Quality. These measures use administrative data to get to measures on inpatient quality, prevention quality indicators, and patient safety. The importance of physician documentation to this data set is as significant as the measures derived from clinical data. If the physician does not document it, the coders cannot code the risk factor or treatment. The ICD9 codes also are used to adjust rates based on the risk factors, diagnoses, and procedures.

If health care is to develop accurate quality measurements, good data are essential. Documentation is key to demonstrate that a provider is delivering quality care. When reported, data can directly or indirectly impact physicians. Indirectly, physicians may be affected if a person sees negative quality reports on a hospital, and his physician does not admit to other hospitals the person might access, then the physician could lose patients. If the Legislature passes a bill that allows disclosure of physician name with the release of THCIC data, then public reporting might impact physicians directly.

Physicians must be active in the process of patient safety and quality reporting by collectively and individually voicing their concerns and alternative strategies to the myriad organizations leading quality initiatives. The medical profession has reached a critical time where physicians must be at the heart of establishing credible healthcare standards for quality and patient safety.

For a summary of organizations with quality and patient safety measurement initiatives, visit www.dallas-cms.org.

Cody Arnold, MD, epidemiologist and neonatologist, and medical director of quality outcomes at Harris Methodist Hospital, contributed to this article.