Why hospitals should use broader measures to track care quality

Although the hospital industry largely tracks care quality and patient safety by measuring individual adverse event rates, monitoring a hospital's total patient harm rate could be far more effective, according to Hospitals & Health Networks.

Hospitals can calculate their total patient harm rates by aggregating several measures of harm occurrences, such as falls, pressure ulcers, surgical-site infections, adverse drug events and central line-associated bloodstream infections. Tracking the more comprehensive number forces hospital leaders and board members to look at the big picture when crafting strategy, write Maulik S. Joshi, an associate executive vice president at the American Hospital Association, and Todd C. Linden, president and CEO of Grinnell (Iowa) Regional Medical Center.

Hospitals that seek to improve patient harm measurement and quality of care should do the following, according to H&HN:

  • Treat total harm as a key measure for patient safety
  • Embrace transparency for both the harm rate and improvement strategies
  • Align leadership incentives with harm elimination in mind
  • Discuss how the organization can improve on total harm
  • Measure and discuss the total harm rate monthly harm

For example, when Frederick Goldberg, M.D., took a job at Nathan Littauer Hospital in Gloversville, New York, as the vice president of medical affairs and chief medical officer, the hospital reported to its board of trustees outcomes measures that were detailed to the point of being overwhelming, which kept the board from getting a clear picture of the path to improvement, Goldberg told H&HN. Goldberg and his team instead developed a report that incorporated quality, patient safety and patient satisfaction to highlight specifically how trends within the organization affected risk-adjusted outcomes measures.

Goldberg's team began to calculate the hospital's harm-across-the-board calculation, or the total per-quarter harm events per 1,000 discharges. After the hospital implemented this measure, its total patient harm rate dropped from six events per 1,000 discharges to one over 17 months, leading Goldberg to later add another tier to the report for surgical harms.

Experts have long warned hospital quality measures do not measure the right goals, focusing more on what is easiest to measure rather than functional outcomes. The American Hospital Association, meanwhile, has called on risk-adjusted quality measures to account for sociodemographic factors such as employment status.  

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