Making the Move to Quality Reporting

The Centers for Medicare and Medicaid Services implemented the Inpatient Psychiatric Facility Quality Reporting Program in 2012, which publicly reports facilities’ performance on restraint and seclusion (R-S) measures. Using data from Massachusetts, we examined whether nonprofits and for-profits responded differently to the program on targeted indicators, and if the program had a differential spillover effect on nontargeted indicators of quality by ownership. Episodes of R-S (targeted), complaints (nontargeted), and discharges were obtained for 2008-2017 through public records requests to the Commonwealth of Massachusetts. Using difference-in-differences estimators, we found no differential changes in R-S between for-profits and nonprofits. However, for-profits had larger increases in overall complaints, safety-related complaints, abuse-related complaints, and R-S-related complaints compared with nonprofits. This is the first study to examine the effects of a national public reporting program among psychiatric facilities on nontargeted measures. Researchers and policymakers should further scrutinize intended and unintended consequences of performance-reporting programs.

Download Full-text

Shifting Landscape of Healthcare-Associated Infection and Antimicrobial Resistant Infection Reporting Policy, 2005–2019

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.1025 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s389-s389

Author(s):

Jeremy Goodman ◽

Samuel Clasp ◽

Arjun Srinivasan ◽

Elizabeth Mothershed ◽

Seth Kroop ◽

...

Keyword(s):

Health Department ◽

Adverse Outcomes ◽

Health Departments ◽

Healthcare Associated Infection ◽

Candida Auris ◽

Quality Reporting ◽

Notifiable Diseases ◽

Reporting Requirements ◽

Resistant Infection ◽

Healthcare Associated

Background: Healthcare-associated infections (HAIs) are a serious threat to patient safety; they account for substantial morbidity, mortality, and healthcare costs. Healthcare practices, such as inappropriate use of antimicrobials, can also amplify the problem of antimicrobial resistance. Data collected to target HAI prevention and antimicrobial stewardship efforts and measure progress are an important resource for assuring transparency and accountability in healthcare, tracking adverse outcomes, investigating healthcare practices that may spread or protect against disease, detecting and responding to the spread of resistant pathogens, preventing infections, and saving lives. Methods: We discuss 3 healthcare-associated infection and antimicrobial Resistant infection (HAI-AR) reporting types: NHSN HAI-AR reporting, reportable diseases, and nationally notifiable diseases. HAI-AR reporting requirements outline facilities and data to report to NHSN and the health department to comply with state laws. Reportable diseases are those that facilities, providers, and laboratories are required to report to the health department. Nationally notifiable diseases are those reported by health departments to the CDC for nationwide surveillance and analysis as determined by Council of State and Territorial Epidemiologists (CSTE) and the CDC. Data presented are based on state and federal policy; NHSN data are based on CDC reporting statistics. Results: Since the 2005 launch of the CDC NHSN and publication of federal advisory committee HAI reporting guidance, most states have established policies stipulating healthcare facilities in their jurisdiction report HAIs and resistant infections to the NHSN to gain access to those data, increasing from 2 states in 2005, to 18 in 2010, and to 36 states, Washington, DC, and Philadelphia in 2019. Reporting policies and NHSN participation expanded greatly following the 2011 inception of CMS HAI quality reporting requirements, with several states aligning state requirements with CMS reporting. States listing carbapenem-resistant Enterobacteriaceae (CRE) as a reportable disease increased from 7 in 2013 to 41 states and the District of Columbia in 2019. Vancomycin-intermediate and vancomycin-resistant Staphylococcus aureus (VISA/VRSA) was added as a nationally notifiable disease in 2004, carbapenemase-producing CRE (CP-CRE) was added in 2018, and Candida auris clinical infections were added in 2019. The CDC and most jurisdictions with HAI reporting mandates issue public reports based on aggregate state data and/or facility-level data. States may also alert healthcare providers and health departments of emerging threats and to assist in notifying patients of potential exposure. Conclusions: Through efforts by health departments, facilities, patient advocates, partners, the CDC, and other federal agencies, HAI-AR reporting has steadily increased. Although reporting laws and data uses vary between jurisdictions, data provided serves as valuable tools to inform prevention.Funding: NoneDisclosures: None

Download Full-text

Zinc as a complementary treatment for cancer patients: a systematic review

Clinical and Experimental Medicine ◽

10.1007/s10238-020-00677-6 ◽

2021 ◽

Author(s):

C. Hoppe ◽

S. Kutschan ◽

J. Dörfler ◽

J. Büntzel ◽

...

Keyword(s):

Systematic Review ◽

Side Effects ◽

Cancer Treatment ◽

Cancer Patients ◽

Survival Data ◽

Positive Impact ◽

Oral Intake ◽

Quality Reporting ◽

Evidenced Based

AbstractZinc is a trace element that plays an important role in the immune system and cell growth. The role of zinc in cancer treatment has been discussed for some time, however without reaching an evidenced-based consensus. Therefore, we aim to critically examine and review existing evidence on the role of zinc during cancer treatment. In January 2019, a systematic search was conducted searching five electronic databases (Embase, Cochrane, PsychINFO, CINAHL and PubMed) to find studies concerning the use, effectiveness and potential harm of zinc therapy on cancer patients. Out of initial 5244 search results, 19 publications concerning 23 studies with 1230 patients were included in this systematic review. The patients treated with zinc were mainly diagnosed with head and neck cancer and underwent chemo-, radio- or concurrent radio-chemotherapy. Interventions included the intake of different amounts of zinc supplements and oral zinc rinses. Outcomes (primary endpoints) investigated were mucositis, xerostomia, dysgeusia, pain, weight, dermatitis and oral intake of nutrients. Secondary endpoints were survival data, quality of life assessments and aspects of fatigue, immune responses and toxicities of zinc. The studies were of moderate quality reporting heterogeneous results. Studies have shown a positive impact on the mucositis after radiotherapy. No protection was seen against mucositis after chemotherapy. There was a trend to reduced loss of taste, less dry mouth and oral pain after zinc substitution. No impact was seen on weight, QoL measurements, fatigue, and survival. The risk of side effects from zinc appears to be relatively small. Zinc could be useful in the prevention of oral toxicities during irradiation. It does not help in chemotherapy-induced side effects.

Download Full-text

Surgical Site Infection Trend Analysis Following Abdominal Hysterectomy, National Healthcare Safety Network, 2009–2018

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.1039 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s396-s397

Author(s):

Qunna Li ◽

Minn Soe ◽

Allan Nkwata ◽

Victoria Russo ◽

Margaret Dudeck ◽

...

Keyword(s):

Logistic Regression ◽

Trend Analysis ◽

Primary Closure ◽

Abdominal Hysterectomy ◽

Incidence Rates ◽

Mixed Effects ◽

Mandatory Reporting ◽

Hospital Inpatient ◽

Quality Reporting ◽

Reporting Requirement

Background: Surveillance data for surgical site infections (SSIs) following abdominal hysterectomy (HYST) have been reported to the CDC NHSN since 2005. Beginning in 2012, HYST SSI surveillance coverage expanded substantially as a result of a CMS mandatory reporting requirement as part of the Hospital Inpatient Quality Reporting Program. A trend analysis of HYST SSI using data submitted to the NHSN has not been previously reported. To estimate the overall trend of HYST SSI incidence rates, we analyzed data reported from acute-care hospitals with surgery performed between January 1, 2009, and December 31, 2018. Methods: We analyzed inpatient adult HYST procedures with primary closure resulting deep incisional primary and organ-space SSIs detected during the same hospitalization or rehospitalization to the same hospital. SSIs reported as infection present at time of surgery (PATOS) were included in the analysis. Due to the surveillance definition changes for primary closure in 2013 and 2015, these were tested separately as interruptions to HYST SSI outcome using an interrupted time-series model with a mixed-effects logistic regression. Because the previously described changes were not significantly associated with changes in HYST SSI risk, mixed-effects logistic regression was used to estimate the annual change in the log odds of HYST SSI. The estimates were adjusted for the following covariates: hospital bed size, general anesthesia, scope, ASA score, wound classification, medical school affiliation type, procedure duration and age. Results: The number of hospitals and procedures reported to NHSN for HYST increased and then stabilized after 2012 (Table 1). The unadjusted annual SSI incidence rates ranged from 0.60% to 0.81%. Based on the model, we estimate a 2.58% decrease in the odds of having a HYST SSI annually after controlling for variables mentioned above (Table 2). Conclusions: The volume of hospitals and procedures for HYST reported to NHSN increased substantially because of the CMS reporting requirement implemented in 2012. The overall adjusted HYST SSI odds ratio decreased annually over 2009–2018, which indicates progress in preventing HYST SSIs.Funding: NoneDisclosures: None

Download Full-text

Quality Improvement in Otolaryngology–Head and Neck Surgery: Developing Registry-Enabled Quality Measures From Guidelines for Cerumen Impaction and Allergic Rhinitis Through a Transparent and Systematic Process

Otolaryngology ◽

10.1177/01945998211011987 ◽

2021 ◽

pp. 019459982110119

Author(s):

Jeremy J. Michel ◽

Seth R. Schwartz ◽

Douglas E. Dawson ◽

James C. Denneny ◽

Eileen Erinoff ◽

...

Keyword(s):

Allergic Rhinitis ◽

Clinical Practice ◽

Head And Neck ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

Clinical Care ◽

Quality Measures ◽

Neck Surgery ◽

Head And Neck Surgery ◽

Quality Reporting

Background and Significance Quality measurement can drive improvement in clinical care and allow for easy reporting of quality care by clinicians, but creating quality measures is a time-consuming and costly process. ECRI (formerly Emergency Care Research Institute) has pioneered a process to support systematic translation of clinical practice guidelines into electronic quality measures using a transparent and reproducible pathway. This process could be used to augment or support the development of electronic quality measures of the American Academy of Otolaryngology–Head and Neck Surgery Foundation (AAO-HNSF) and others as the Centers for Medicare and Medicaid Services transitions from the Merit-Based Incentive Payment System (MIPS) to the MIPS Value Pathways for quality reporting. Methods We used a transparent and reproducible process to create electronic quality measures based on recommendations from 2 AAO-HNSF clinical practice guidelines (cerumen impaction and allergic rhinitis). Steps of this process include source material review, electronic content extraction, logic development, implementation barrier analysis, content encoding and structuring, and measure formalization. Proposed measures then go through the standard publication process for AAO-HNSF measures. Results The 2 guidelines contained 29 recommendation statements, of which 7 were translated into electronic quality measures and published. Intermediate products of the guideline conversion process facilitated development and were retained to support review, updating, and transparency. Of the 7 initially published quality measures, 6 were approved as 2018 MIPS measures, and 2 continued to demonstrate a gap in care after a year of data collection. Conclusion Developing high-quality, registry-enabled measures from guidelines via a rigorous reproducible process is feasible. The streamlined process was effective in producing quality measures for publication in a timely fashion. Efforts to better identify gaps in care and more quickly recognize recommendations that would not translate well into quality measures could further streamline this process.

Download Full-text

FRI0524 THE ACR’S RHEUMATOLOGY INFORMATICS SYSTEM FOR EFFECTIVENESS (RISE) REGISTRY SUPPORTS SMALL RHEUMATOLOGY PRACTICES FOR FEDERAL QUALITY REPORTING PROGRAM

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.6220 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 861-862

Author(s):

Z. Izadi ◽

T. Johansson ◽

J. LI ◽

G. Schmajuk ◽

J. Yazdany

Keyword(s):

Quality Measures ◽

Quality Reporting ◽

Practice Characteristics ◽

Informatics System ◽

Group Practices ◽

Status Assessment ◽

And Performance ◽

Reporting Programs

Background:The Rheumatology Informatics System for Effectiveness (RISE) Registry was developed by the ACR to help rheumatologists improve quality of care and meet federal reporting requirements. In the current quality program administered by the U.S. Centers for Medicare and Medicaid services, rheumatologists are scored on quality measures, and performance is tied to financial incentives or penalties. Rheumatoid arthritis (RA)-specific quality measures can only be submitted through RISE to federal programs.Objectives:This study used data from the RISE registry to investigate rheumatologists’ federal reporting patterns on five RA-specific quality measures in 2018 and investigated the effect of practice characteristics on federal reporting of these measures.Methods:We analyzed data on all rheumatologists who continuously participated in RISE between Jan 2017 to Dec 2018 and who had patients eligible for at least one RA-specific measure. Five measures were examined: tuberculosis screening before biologic use, disease activity assessment, functional status assessment, assessment and classification of disease prognosis, and glucocorticoid management. We assessed whether or not rheumatologists reported specific quality measures via RISE. We investigated the effect of practice characteristics (practice structure; number of providers; geographic region) on the likelihood of reporting using adjusted analyses that controlled for measure performance (performance in 2018; change in performance from 2017; and performance relative to national average performance). Analyses accounted for clustering by practice.Results:Data from 799 providers from 207 practices managing 213,757 RA patients was examined. The most common practice structure was a single-specialty group practice (53%), followed by solo (28%) and multi-specialty group practice (12%). Most providers (73%) had patients eligible for all five RA quality measures. Federal reporting of quality measures through RISE varied significantly by provider, ranging from no reporting (60%) to reporting all eligible RA measures (12.2%). Reporting through RISE also varied significantly by quality measure and was highest for functional status assessment (36%) and lowest for assessment and classification of disease prognosis (20%). Small practices (1-4 providers) were more likely to report all eligible RA quality measures compared to larger practices (21%, 6%; p<0.001). In adjusted analyses, solo practices were more likely than single-specialty group practices to report RA measures (42%, 31%; p<0.027) while multispecialty group practices were less likely (18%, 31%; p<0.001). Additionally, higher performance in 2018 and performance ≥ the national average performance was associated with federal reporting of the measures through RISE (p≤0.004).Conclusion:Forty percent of U.S. rheumatologists participating in RISE used the registry for federal quality reporting. Physicians using RISE for reporting were disproportionately in small and solo practices, suggesting that the registry is fulfilling an important role in helping these practices participate in national quality reporting programs. Supporting small practices is especially important given the workforce shortages in rheumatology. We observed that practices reporting through RISE had higher measure performance than other participating practices, which suggests that the registry is facilitating quality improvement. Studies are ongoing to further investigate the impact of federal quality reporting programs and RISE participation on the quality of rheumatologic care in the United States.Disclaimer: This data was supported by the ACR’s RISE Registry. However, the views expressed represent those of the authors, not necessarily those of the ACR.Disclosure of Interests:Zara Izadi: None declared, Tracy Johansson: None declared, Jing Li: None declared, Gabriela Schmajuk Grant/research support from: Pfizer, Jinoos Yazdany Grant/research support from: Pfizer

Download Full-text