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Voluntary Reporting System Gauges Wisconsin Hospital Data

Donna Young

More than 120 Wisconsin hospitals are participating in a new voluntary program to provide safety and quality-of-care information to residents and health care purchasers.

The Wisconsin Hospital Association (WHA) is posting the data, which includes information about three common causes of hospitalization—heart attack, heart failure, and pneumonia—and error-prevention goals, on its CheckPoint Web site, which launched in March.

Dana Richardson, WHA's vice president of quality initiatives, said that to measure hospitals' quality of care and safety the association chose five error-prevention safety goals that are based on the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) National Patient Safety Goals: surgical-site marking; procedure verification process; eliminate dangerous medication abbreviations, acronyms, or symbols; remove potassium chloride, potassium phosphate, and sodium chloride from patient care units; and free-flow protection on infusion pumps.

WHA also identified 10 clinical interventions that practitioners should take, such as administering an aspirin to heart attack patients within 24 hours of arriving at the hospital or offering a pneumococcal vaccination to patients who have been admitted with pneumonia.

Hospitals report the data directly to WHA's CheckPoint program through a Web-based application, Richardson said. Facilities are not charged a fee and are not required to be a WHA member to participate, she added.

More than 70 hospitals reported error-prevention data from the last two quarters of 2003, Richardson said. Data from the first two quarters of 2004 will be added to the Web site in September.

The clinical intervention data was gleaned from information reported in the first two quarters of 2003 by nearly 100 hospitals to the Centers for Medicare & Medicaid Services (CMS) and aggregated for the Web site by MetaStar, a nonprofit health care quality improvement organization in Madison, Richardson said.

Information from the last two quarters of 2003 will be added to the Web site in September, she added.

The steering committee that oversees the CheckPoint project, Richardson said, is a "very broad-based" body consisting of hospital administrators and providers, insurance and employer groups, and representatives from research and public policy.

WHA's "measures team," which includes several pharmacists, is developing future performance standards for the project, she noted, and it also developed the method used to measure the safety goals.

Kristin K. Hanson, medication safety officer at Froedtert Hospital in Milwaukee, said she was glad that WHA "stuck close" to JCAHO's survey standards so that hospitals are not spending valuable time and resources monitoring "something over and above what we already were doing and focusing on."

Steve Rough, pharmacy director at the University of Wisconsin Hospital and Clinics at Madison, agreed and said that his hospital is asked to report quality-of-care and safety data to more than 20 organizations.

"This is sort of a trend," he said. "It gets very confusing."

Organizations that request comparison data from hospitals should standardize their measurements, Rough said, so that facilities are not spending time and resources "focusing on what can we do to make our scores look good."

He is concerned that hospitals, under pressure to have good reports because they "can't possibly afford to have data that shows [they are] not doing well on public Web sites," will "game the system" and focus on making reported data look good, rather than concentrating on improving patient care and safety.

Hanson said that she is concerned that the CheckPoint system might not be comparing "apples to apples" when measuring whether hospitals are removing dangerous medication abbreviations, acronyms, or symbols because each facility is only asked to identify 3 of a list of 10.

Not all hospitals will be reporting the same three abbreviations, acronyms, or symbols, and therefore are not being measured on the same three indicators, she noted.

"Every hospital that looks at that, if they know what their abbreviation rates are, they're not going to pick one that looks really bad," Hanson said. "We may be picking those internally to focus on and improve, but you don't want to report that data. It sounds terrible, but you want to look good."

The current measures, Rough added, allow hospitals to choose the three in which they are doing best at eliminating.

But, he warned, that could lull a hospital into a false sense of security "because the numbers on the Web site say you're doing great and then you stop applying resources to do the right thing."

When hospitals are surveyed by JCAHO under the new medication management standards, said Chris Decker, executive vice president of the Pharmacy Society of Wisconsin, "it will be interesting" whether data voluntarily reported to CheckPoint matches JCAHO's findings.

Decker, who chairs the Wisconsin Patient Safety Institute, said that pharmacy has made a significant contribution to and provided a "fair degree of leadership" in Wisconsin's focus on patient safety over the past few years.

"When it comes to health care safety and health care quality and the use of medications, pharmacists need to be a champion," he said.