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Now that Pennsylvania is requiring public disclosure of outcomes data, hospitals at first terrified at the prospect are seeing good results. The average cost for coronary artery bypass graft surgery at Lehigh Valley Hospital in Allentown has steadily decreased each year from 1994 to 1997. Last year, the decline was 10%. Length of stay has decreased about 30%. Meanwhile, patient satisfaction has remained high.
Lehigh was surprised at its ratings the first year the state collected data on its cardiac systems, says William W. Frailey, MD, vice president for care management systems. "We didn’t do as well as we thought we would. It was a real eye-opener for us," he says. "In subsequent years, we’ve done much better."
The hospital now has gone beyond merely collecting the state-required data to making sure improvements are made. "The public focus emphasizes the need to look at and improve our performance," Frailey says. Regular feedback is given to physicians, and clinical changes have been made to improve cardiac care, a major component of the hospital’s services. Protocols have been changed for anesthesia, oxygen, ambulation, and preoperative education. Ventilator time has been reduced from about 24 hours to six to eight hours.
At St. Luke’s Hospital in Bethlehem, PA, the published reports have led to significant changes, notes James Cowan, MD, chief of medicine and director of clinical performance improvement, including the development of a protocol that has reduced average ventilator time from 24 hours to six hours.
The hospital has also paid special attention to areas such as administration of aspirin on arrival and discharge of cardiology patients, smoking cessation therapy, use of thrombolytic therapy, use of primary angioplasty, and discharge of patients on appropriate beta blockers and angiotensin-converting enzyme inhibitors. Follow-up studies show that more than 90% of patients are now getting these potentially lifesaving treatments, up from about 80%.
"That progress was not driven by anything specific in the outcomes report. Merely the fact that the report existed and was being produced on a regular basis created the improvements," Cowan says. "I think it’s made us more attentive to every patient."
It’s not enough just to collect the data, Cowan says. St. Luke’s has done internal reviews, follow-up studies, and physician education to make sure the compilation is doing its job. "Physicians sometimes think that every patient gets perfect care. Without some kind of feedback mechanism, they don’t realize they might not have done a perfect job," Cowan says. "It’s just human nature to focus on and remember the successes and forget the failures. Physicians by virtue of their professional ethic are very eager to meet true standards of excellence."