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What happens when big health care purchasers such as AT&T, Boeing, Caterpillar, Delta Airlines, Eli Lilly, Ford, General Motors, and IBM get together and voice an opinion about the quality of health care? Hospitals listen. At least that’s the theory behind the Leapfrog Group, an organization sponsored by the Business Roundtable and including some 70 companies with the goal of improving safety in health care by alerting patients to key features of hospitals around the country.
Together, the private and public-sector purchasers represent more than 20 million Americans and $40 billion in health care expenditures, says Leapfrog’s executive director, Suzanne Delblanco, PhD. The group contends that by leveraging its collective might, it can get health plans and hospitals to adhere to three specific safety initiatives and in the process save an estimated 58,000 lives and prevent more than 500,000 medication errors.
"After the Institute of Medicine report [on medication errors] came out, we felt that we had some real areas of common ground and a chance to get consumers interested in health information," explains Delblanco. "Quality is hard to relate to, and consumers don’t usually think about health plans but about physicians and hospitals. We felt that if we come up with a common set of purchasing principles, we could help patients."
Those principles are to educate and inform enrollees about medical errors; let patients know what systems and processes can help protect them; and use incentives, recognition, and rewards for those providers and hospitals who put practices in place that will save lives.
The group asked "safety gurus" and systems experts to come up with lists of what might help improve patient safety. "We also looked at published information," she adds. The goal was to identify actions or methods that would serve as concrete evidence that a facility was working on patient safety.
Eventually, three initiatives were chosen:
1. Use of computerized physician order entry. Using such a system eliminates the problem of illegible physician handwriting and allows for automatic checks for drug interactions, allergies, and appropriate doses. "Hospitals that have these in place can prevent up to 88% of serious medication errors," says Delblanco.
2. Specialist-managed intensive care units (ICUs). "Really sick people need special care," says Delblanco. Ensuring ICUs are managed by physicians with special training can reduce mortality by 10%. Yet these physicians, called intensivists, are in place in only 10% of ICUs. "You aren’t usually in a situation where you can choose an ICU," she admits. "But if you are going to a hospital for a procedure that may lead to a critical situation, choose one that is intensivist-managed."
3. Referral of special patients to specialized hospitals. Certain high-risk surgeries have better outcomes if they occur at specialized hospitals, says Delblanco. Leapfrog established seven specific conditions, "for which there is a rock-solid relationship between volume and outcome," she notes. The conditions and related volume are:
• coronary artery bypass graft — 500 or more per year;
• coronary angioplasty — 400 or more per year;
• abdominal aortic aneurysm repair — 30 or more per year;
• carotid endarterectomy — 100 or more per year;
• esophageal cancer surgery — seven or more per year;
• delivery with expected birth weight less than 1,500 g or gestational age less than 32 weeks — regional neonatal ICU with average daily census greater than or equal to 15;
• delivery with prenatal diagnosis of major congenital anomalies — regional neonatal ICU with average daily census greater than or equal to 15.
During the coming year, Leapfrog will launch a web site that will collect data from hospitals to determine if they meet standards. There will be interim measures, too, for facilities that are working on issues but haven’t completed their work. For instance, says Delblanco, a hospital might be researching computer order entry before implementing it. "That means we can highlight them as working toward our standards."
Delblanco expects the data eventually will show more admissions to hospitals that meet the Leapfrog standards. "We’ll be analyzing the data to see if the admissions change at all." She says she hopes the data collection will start in May for pilot tests before the standards are initiated in a variety of large markets. Currently, Detroit; Seattle; California; Knoxville, TN; St. Louis; and Atlanta are scheduled, but the list will expand over time. "We think this is a great opportunity for hospitals to be recognized and rewarded for meeting standards that we know will improve safety," says Delblanco. "Having these data available for everyone to see will let us use market forces to effect change."
[For more information, contact:
• Suzanne Delblanco, PhD, Executive Director, The Leapfrog Group, 1801 K St. N.W., Suite 701-L, Washington, DC 20006. Telephone: (202) 292-6711.]