Tuesday, October 21, 2014

A new look at "safe seats"

Michael Millenson, President, Health Quality Advisors, writes:
Working with data analytics colleagues, I've produced a report on safest Congressional districts looking not at political safety (whose seat is secure) but the physical safety of constituents getting care at hospitals in that district. 

We used 20 different measures to rank each district, seven of which were measures of infection control or prevention and divided districts into good, fair and poor. Using the most conservative and evidence-based estimates, we translated those results to the political environment. We found that 59 House districts were less safe than the norm and 114 districts were safer, with measurable consequences. (I also took a look at the home districts of Obama, Biden, McConnell and Reid, plus House leadership.)

In each Congressional district ranked “poor” on safety, preventable medical errors cause an average of 553 deaths and 4,148 injuries annually; in “fair” districts, the average toll of preventable harm is 469 deaths and 3,518 injuries each year; and in “good” districts, preventable errors cause an average of 385 deaths and 2,888 injuries each year. Put differently, on average 14 more individuals die every month and 105 are injured in hospitals in districts rated “poor” on safety than in those rated “good.” Even in “good” districts, however, at least one individual dies unnecessarily every day and another eight are harmed. We also looked at Republican versus Democrat: when it comes to patient safety, there is no red America or blue America, only the United States of America: there was no difference between the parties.

You can look at the report, and your district, at www.safedistricts.com.

Separately, as you may know, there's an infection that kills up to one in five of those who contract it, costs the nation billions of dollars to treat. And yet the CDC thinks hospitals can take more than a decade to dramatically reduce it, even though a paper in the NEJM by Peter Pronovost showed what to do back in 2006. Did laxity by the Centers for Disease Control and Prevention in eliminating central-line associated bloodstream infections (CLABSIs), which are caused by hospitals, leave the way open for infection control lapses that are hurting the Ebola fight?

See my analysis at Forbes.comhttp://t.co/3a7Ao7vbG3. Retweeting appreciated.

Oh: the Congressional district in which Texas Health Presbyterian Hospital is located scored "poor." In addition, the only two districts of 436 (including DC) we could not rate, because their hospitals did not report enough information, were in Texas.

Both of these, by the way, are anchored in the medical literature, although the blog post has links, not footnotes. :-)

Hope you find this useful in your own good works.


nonlocal MD said...

Interesting concept, and I am not at all surprised about Texas. It again raises the question that you and I debate, Paul - will hospitals do the right thing of their own accord or is it necessary to demand accountability from an outside source? And when you answer with the word 'leadership', I ask then, how will we find those leaders? They seem to be in short supply.

John Freedman MD said...

Michael Millenson has been a champion of patient safety since long before it was on everyone's radar. His book, Demanding Medical Excellence, is a must-read, as is his decade-or-so-later follow up article "The Silence" (in Health Affairs, I think).

Thank you again for shining the light, and thank you Paul for posting.

Richard said...

Echoing "nonlocalMD", how does leadership become incentivized to champion quality and safety? No question that those leaders who have a quality-safety mindset are few and far between. Changing professional awareness and behaviors is a tough challenge and runs the risk of being labeled micromanagement. I prefer to replace the m word with education.

Anonymous said...

I’m still reeling from the poor performance of the hospitals in Maryland, according to Michael Millenson’s report. Despite having Johns Hopkins, MedStar and the University of Maryland in our “backyard” - all supposed to be centers of excellence - we still are in worse shape than even Texas! What gives?

A very interesting report and I thank you for sharing it with all of us.