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Avoiding the #3 Cause of Death in the USA: US Hospitals & What You Need To Know About It – Part 2

The gauntlet had been laid.  Don Berwick and the Institute for Healthcare Improvement (IHI) had challenged hospitals in America to save 100,000 lives.  Time was ticking away, educational programs, mentoring, training had begun but would they achieve the goal?

Eighteen months later on June 14th 2006 at 9 a.m. – Dr. Berwick took the stage to announce the results: “Hospitals enrolled in the 100,000 Lives Campaign have collectively prevented an estimated 122,300 avoidable deaths and, as importantly, have begun to institutionalize the new standards of care that will continue to save lives and improve health outcomes into the future.”

But that was only the beginning.  Remember, if there are 5,723 registered hospitals in the US, this initiative got 2,300 of them to commit in the first few months.  By the end of the campaign 3,100 hospitals had enlisted.  But thousands of Americans were still dying in US hospitals from preventable causes each month.  So the IHI moved the goal – in December 2006, IHI launched a second, expanded effort, the Five Million Lives campaign.   At its formal close in December 2008, the Campaign celebrated the enrollment of 4,050 hospitals, with more than 2,000 facilities pursuing each of the Campaign’s 12 interventions to reduce infection, surgical complication, medication errors, and other forms of unreliable care in facilities. Eight states enrolled 100% of their hospitals in the Campaign, and 18 states enrolled over 90% of their hospitals in the Campaign.

In 2011 the Secretary of the Department of Health and Human Services Kathleen Sebelius and Dr. Berwick launched the Partnership for Patients, which brings together hospitals, employers, physicians, nurses, and patient advocates along with state and federal governments in an effort to make hospital care safer, more reliable, and less costly.  The Partnership for Patients aimed to decrease preventable hospital-acquired conditions by 40 percent by the end of 2013, resulting in approximately 1.8 million fewer injuries to patients and more than 60,000 lives saved over the next three years. It also sought to reduce hospital readmissions by 20 percent by decreasing the rate of preventable complications during transitions from one care setting to another. The Partnership was to be funded by up to $1 billion in federal money made available under the Patient Protection and Affordable Care Act, including $500 million through the Community-Based Care Transitions Program and up to $500 million through the Centers for Medicare and Medicaid Innovation.    At the core of this initiative are 26 Hospital Engagement Networks, with 3,700 hospitals, working with health care providers and institutions to identify best practices and solutions to reduce hospital acquired conditions and readmissions.  Early results are showing strong progress in 8 of the 10 patient safety priority areas of the Partnership for Patients, more findings are scheduled to be released soon.

But recall that only 3,700 of the 5,723 hospitals in the US are engaged, meaning that over 2,000 hospitals are not on board and thousands of Americans are still suffering unnecessarily.  And recognize that this is looking at the prevention of adverse events, not at which institutions are the best at different procedures.  The best spine hospital may not be (and often isn’t) the best heart surgery facility in your community.

So how do you find the right hospital?  It takes research and time. It also takes a willingness to sift through a lot of different data to tease out what information would be important to you. Let’s think through a visit to the hospital – the quality of the health care a patient receives depends on many things besides the skill of the surgeon. Many health care providers at a hospital will be directly involved in care before, during, and after surgery. The metrics a patient will want to know span a broad spectrum of considerations, from scientific data on mortality and complications associated with previous treatment of patients with the same condition to the more subjective data on how patients respond to the physician and staff managing their care.

A result of this complexity in defining a good hospital is the proliferation of information sites that exist. In addition to the payers websites (carriers who are often dependent on contracting agreements with the hospitals), patients can go to anything from and Angie’s List (which also provide reviews on low complexity services like dry cleaning), to state report card sites or national sites such as Hospital Compare which may or may not have information on metrics associated with your condition. For heavier science aficionados, there are reporting agencies like CareChecks and The Dartmouth Atlas which may look at patient outcomes on a larger system level. Reports are also often put out by institutions such as the Kaiser Foundation or Commonwealth Fund that speak to hospital quality.  Somewhere in the middle of this very complex gamut are sites like Vitals or Health Grades. More traditional outlets such as Consumer Reports or the US News & World Report create hospital listings as well.

But it is not just the hospital.  The doctor and the care team he or she works with make a significant difference.  In the next blog we will consider how to find and use these “best in class” doctors.

Will You Die from the #3 Cause of Death in the USA?


By DrScott – Posted on March 13, 2014 on

In the 2013 September edition of Journal of Patient Safety Article Asks: Will You Die from the #3 Cause of Death in the USA?

Ask most people what the #1 & #2 causes of death are and they will usually know they are heart disease and cancer. Ask them for the #3 cause and you are likely to hear infections, trauma, or pneumonia but few guess American Healthcare.

But the correct answer is the Hospitals in the US. The Journal of Patient Safety in September of 2013 revealed that between 210,000 and 440,000 people die from hospitalizations in the US each year. Here’s how they come to this conclusion:

To begin, it is important to understand the concept of preventable adverse events (PAE’s). These are unexpected and harmful experiences that occur because high quality, evidence-based medical care was not delivered during hospitalization. PAE’s can be:

  • Immediate – a side effect of a drug, or
  • Delayed for months – contracting hepatitis from dirty needles a few months after hospitalization, or
  • Delayed for years – getting pneumonia because a pneumonia vaccination was not given to a patient receiving a splenectomy years prior.

PAE’s are further categorized into:

  1. Errors of Commission – the wrong action or right action performed incorrectly on a patient.
  2. Errors of Omission – an action needed by a patient was not performed; for instance, a medicine was indicated but not given in a vital situation.
  3. Errors of Communication – for example, two providers failing to communicate clear instructions during surgery; or a provider and patient inadequately reaching an understanding of discharge instructions.
  4. Errors of Context – an example is when a patient is discharged but is unable due to cognitive ability, to perform tasks needed for their safety.
  5. Diagnostic Errors – resulting in delayed, incorrect, or ineffective treatment such as mis-identifying a tumor biopsy as benign when it is actually malignant.

To identify these PAE’s, a systematic review of medical records was performed at hospitals by trained personnel with the Global Trigger Tool (GTT), developed by the Institute for Healthcare Improvement (IHI). The results were then validated by one or more physicians. Four studies with a total of 4,252 records revealed 38 total deaths associated with adverse events. The ratio equates to a death rate from adverse events of 0.89%.

As previously referenced, the September 2013 The Journal of Patient Safety article indicated that there were an estimated 34.4 million hospital discharges in 2007, and the average percentage of preventable adverse events was reported at 69%. Thus, the best estimate from combining these 4 studies is 34.4M discharges × 69% with PAEs × .89% death rate = 210,000 preventable adverse events per year that contribute to the death of hospitalized patients.

According to the Center for Disease Controldeath statistics in the US are:

  1. Heart disease: 597,689
  2. Cancer: 574,743
  3. Chronic lower respiratory diseases: 138,080
  4. Stroke (cerebrovascular diseases): 129,476
  5. Accidents (unintentional injuries): 120,859

As you can see, 210,000 deaths puts US Healthcare squarely in the #3 position for annual cause of death.

But even this may be an underestimate.

This conclusion is based only upon medical records. This fails to account for confounders such as poor documentation, complications managed by non-hospital facilities or in the outpatient setting, the “wall of silence” of health professionals altering or omitting critical data when mistakes occur, and the fact some medical errors are not known by clinicians and only come to light during autopsies (rarely performed), to name a few. Thus the actual number of deaths is significantly underestimated by at least 50%, based upon chart reviews, given the high probability of these confounders. The Journal Article therefore estimates the actual number of deaths is closer to 440,000 deaths per year, making medical inpatient errors the number three cause of death in the US by a significant margin.

A scary conclusion to say the least. What can be done to protect ourselves, and our employees, from this challenge? Join us for next week’s blog.

It is Time to Bend the Healthcare Cost Curve & Receive Higher Quality Care

By DrScott – Posted on March 11, 2014 on

Companies in America spend billions of dollars on medical care expecting high value, safe and evidence based care. But are they getting it? Transparency data suggests they are not. Specific areas being questioned include:

  1. Are patients getting too much care? How can employers and employees minimize excess care?
  2. Is 30% to 50% of the care delivered worthless? How do we avoid these costs and reduce healthcare spend dramatically?
  3. Is US Healthcare really the #3 cause of death behind heart disease and cancer? How can employers and employees avoid being killed by American Healthcare?
  4. Do up to 80% of bills submitted to insurance companies contain errors, requiring time, energy and money for employees to correct? How can employees avoid paying incorrect bills?
  5. Are employees actually being driven into bankruptcy due to the medical care they are receiving? How can employers protect their employees from the time, energy and distraction of huge, and at times inappropriate, financial challenges from health care bills?

Asked another way: Are employers paying billions for often inappropriate, misguided and expensive care?

What can be done to reverse this trend and to protect the employees and the financial bottom line?

In the next weeks we will explore these questions and discover how Don Berwick and the Institute for Healthcare Improvement (IHI) inspired hospitals to save over 100,000 lives in 18 months. We will also discover how to avoid paying 300% more for tests and services, how to protect yourself from incorrect billing practices, and how to avoid being hassled and bankrupted by the medical industrial complex.

One key is to make sure your employees are seeing the best providers.

How the “I Feel Fine” Syndrome™ is Costing You Millions – Part 1

By DrScott – Posted on December 26, 2013 on

How could this go on all these years without us discovering diabetes, heart disease, or cancer in your body and not acting? To understand this we just need to ask a person with pre-cancer, early cancer, metabolic syndrome, hypertension, diabetes, or heart disease how they feel. What would they tell you?

As a practicing doctor I can assure you it is almost always the same; “I Feel Fine.”

How could this be? The changes discussed in the first of the Seven Numbers Series describing the changes occurring in our bodies as we begin to develop diabetes, hypertension, heart disease, strokes, and cancer all occur without symptoms. Literally our bodies start to fail, either in the processing of food – metabolic syndrome, in the deposition of fat in the arteries – heart disease and strokes, or in the regulation of cells – cancer, without us feeling a significant difference in our bodies.

On one level this may not be a bad thing. ”Mother Nature” had to make a choice. Should I have people with early conditions “feel bad”, with milder symptoms as conditions begin, and then gradually increasing during the five to fifteen year window before the disease is fully manifest? Or should the pain and suffering be delayed as long as possible, with symptoms beginning much later in the process? Well, for diabetes, heart disease, and early cancer the choice was option B – hold off symptoms as long as possible, even though it is often too late when symptoms finally do appear to completely reverse the illness.

Until modern medicine discovered how these processes occur in our bodies, it was difficult to know where we are in this continuum. This means if we “feel fine” we may be perfectly healthy (and so as not to alarm everyone, the majority of working-age people are functionally healthy), or we may be walking around with a debilitating or terminal condition percolating in our bodies. But that is not the case today. With a few tests like blood pressure, cholesterol, blood sugar, and cancer screening (following the USPTSF recommendations) we can substantially increase the odds of knowing whether we are in this situation, though the testing is not perfect. Acting early, to reverse or remove the problem, is not only possible, but it is very likely to lead to arresting or delaying the problem for years. Even better news is that it is not necessary to do this testing daily or even monthly. Annual, bi-annual or even every decade (depending on the guideline) is enough to allow us to discover and keep these nefarious characters out of our bodies, while balancing the risk of being stressed over false-positives that can arise from over testing.

Setting up and encouraging employees to discover whether “I Feel Fine” = “I Am Healthy” or “I have not developed symptoms yet” is vital to preventing further illness and costs for your company.