Hospital Accrediting Organization Names “Top Performing” Hospitals In NC

Fourteen North Carolina hospitals have been labeled as ‘top performing’ by the Joint Commission, the nation’s leading hospital accreditation organization.

The hospitals represent all parts of the state, large community and small, urban and rural. Absent are major medical centers associated with medical schools in the state: Duke, UNC Hospitals, Wake Forest Baptist and Pitt Memorial Hospitals.

Table showing 14 'top performing' hospitals in NC

Joint Commission's 'Top Performing Hospitals' in North Carolina

Almost all hospitals in the country now follow a series of 28 procedures and practices that researchers and Joint Commission accreditors have identified as being the best practices to reduce patient complications and adverse outcomes.  Examples include simple interventions such as giving aspirin to a patient after a heart attack or giving antibiotics before surgical procedures. In the past, researchers found these simple practices were practiced inconsistently, often leading to patient injury.

Tracking the use of these practices has become a standard way of approximating hospital quality.

The Joint Commission defines a hospital as ‘top performing’ when it falls into the top 14 percent of hospitals following what accreditors call a ‘core’ of 22 such procedures and practices. Hospital adherence to these practices has risen sharply in recent years, first after Medicare started publishing hospitals’ performance on the Hospital Compare website and more recently when Medicare announced it would start reducing payment to hospitals not performing enough of the practices.

In a 2010 article published in the New England Journal of Medicine, Joint Commission head Marc Chassin wrote:

Because … virtually all U.S. hospitals participate in them, it is not possible to know how many of these improvements would have occurred in the absence of standardized measurement, Joint Commission accreditation requirements, public reporting, or the threat of Medicare payment penalties.

How budget cuts are affecting UNC Health Sciences Library

Walk into the Health Sciences Library at UNC Chapel Hill and you can’t help but miss this display in the window of the main entrance:

Effects of budget cuts on the Health Services Library at UNC.

Window display in the Health Services Library at UNC Chapel Hill

In case you can’t read it in the photo, the text says:

The HSL budget was CUT by 12.7%
The HSL will CANCEL 34 journals.
35 journals will be RENEWED. 4 decisions will be DELAYED.
We will also cut:
Books
Hiring
Databases
Equipment
Operating Costs, etc.

The journal cancellation program has been underway for 3 years now and library administrators have solicited user feedback in deciding which journals to cut, in part by comparing usage to cost.

According Jake Wiltshire, development and communications head for the Health Sciences Library, no one’s lost a job yet.  Instead, HSL administrators cut vacant positions. Some services (IT, admin) were picked up by a newly ‘convergent’ library system. He says hours have been cut some, but what’s more significant is there are fewer librarians to assist students during those hours the library is open. 

The HSL also got some money from the University provost to keep open, longer.  “Without it,” Wiltshire says “we would have been closed weekends.

We regularly get requests for extended hours, especially from medical students,” he says. Wiltshire points out many of the health sciences schools built their facilities without study areas, relying on the fact the HSL would be there to provide those medical students with places to study – along with nursing, public health and dental students, among others.

But Wiltshire says one of his biggest concerns is access to journals for health care professionals at UNC Hospitals. They use the HSL to do real time research while caring for patients. And those are the people who might be likely to look for an article in a more obscure journal – one that’s been cut because of the budget.

“They need that up-to-date information at the point of care. We’re less equipped to support them,” he says.

Correction: when this post was originally written, the HSL was identified as the Health Services Library, not by it’s correct name as the Health Sciences Library.  D’oh!

Reboot

As some of you might know, I left North Carolina Public Radio – WUNC at the end of June.

After taking off two months to attend to some family business and rest a little, I’m back blogging and tweeting as I create the infrastructure for an exciting new venture.

The plan: In January 2012, I will launch North Carolina Health News, a website and news service dedicated to covering health care in North Carolina.

Hey, no one else is doing it!  The health reporting staff at the N&O is all but gone, there’s only one person at the Charlotte Observer and there are only a handful of full time health reporters left in the entire state. But health care is an important part of NC’s economy, jobs landscape, research base and health care affects everyone at at some time or another. Some talented and experienced health reporters are committed to coming on board, so we think we’ll have something worth reading (and listening to).

In the meantime, I’ll be writing occasional reported stories and posting them here. I’m also lending a hand at the Raleigh Public Record and writing some stories about health care in our capitol city.

Let’s hear it for high-quality, local journalism!!

State Health Directors’ Meeting

This week is the annual confab in Raleigh, where health directors from around the state come to discuss, share successes and plan for the upcoming year.

This year, the Division of Public Health is also presenting the latest iteration in the “Healthy People” policy goals – Health People 2020.  It’s a series of policy goals for the next decade, and include such laudable goals as reducing rates of smoking and lowering transmission of STDs.

In national health rankings, North Carolina continues firmly in it’s place at the ‘top of the bottom.’  Overall, we rank 35th in the nation in overall health.

According to State Health Director Jeff Engel, he has three priorities for the upcoming decade: reducing tobacco use, improving nutrition and getting people more active.

I’ve had a casual interest in the past few years in observing the treats offered at public health meetings.  Over the 7 state health directors’ meetings I’ve attended, I’ve noticed the lunch and treats becoming slowly more ‘healthy’, but change comes slowly.  To whit, the break between afternoon sessions featured the lovely crudite cups pictured below:

Crudite table

Problem is… not so many people were eating the crudite.  But down the hall, there was a table with sweets on it.  The plates on that table were… um, empty.

I guess, old habits are hard to break…

Sweets table.

Fat Stat

New data from the CDC were released today on the caloric intake of Americans and how that’s changed over the past two decades. In short, we eat more… a couple of hundred calories more each for men and women.

Age-Adjusted Daily Kilocalorie Intake Among Adults Aged 20--74 Years, by Sex --- National Health and Nutrition Examination Survey, United States, 1971--2008

 

The data are self-reported, so presumably, self-reporting bias should smooth out over time and the number of people surveyed.  If anything, I’d bet that with increased attention on obesity over the past 5-10 years, there’s a reporting bias wherein people will recall that they ate fewer calories over the past few days than they actually did. In other words, people want to believe they’re being virtuous, but their waistlines belie their memories.

So, to me, the most interesting portion of the data is that steadily increasing region between 1980 – 1994, before overeating became unfashionable.

What do we need to know about flu deaths – redux

Last year during the H1N1 flu pandemic, I noticed something – when someone died in North Carolina, health officials told the public next to nothing about  the person or the circumstances around their deaths.  Long conversations ensued with health officials about this… finally, I produced this story.

While reporting the story, I queried the listserv for the Association of Health Care Journalists (AHCJ), of which I’m a member.  I learned that standards for death reporting by public officials varies widely.  In places like Kansas, health officials practically give out addresses, while in NC, health officials say “someone” died in the state.  I questioned the need for such draconian standards of privacy protection.   The rationale from state health officials was 1) compliance with HIPAA and 2) the desire to protect the feelings of families that may have recently lost a loved one.  The implication was that journalists would be insensitive enough to ‘camp out’ in front of the homes of families where someone had died of flu and make things more difficult for grieving families.

2011 – Round 2.  Last week, state health officials announced a 15 year old had died from flu this season. We don’t know if it’s a male or female. We don’t know where the teen lived – even something as vague as “in the Piedmont” or “in the Charlotte area”.  Somehow, NC officials are convinced that the least amount of information is better.

Why does this matter? Is it just a nosy journalist thing?

Gene Matthews from the NC Institute of Public Health thinks it matters. He was the lead counsel for the CDC for 25 years – through the beginning of AIDS and a number of crises.  He puts it best, “If we don’t tell people what’s happening, they’ll make it up.”

He agreed with me.  I argued that you could reasonably say something like “a teenaged boy from the Piedmont who had diabetes, and who did not get vaccinated” without compromising privacy.  That amount of information would satisfy public curiosity, but more important, it would  give some context to the circumstances surrounding the death

Well, it turns out the Association of State and Territorial Health Officers decided last summer it matters to them, too. They produced a document reviewing how the H1N1 situation was handled countrywide (pdf). The document talks about how communication among all of the stakeholders, from the CDC to local health departments to the media to the public could have been better, and needs to improve, because H1N1 will definitely not be the last flu pandemic we see.

That resulted in several of us from AHCJ being invited to Washington this fall to discuss creating some principles for state health officers to follow when publicly reporting on deaths during an epidemic.  The day-long meeting was a lively discussion between the journalists, several state health directors, some state level public affairs folks and staff at ASTHO (among others) on how to improve communications at all levels.

The final draft is still forthcoming, but will be coming, I’ve been assured.  I called the ASTHO office last week to ask about it. Chief of staff Shawn Polk told me, “I don’t think its going ot disappear, fall into oblivion… ”

Stay tuned.

Department of Justice to investigate North Carolina’s use of adult care homes to house mentally ill

An untitled press release appeared in my inbox this afternoon.  When opened, it read:

“The North Carolina Department of Health and Human Services has received notice that the US Department of Justice will investigate a complaint of alleged violations of Title II of the Americans with Disabilities Act of 1990.  The investigation was opened in response to a complaint alleging the state of North Carolina relies on institutional and inappropriate adult care homes as settings for services to individuals with mental illness. DHHS will work with the Department of Justice to provide all necessary documents and information in response to the complaint.”

What does this mean?

According to Vicky Smith at Disability Rights NC, this could be the action that breaks the log jam on chronic mental health underfunding in NC. Her organization, and others, have long argued that the state hasn’t lived up to the promises made at the start of reform – that closing state hospitals would result in savings that could be used to generate  more community based services.  Except, the community based services never materialized.

This isn’t just a NC problem.   The state of Georgia recently settled with DoJ on similar issues, promising to spend money on community based care, rather than housing the mentally ill in state institutions.

Renee McCoy from the press office at DHHS says because of the ongoing investigation, no one will comment.  She did send me the Department of Justice letter:  ADA Complaint 11 17 2010 (pdf)

What’s happening in NC is similar, but not the same – what Disability Rights concluded in a report this summer was that the state has been warehousing folks with severe and persistent mental illnesses in adult care homes originally intended to house frail elderly people – sometimes with tragic results.   While these folks DO need roofs over their heads, for the most part, adult care homes don’t provide any treatment, little – if any- meaningful activity or treatment services to address the ongoing mental health problems these folks have.   Disability Rights also found some pretty deplorable conditions.

Vicky Smith from Disability Rights maintains that’s a violation of the Americans with Disabilities Act and subsequent Supreme Court decisions that say people with disabilities need to be housed in the least restrictive settings possible.

It seems DoJ agrees to the extent that they’re willing to investigate.