Health professionals’ education system needs “overhaul,” says IOM

Current academic and continuing education programs do not equip physicians, nurses and other health care professionals with the skills they need to provide safe, high-quality medical care to today’s demanding patient population, says a new report from the Institute of Medicine (IOM). Among the many challenges facing health care professionals are managing a rapidly expanding evidence base, working in interdisciplinary teams and caring for an aging population with multiple chronic illnesses.

“We owe it to our patients to change the way we are educated in order to improve quality and safety,” said Edward Hundert, MD, co-chair of the committee that wrote the report, and president of Case Western Reserve University in Cleveland.

The IOM report recommends that all medical education programs should teach – and all health care professionals should possess – five core competencies:

1. The ability to provide patient-centered care,

2. The ability to work as a member of an interdisciplinary team,

3. The ability to engage in evidence-based practice,

4. The ability to apply quality improvement approaches,

5. The ability to use information technology.

The report asks accreditation, licensing and certification organizations to take steps to ensure that students and working professionals are proficient in these core areas. For example, licensing boards could require doctors, nurses and other health care professionals to demonstrate their clinical skills, rather than simply renewing their licenses because they paid a fee and attended a course.

“Research has raised questions about the efficacy of continuing education courses, the most common way to demonstrate ongoing competency,” says the report. The committee acknowledges that there is not yet agreement on what constitutes evidence of proficiency or the most effective methods to assess health professionals’ competence.

To read the full text of Health Professions Education: A Bridge to Quality, go to www.nap.edu/books/0309087236/html.

New program pays docs for quality

“In health care, everybody is used to getting paid the same whether they have the best care or the worst care, and that’s insane,” said Tom Scully, Centers for Medicare & Medicaid Services administrator, in the April 27 Chicago Tribune. However, a coalition of large companies, health plans and physicians is trying to change that. Earlier this year, they launched a pilot, pay-for-performance program in Boston, Cincinnati and Louisville, Ky. The program, “Bridges for Excellence,” provides physicians with annual bonuses for improvements in diabetes care, cardiovascular care and patient care management systems. Top-performing doctors could see income gains of up to 10 percent in the form of bonuses paid by participating employers.

Primary care to lead change of Americans’ unhealthy behaviors

A new initiative aimed at changing Americans’ unhealthy behaviors is counting on primary care physicians to rise to the challenge. Sponsored by the Robert Wood Johnson Foundation (RWJF) and the Agency for Healthcare Research and Quality (AHRQ), the program, called “Prescription for Health,” will seek effective, practical strategies primary care physicians and their staffs can employ to help patients reverse four behaviors that are the nation’s leading causes of preventable disease and death: physical inactivity, poor diet, tobacco use and risky alcohol use.

The two organizations will provide up to $5 million in grants to help primary care practice-based research networks develop new models of care or tools for changing health-related behaviors. The first round of grants will be announced this summer and will provide up to $125,000 in support to up to 20 primary care practice-based research networks.

“These networks are laboratories in which we hope to find practical solutions for advancing primary care,” says Larry Green, MD, a family physician and director of Prescription for Health. “In that way, the ideas for this program will be coming from people who are where the rubber meets the road.” He envisions posting best practices identified through the program on its Web site (www.prescriptionforhealth.org).

“We need to start a revolution in human health behavior, and primary care physicians are in a perfect position to lead that revolution,” Green says. “Most people go to their primary care provider for most of their health care. These visits are great opportunities for providers to teach their patients healthy behaviors.”

HIPAA gets a rough start

It’s been a bit of a bumpy ride since the Health Insurance Portability and Accountability Act (HIPAA) privacy rule went into effect on April 15, making the release of confidential patient information to unauthorized parties a federal offense. Government officials say the law was never intended to create obstacles to care, but according to the April 24 Wall Street Journal, that’s exactly what’s been happening as some hospitals and health care professionals try to avoid violation by overzealously interpreting the law. Misconceptions are causing “a slowdown in how health information is moving through the system, effectively creating the opposite of HIPAA’s intended goal of moving information more quickly and securely,” says Stephen W. Bernstein, an attorney specializing in health privacy.

Error rates higher in U.S.

Over the past two years, American adults with medical conditions reported a greater number of medical errors than those in Australia, Canada, New Zealand and the United Kingdom. The May/June Health Affairs reports that 28 percent of American respondents experienced a mistake in treatment or care, or were given an incorrect medication or dose. In each country, nearly twice as many patients who saw three or more doctors reported experiencing medical errors as patients who saw one or two doctors.

Saving more with EMRs

Implementing an electronic medical record (EMR) system can save health care organizations a substantial amount of money, according to a study in the April 1 American Journal of Medicine. Over a five-year period, the use of EMRs resulted in an estimated $86,400 net benefit per provider in a primary care setting. Some of the most notable benefits came from savings in drug expenditures, improved use of radiology tests, better capture of charges and fewer billing errors.

Average hospital stays

The average hospital stay for U.S. patients in 2001 was 4.9 days, almost three days shorter than it was 30 years ago, according to a recent CDC report. The 2001 National Hospital Discharge Survey found that the average length of stay decreased for all age groups except children. The decrease is attributed to improvements in prescription drug treatment, surgical advances, better outpatient care, stricter admission guidelines and Medicare coverage of stays in post-acute-care facilities, reports the April 9 Nando Times.

The key to preventive care

People with health insurance and a regular source of care are more likely than others to receive preventive services, according to a recent study by The Robert Graham Center for Policy Studies in Family Practice and Primary Care. The study, published in the May 2003 American Journal of Public Health, found that the groups most likely to lack insurance and a usual source of care were “Hispanic and non-White subgroups and those living in households headed by individuals lacking a high school education.”