Joint Commission Safety Goals and Accreditation, do they relate to quality of care>?

Tom Benzoni benzonit at GMAIL.COM
Sun Dec 23 05:45:21 UTC 2018


Apropos to Dr. Brush comment on MI:
What is the n for the study that lead to the headlines on medical error
being 3rd leading cause of deaths?
What were the definitions of error used; are they externally valid.
I'll await an answer; it's interesting.

This topic is important for the same reason the vaccine-autism non-link
should infuriate parents of children with autism:
It diverts precious resorts, so the reasoning better be good.

What is the reasoning/math behind "3rd leading cause?"
References, please, and be sure to include the original article.

tom

On Sat, Dec 22, 2018 at 5:16 PM John Brush <
0000001664901ea2-dmarc-request at list.improvediagnosis.org> wrote:

> It is commonly stated that the diagnosis of acute myocardial infarction is
> missed more commonly in women than men. I wrote a grant on this topic, so I
> went looking for a reference. I could only find one study that reported the
> miss rate (Pope, et al. Missed diagnosis of acute cardiac ischemia in the
> emergency department. NEJM 2000;342:1163). This was a registry that
> prospectively collected data by following all patients with suspected AMI,
> even those who were sent home. But even this study doesn’t give the true
> rate. How about patients with missed AMI in whom the diagnosis wasn’t
> suspected? We can find cases of missed diagnosis and start to count the
> numerator, but how do you identify the patients in the denominator? If you
> can’t define a denominator, you can’t calculate the rate. If you can’t
> calculate the rate of missed diagnosis, you can’t compare women with men.
> And also, you can’t use the measure to accredit hospitals, compare
> hospitals, or drive improvement efforts.
> That is the biggest limitation in measuring diagnostic accuracy - defining
> the denominator. This problem is analogous to measuring fielding in
> baseball. You can count the errors, but it is hard to determine what counts
> as an opportunity, so it becomes impossible to measure an error rate.
> John
>
> John E. Brush, Jr., M.D., FACC
> Professor of Medicine
> Eastern Virginia Medical School
> Sentara Cardiology Specialists
> 844 Kempsville Road, Suite 204
> Norfolk, VA 23502
> 757-261-0700
> Cell: 757-477-1990
> jebrush at me.com
>
>
>
>
> On Dec 22, 2018, at 11:37 AM, Swerlick, Robert A <rswerli at EMORY.EDU>
> wrote:
>
> I agree with Jason. The inability to consistently measure diagnostic
> accuracy and misdiagnosis represents a significant bottleneck. This
> organization has been grappling with this since I have been a member. An
> organization such as TJC cannot make diagnostic error a priority without
> having some sort of metric which can be tracked.
>
> Perhaps this is ground where a patient reported tool could make some
> headway. Perhaps we could simply ask patients whether they know what
> diagnosis (diagnoses) they carry and whether these have changed over time?
>
> Robert A. Swerlick, MD
> Alicia Leizman Stonecipher Chair of Dermatology
> Professor and Chairman, Department of Dermatology
> Emory University School of Medicine
> 404-727-3669
> ------------------------------
> *From:* Jason Maude <jason.maude at ISABELHEALTHCARE.COM>
> *Sent:* Friday, December 21, 2018 5:20 PM
> *To:* IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
> *Subject:* Re: [IMPROVEDX] Joint Commission Safety Goals and
> Accreditation, do they relate to quality of care>?
>
> Ruth
> That’s a great question but will bring us back to the issue of having a
> measure of diagnosis. Unless we have a measure then TJC are unlikely to
> focus on diagnosis. As the previous posts have shown, we do not seem to
> have support/consensus for any measures that have been suggested. I see
> this as a major hurdle we need to overcome if diagnosis is going to get the
> attention it deserves from institutions like TJC.
>
>
> Regards
> Jason
>
>
> Jason Maude
> Founder and CEO Isabel Healthcare
> Tel: +44 1428 644886
> Tel: +1 703 879 1890
> www.isabelhealthcare.com
>
>
>
>
> *From: *Ruth Ryan <ruth at RYAN-GRAHAM.COM>
> *Reply-To: *Society to Improve Diagnosis in Medicine <
> IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>, Ruth Ryan <ruth at RYAN-GRAHAM.COM>
> *Date: *Friday, 21 December 2018 at 19:14
> *To: *"IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG" <
> IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
> *Subject: *[IMPROVEDX] Joint Commission Safety Goals and Accreditation,
> do they relate to quality of care>?
>
>
> Hello All,
>
>
> The Joint Commission or TJC has been much in the news of late, e.g., Wall
> Street Journal (Hospital Watchdog Gives Seal of Approval, Even After
> Problems Emerge 9.6.17), AMA News (Trump administration weighing possible
> financial conflicts in hospital accreditation process, 12.19.18), and now
> this article by Ashish Jha:
> Accreditation, Quality, and Making Hospital Care Better. The JAMA Forum
> December 18, 2018 Ashish K. Jha, MD, MPH.
> JAMA. 2018;320(23):2410-2411. doi:10.1001/jama.2018.18810.
> referring to this new study:
> Lam MB, Jha, A et al. Association between patient outcomes and
> accreditation in US hospitals: Association between patient outcomes and
> accreditation in US hospitals: observational study
> Jha concludes from this recent comparative study that *accreditation by
> TJC, the states or any other body is not associated with improved outcomes
> or patient experience.*
>
>
> He states, “The problem, it seems, is that accrediting organizations are
> not focusing on what actually matters to patients. The criticism that these
> organizations spend enormous amounts of energy requiring hospitals to focus
> on things like signs in the hallway or how documentation is done appears to
> have some merit. We need to reexamine the standards required for
> accreditation to ensure that they are promoting what’s actually important:
> the health, safety, and optimal experience of patients.”
>
>
> Diagnosis is largely unaddressed by the patient safety goals and measures
> of either TJC  or CMS.  How can we who are advocates of improving diagnosis
> participate in this discussion of changing the quality measures used by
> accrediting bodies?
>
>
> *Ruth*
>
>
> Ruth Ryan RN, MSW, CPHRM
> Telephone (504) 256-8797
> Email ruth at ryan-graham.com
> Save the Date: Diagnostic Error in Medicine Conference, November 10-13,
> 2019, Washington, D.C.
> Save the Date: Australasian Diagnostic Error in Medicine Conference, April
> 28-30, 2019, Melbourne, Australia
>
>
>
>
>
>
>
>
>
>
>
>
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Moderator: David Meyers, Board Member, Society to Improve Diagnosis in Medicine


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