Wednesday, May 28, 2008

The First Real Hospital Quality Measure

How many hospital measures exist for physicians today? Answer "119." (Somehow I count 134, but hey, what's the difference)

Now, how many hospital measures exist for hospitals today? Answer: 35.

But these quality measures for hospitals, are really clinical measures for physicians, so all told, physicians now have 155 quality measures to which they must conform, should they want to be paid.

The bottom line is that hospital quality measures, as they exist today, are really more physician quality measures.

But hospitalists are paid by hospitals, and as such, have now become a "hospital quality standard." Same with nocturnists - hospitalists that do the night shift. Heck, these used to be medical students and residents, but because of the ever-growing concern over sleep deprivation in medicine, residents' hours may soon be restricted to 56 hours a week. With the growing realization of the paucity of care delivery after hours, coupled with the reality of the need for 24/7 care, hospitals are now in the position to differentiate themselves with a measure that can actually affect outcomes.

So, here's my proposal for the first real hospital quality measure (always looking for ways to cut the bureaucracy):

Does the hospital employ full time hospitalist and nocturnist services?

The next might be clinical nursing staff to patient census ratios.

Once we stop confusing hospital quality measures with physician quality measures, we might get somewhere.


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