PRESS-NEWS.org - Press Release Distribution
PRESS RELEASES DISTRIBUTION

Report: Performance measures should include patient actions

Shared accountability could improve outcomes

2014-11-03
(Press-News.org) WASHINGTON (Nov. 3, 2014) — The actions — or inaction — of patients should be considered in programs designed to improve care and patient outcomes, according to a report released today by the American College of Cardiology, American Heart Association, American Association of Cardiovascular and Pulmonary Rehabilitation, American Academy of Family Physicians and the American Nurses Association in collaboration with other professional organizations.

The work of doctors and other clinicians is often evaluated based on "performance measures," specific measurable steps that should be taken or avoided in treating patients for specific conditions. For instance, whether aspirin is given within the first 24 hours of a patient arriving at a hospital having a heart attack is an important performance measure. Incorporating both clinicians and patients into shared-accountability performance measures may be an important way to improve patient-centered outcomes, morbidity, and mortality, according to the report, "The Concepts for Clinician–Patient Shared Accountability in Performance Measures," which was published online today.

The report was developed in collaboration with the National Committee for Quality Assurance, the American Society of Health System Pharmacists, and the American Medical Association–convened Physician Consortium for Performance Improvement. It is endorsed by the American Society of Health-System Pharmacists.

While performance measures have traditionally been clinician focused, their goal of improving patient outcomes is heavily dependent on the healthcare system as well as patient actions. Recognizing this, the developing organizations sought to outline the key concepts, measurements, and considerations for implementing patient-clinician shared-accountability performance measures.

Shared-accountability performance measures track patient actions that affect outcomes—such as following treatment plans, taking medications as prescribed, going to follow up appointments, and maintaining lifestyle changes—along with physician processes. The use of shared-accountability performance measures, which recognizes the "inextricably linked" nature of patient and clinician action, has been advocated by the Institute of Medicine.

In order to implement shared-accountability performance measures, patients must have "sufficient support and knowledge to actively participate in their health care," the report says. Shared goal setting, shared decision making, and shared care planning and monitoring between patient and clinician are all important concepts to implement as part of shared-accountability performance measures, the report said.

Further, measures should be shifted from assessing acute care processes to longitudinal outcomes, according to the report. For example, medication adherence should be tracked instead of only drug prescription and whether treatments achieved their goal should also be evaluated.

"Current performance measures often just focus on whether a medication is prescribed or not, but these medications are often used to treat chronic conditions, like hypertension, and need to be taken lifelong or for extended periods of time," said P. Michael Ho, MD, PhD, staff cardiologist at the Veterans Affairs Eastern Colorado Health Care System and writing committee co-chair. "Achieving this longitudinal adherence is a shared responsibility, as the clinician must discuss treatment preferences and provide proper education, while the patient must follow the regimen and communicate any adverse effects. By properly acknowledging and motivating these interrelated factors, shared-accountability performance measures can help improve longitudinal treatment adherence, which a growing body of evidence has shown is quite poor."

The report further discusses methodological challenges involved with shared-accountability performance measures. These include how to measure patient adherence, where to incorporate patients who refuse treatments, and how to specify episodes of care for longitudinal measures.

The document also examines the need to risk adjust for patient case mix, considering such factors as cultural beliefs, religion, socioeconomic status, and clinical characteristics. Moreover, the writing committee addresses the health information infrastructure necessary for tracking patients across multiple healthcare settings and highlights current payment reform policies that support the adoption of concepts behind shared-accountability performance measures. Noting that performance should be reported back to both clinicians and patients to facilitate improvement, the report additionally cautions that careful monitoring should be conducted to ensure implementation does not result in a negative clinician-patient relationship, adverse patient selection by clinicians, or greater barriers to care. Instead, focus should be placed on uniting the various stakeholders in a collaborative effort to enhance care quality.

"The goal of performance measurement is to improve patient outcomes, including improving the patient's health status, and reducing their morbidity and mortality. Therefore, it is important to engage everyone that can have an impact on these goals including patients, family members or caregivers, clinicians, and the healthcare system," said Eric D. Peterson, MD, MPH, director at the Duke Clinical Research Institute and writing committee co-chair. "Shared-accountability performance measures explicitly acknowledge these interdependencies so that everyone can work together towards the improved health of the patient."

INFORMATION:

The paper was published today on the websites for the ACC and AHA and will appear in an upcoming print edition of the Journal of the American College of Cardiology. The work of the writing committee was supported exclusively by the ACC and AHA, without commercial support.

The American College of Cardiology The American College of Cardiology is a 47,000-member medical society that serves as the professional home for the entire cardiovascular care team. The mission of the College is to transform cardiovascular care and to improve heart health. The ACC leads in the formation of health policy, clinical standards and practice guidelines. The College operates national registries to measure and improve care. It also provides professional medical education, disseminates cardiovascular research, and bestows credentials upon cardiovascular specialists who meet stringent qualifications. For more information, visit cardiosource.org/ACC.

About the American Heart Association The American Heart Association is devoted to saving people from heart disease and stroke – America's No. 1 and No. 4 killers. We team with millions of volunteers to fund innovative research, fight for stronger public health policies, and provide lifesaving tools and information to prevent and treat these diseases. The Dallas-based association is the nation's oldest and largest voluntary organization dedicated to fighting heart disease and stroke. To learn more or to get involved, call 1-800-AHA-USA1, visit heart.org or call any of our offices around the country. Follow us on Facebook and Twitter.



ELSE PRESS RELEASES FROM THIS DATE:

New test shows promise in identifying new drugs to treat Lyme disease

2014-11-03
Researchers from the Johns Hopkins Bloomberg School of Public Health have developed a test they say will allow them to test thousands of FDA-approved drugs to see if they will work against the bacteria that causes tick-borne Lyme disease. The researchers, reporting Nov. 3 in the journal PLOS ONE, say doctors and patients are desperate for new treatments for Lyme disease, which in many people is cleared up with a few weeks of antibiotics but, in some, lingers long after completion of the standard drug regimen. Until now, it has been very difficult to determine on a large ...

PNAS: From HIV to cancer, IL-37 regulates immune system

PNAS: From HIV to cancer, IL-37 regulates immune system
2014-11-03
A University of Colorado Cancer Center study published in this month's Proceedings of the National Academy of Sciences describes the activity of a recently discovered communication molecule of the body's immune system, Interleukin 37 or IL-37. It has been known to limit inflammation and the current study reports its activity in the adaptive immune system: IL-37 inhibits the ability of the immune system to recognize and target new antigens. "Knowing this mechanism that underlies IL-37's effect on the immune system now allows us to study IL-37 function and perhaps dysfunction ...

NASA sees Super Typhoon Nuri's eye open in 2 days

NASA sees Super Typhoon Nuris eye open in 2 days
2014-11-03
Over the course of two days, from Nov. 1 to Nov. 3, NASA's Aqua satellite watched from space as Tropical cyclone Nuri strengthened into a Super Typhoon and "opened" or developed an eye. On Nov. 1, when the Moderate Resolution Imaging Spectroradiometer or MODIS instrument aboard NASA's Aqua satellite captured a visible image of Super Typhoon Nuri at 04:30 UTC (12:30 a.m. EDT) and it had not yet developed an eye. On Nov. 3 at 04:20 UTC (12:20 a.m. EDT) MODIS on Aqua passed over Super Typhoon Nuri again after it developed an eye. By Nov. 3 the bands of thunderstorms spiraling ...

String field theory could be the foundation of quantum mechanics

2014-11-03
Two USC researchers have proposed a link between string field theory and quantum mechanics that could open the door to using string field theory — or a broader version of it, called M-theory — as the basis of all physics. "This could solve the mystery of where quantum mechanics comes from," said Itzhak Bars, USC Dornsife College of Letters, Arts and Sciences professor and lead author of the paper. Bars collaborated with Dmitry Rychkov, his Ph.D. student at USC. The paper was published online on Oct. 27 by the journal Physics Letters. Rather than use quantum ...

'Mild' control of systolic blood pressure in older adults is adequate: 150 is good enough

Mild control of systolic blood pressure in older adults is adequate: 150 is good enough
2014-11-03
CORVALLIS, Ore. – A broad review of the use of medications to reduce blood pressure has confirmed that "mild" control of systolic pressure is adequate for adults age 65 or older - in the elderly, there's no clear benefit to more aggressive use of medications to achieve a lower pressure. Historically, most medical practitioners tried to achieve control of systolic pressure – the higher of the two blood pressure readings – to 140 or less. Recently changed guidelines now suggest that for adults over 60, keeping the systolic pressure at 150 or less is adequate, ...

Inhaled Ebola vaccine may offer long-term protection from virus

2014-11-03
AUSTIN, Texas—A potentially breathable, respiratory vaccine in development has been shown to provide long-term protection for non-human primates against the deadly Ebola virus, as reported this week in the online edition of the journal Molecular Pharmaceutics. Results from a recent pre-clinical study represent the only proof to date that a single dose of a non-injectable vaccine platform for Ebola is long lasting, which could have significant global implications in controlling future outbreaks. A breathable vaccine could surmount the logistical obstacles of storing, ...

New research reveals what to discuss near life's end

2014-11-03
Hamilton, ON (Nov. 3, 2014) – A study led by a McMaster University researcher has identified the top five things health care teams should discuss with hospitalized patients and their families at the end of life, but the research also found gaps between what patients would like and the care they receive. In the study published today in CMAJ (Canadian Medical Association Journal), seriously ill hospitalized patients and their families say the most important aspects to discuss are: Preferences for care in the event of life-threatening illness ...

End-of-life discussions: The top 5 things to talk about with patients and their families

2014-11-03
What are the most important things for health care teams to talk about in end-of-life discussions with patients in hospital and their families? A new study published in CMAJ (Canadian Medical Association Journal) asked older patients and their families for their top priorities and found gaps between what patients would like and the care they actually receive. "Our findings could be used to identify important opportunities to improve end-of-life communication and decision-making in the hospital setting," states Dr. John You, lead author of the study and associate professor ...

Most mental health disorders not increasing in children and youth: Large Canadian study

2014-11-03
Symptoms of mental illness in children and adolescents do not appear to be increasing, according to a large study of Canadian youth published in CMAJ (Canadian Medical Association Journal) "Popular media tends to perpetuate the idea that the prevalence of mental disorders is increasing," writes Dr. Ian Colman, Canada Research Chair in Mental Health Epidemiology and associate professor at the University of Ottawa, Ottawa, Ontario, with coauthors. "However, research supporting this position has been inconsistent." Dr. Colman and colleagues sought to better understand ...

NYU study points to perception divide in abortion: Whom we think we know

2014-11-03
Pro-life Americans are less likely to hear about the abortions women they know have had than are pro-choice Americans, a New York University study shows. The findings, which appear in the journal Sociological Science, point to a previously unexplored divide on the abortion issue: differences in perceptions of those we associate with. "Americans who are opposed to abortion are less likely to hear that their sister, mother, or friend had an abortion than their pro-choice peers," says Sarah K. Cowan, an assistant professor in NYU's Department of Sociology and the study's ...

LAST 30 PRESS RELEASES:

Corpse flowers are threatened by spotty recordkeeping

Riding the AI wave toward rapid, precise ocean simulations

Are lifetimes of big appliances really shrinking?

Pink skies

Monkeys are world’s best yodellers - new research

Key differences between visual- and memory-led Alzheimer’s discovered

% weight loss targets in obesity management – is this the wrong objective?

An app can change how you see yourself at work

NYC speed cameras take six months to change driver behavior, effects vary by neighborhood, new study reveals

New research shows that propaganda is on the rise in China

Even the richest Americans face shorter lifespans than their European counterparts, study finds

Novel genes linked to rare childhood diarrhea

New computer model reveals how Bronze Age Scandinavians could have crossed the sea

Novel point-of-care technology delivers accurate HIV results in minutes

Researchers reveal key brain differences to explain why Ritalin helps improve focus in some more than others

Study finds nearly five-fold increase in hospitalizations for common cause of stroke

Study reveals how alcohol abuse damages cognition

Medicinal cannabis is linked to long-term benefits in health-related quality of life

Microplastics detected in cat placentas and fetuses during early pregnancy

Ancient amphibians as big as alligators died in mass mortality event in Triassic Wyoming

Scientists uncover the first clear evidence of air sacs in the fossilized bones of alvarezsaurian dinosaurs: the "hollow bones" which help modern day birds to fly

Alcohol makes male flies sexy

TB patients globally often incur "catastrophic costs" of up to $11,329 USD, despite many countries offering free treatment, with predominant drivers of cost being hospitalization and loss of income

Study links teen girls’ screen time to sleep disruptions and depression

Scientists unveil starfish-inspired wearable tech for heart monitoring

Footprints reveal prehistoric Scottish lagoons were stomping grounds for giant Jurassic dinosaurs

AI effectively predicts dementia risk in American Indian/Alaska Native elders

First guideline on newborn screening for cystic fibrosis calls for changes in practice to improve outcomes

Existing international law can help secure peace and security in outer space, study shows

Pinning down the process of West Nile virus transmission

[Press-News.org] Report: Performance measures should include patient actions
Shared accountability could improve outcomes