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Residents doubt work-hour limits benefit patient safety

Two new studies say limits placed on resident work hours in 2011 may need to be tweaked to foster the safer learning and patient care environments these rules set to create. Limits on resident work hours — particularly a 2011 rule that allows first-year interns to work only 16 consecutive hours instead of the previous 30 hours — resulted in more self-reported medical errors, according to a University of Michigan Medical School study published online March 25 in JAMA Internal Medicine, formerly Archives of Internal Medicine. The limits also resulted in a perception that the quality of care deteriorated and documentation that more patient handoffs occurred, something shown to increase errors, said a study by the Johns Hopkins University School of Medicine that also was published online March 25 in JAMA Internal Medicine. The studies found that the extra sleep residents got as a result of working fewer hours did not seem to be significant, depression rates were not significan ...

Volume, not quality, still determines most doctor pay

The vast majority of payments to U.S. physicians continues to be based only on the volume of services the doctors provide rather than the quality of those services, according to a nonprofit employer coalition that released its first annual national payment reform scorecard. The national scorecard by the Catalyst for Payment Reform, a coalition of large corporations and other health care purchasers, offers a preliminary snapshot of how the concept of value-oriented payments is progressing in the U.S. In conducting a voluntary survey of 57 health plans that represented about 67% of the commercial group market, or 104 million covered lives, the report found that only 6% of all outpatient primary care and specialist payments, and 11% of all inpatient hospital payments, were based on value. Most of the health care dollars paid to health care professionals “remain in traditional fee for service, paying providers for every test and procedure they perform regardless of necessity or out ...

Quality effort yields big drop in death rate at hospitals

Working together to share best practices, analyze data and implement care improvements, 333 hospitals participating in a quality collaborative have cut their risk-adjusted mortality rate by 36% since 2007, said a report issued in March by the project's organizers. The Quality, Efficiency, Safety, Transparency initiative — dubbed QUEST for short — was launched in 2007 with 157 hospitals by Premier Inc., a Charlotte, N.C.-based purchasing and quality improvement alliance of more than 2,800 U.S. hospitals. Premier officials said the hospitals have averted nearly 92,000 deaths since 2007 by dramatically cutting mortality related to sepsis, respiratory conditions, cardiac conditions and shock. The estimates were made by comparing expected mortality rates based on prior-year results with actual deaths adjusted for patients' illness severity. Many other hospitals have lowered their death rates in recent years, but a comparison found that QUEST hospitals outperformed other facilit ...