Volume 197 - Issue 10
Designing incentives for good-quality hospital care
Authors: Sue M Evans, Peter A Cameron and John J McNeil
Med J Aust 2012; 197 (10): 554. || doi: 10.5694/mja12.11089
Published online: 19 November 2012
Published online: 19 November 2012
To the Editor: Duckett makes a compelling argument for introducing non-pay for non-performance.1 However, such a scheme will not produce discernible results, for two reasons.
First, interventions such as “time out” and surgical checklists have proven successful in reducing rare but clearly defined events, such as wrong-site surgery and retained foreign bodies.2 Not paying when these errors occur will have no impact on efforts to reduce ...
To the Editor: Duckett makes a compelling argument for introducing non-pay for non-performance.1 However, such a scheme will not produce discernible results, for two reasons.
First, interventions such as “time out” and surgical checklists have proven successful in reducing rare but clearly defined events, such as wrong-site surgery and retained foreign bodies.2 Not paying when these errors occur will have no impact on efforts to reduce their occurrence.
Second, more common events, such as catheter-related urinary tract infections (UTIs) and pressure ulcers, are not systematically reported and are difficult to define and attribute to poor-quality care. While the “condition present on admission” code attempts to distinguish patients with pre-existing conditions that would be excluded from incurring a penalty, this relies on accurate recording in the medical record, which is often poor, and recognition at the time of admission, which is often unknown. Attributing a UTI to a catheter is a difficult clinical decision; even distinguishing between colonisation and infection is difficult. Patients most likely to require a catheter are older, frail and immunocompromised, and therefore most at risk of infection. The decision to catheterise is based on considered clinical risk.3
It is important to reduce adverse events and drive quality improve-ment. However, instead of using administrative data, which are manipulated for funding purposes, not collected in an epidemiologically sound manner and not respected by clinicians, a more sensible approach is to collect credible data through audits and registries and provide interpret-able statistics back to clinical units that compare their practice with their peers. This will foster education, discussion and competition. Most other industries have already learned this.
Competing interests
No relevant disclosures.
References
- Duckett SJ. Designing incentives for good-quality hospital care. Med J Aust 2012; 196: 678-679. 0_CHDIGAJA
- Haynes AB, Weiser TG, Berry WR, et al. A surgical safety checklist to reduce morbidity and mortality in a global population. N Engl J Med 2009; 360: 491-499. 0_i1142864
- Ricciardi R, Baxter NN, Read TE, et al. Surgeon involvement in the care of patients deemed to have “preventable” conditions. J Am Coll Surg 2009; 209: 707-711. 0_i1142868