Quality of Care and Outcomes in Oklahoma W e have more work to do!

1. Quality of Care and Outcomes in OklahomaWe have more work to do! Dale W. Bratzler, DO, MPH Professor and Associate Dean, College of Public Health Professor of Medicine and Chief Quality Officer, OU Physicians Group University of Oklahoma Health Sciences Center, Oklahoma City, OK

2. Quality Structure Process Outcome (Resources) (Performance) (Indicator) Donabedian’s Framework for QualityTargets for Improvement in Oklahoma • Examples: • Resources • Uninsured population • Shortage of primary care • Socioeconomic status • Patient behaviors • Tobacco • Alcohol • Obesity • Inactivity Examples: - Low rates on nationally standardized measures - Hospital core measures - Nursing home MDS - Home health OASIS - Ambulatory - Poor coordination of care - Staff turnover Examples: - High death rates - High disability rates - Relatively high costs - Excess hospitalizations - Excess readmissions - Harm - Patient experience Donabedian A. The Milbank Memorial Fund Quarterly, Vol. 44, No. 3, Pt. 2, 1966 (pp. 166–203).

3. Board of Health Releases 2011 State Health Report ….. The report provides updates on several areas of concern including Oklahoma’s high prevalence of smoking and obesity, limited access to prenatal care and availability of primary care physicians, and high rates of preventable hospitalizations and cardiovascular disease. As a state, Oklahoma has fewer babies that survive their first birthday and a life expectancy for residents that is shorter than almost every other state in the country. Significant health disparities exist for those Oklahomans who earn $25,000 per year or less and among those with a high school education or less – both critical social determinants of health that the report says should not be overlooked. http://www.ok.gov/health/pub/boh/state/index.html

4. http://www.americashealthrankings.org/ The United Health Foundation released its annual state health ranking scorecard which indicates that Oklahoma’s ranking dropped by two points, scoring 48th in the nation for 2011, down from 46th in 2010.

5. AHRQ State SnapshotsProcesses of Care http://statesnapshots.ahrq.gov

7. To Err is Human • America’s wake up call about medical errors in our healthcare system • 44,000 – 99,000 deaths from medical errors annually • (Another ~100,000 from healthcare associated infections) • Between $17-29 billion annually • Report highlighted the fact that human error is inevitable – the only way to reduce medical errors is to design a safer system http://www.nap.edu/openbook.php?isbn=0309068371

9. Three Recent Studies On average, about 50% of events are considered preventable.

10. Bates DW, et al. J Gen Intern Med. 1995 Apr;10(4):199-205.

11. CDC: Painkiller-Overdose Deaths Have Tripled in Decade Since 1999! Oklahoma ranks 1st in painkiller abuse, and 9th in overdose deaths in the US! Oklahoma’s New Epidemic! http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6043a4.htm?s_cid=mm6043a4_w

12. Causes of Premature Mortality Tobacco Alcohol Obesity Inactivity Unsafe behaviors The focus of the majority of resources – acute illness care

13. The work that you do to improve quality and patient safety shows itself only by the events that do not happen. dale-bratzler@ouhsc.edu