Duke hospitals scoop up rewards

Staff WriterAugust 18, 2009 

Three Duke-owned hospitals have received nearly $250,000 in a pilot program that rewards hospitals for improving care in five clinical specialties.

The program, run by the federal Centers for Medicare and Medicaid Services, is seen as one model for helping reform U.S. health care by rewarding hospitals with cash and national recognition for improving patient outcomes. Under the present system, hospitals get paid more when they perform more procedures; this program pays them for getting better results.

Three Triangle hospitals, all owned by Duke, are among the 19 across North Carolina participating in the program, the Hospital Quality Incentive Demonstration. Nationwide, 230 hospitals are taking part.

Duke University Hospital in Durham was named a top performer in heart-attack care and won other awards for care of coronary artery bypass graft, heart failure, pneumonia, and hip and knee replacements.

Durham Regional Hospital received top improvement awards in care for heart failure.

Duke Raleigh Hospital was a top improver in hip and knee replacement and won other awards in the care of heart attack, hip and knee replacement and pneumonia.

The awards announced Monday were for improvements measured in the fiscal year ending Sept. 30, 2007; it takes that long to collect and collate the data. The experiment was launched in 2003.

Dr. Eric Peterson, a professor of medicine at Duke, said a key element of the program has been its focus on measuring and evaluating, which gives practitioners a clear understanding of what works. For instance, Peterson said, when the program began, Duke assumed that doctors were acting as quickly as they could to open blocked arteries in heart attack patients, something that improves survival rates.

In fact, he said, when they began to be measured against other hospitals in the program, "Lo and behold, those times got a little lower."

Already, proponents say, the competition created by the program has prompted hospitals to improve their care in ways that may have saved thousands of lives, by doing such things as administering antibiotics or vaccines so that patients don't get additional illnesses while hospitalized.

Premier Inc., the Charlotte-based health-care quality and cost improvement alliance of 2,200 U.S. hospitals, gathers the data from hospitals to conduct the comparisons. Company spokesman Alven Weil said that the program helps hospitals see how they're doing, not only compared to other hospitals but relative to how they thought they were doing.

If evidence shows that nine particular treatments will lead to healthier patients, said Weil, "you might be doing eight, but you don't know about the ninth."

"For the hospital, it's a matter of making sure they're doing all of them every time and making sure they're doing all of them to the best of their abilities."

martha.quillin@newsobserver.com or 919-829-8989

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