Journalists should approach hospital quality awards with skepticism, partly because they can gloss over serious shortcomings in care.
Take the recent example, reported by the Asheville (N.C.) Watchdog, of HCA’s Mission Hospital being hit with a federal immediate jeopardy citation within months of receiving two national quality distinctions.
That said, one new seal of approval may be worth examining.
In an unusual partnership, the American Diabetes Association (ADA) and safety watchdog Leapfrog Group have created a designation for hospitals that achieve quality benchmarks in treating patients with diabetes.
Why is this important? Consider the many horrific news stories in recent years about high rates of avoidable leg amputations among Blacks and Hispanics as a result of diabetes-related complications.
As ABC News reported in February, many patients with diabetes still do not get appropriate treatment and education early on that could prevent devastating outcomes.
The “Recognized Leader in Caring for People Living with Diabetes” designation is meant to prod hospitals to take evidence-based steps to reduce avoidable complications for the approximately 8 million patients with diabetes who are hospitalized each year.
For journalists, the new designation offers a pathway to examine what local hospitals are doing to improve. Here are key things to know.
Why now?
There’s growing recognition of the human and financial costs of diabetes-related complications such as amputation, coma and death. According to Leapfrog, those complications often result from medical errors, surgical injuries, and infections that commonly occur in the hospital.
How many hospitals are on the list?
Seventeen hospitals made the initial list, out of 51 that applied. They are in California, New Jersey, New York, Ohio, Pennsylvania, Texas and Washington state.
Missy Danforth, Leapfrog’s senior vice president of health care ratings, said via email she expects about 200 applications for next year’s list, which will have a longer application period. There’s no cost for hospitals to apply.
How are hospitals evaluated?
To earn recognition, hospitals must provide blood glucose testing, specialized preparation for surgery, meals and insulin regimen planning, and comprehensive discharge planning.
The key indicators draw from the ADA’s standards for inpatient care. Medication safety measures from the Leapfrog hospital survey are also considered.
How do we know that hospitals provide accurate information?
Hospitals were required to document the care of 90 patients with diabetes, including high-risk patients and surgical patients.
ADA Chief Scientific and Medical Officer Robert Gabbay, M.D., Ph.D., said via email that applicants “certified that their policies and procedures follow the ADA’s Standards of Care in Diabetes, with expert review confirming adherence to the policies.”
Shouldn’t all of the nation’s 6,000 hospitals be following best practices?
The ADA has published inpatient care guidance since 1989, but U.S. providers are often slow to adopt evidence-based guidelines.
“We know for some time now how we can improve the outcomes of people with diabetes,” Gabbay said during a webinar for applicants. He added that the designation is an effort to “go from that knowledge to action.”
Some of the guidance seems pretty obvious, like providing appropriate food and insulin. Yet during the webinar, a patient who served on the panel that crafted the benchmarks, Tara Rose Murphy, told of repeatedly being offered graham crackers and apple juice while in the hospital with no insulin.
“The biggest issue identified is that many hospitals are still not aware of the ADA’s guidelines for caring for hospitalized patients with diabetes,” Danforth said, adding, “A goal of the program is to significantly increase both awareness and implementation of the guidelines.”
What are some limitations?
According to Leapfrog, the designation will help patients and their families identify hospitals that have “demonstrated the strongest commitment to the care and safety of patients with diabetes.”
But patients can’t benefit if they lack a choice of where to go, Gabbay acknowledged via email. “Hospital care often depends on how acute the need is; in the setting of an emergency, the nearest hospital is typically the best place to go,” he said. “This new information is most helpful for those that are engaging in elective admissions.“
Ideas for journalists
Reporters can use the Leapfrog/ADA benchmarks to evaluate care at their local hospitals. For example, do hospitals follow recommendations for glucose monitoring and surgical preparation? Are there diabetes educators on staff to ensure that patients know how to manage the disease when they return home? What are the complication rates for patients with diabetes?
What’s next?
Eventually, journalists and the public will have more data to go by. Starting in 2025, the Centers for Medicare & Medicaid Services will require hospitals to electronically report when a patient experiences severe hypoglycemia or hyperglycemia. Both low and high blood sugar are risk factors for complications, whether a patient is diabetic or not.
