Gerald Miller                Joan Richards

Joseph R. Stock, M.D.   Arthur Baker, M.D.

Dear Friends and Colleagues:

This past summer, President George W. Bush signed a bill to create a national system that would facilitate the reporting of medical errors. Healthcare officials would voluntarily (and confidentially) report medical errors to patient safety organizations, which would then be able to analyze the information and use it to identify strategies for improvement. Although the exact form this national database will take remains to be seen, its creation signifies the growing belief that, when it comes to transforming healthcare, knowledge really is power.

This federal initiative is just the latest development in an ongoing national conversation about how to improve healthcare quality, inspired in large part by a landmark 1999 Institute of Medicine report which estimated that up to 98,000 deaths occur every year in U.S. hospitals as a result of medical errors. This report helped to focus attention on the challenge of creating care processes that not only guard against mistakes, but also ensure that patients receive care based on the latest medical evidence—a concept better known as “evidence-based medicine.” Organizations such as the Institute for Healthcare Improvement, VHA, the Agency for Healthcare Research and Quality, and the Joint Commission on the Accreditation of Healthcare Organizations, among others, have stepped in with a range of projects and initiatives designed to help hospitals and health systems work toward these goals.

Five years ago at Crozer-Keystone Health System, we decided to establish our own mechanism for ensuring that we remain up-to-date on the latest medical evidence and use it to guide the care we provide. Our Evidence-Based Medicine (EBM) program has become the centerpiece of our efforts to improve processes, ensure quality, and, perhaps most importantly, build a culture of communication among all of our clinicians and staff. Although previous CKHS annual reports have chronicled some of our EBM efforts, this eighth Annual Report on Quality offers us an ideal opportunity to step back and offer a complete account of what evidence-based medicine is, how it has shaped and will continue to shape the care we provide, and how we approach the challenge of diffusion—that is, communicating information to the doctors, nurses, and other clinicians on the front lines of care.

This last point is especially important, because studies have shown that, despite all of the attention being given to improving healthcare, there is still a major “quality gap.” Too often, patients at hospitals throughout this country do not receive care that is based on the latest medical evidence. A 2003 Institute of Medicine report, Priority Areas for National Action: Transforming Health Care Quality, noted that it takes much too long for new and more effective treatments to find their way into clinical practice, and that many patients suffer needlessly as a result.

There is no doubt that change takes time, especially in an organization as large and complex as a healthcare system. At CKHS, it certainly has taken significant time and energy to establish our EBM program, but it has been well worth the effort. In this report, you will read about the results of our EBM projects to date, and you will see how we have been able to expand beyond our original projects into new areas. You also will read about our ongoing efforts to educate physicians and other clinical staff about EBM projects, their goals, and their importance. Finally, you will become more acquainted with our efforts to improve the health of our community—efforts that are also “evidence-based” in the way they are shaped by data that indicate where the areas of greatest need are.

Thanks to the progress we have made in EBM over the past five years, we are well-positioned to expand our efforts into new areas and to devise new and better ways to diffuse information. We also are exceptionally well-positioned to operate in an environment where hospitals and healthcare systems are being held accountable for quality. In April 2005, for example, the Department of Health and Human Services launched a consumer-oriented Web site, www.hospitalcompare.hhs.gov, which currently offers information from over 4,200 hospitals in the U.S. that

voluntarily report on the quality of care they provide. Already, the public can compare the performance of hospitals in Delaware County to that of the top ten percent in the nation, the national average, the state average, and directly to other local hospitals in treating certain conditions.

The next logical development—one that is already starting to materialize—is pay-for-performance. The Centers for Medicare and Medicaid Services (CMS) is engaged in a demonstration project that is reimbursing hospitals according to the quality of care they give for conditions that commonly affect older patients, including heart attack, heart failure, and pneumonia. CKHS also has recently agreed to participate in a pay-for-performance program with Independence Blue Cross (IBC). The new program, effective August 1, 2005, rewards the health system for following best practices and meeting quality standards related to identified conditions.

At the heart of all our efforts, however, is one central preoccupation: delivering the best possible healthcare to the patients who turn to us for help every day. Even as we become immersed in the details of various quality projects, we never lose sight of the fact that our efforts will make us better, and in so doing, improve the lives of people in our community. As you read this eighth Annual Report on Quality, we hope you will see what we mean.