Back to Front PageVOLUME 6, NUMBER 4
 

Susan Delbanco, Ph.D. Executive Director, Leapfrog Group

On Nov. 15, the Leapfrog Group unveiled an ambitious effort to improve patient safety across the nation. Sponsored by the Business Roundtable, the Leapfrog Group is a consortium of Fortune 500 companies and other large private and public health care purchasers. Through educating consumers and rewarding health care providers who meet defined safety standards, the group is working to mobilize employer purchasing power to effect big "leaps" in patient safety.

The 1999 Institute of Medicine report "To Err Is Human" found that up to 98,000 Americans die every year from preventable medical errors and recommended that large purchasers provide market reinforcement for quality and safety. Precisely because so many medical errors are preventable, the Business Roundtable is encouraging employers to help employees, retirees, and their families by rewarding hospitals and health systems that implement significant safety measures.

The Leapfrog Group's approximately 60 members provide health benefits to more than 20 million Americans; Leapfrog members and their employees spend more than $40 billion on health care annually. Under Leapfrog, employers have agreed to base their purchase of health care on principles encouraging more stringent patient safety measures, including: 1. educating and informing enrollees about patient safety and the importance of comparing health care provider performance, with initial emphasis on the Leapfrog safety measures; 2. recognizing and rewarding health care providers for major advances in protecting patients from preventable medical errors; 3. holding health plans accountable for implementing the Leapfrog purchasing principles; and 4. building the support of benefits consultants and brokers to utilize and advocate the Leapfrog purchasing principles with all of their clients.

As a first step, the Leapfrog Group has identified three hospital safety measures as a focus for comparisons of performance by health care providers. These will serve also as the basis for hospital recognition and reward. Based on independent scientific evidence, the initial set of safety measures includes: o Computerized Physician Order Entry (CPOE) - With CPOE systems, physicians enter medication orders via computers linked to software designed to prevent prescribing errors. Data suggest that CPOE can reduce serious prescribing errors in hospitals by more than 50 percent. o Evidence-Based Hospital Referral - By referring patients needing certain complex medical procedures to hospitals offering the best chances for survival - based on carefully analyzed criteria, such as the number of times a hospital performs these procedures each year - research suggests that a patient's risk of dying could be reduced by more than 30 percent. o ICU Physician Staffing - Staffing ICUs with physicians who have credentials in critical care medicine may reduce the risk of patients dying in the ICU by more than 10 percent.

The impact of these interventions could be consequential. Indeed, a recent study by John D. Birkmeyer, M.D., of Dartmouth Medical School, finds that Leapfrog's approach could save as many as 58,000 lives, and prevent up to 522,000 medication errors each year.

The effort plans to empower consumers with meaningful and relevant information addressing patient safety. We expect this will help them decide where they want to go to receive care; they may then "vote with their feet." Today, the average consumer finds it almost impossible to find this type of information. Leapfrog's efforts will create a database to make it possible. Employers do not want to reduce the choice of hospitals offered to their employees, but they do want to provide their work force with better information, thereby stimulating and, perhaps in the future, rewarding more informed choices.

We plan to reward hospitals that meet the safety standards, not sanction those that do not. Obviously, if consumers begin to make choices based on such standards, we can expect growing numbers of hospitals to meet them. Consumers have demonstrated their ability to drive quality improvements in other industries; we expect to launch a similar quality revolution in health care. Some hospitals have already applied these best practices, and others have taken notable steps toward doing so.

How can members of the AAMC get involved? We believe the Leapfrog Group can collaborate with medical schools and teaching hospitals, working toward common goals. First, starting next spring, report to our Web site (www.leapfroggroup.org) when your institutions and practices meet our safety standards, so that our members can begin to recognize and reward you. Second, promulgate our standards throughout the health system clinical service lines in which your schools and hospitals play a part. Third, engage and activate your patients. Educate them about your safety practices, so that together we can create a market that demands and supports safety. Fourth, teach your students and house staff that "to err is human," and that processes and systems hold the key to significant error prevention.

Finally, keep us informed of your research. We are eager to refine our safety standards as new research becomes available, as well as to identify additional standards that present opportunities for us to work together to improve patient safety. The Leapfrog Group will be watching carefully to see if our efforts encourage more hospitals to protect patients from errors. We hope to work closely with you to meet our goals.

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