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There is a growing interest in quality measurement in the healthcare sector. Hospitals in Germany are obligated to participate in measures for external quality assurance and they must establish an internal quality management system. In addition to the legal requirements, measurement of quality is also possible with routine data. Suitable sources are the ICD system or unstandardized information from treatment documentation. The selection of suitable quality indicators is necessary to interpret the data. Complications or achievement of surgical objectives can be suitable quality indicators. Analysis of procedures or the assessment of waiting time are also possible indicators. Our first data concerning waiting time show that with increasing use of an electronic patient guidance system, the waiting time decreased in our outpatient department. Assessment of quality indicators from routine data enables a continuous measurement of quality over a long period. Measures to increase quality can easily be checked. Routine data also provide the possibility to participate in a public reporting of quality indicators., Competing Interests: Interessenkonflikt: Die Autoren geben an, dass kein Interessenkonflikt besteht., (Georg Thieme Verlag KG Stuttgart · New York.)

There has been a proliferation in the use of digital health records. Although electronic records have many benefits, concerns have been raised about associated risks and barriers. This article focuses on risks associated with development, utilization, and maintenance of provider-owned electronic medical records and institution-owned electronic health records. Strategies to reduce risks and overcome barriers are also offered. Attention to these issues can minimize risks and improve healthcare services delivered to consumers.

The medical biology laboratory accreditation according to the Iso 15189 standard, which main lines are mentioned in the article, is henceforth becoming a statutory obligation in France. All laboratories must apply, at least partly, to the COFRAC, by 31(st) October 2012. The EFS has largely anticipated the necessary steps to reach this objective and has developed an approach based on six basic processes. To date, 24 laboratories of various technical fields are accredited and several other submissions are pending. The Iso 15189 standard requirements match those already implemented at the EFS with the Certification. The trade standard operating procedures are almost included in the risk control management. Through the involvement of all the EFS members following precision action plans based on the sharing of successful experiences and the harmonization of trade practices, this compulsory objective will be reached and the deadline respected., (Copyright © 2011 Elsevier Masson SAS. All rights reserved.)

Physicians, risk managers, and quality assurance personnel may incorrectly assume that all communications that take place in hospital committee discussions or investigations are privileged and thus protected from discovery. This article addresses that inaccurate assumption and sets forth some simple steps to help protect these communications, including the protections afforded by the agency privilege.

Context: The abuse of stimulant drugs is increasing in the western United States. Although numerous case reports and animal studies suggest a link with stroke, epidemiologic studies have yielded conflicting results., Objective: To test the hypothesis that young adults who abuse amphetamines or cocaine are at a higher risk of stroke., Design, Setting, and Participants: Using a cross-sectional design and from a quality indicators' database of 3 148 165 discharges from Texas hospitals, we estimated the secular trends from January 1, 2000, to December 31, 2003, in the abuse of various drugs and of strokes. We developed separate logistic regression models of risk factors for hemorrhagic (n = 937) and ischemic (n = 998) stroke discharges of persons aged 18 to 44 years in 2003, and for mortality risk in patients with stroke. Main Outcome Measure Incidence of stroke using definitions from the Agency for Healthcare Research and Quality's stroke mortality Inpatient Quality Indicator., Results: From 2000 to 2003, the rate of increase was greatest for abuse of amphetamines, followed by cannabis and cocaine. The rate of strokes also increased, particularly among amphetamine abusers. In 812 247 discharges in 2003, amphetamine abuse was associated with hemorrhagic stroke (adjusted odds ratio [OR], 4.95; 95% confidence interval [CI], 3.24-7.55), but not with ischemic stroke; cocaine abuse was associated with hemorrhagic (OR, 2.33; 95% CI, 1.74-3.11) and ischemic (OR, 2.03; 95% CI, 1.48-2.79) stroke. Amphetamine, but not cocaine, abuse was associated with a higher risk of death after hemorrhagic stroke (OR, 2.63; 95% CI, 1.07-6.50)., Conclusion: Increases in stimulant drug abuse may increase the rate of hospital admissions for strokes and stroke-related mortality.

In February 2004, privacy concerns captured the public's attention when the United States government, the defendant in a lawsuit challenging the constitutionality of the Partial-Birth Abortion Ban Act of 2003, sought to subpoena the medical records of patients receiving intact dilation and extraction (also known as "partial birth") abortions in six different hospitals and six Planned Parenthood centers across the country. Three different federal court cases explored the enforceability of the subpoenas. This Note explores the rationales used by the three courts in examining the privacy interests involved. It then suggests some possible solutions for systematically protecting medical information: a legal solution; a technological solution; and a combination of both. The legal solution involves creating a federal physician-patient privilege, similar to that enforced in many states and parallel to the federal psychotherapist-patient privilege. The technological solution requires the complicity of multiple jurisdictions to verify the necessity of revealing medical information. Taken together, these solutions can assist the government in protecting its citizens by imposing more checks on itself.

Background: Federal regulation requires hospitals to present patients with a Notice of Privacy Practices (NPP) that contains all stipulated content items, is readable by patients, and posted on institutional web sites., Objective: The objective of this study was to determine whether the NPP texts contain the required content, if readability is influenced by local literacy rates, and if readability or the presentation of NPP texts in other languages is influenced by local rates of English proficiency., Research Design: The authors conducted a cross-sectional study of the web sites of 115 hospitals selected from the US News and World Report list: Best Hospitals in America., Measures: English NPP texts were evaluated for 18 content items and readability using the Flesch-Kincaid scale, which assigns the minimal grade level required to read a text (range, 0-16)., Results: NPP texts were available for all hospitals (115 of 115). A Spanish-language NPP was available for 25% (29 of 115). All content items were evident in 76% (87 of 115) of hospitals' NPP texts. The average grade-level readability of NPP text was 12.3 (95% confidence interval, 12.0-12.7). Readability was not associated with the rate of local literacy (P = 0.07). Hospitals with a lower local rate of English proficiency had NPP texts that were more difficult to read (P = 0.03) and did not present NPP texts in other languages more frequently (P = 0.15)., Conclusions: Although NPP texts typically cover the stipulated content, they are written beyond the reading capacity of the majority of American adults. Explicit federal guidance is needed to help privacy lawyers draft NPP texts that are both comprehensive and comprehensible. The goals of the Health Insurance Portability and Accountability Act of 1996 Privacy Rule cannot be met with NPP texts patients cannot decipher.

A new amendment to its state constitution has opened up Florida's peer review meeting notes to the public, with chilling effects on the entire peer review process.

Background: The objective was to investigate how data on race and ethnicity are collected by hospitals reporting to the New Hampshire State Cancer Registry (NHSCR)., Method: NHSCR surveyed hospitals asking how information on race and ethnicity were collected. A review of relevant legal mandates and national guidelines was undertaken., Results: Many hospitals lack policies on collection, computer systems fail to support national guidelines, and staff rely on visual inspection., Conclusions: Hospital staffs are not now culturally equipped to collect race and ethnicity in a meaningful way. The numerator in cancer incidence rates is most likely not accurate and for some smaller populations very biased. A new framework is needed that takes into account the needs of the democracy.

In 2004, principles and practice of clinical performance measurement (CPM) in German hospitals were changed according to new legislative and administrative regulations. In many respects, focus and methods of clinical performance measurement were improved in favour of hospitals. Starting from January 1, 2004, the new Gemeinsamer Bundesausschuss (Joint Federal Board) has competence for decisions on future focus and scope of CPM. Former agreements on implementation of CPM in 2004 will be effective as long as Gemeinsamer Bundesausschuss passes new resolutions. Methods to identify relevant cases for CPM particularly changed in 2004. Until end of 2003, obligations to report case data were based on special types of hospital reimbursement. In 2004, obligations for reporting no longer derive from financial criteria, but from medical criteria such as diagnoses and procedures. In 2003, reporting for CPM covered more than 30 subjects in medicine and nursing. For 2004, the scope of CPM has been reduced by 13 subjects which need to be reconsidered in order to secure unified quality goals for out-patients as well as in-patients and to allow long-term follow-up of outcome data. For their CPM expenditure, hospitals receive an additional fee of euro 0.58 per case reimbursed by DRG. Financial sanctions will be effective for hospitals with overall CPM reporting rates below 80 %. Starting from 2005, hospitals are obliged to publish CPM reporting rates for each CPM subject in annual hospital quality reports.

What should healthcare facility security directors and administrators do when patients or employees are the victims of identity theft? Taking the right steps to safeguard personal data won't insulate your facility from ever having to deal with this growing crime but, says the author, it will reduce the opportunity and desire for a criminal to steal the data.

Objective: Record keeping contributes to the quality of health care in addition to fulfilling medicolegal and accreditation regulations. We conducted an audit of patient files in 15 public hospitals in Aquitaine to determine their compliance with national laws., Methods: One hundred patient files were randomly selected in each hospital. Their compliance with 18 criteria established in 1992 by the ANDEM was studied. These 18 criteria were updated in accordance with the latest decrees from the health ministry and precisely defined in order to achieve good reproducibility of the measurements., Results: Ten percent of the files fulfilled all 18 criteria. Each component of the record was correctly identified and the name of the general practitioner, admission documents, and delivery, anesthesia and transfusion records were almost always present. Surgery reports were found in 65 to 89% of the files. Low compliance with three criteria was observed: authorization to give health care to a minor (39 to 80% of the files), identification of the physician who prescribed the drugs during hospitalization (6 to 32%) and discharge prescription (42 to 95%). We also pinpointed problems concerning archiving and retrieval, especially concerning the results of complementary exams which were not necessarily stored with the patient files., Conclusion: This audit allowed us to define the first steps of a quality improvement project for patient records. We were able to deduct recommendations for analyzing compliance with legal requirements and suggest that the 1992 ANDEM criteria be updated to allow for valid comparisons between health care establishment.

This proposed rule would implement part of the paternity establishment provisions contained in section 331 of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA) and amended by section 5539 of Pub. L. 105-33, which impose new statutory requirements for a State's voluntary paternity acknowledgement process and require the Secretary to promulgate regulations governing voluntary paternity establishment services and identifying the types of entities other than hospitals and birth record agencies that may be allowed to offer voluntary paternity establishment services. States will be required to adopt laws and procedures that are in accordance with the statutory and regulatory provisions. These proposed regulations will address these procedures and related provisions.