US Hospital Groups Call for Science-Based Standards
WASHINGTON (Reuters Health) - In the opening shot of what promises to be a testy battle this year, the American Hospital Association (AHA) and the Federation of American Hospitals (FAH) on Tuesday issued criteria to assess whether hospitals should accept quality standards issued by outside organizations.

The private, employer-based Leapfrog Group and the federal Centers for Medicare and Medicaid Services, among others, are preparing to release quality standards they say hospitals should live up to in order to receive payment.

But hospitals are concerned the standards could prove onerous to implement, or that they might not be backed by the best evidence, said Chip Kahn, president of the FAH, a group representing 1,700 mostly private, for-profit institutions.

``We need to avoid a flavor-of-the-month approach with standards,'' said Kahn, adding that hospitals can't turn on a dime to institute the latest approach.

The FAH, the AHA and the Healthcare Leadership Council jointly hired Santa Monica, California-based consulting group Protocare, Inc. to develop a framework to evaluate an ever-burgeoning thicket of quality standards.

Protocare's criteria were developed for hospitals. But Kahn said FAH and AHA also hoped that Washington policymakers, the Centers for Medicare and Medicaid Services, and groups like Leapfrog would look at the report ``before moving forward'' with their standards.

Protocare defines a ``standard'' as the minimum level of performance that should be expected of any hospital in America.

Before a standard is adopted, it should be determined if it is relevant and appropriate for all hospitals in the US, and if it was developed using accepted scientific evidence, according to Protocare. The suggested new standard should be superior to other practices, and key stakeholders should be involved in its development, the group states. Also, feasibility and cost-effectiveness for any standard should be considered.

Using its own framework, Protocare evaluated a few standards, some in current use and others that have been suggested. The group found, for instance, that it was feasible to make the administration of antibiotics before surgery standard. There is sufficient evidence for effectiveness, no better alternative, low barriers to implementation and evidence that this approach can be used outside an academic hospital setting.

With computerized physician entry of pharmacy orders, however, there is evidence of effectiveness, but there also appear to be less expensive, equally effective ways to reduce prescription-ordering errors, according to Protocare. One study found that it cost $1.9 million to set up a computerized ordering system, the group notes, with maintenance costs of $500,000 yearly--an expense that many hospitals might not be able to shoulder.

The hospital groups said they would not use the study to shirk patient care standards, but that they wanted realistic, science-backed approaches.

``For us, patient safety is a priority,'' said Carmela Coyle, senior vice president at AHA, adding that the challenge is to put quality information to the best use.

``At the end of the day, patients and their families must feel confident that the benchmarks for assuring accountability are proven and effective,'' agreed Kahn.