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March 25, 2008

Upcoming Releases: "Unnatural Causes" PBS Series
Dartmouth Study on Chronic and End of Life Care

TO: Chief Executive Officers
  Chief Financial Officers
  Chief Medical Officers
  Quality Directors
  Public Relations Directors
  COMPdata Contacts


There are a couple of upcoming releases that provide an opportunity for hospitals to have discussions about two topics that are sometimes challenging as a society to discuss. The first issue deals with disparities in health outcomes for various racial and ethnic groups as they relate to socioeconomic disparities. The second issue focuses on chronic disease and end-of-life care as they relate to the quality of life and financial costs.

We hope you will take time to discuss these issues with your management and staff as well as with your Board members. We are aware that many community organizations and groups are taking up these topics and would welcome the participation of hospitals and clinicians in their discussions.

"Unnatural Causes: Is Inequality Making Us Sick?" PBS Series
In communities throughout the United States, people are gathering to watch together the four-part series on "Unnatural Causes: Is Inequality Making Us Sick?" "Unnatural Causes" was produced by Larry Adelman as he tried to discern why the United States infant mortality is higher than 37 industrialized nations; U. S. ranking in life expectancy has dropped to 29th among nations; and yet our health care expenditures exceed our counterparts, with the highest level of spending among the Organization for Economic Cooperation and Development (OECD) countries.

Adelman looks at the root causes of health and illness to help reframe the debate about how the United States has slipped so far behind other nations. The series explores the economic conditions of racial and ethnic groups and draws attention to the disparities in schools, jobs, wages and benefits, and access to resources. As the series demonstrates, some of the chronic diseases and avoidable disease conditions can be closely linked to life experiences.

PBS Series Airing Varies by Location
As with all documentaries on the Public Broadcasting System, the airing of the show will vary by location. In the Chicago area, WTTW Channel 11, will air it on four consecutive Sundays at 1:00 p.m. starting April 6 and continuing on April 13, 20, and 27. WYCC TV20 is running the series on Thursday evenings in May. WYCC will also be having a local segment following each of the broadcasts with a discussion on the featured topic for that evening. Additional information on the WYCC segments will be made available to IHA members shortly. Other public broadcast stations airing the series are in Peoria, Urbana, Bloomington, St. Louis, Indianapolis, South Bend, and state stations in Iowa and Wisconsin, with some areas beginning the series on March 27. A full and updated listing is at http://www.unnaturalcauses.org/assets/uploads/file/broadcastdates.pdf.

Resources Available
As this program is being used to facilitate discussions within communities and among stakeholders, there are a variety of resources and tools available targeted to different audiences. Some of the toolkits that can be useful in internal discussions are specifically targeted toward health professionals. The resources are available at http://www.unnaturalcauses.org/for_educators.php and under other locations on the web site.

While the documentary was filmed all over the United States, there are some feature stories from Chicago area hospitals and nearby Kentucky as health researchers uncovered variations in clinical outcomes based on racial and ethnic groups.

Dartmouth Study on Chronic and End of Life Care
On Monday, April 7, Dartmouth researchers will release a new study entitled "Tracking the Care of Patients with Severe Chronic Illness: The Dartmouth Atlas of Health Care 2008." The study focuses on the last 2 years of life for Medicare patients with severe chronic illness and documents the amount of medical care they received and the outcomes of care. The study covers five years of Medicare information from 2001 through 2005.

As in the past, Dartmouth will release rankings of hospitals by state and include the expenditures by service as well as rankings by quality of care and end-of-life care. The rankings for quality of care and end-of-life care are measured by the amount of time and visits to ICU care within two years before death.

Actual Study and Results
While IHA and other state hospital associations will not be provided the final study presentation or rankings until Tuesday, April 1, we will share it with you as soon as we have the information. However, we have been told that it will be quite similar to the study released in 2006. Information, methodology, and results of the 2006 Dartmouth Study are on IHA’s web site (click here). Scroll down to "Special Studies" and you will see several documents on Dartmouth Study. Please remember that this is the challenging study where costs outside of the hospital provided in physician offices, home health, hospice, etc. are all tied to the hospital. There is no way a hospital could ever replicate the study without utilizing all of the same data from different service settings and applying the complex methodology.

Your Hospital- Specific Preview Results
For the 2006 Dartmouth Study, state associations were provided the study almost 6 weeks in advance of its release and IHA e-mailed the results out to all hospitals. This year, IHA and other state associations were provided the raw data on March 25 and will be sending out to CEOs starting on Thursday, March 27 via e-mail. IHA will e-mail the Illinois study which is about 144 pages and includes the methodology, tables, and information by non-hospital identifiable code numbers. As in the past, we are only allowed to provide hospital CEOs with their own code numbers for their own hospital so that they may see where they rank.

Media Response
It is difficult to gauge or anticipate media response to this study as this is quite complex with many results and methodologies to understand. However, it is best that hospitals be somewhat prepared. We will know after our conference call with Dartmouth researchers on April 1 if Dartmouth researchers plan a major media release or are not heavily promoting the study. We will update you on expected media outreach by Dartmouth.

April 16 – National Healthcare Decisions Day
IHA has sent several memos and background information on the upcoming National Healthcare Decisions Day being held throughout the nation on April 16. The day is focused on efforts to highlight and engage in advance healthcare decision-making, such as advance directives. IHA’s information can be found by clicking here.

Illinois Quality Leadership Conference – May 15 and 16
At the Illinois Quality Leadership Conference, there will be panel discussions on race and ethnic variations in health outcomes and end-of-life care issues in addition to state and federal regulatory updates, IHI best practices and outcomes, QIO 9th Statement of Work, and the emerging roles and integration of CMOs and CMIOs in hospital settings.

If you have any questions, please send them to Pat Merryweather at pmerryweather@ihastaff.org or Danny Chun at dchun@ihastaff.org. Thank you.