We need to view quality and safety research as essential rather than separate from basic and clinical research, according to Peter J. Pronovost, MD, PhD, Professor of the Departments of Anesthesiology and Critical Care, Surgery, and Health Policy and Management at Johns Hopkins University. He is also the Medical Director for the Center for Innovations in Quality Patient Care, and Director for the Quality and Safety Research Group.
Dr. Pronovost appearing before the Senate Committee on Health, Education, Labor, and Pensions recent hearing on “Implementing Best Patient Care Practices” said “We need to eliminate the gap that exists between what we learn in a lab and what actually reaches the patient plus we need to approach patient safety the same way that we approach curing a disease. This means that we need to use rigorous scientific research to produce hard data with clear measurable results.”
He described how researchers at Hopkins worked on the problem of catheter related blood stream infections which kills between 30,000 and 62,000 people a year and causes nearly $3 billion in excess costs.
Hopkins used a plan developed in three phases to prevent this infection:
- Phase 1—Existing data was reviewed and five key procedures were selected that would most likely prevent these infections. These procedures were compiled into an easy to follow checklist. Potential barriers to using the checklist were identified and tactics were developed to overcome those barriers. The intervention was pilot tested at Hopkins and performance was measured with the result that these infections were nearly eliminated
- Phase 2—AHRQ provided a matching grant to help Hopkins pilot test the program in Michigan. Within 3 months after implementing the interventions, the median rate of infection in the 103 participating ICUs plummeted to 0 and has stayed at 0 for 4 years. In just one year, the reduction in infections were estimated to have saved the hospital system millions and thousands of lives
- Phase 3—AHRQ provided funding to enable Hopkins to partner with the American Hospital Association to implement this life saving program in 10 hospital systems in 10 states. In addition, philanthropic support was donated to enable Hopkins to reach another group of states
- Dr. Pronovost pointed out that the fragmented approach that our country uses to reduce infections points to deep problems within our healthcare system. These include vague or non-existent performance standards, poor or absent and often invisible measures of performance, misaligned financial incentives, and fragmented and under resourced labors. These factors all cripple efforts to improve quality, reduce cost, and implement health IT.
His other suggestions for improving quality and patient safety are to:
- Advance and invest in the science of healthcare delivery and with more funding for AHRQ
- Create an Institute for Healthcare Delivery that would be similar to the human genome project to link provider organizations, insurers, payers, and regulators to work together to design, implement, and evaluate interventions
- Establish a “supra agency” to facilitate and monitor the integration of inter-agency activities. This group should report directly to the Secretary of HHS
Invest in health IT so that efforts to improve health IT would be linked with efforts to improve quality and reduce costs