Integrating Research and Practice Health System Leaders Working Toward High-Value Care: Workshop Summary (2015) / Chapter Skim
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4 Integrating Clinical Research and Practice: Examples
4 Integrating Clinical Research and Practice: Examples
Pages 45-56
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From page 45... ...
• Another important reason for being part of a network dedi cated to improving care while reducing costs, even when it uses scarce resources, is that it enables staff to "do the right thing," Edward Havranek said. "I think we forget that one of the most important aspects of quality, value, diffusing research, new 45
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From page 46... ...
Susan Huang of the University of California, Irvine, described the multi partner REDUCE MRSA trial; Uma Kotagal of Cincinnati Children's Hospital Medical Center provided details on the Improve Care Now Network; David Grossman of Group Health and the Group Health Research Institute discussed Group Health's approach to integrating care delivery and research; and Edward Havranek of Denver Health spoke about the High Value Healthcare Collaborative. An open discussion, moderated by Harold Luft of the Palo Alto Medical Foundation, followed the presentations.
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From page 47... ...
The most important reason, she said, was that the research question aligned well with a major health system priority and with HCA's "strong dedication to quality." As an aside, Huang noted that HCA's administration emphasized the need to conduct the trial rapidly in order to not impede the health system's quality improvement goals, because the trial would prohibit the
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From page 48... ...
"It is not conceivable that each entity, whether it is an academic center or the health system, would excel in every part of what it takes to conduct a clinical trial," Huang said. As examples of how the trial design highlighted each partner's strengths, she cited HCA's centralized data systems and its ability to command a large number of hospitals, the experience of the academic partners at running large clinical trials and at conducting the highly specialized tests for bacterial isolates, and the longstanding experience with quality improvement studies of the Harvard Pilgrim Health Care IRB and that board's willingness to serve as a central IRB for 38 of the 43 hospitals.
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From page 49... ...
A fundamental principle of the Improve Care Now Network, Kotagal said, is that data are collected systematically and at the point of care using an EHR. This minimizes the burden imposed on providers to collect data and allows it to be used for both quality improvement and research.
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From page 50... ...
Kotagal noted in closing that networks such as this are critically important in the pediatric world because childhood diseases are rare. "It is difficult for us to learn at a single site what needs to happen," Kotagal said, adding that "for those health systems that have continued to participate in these networks there is a strategic commitment from their boards, their CEOs, and their clinical chiefs and an understanding that these networks offer us the best chance to rapidly bring new knowledge to the bedside to improve the outcomes for care." EMBEDDED RESEARCH AT GROUP HEALTH The process of embedding research into clinical care at Group Health takes a great deal of hard work, said David Grossman, speaking as both a researcher and the operational medical director of Group Health, a nonprofit health system with about 600,000 members in Washington State and $3.8 billion in annual revenue.
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From page 51... ...
Group Health also reduced co-pays for certain services such as the provision of highly effective medications to control hypertension, heart failure, asthma, and depression, with a goal of improving drug adherence and preventing complications from chronic disease. GHRI is evaluating the impact of the changes on employee health status and workplace productivity as primary outcomes, and on care quality, utilization, and total cost of care as secondary outcomes.
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From page 52... ...
We cannot be 2 or 3 or 4 years into a project before we discover that we are losing money." An example of a quality improvement project that met these criteria involved testing an evidence-based approach for venous thromboembolic prophylaxis. After the project was initiated in 2008, there was a clear decrease in the amount of money spent on venous thromboembolic prophylaxis, while at the same time the incidence of postoperative deep vein thrombosis and pulmonary embolism went down.
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From page 53... ...
Being able to compare ourselves to the other members of the network creates a context for our efforts that is important." Another important reason for being part of a network dedicated to improving care while reducing costs, even when it uses scarce resources, is that it enables staff to "do the right thing," Havranek said. "I think we forget that one of the most important aspects of quality, value, diffusing research, new knowledge, and doing things better is that it appeals to that very uniquely moral and idealistic motivation for doing what we do." Returning to what Havranek considers a failure -- the inability to improve its hypertension control outcomes beyond being in the top quartile -- he described a study that Denver Health, Kaiser Permanente, and the U.S.
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From page 54... ...
Grossman said that if there is a tension it is positive, as it motivates the different constituencies in a health system to work and communicate effectively together, creating a stronger system overall. Kotagal disagreed, saying there is a tension that has to do with timelines and producing pragmatic results versus developing ideal solutions.
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From page 55... ...
I think systems need to recognize that when there needs to be a very quick expedited process for demonstrating that things are of no or little risk to individual patients and that the risk in not doing it is substantial, we need to move ahead. There needs to be a real lifting of this cloud over us that is imposed by the IRBs." Jonathan Tobin from the Clinical Directors Network and Rockefeller University asked if there was a way to look at some of the organizational variables that may facilitate or inhibit uptake by health systems.
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