The grants were created this year to support projects that use research-quality methods to design, implement, and evaluate innovative solutions to operational problems, or identify areas throughout the spectrum of treatment that need improvement.
National funding agencies generally overlook the growing field of health care delivery science, a discipline with the goal of using research to discover innovative ways to better deliver care to patients.
In recognition of the lack of adequate funding, the program was jump-started by a gift from an anonymous donor and then matched by the office of the president of the University of Chicago Medical Center.
A team of 17 University of Chicago Medicine operational and research leaders reviewed the grant applications, rigorously assessing methodological strength, operational innovation, and feasibility.
“This process really validated the need and desire for this kind of grant program,” said Michael Howell, MD MPH, Associate Chief Medical Officer for Clinical Quality. “We received 27 full grant applications and could only fund two – making this a little more than twice as selective as a National Institutes of Health R01.”
Alexander Langerman, MD, assistant professor of surgery and a specialist in head and neck cancer and reconstructive surgery, and Tina Shah, MD, MPH, a pulmonary and critical care fellow, were the principal investigators behind the two winning proposals. Each received $50,000 towards their research.
Langerman’s study, entitled “Prudence” Surgical Cost Reduction Initiative, will use Lean-based methods to examine ways to reduce operating room costs related to wasted and unnecessary surgical supplies.
“As a practicing surgeon, I am inspired by the challenge of coordinating complex surgical cases - the staff, supplies and equipment,” he said. “We are doing a great job at treating surgical problems, but I believe we can do it more efficiently.”
Langerman noted that operating rooms are key areas of expenditures in hospitals, and can account for more than 50% of the total cost of surgical hospital stays for routine procedures.
Included in the plan is a pilot project for an interactive software interface that allows surgeons to modify the planned surgical supplies for a given procedure based on preferences and patient factors.
This “Supply Order System” will ensure the correct equipment is available and collect data on surgical supply decision making, surgeon preference and patterns of waste. This information will give feedback to surgeons and staff “to engender cost-consciousness and provide targets for cost reduction. Our working hypothesis is that feedback will facilitate behavior change,” the proposal states.
There is evidence that if surgeons and others are more aware of the input costs associated with the care they provide, they will be more conscious of how various supplies are used and consider less expensive, though equally effective, alternatives.
The study’s name, “Prudence,” is based on the definition offered by St. Ignatius: “Prudence has two eyes: one that foresees what one has to do, the other that examines afterward what one has done.”
“The research we are conducting as part of this grant will have impacts far beyond UCM as we develop better ways to treat patients and improve healthcare delivery,’ said Langerman.
Shah’s proposal, entitled: Improving the Health of our Patients: The COPD Readmissions Intervention, centers on treatment models for chronic obstructive pulmonary disease (COPD).
The goal is to use research-quality methods, including a novel screening algorithm that better identifies which patients will be coded upon discharge with COPD, to evaluate a multidisciplinary program aimed at improving the management of these patients and reduce readmissions.
This project marries Shah’s twin interests of pulmonary/critical care medicine and health policy.
Beginning in October, hospitals will be subject to penalties by the Centers for Medicare & Medicaid if they experience excessive readmissions of Medicare patients for COPD. The condition will be added to the list of ailments being tracked in an effort to cut down on costly readmissions.
COPD is the third leading cause of the death in the U.S. and is also the third leading cause of readmissions. Nearly $50 billion was spent in direct treatment costs, including $13.2 billion on hospital care alone, in 2011, Shah said.
“It’s an amazing position to be in to be the doctor who is treating patients at the micro-level, seeing how their condition is affected by insurance and education barriers to treatment,” she said. “Then seeing the government, on the other hand, recognizing there’s a problem in the treatment of COPD and incentivizing, by penalty, to improve the process.”
Unlike heart attacks and congestive heart failure, which are currently being tracked for excessive readmission rates, COPD has no measurable biological markers that would indicate a flare up, making it difficult to diagnose by looking at a patient’s chart.
As a result, coding for this condition is often open to interpretation by the non-medical personnel involved in hospital encounter coding.
In fact, a one-week demonstration by Shah’s working group found that only 60% of patients were coded at discharge as having had an acute exacerbation of COPD despite being diagnosed by attending physicians with the condition when admitted.
This mismatch makes it difficult to effectively track and, more importantly, intervene in the treatment of patients. Shah’s screening algorithm is already catching about 94% of patients that are ultimately coded with COPD.
The overall treatment pilot program includes medication reconciliation prior to discharge, patient education on inhalers, and a COPD action plan to guide home management if symptoms worsen. The program will be expanded to include post-discharge visits to the pulmonary clinic.
Shah’s is the first study of COPD readmissions, from both a quality and efficiency point of view, seeking to fill a gap in the medical literature.
She said the research has wider ramifications beyond COPD, as her group seeks to create a methodology that can be used to care for a given population of people who have multiple chronic diseases.
“I see this as a blueprint that we can then apply to other diseases,” she said.
The cornerstone of the annual Quality and Safety Symposium continues to be the poster presentation.
This year, there were more than 60 submissions by improvement teams representing a cross section of the University of Chicago Medicine, from physicians and nurses, to pharmacists, respiratory therapists, dieticians, and other professionals.
The Ten Posters of Distinction are below, including the lead investigator:
• Pediatric Sepsis Initiative in the Emergency Room: Emily C. Dawson, MD• Applying ACLS and Pregnancy Modifications to Maternal Cardiac Arrest - A Team-based Approach: Marie-Teresa Colbert, MD, MPH• Improving the Care Pathway for Total Joint Patients: Samira Qadir, MHA• Using Smart Forms to Discretely Capture Stroke Data for Electronic Reporting: Elaine Tsiakopoulos, RN, MSN• Identification of Clinical Factors for Performing Voriconazole (VCR) Therapeutic Drug Monitoring (TDM) at an Academic Medical Center: Mildred Vicente• Protecting Patients from Self Harm: Implementation of an Evidenced-Based Suicide Screening Process: Mary Ann Francisco, MSN, APN, GCNS-BC,CCRN• Teaching Patient-Centered Use of the Electronic Medical Record to Millennial Learners: Wei Wei Lee, MD, MPH• Colorectal Bundle: A Multi-disciplinary Teamwork Approach To Reduce Surgical Site Infections: Rena Thompson, APN, MSN, CNS-BC• Antimicrobial Stewardship Initiatives to Optimize Vancomycin Dosing and Reduce Nephrotoxicity: Zhe Han, PharmD• Ask Me To Explain Campaign: Improving Communication to Increase Patient Satisfaction in the Pediatric Emergency Department: Alison S. Tothy, MD