# Presentation: 218276

## Improving Research and Population Health

- Carolyn Clancy, MD
- Director
- July 1, 2003

## Slide 2

## RAND Study:  Quality of Health Care Often Not Optimal

**RAND Study:  Quality of Health**** Care Often Not Optimal**

**Medical Care Often Not Optimal  **
**Failure to Treat Patients Fully Spans Range of What Is Expected of Physicians and Nurses**

**Study:  U.S.**
**Doctors are not following the guidelines for ordinary illnesses**

- .

**The American healthcare system,**
**often touted as a cutting-edge **
**leader in the world, suddenly**
**finds itself mired in serious **
**questions about the ability of its**
**hospitals and doctors to deliver**
**quality care to millions.**

**Medical errors corrode**
**quality of healthcare system**

## RAND Study:  Quality of Health Care Often Not Optimal

- Doctors provide appropriate health care only about half the time

- Percentage of time

- E. McGlynn, S. Asch, J. Adams, et al., The Quality of Health Care Delivered to Adults in the United States, *N Engl J Med*, 2003

## Potential of IT for Assessing Quality

- IT can enhance the precision and decrease the cost of measurement – i.e., getting to the “right” measures
- IT can also enhance translation of strategies to improve quality (e.g., decision support)
- IT can greatly enhance the timeliness of data collection

**Notes:**
One survey of 1,000 U.S. hospitals revealed that, among the roughly 30% of hospitals with CPOE completely or partially implemented, over half report usage by fewer than 10% of physicians.[Ash, 1998]  Over half of hospitals with CPOE also reported that over 90% of orders are entered without the computerized system. 

## HHS Quality Reporting 

- Nursing Home Initiative
- Home Health Care Initiative*
- AHA-JCAHO-VHA .... Hospital reporting initiative*
- Patient experience in hospitals*

## Slide 7

## “Potential is what you have when you haven’t done it yet” 

- 				Darrel Royall
- 				University of Texas
- 				Football coach

## Percent of Americans Saying

**“****I Have A Chronic Condition” **

- Source: Chronic Illness and Caregiving Survey, Harris 2000

**Notes:**
Gave American public this definition
Do you have a chronic condition?
Those without current – 2/3
Similar to actual prevalence

## Patient-Centered Care

- Information technology can support:
- Communication
- Clinical knowledge
- Online support groups
- Decreased hospitalizations and shorter lengths of stay
- Improve health care outcomes
- Improved quality of life
- Gustafson et al. Am J Prev Med. 1999

## IT and Research

- Identify and prioritize critical questions: e.g., clinical variations as a reflection of inadequate knowledge
- Accelerate collection of relevant data
- Facilitate consistent measurement of key outcomes
- Enhance participation of communities and stakeholders
*“**Reinvent” dissemination and translation*

## VARIATIONS ARE WIDESPREAD

## SHARED DECISION MAKING:DECISIONS AND OUTCOMES

**SHARED DECISION MAKING:****DECISIONS AND OUTCOMES**

**Alternative 1**

**Alternative 2**

**Patient**

## New Report: Safe Practices for Better Healthcare: A Consensus Report

- Consensus on set of 30 evidence-based patient safety practices that should be universally used in health care settings
- For example:
_**Inform patients that they are likely to fare better if they have certain high-risk elective surgeries at facilities that  have shown superior outcomes**_
- Specify explicit protocols for hospitals and nursing homes to ensure adequate nurse staffing
- Make sure hospital pharmacists are more actively involved in the medication use process

## IT and Population Health

- _Enhance healthy behaviors_ – e.g., exercise, diet
- Facilitate data sharing within and across communities regarding potential threats to public health
- Facilitate registries (e.g., immunizations) and exchange of information *across* systems
- Linking data sources: _target_ improvement efforts

## EXAMPLE

- “Dorothy*”, a very obese 32 year old women, is seen for a suspected UTI and found to have diabetes
- Her physician provides information about diet and exercise – but is only cautiously optimistic
- One month later, Dorothy returns, having lost 30 lbs – and shows Dr. C how she is using a customized application for her Palm Pilot to track her progress with diet and exercise

## Diabetes - Long Term Complications

- 100,000
- Population --
- County of Patient
- Residence

**Diabetes - Long Term Complications**

- Dallas-Fort Worth Hospital Council -- Data Initiative -- 2000 Hospital Discharge Data

- September 26, 2002

- Texas

## Bioterrorism Preparedness: Improved  Coordination Through IT

**Front-Line Clinical Providers**

-    Primary care clinicians
-    Managed care organizations
-    Emergency Departments
-    Hospitals

**Public Health Infrastructure**

**IT**

-    Public health departments
-    State laboratories
-    Emergency preparedness

## Critical Challenges

- Common data elements and definitions; build capacity to make improvements
- _Clear rules of the road_: Who owns the data?  Who decides what is in a record? Who can make changes? IRB’s
- Transparency of purpose of data collection anduse
- Making it _easy_

**Notes:**
One survey of 1,000 U.S. hospitals revealed that, among the roughly 30% of hospitals with CPOE completely or partially implemented, over half report usage by fewer than 10% of physicians.[Ash, 1998]  Over half of hospitals with CPOE also reported that over 90% of orders are entered without the computerized system. 

## Slide 20

## Secretary ThompsonMarch 21, 2003

*In the modern era, every century has had its*
*major  advance that has brought medical *
*science another giant step forward. ....  What will *
*the major advance of the 21st century be?*
**I am convinced that the medical revolution **
**of our children’s lifetimes will be the **
**application of information technology to **
**health care.**