Pioneering Ideas

What’s New on the Pioneer Blog?

Innovative health care delivery, hospital-acquired infections (HAIs) and the OpenNotes demonstration project were hot topics on Pioneering Ideas over the past several weeks.  

• Sanjeev Arora, M.D., director of Project ECHO (Extension for Community Healthcare Outcomes) shared his experiences and perspective on how to tackle health care delivery issues in rural and underserved areas.  Dr. Arora outlines real examples of how Project ECHO’s system is working in New Mexico.
• Steve Downs recently shared his thoughts on Open Notes, a demonstration project at the Beth Israel Deaconess Medical Center where patients will have access to their physician’s notes about a visit.  This month, the team announced the full details of the 12-month study funded by a Pioneer grant.  What will be the outcomes from patients having full, real-time access to the notes from their doctors’ visits?
• In early July, Ramanan Laxminarayan of Extending the Cure co-wrote an editorial that sparked the question: Can best practices in infection control reduce HAIs and save billions of dollars a year? Ari Kramer talked about this and also discussed research by Health Care Without Harm that explores whether alternative cleaning strategies for the health care sector could prevent infection in a way that would be both healthier and friendlier to the environment.  Take a look and let us know what you think.

Keep up with Pioneering Ideas to see what inspires us next month – or join the conversation and add your own ideas. And don’t forget to follow Pioneer Portfolio on Twitter for real-time updates.

A Model for Bringing Specialty Care to Underserved Areas

Sanjeev Arora, M.D., is executive vice chair for the Department of Internal Medicine at the University of New Mexico Health Sciences Center and the director of Project ECHO (Extension for Community Healthcare Outcomes), which is supported by the Robert Wood Johnson Foundation’s Pioneer portfolio. He is also the principal investigator on grant funding for the project from the federal government, New Mexico Department of Health, and New Mexico Legislature.

For health reform to achieve meaningful cost savings, we must substantially change how we deliver health care.  Here in Albuquerque, we are tackling this by combining evidence-based medicine and telehealth technology to expand treatment for common, chronic, complex diseases in rural and underserved communities.

In New Mexico, an estimated 32,000 people – most of them poor and living in very remote, rural areas – suffer from Hepatitis C (HCV).  Few health care providers in the state are equipped to treat this disease.

Project ECHO, based at the University of New Mexico’s Health Sciences Center and funded by the Robert Wood Johnson Foundation’s Pioneer program, engages primary care providers in cross-disciplinary education and mentoring that makes it possible to deliver highly effective care to patients in different locations in a remarkably brief window of time.

Recently, we conducted our weekly HCV clinic with providers from a half-dozen sites, all linked to us through confidential videoconferencing or phone.  At a table in Albuquerque with me sat a pharmacologist, a mental health specialist, a nurse, an HCV outreach worker, and others.

Prior to the clinic, we had all received summaries for each case, highlighting what we needed to know to offer an informed consult.  With these summaries in hand, we listened to our remote colleagues present their cases:  A 52-year-old man needed to lose at least 40 pounds to improve his chance for a cure from HCV treatment and, if treatment failed, qualify for an eventual liver transplant. A 35-year-old woman struggling with the punishing side effects of HCV treatment needed medication to treat her depression. Thanks to real-time technology and having all the right people at the table at the same time, we worked through 20 cases in 2.5 hours.

In essence, we are providing care to very sick people who would otherwise go untreated.  At the same time we are expanding the capacity and reach of the health care system by engaging more colleagues in a highly needed specialty.  We are also using this vehicle to provide care for people dealing with substance abuse and mental health problems, rheumatology, chronic pain, asthma, and high-risk pregnancies.

We believe that this approach can help bring sorely needed specialty care to millions of Americans in rural and underserved areas without increasing costs, and we see Project ECHO as a potential model for other parts of the country.

Can Green Cleaning Products Prevent and Control HAIs?

We’ve written several times on Pioneering Ideas about the impact of hospital acquired infections (HAIs) on lives and hospitals as well as the costly drain HAIs have on the health care system.  Simply increasing the use of cleaning and disinfecting products to tackle HAIs can create a host of other health hazards for both health care facility workers and patients – not to mention significant harm to the environment.

This conundrum has led to the development of wide range of green cleaning methods, but at this point there remains a need for more evidence of about the extent to which these programs meet infection control and prevention goals. In a recent white paper, Health Care Without Harm(HCWH), in collaboration with the Global Health and Safety Initiative(GHSI), explores whether there are cleaning strategies for the health care sector could effectively prevent and control infection in a way that would be both healthier and friendlier to the environment.

The paper, which was produced with support from Pioneer, does not present any final answers, but it does lay out some out compelling recommendations for “closing the knowledge gap.”  Please take a look and let us know your thoughts.

An OpenNotes Annoucement

A couple of weeks ago, Steve Downs discussed the Boston Globe coverage of the OpenNotes© study at the Beth Israel Deaconess Medical Center (BIDMC). Last week, BIDMC announced the details of the OpenNotes© demonstration project, which is funded by a grant from Pioneer.

One hundred primary care physicians and 25,000 patients will participate in the 12-month study at three sites – BIMDC in Boston, Geisinger Health Systems in Pennsylvania and Harborview Medical Center in Seattle. The study – the focus of a July 6 article in American Medical News – is looking at what happens when patients are given full, real-time access to the notes from their doctors' visits.

This project could affect behavior in both patients and physicians, perhaps even creating more openness and engagement. That said, as Steve notes, it is “a controversial idea that needs to be tested.” Or, as one internist quoted in the AMA news article put it, "I want to be a part of this even though I'm not sure I'm going to like it." We look forward to your questions and the many that are sure to follow as this project moves forward. 

Now that’s Progress

1899

 

2009

 

My family dog, Chance, testing the latest prototype. 

Credit to my wife, Naomi, for the idea.

The back story: Chance is about seven months old. He learned to swim in a local creek the other day. Then, in his excitement, he jumped off a bridge and landed on ground 10 feet below. I think he figured if he could swim, then he could also fly. We spent a good five hours at the emergency room, most of it waiting. The vet on call wanted a specialist to see him. The specialist, a doggie ortho surgeon, thought they would need to operate—to the tune of $4,000.  Additional x-rays showed no broken bones, but some torn tendons. It was just like a visit to a human ER, only with a lot more fur. Chance should be ok in three or four weeks.  In the mean time, he claims to be receiving podcasts from New Zealand.

Can a Reduction in Hospital Acquired Infections Cut Health Care Costs?

There is no denying that hospital acquired infections (HAIs) are an expensive drain on the system and impact the lives of an estimated 1.7 million hospital patients a year – killing nearly 99,000 annually. Is it possible that simply instituting best practices in infection control can substantially reduce these infections and save the nation’s healthcare system billions of dollars a year?  Yes, according to an article in last week’s Roll Call by Ramanan Laxminarayan of the Extending the Cure initiative, a Pioneer grantee, and Ed Septimus from HCA Healthcare System.  Laxminarayan and Septimus propose several ideas and incentives, which they believe will reduce the rate of resistant HAIs and control the rise of antibiotic resistance. 

Are hospital acquired infections really the low hanging fruit that will benefit patients and cut health care costs?  Check out the article and then come back here and let us know what you think.