|by Sharon J. Glazer, MPH, Editor, Academics@Baystate newsletter | October 15, 2010
Peter Lindenauer, MD, MSc, Director of CQCR, and Michael Rothberg, MD, MPH, have each been awarded a 3-year grant from Agency for Healthcare Research and Quality (AHRQ), which together represent nearly 2 million dollars in research funding to Baystate Medical Center's Center for Quality of Care Research. Securing 2 highly competitive grants from the federal government a mere 2 years after it was established is a major milestone for the CQCR. “This raises our visibility as a center, as investigators, and as an institution,” says Dr. Lindenauer.
Impact of a Quality Improvement Collaborative
Lindenauer’s study, “Contextual Factors Associated with Mortality Reduction within a Quality Improvement Collaborative,” will examine QUEST, a collaborative of more than 160 hospitals from around the U.S. launched in 2008 by Premier healthcare alliance. According to Lindenauer, QUEST is a “high risk, high reward” collaborative because of its ambitious goal of reducing risk-adjusted hospital mortality rates by attempting to implement more than a dozen clinical practices, ranging from “sepsis bundles” to rapid response teams.
To discover why some hospitals are more successful at implementing the recommendations than others, the study will use a theoretical framework, determinants of innovation implementation success, developed in a business setting to help explain why some businesses are more successful at implanting new technologies. According to Lindenauer, “implementing a new computer system has many parallels to implementing a rapid response team, in that there are organizational climate and staff perception factors that influence willingness and ability to adopt innovatiions.” The impact of implementing QUEST’s recommendations and the effectiveness of the collaborative method will also be analyzed. But Lindenauer stresses that the essence of the proposal is to discover the factors and strategies that enable some hospitals to be more successful at implementing new car innovations than others, and then use those learnings to catalyze quality improvement efforts at less successful hospitals.
Co-investigators are Penelope Pekow, PhD, CQCR Senior Biostatistician, and Evan Benjamin, MD, Baystate Chief Quality Officer. Aruna Priya, MS of the CQCR will provide biostatistical support to the project.
Evaluating HCAP Treatment Guidelines
Patients with healthcare acquired pneumonia (HCAP) are at risk for multi-drug resistant organisms due to past exposures in healthcare settings such as, hospitals, nursing homes, and dialysis units, and tend to have more co-morbid illnesses than patients with community acquired pneumonia (CAP). Rothberg’s study, “Quality of Care and Outcomes of Healthcare-Associated Pneumonia,” will look at whether patients hospitalized for HCAP have worse outcomes than those admitted for CAP, whether differences in outcome are due to co-morbid illnesses or to resistant organisms, and whether HCAP patients who are treated initially with the 3 broad-spectrum antibiotics recommended in the 2005 guidelines developed by the American Thoracic Society/Infectious Diseases Society of America have better outcomes than patients treated with other antibiotics.
Rothberg will mine Premier’s rich Perspective database to examine data from approximately 700 hospitals on 30,000+ patients at least 18 years old who were hospitalized with a diagnosis of pneumonia. The Perspective database allows researchers to look at “highly detailed information like the actual dates and times drugs were given,” says Rothberg, "and in some cases, lab data on the organisms involved.” According to Rothberg, some physicians are reluctant to follow the guidelines because evidence of their effectiveness is lacking. The results of his study will help guide physicians in the treatment of HCAP patients as well as aid in the development of evidence-based practice guidelines.
Co-investigators are Peter Lindenauer, MD, Dan Skiest, MD, Chief, Infectious Diseases Division, Richard Brown, MD, Infectious Diseases Division, Penelope Pekow, PhD, CQCR Senior Biostatistician, and Raquel Belforti, MD, Department of Internal Medicine. Aruna Priya, MS of the CQCR will provide biostatistical support to the project.
This article was published in the September-October 2010 Academics@Baystate newsletter.