Contextual Factors Associated with Implementation Effectiveness within a QI Collaborative
PI: Peter K. Lindenauer, MD, MSc
A common approach for improving the quality and safety of hospital care in the United States involves bringing teams of doctors and nurses together from different hospitals to work collaboratively towards a common improvement goal. While the concept makes sense, quality improvement collaboratives are costly to run, and evidence of their benefit is limited. More importantly, little is known about why, within the same collaborative, some hospitals are more successful than others. Through surveys of senior hospital leaders and quality improvement staff, this study will examine how perceptions of new clinical practices, together with other hospital factors, contribute to successful implementation efforts. Additionally, this study will evaluate the effects of a large quality improvement collaborative focused on reducing hospital complication and death rates.
Funding: AHRQ
Implementation of a COPD Care Bundle to Improve Quality of Care in Acute COPD
PI: Peter K. Lindenauer, MD, MSc
Chronic obstructive pulmonary disease is a key health condition. Comparative effectiveness research (CER) is underdeveloped, particularly in COPD, and requires a collaborative infrastructure between the various stakeholders in healthcare. The COPD Outcomes-based Network for Clinical Effectiveness and Research Translation (CONCERT; https://www.kpchr.org/concert/) proposes to develop a research infrastructure that will accelerate the development and conduct of multi-institutional, multi-disciplinary studies that are responsive to the COPD CER priorities of stakeholders (CONCERT-CER).
Funding: NHLBI
Quality of Care and Outcomes of Healthcare-Associated Pneumonia
PI: Michael Rothberg, MD, MPH
This study will provide important insight into a clinical dilemma faced by physicians who care for as many as 300,000 patients each year with Healthcare-Associated pneumonia (HCAP). This study will assess whether patients with HCAP are receiving care consistent with the recommendations found in guidelines developed by the American Thoracic Society and the Infectious Disease Society of America, and whether those treated according to the guidelines have better outcomes than patients who are treated with other antibiotics. These results will help clinicians balance the potential benefits of the recommended antibiotics against the potential harms of antibiotic side effects, future antibiotic resistance, and increased costs. If recommended therapy is beneficial but underutilized, these results will alert quality improvement officers and policy makers to an important opportunity to improve patient care for a common and deadly illness.
Funding: AHRQ
The Effectiveness and Safety of Beta Blockers in Patients Admitted with Acute COPD Exacerbations
PI: Mihaela Stefan, MD
We are examining the effects of beta-blocker therapy on outcomes of patients admitted with an acute COPD exacerbation with coexistent hypertension, ischemic heart disease, or heart failure.
Funding: CTSI/Tufts Award
Patients’ Evaluations of Health Care Providers in the Era of Social Networking: an Analysis of Physician-rating Websites
PI: Tara Lagu, MD, MPH
In the first study of its kind, Dr. Lagu sought to describe the structure and content of physician-rating websites in the United States, evaluating 33 websites and 300 Boston physicians. Dr. Lagu is continuing her research on the public reporting of patient opinions and expanding her approach to include reviews of hospitals, a wider geographic area, and qualitative analysis.
The Impact of Transfer Status on Mortality Measurement
PIs: Evan Benjamin, MD and Peter K. Lindenauer, MD, MSc
This study is seeking to determine if current methods of measuring hospital mortality account for the issue of the complexity of transferred patients to tertiary hospitals.
Funding: AAMC
Validation of the Premier Harm Index
PI: Evan Benjamin, MD
This study seeks to validate an administrative measure of harm for benchmarking hospital patient safety. Using the hospitals in the Premier QUEST project, we will validate administrative coding of various harm scores against chart review.
Funding: Premier
Improving Women’s Health by Identifying Factors Associated with Risk-adjusted Obstetric Complications
PI: Sarah L. Goff, MD
In this study, we are using Premier's Perspective database to describe risk-adjusted variation in hospital level rates for three common obstetric complications, trauma infection, and hemorrhage. We will also describe the relationship between cost of uncomplicated deliveries and hospital complication rates and begin to assess organizational strategies used by hospitals with lower complication rates.
Obstetric Healthcare-associated Infections: Identifying Hospital Characteristics and Clinical Practices Associated with Lower Infection Rates
PI: Sarah L. Goff, MD
This project seeks to identify potentially modifiable factors associated with risk-adjusted obstetric healthcare-associated infection rates at the hospital level using Premier's Perspective database.
Variation in Treatment and Outcomes in Sepsis
PI: Tara Lagu, MD, MPH
Working with faculty from the Critical Care Division at Baystate Medical Center, we are studying the care and outcomes of more than 200,000 patients hospitalized for the treatment of sepsis. Our work is focused on describing variations in treatment patterns and outcomes across hospitals, examining the effectiveness of common therapies, and exploring the relationship between cost and outcomes of care. In future studies, we hope to identify hospital characteristics and processes associated with high-value sepsis care.
VTE prophylaxis in Hospitalized Medical Patients
PI: Michael Rothberg, MD, MPH
We are performing a comprehensive analysis of patient risk, physician prescribing, and outcomes for medical patients at high risk for venous thromboembolism at 400 US hospitals. Specific projects include developing a risk prediction model for developing VTE; describing patient, physician and system factors associated with VTE prophylaxis; and examining the comparative effectiveness and cost-effectiveness of low molecular weight and unfractionated heparins. This project is funded by a grant from the Doris Duke Foundation.
Readmission and Hospital Quality
PI: Mihaela Stefan, MD
Readmission of patients following hospital discharge is a clinically important, expensive, and often preventable adverse outcome. Working with colleagues at the Oklahoma Foundation for Medical Quality, we are using Medicare claims files and patient-level data from Medicare's Hospital Compare database to study the relationship between existing quality measures and risk-adjusted hospital readmission rates for pneumonia, heart failure, and myocardial infarction. This project is supported by a grant from the Baystate Medical Center Incubator Fund and is part of a larger effort to examine the effects of public reporting on readmission rates.
Completed Projects
The Effectiveness of Antibiotics and Steroids in Patients Hospitalized for Acute Exacerbations of Chronic Obstructive Pulmonary Disease (COPD)
PI: Peter K. Lindenauer, MD, MSc
In collaboration with the Division of Infectious Disease at Baystate Medical Center, we examined the effects of antibiotic therapy on the outcomes of patients hospitalized for acute exacerbations of COPD. In a related project, we studied the comparative effectiveness of orally and intravenously administered corticosteroids. We previously reported that the vast majority of hospitalized patients are initially treated with intravenously administered steroids despite the fact that current guidelines suggest that oral therapy is equally effective, less expensive, and may be associated with fewer complications.
