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Baystate researchers advance work to improve quality of care

October 25, 2011

SPRINGFIELD, MA — Clinical researchers at Baystate Medical Center have received $2.4 million in grant funding from the National Heart, Lung and Blood Institute for a new study that examines the effectiveness of care provided for chronic obstructive pulmonary disease (COPD), the nation’s fourth-leading cause of death.


The study, led by Dr. Peter Lindenauer, medical director of Baystate’s Center for Quality of Care Research, focuses on the implementation and clinical outcomes of a noninvasive form of mechanical ventilation, one which infuses oxygen into a patient’s lungs without requiring a tube to be inserted down the patient’s throat.


Patients with severe exacerbations of COPD often require assistance with breathing; mechanical ventilation, in which a tube is inserted into the trachea, tends to require long stays in an intensive care unit, and can be associated with higher levels of complications. More than 500,000 people a year are hospitalized in the U.S. due to complications of COPD.


Although there is strong evidence that noninvasive ventilation can lead to better outcomes for patients—randomized trials in the 1990s indicated that the approach has the potential to reduce mortality by 50%-- there is limited information about the degree to which it has been widely adopted by hospitals. There is also a lack of understanding of the factors that lead some hospitals to be more rapid adopters of the new approach.


“The ultimate objective, in any healthcare-quality research, is more effective delivery of care, and better patient outcomes,” said Dr. Lindenauer. “If noninvasive ventilation is an effective means for hospitals to improve the outcomes of patients in their ICUs, we need to make sure that the therapy is being as fully adopted as possible. This study aspires to make that case.”


The award is the second largest in the history of Baystate Medical Center.


Nearly a decade after its discovery, little is known about the use or outcomes of noninvasive ventilation in hospitals. The new Baystate study will employ statistical analyses of records from a representative sample of more than 600 U.S. hospitals, combined with interviews and surveys of clinical staff, to close the gap in understanding the degree to which noninvasive ventilation is being used, and identify strategies for faster and broader implementation where appropriate.


The study responds to a call by the Heart, Lung and Blood Institute to generate an improved understanding of the processes involved in translating healthcare research into practice, and to use that understanding to enable improvements in public health and to stimulate further scientific discovery. In the study’s second stage, investigators will dig deeper into the practices of hospitals that have successfully implemented noninvasive ventilation and test the fit of those practices with lower performing institutions.


“Put simply, we will be trying to identify how successful hospitals have managed to achieve superior outcomes in order to spread those strategies to all hospitals,” added Dr. Lindenauer.


Baystate Medical Center is becoming a national leader in research into the effectiveness of care for COPD, which is expected to become the third leading cause of death in America by 2020. The Tufts University-affiliated medical center in 2010 joined a national effort to create a national repository for information about COPD care and how patients fared, and to analyze that data to paint a picture of the effectiveness of overall care for the disease. That work continues.