Embracing science, continued...

Also out today, the Department of Health and Human Services announces a new initiative entitled, "Partnership for Patients: Better Care, Lower Costs". From my initial reading, it looks like a 1 billion dollar investment, mostly in implementation of existing prevention approaches.

I'm sure we'll comment further as more details emerge, but I would like to highlight this paragraph from SHEA's statement on this initiative, which appropriately focuses on the need to advance the science of prevention (italics, for emphasis, are mine):

As the Obama Administration moves forward, we urge officials to think beyond the changes that past practice has suggested can make a difference, as well as the financial incentives and disincentives that ostensibly prompt providers to modify how they work. To really be successful, both now and in the long term, the NPSI must invest in the medical research and technology that will identify how the nation’s health system can avoid errors in care. The initiative also must be able to track and validate improvements through standardized measures and solid data. If we focus on implementation without advancing the science, we will fall short of immediate goals and risk being equally unprepared for future exigencies.

Photo credit: Kathleen Sebelius, HHS director, with Elmo. From the NY Daily News.

Addendum: Don't miss Bob Wachter's post on this initiative, here.

National Patient Safety Awareness Week

This week is National Patient Safety Awareness Week. I especially like the AskMe3 campaign, a health literacy initiative that aims to improve patient-provider communication by encouraging patients to ask three basic questions of their healthcare providers:

1. What is my main problem?
2. What do I need to do?
3. Why is it important for me to do this?

I think we should each ask ourselves these three questions every so often.

More good reading for a winter weekend

The December edition of the Atlantic has 3 interesting pieces if you have any time left over after finishing Eli's weekend reading assignment.

• Carl Elliott has written a piece on ghostwriting in medical journals (free full text here). He notes that one large pharmaceutical company labelled it's ghostwriting campaign "Case Study Publication for Peer Review." Sounds like a boring campaign name until you look at the acronym (CASPPER). Not so friendly, this ghost, however.
• Megan Mcardle writes about information technology in medicine (or the lack thereof) in "Paging Dr. Luddite" (free full text here).
• An eye-opener by Robin Fields, "God Help You. You're on Dialysis," uncovers problems with quality and safety in outpatient dialysis centers and how little is being done about it (free full text here).

James Bagian on medical error

Kathryn Schulz has a wonderful Q&A with James Bagian, director of the VA national center for patient safety, at the Slate blog "The Wrong Stuff". Read it all, but I especially enjoyed his thoughts on blame, punishment, and the perverse incentives that can be introduced by public disclosure.

Kathryn Schulz is the author of the book, Being Wrong: Adventures in the Margin of Error. I haven't read it, but I think I'll check it out.

Keeping veterans safe

As we pause on Memorial Day to remember those who have died fighting our wars, it seems fitting to recognize the strides that Veterans Health Administration (VHA) hospitals have made in patient safety, including prevention of healthcare associated infections. Over the nine years I was hospital epidemiologist at the Iowa City VAMC, I became convinced that most U.S. hospitals could learn a lot from the VA system (beginning with their early implementation of an electronic medical record that remains superior to the one we have implemented in our university hospital). While I can nitpick about the way certain directives came down, overall I think the VHA has been ahead of the curve, which may also be a commentary on progress in the rest of our fragmented healthcare system.

The VHA is the largest integrated healthcare system in the United States. It can and should serve as a model for healthcare-associated infection prevention.

Safe Patients, Smart Hospitals

I had some beach time last week so I read Peter Pronovost's new book, Safe Patient, Smart Hospitals. It's the story of his journey in patient safety, which starts with his father's death, likely hastened by a medical error. Parts of the story are probably familiar to those who work in infection prevention, but I think it's worth reading.

One of the major points he makes is that the checklist, while important, can really only work when the hospital unit embraces a culture of safety. An aspect of the book that I particularly liked is his criticism of some of the work in quality improvement because measurements lack validity. Like Pronovost, I've been accused of trying to do research by QI folks, when all I was asking was to measure a process or outcome accurately and precisely. He also points out how often ego gets in the way of doing the right thing. Over and over, I kept wondering why change is so difficult in  hospitals even when the data for a new intervention are compelling. And he reinforced my belief that infection prevention, like many other aspects of patient safety, is all about high levels of compliance with simple practices.

Unfortunately, I suspect that Dr. Pronovost is preaching to the choir. Those who might benefit most from his words are least likely to turn the pages of this book.

Patient safety education: Let's get it started!

I just reviewed the new white paper, Unmet Needs: Teaching Physicians to Provide Safe Patient Care, which outlines recommendations on incorporating patient safety concepts into medical education beginning at the start of medical school. Moreover, it even calls for incorporating questions on patient safety into the MCAT, and assessing medical school applicants for interpersonal skills that promote patient safety. We know that it's too late to begin teaching patient safety after medical school graduation, and it's too important for an incremental approach.