Plenary sessions at AHRQ annual meeting focus on connecting the dots between research and practice
With interest in the Nation's health care system at an historic high, 1,823 participants from 20 countries gathered at the Agency for Healthcare Research and Quality's annual conference September 26-29 in Bethesda, Maryland, to explore how health services research can improve care for all Americans.
"We believe data can reveal new knowledge otherwise invisible to individual observation, and execution of that new knowledge can save lives and save resources," said Dr. Atul Gawande during the conference's keynote address on September 28. The surgeon, professor, New York Times bestselling author, New Yorker contributor, and AHRQ-funded researcher spoke to a packed ballroom about "Transformation and Change: Making a Complex System Safe and Right."
Dr. Gawande's speech, the conference's second plenary session, provided examples of how U.S. Army researchers harnessed trauma registry data to discover patterns in battlefield deaths.(Figure 1). Col. John Holcomb, a U.S. Army trauma surgeon, found that injuries that should have been prevented by body armor weren't, because soldiers weren't wearing it. Using research to initiate changes in troop behavior and battlefield surgery, the military has been able to reduce battlefield death rates that stubbornly remained at 25 percent since World War II to less than 10 percent today. "The key to all of this was the willingness to treat failures like scientific problems and to pursue innovations wherever that took them," said Dr. Gawande. "They're saving people who have never been saved before."
Now in its fourth year, the AHRQ conference is where "we try to connect the dots between research and practice," said Health and Human Services Secretary Kathleen Sebelius in a video address at the opening plenary session on September 27. "Translating the purity of the scientific investigation into the daily demands of a doctor's office is not an easy thing to do." Panelists at the opening plenary session agreed.
The panel, moderated by AHRQ Director, Dr. Carolyn Clancy, was convened to gather feedback from those practicing in the field on what is needed to improve 21st century health care. Dr. Maulik Joshi of the Health Research and Educational Trust, Debra Ness of the National Partnership for Women and Families, and Dr. James Mold of the University of Oklahoma Health Sciences Center "model the kind of collaboration we need to see across the country," Dr. Clancy said.(Figure 2).
Tailoring solutions at the local level
Some of the solutions for fulfilling the conference's theme of "Better Care, Better Health: Delivering on Quality for All Americans" may find purchase if they are tailored for delivery at the local level, according to the plenary speakers. For example, Dr. Mold said the family physicians he visits in rural Oklahoma could benefit from a structure similar to the U.S. Department of Agriculture's local network of extension offices, which advise local farmers on improved practices and share farming innovations. "They (physicians) need a dissemination and implementation infrastructure, something that's local but connected to each other," he said. "It's all about relationships."
Solutions must also be patient-centered, asserted Ms. Ness. Although the current health care system appears to be provider-centric, consumer preferences must be a "game-changing force" in transforming the health care system, she said. "Patients want care from somebody who knows them. They want coordinated care. More than anything else, they want their docs to talk to each other." She added that patients also want tools to help them participate as partners in their care and access to care when they need it.
Moving from identifying problems to providing solutions
Research must move beyond identifying problems to providing realistic solutions that meet both physician and consumer needs, noted Dr. Gawande. He told the audience that after "two decades chronicling the patterns and recording the symptoms and pathologies of our systems of health care delivery," it is now time to move from being "diagnosticians" to providing solutions.
Health services research has shown that solutions are within reach. For example, Dr. Gawande's AHRQ-funded research showed that when surgical team members introduce themselves and use safety checklists before and after surgery, error rates plummet. He believes research can also help local health care systems reduce overuse of inappropriate services, such as imaging and surgery, and reduce inappropriate emergency department and hospital use. Research may also provide answers for how to improve care for the terminally ill and chronically disabled, he added.
Providing solutions that will work at the local level is challenging, because communities and their needs differ widely. Using the statistic that 1 percent of patients account for 30 percent of costs, Dr. Gawande gave three examples of communities and the problems that cost them the most. The 1 percent of patients in Camden, New Jersey, suffer from severe disabilities with drug and alcohol addiction, homelessness, and poverty. Massachusetts General Hospital's 1 percent struggles with terminal illness. Finally, a self-insured company's 1 percent contends with chronic back pain and musculoskeletal injuries. Implementation of evidence-based solutions is also a challenge. Dr. Joshi remarked that hospital staff often quiz him on implementation issues. "I hear the 'how to' question all the time," he said, adding that he commends AHRQ for investing in implementation and dissemination in addition to research.
One solution for disseminating innovations may be found in AHRQ's Medicaid Medical Directors Learning Network, noted Dr. Clancy. The network provides a forum where clinical leaders of State Medicaid programs can discuss their most pressing issues. Learning network participants often use AHRQ products, such as evidence reports comparing the effectiveness of different treatments for a condition, to tackle these issues. "The idea that they have these resources at their disposal and that we could in some way hook them up with someone who could help them make sense of all these data is pretty remarkable," Dr. Clancy said.(Figure 3).
Conducting research, developing solutions, and providing answers to the "how to" falls squarely on the shoulders of those who attended the conference, concluded Dr. Gawande. "Close attention to the patterns of our failures, of our system failures, can be contentious but absolutely necessary. And we'll need to couple that with a kind of creativity to try new solutions on the smallest level, based on these patterns. That is the challenge that all of us face, and this is the room where there are the people who will do it. And this is the Agency that will help drive it. And this is the time."
Editor's Note: Webcasts of the two plenary sessions are available at http://www.ahrq.gov/about/annualconf10/. Session speaker presentations will be posted on the AHRQ Web site later this fall. The 2011 conference is September 18-21.
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