Studying HAI Prevention Efforts to Inform Better Clinical Care and Policy
"Throughout my career, AHRQ funding has helped me pursue multiple avenues of research to improve patient outcomes and inform better decisions."
For many health care providers, reducing healthcare-associated infections (HAIs) has become a high priority.
For Grace M. Lee, M. D., M.P.H., Associate Chief Medical Officer for Practice Innovation at Stanford Children’s Health, preventing infections in children has long been a priority. AHRQ funding beginning in 2004 helped her build the foundation for ongoing work on the issue.
As a junior researcher at Harvard Medical School and Boston Children’s Hospital, Dr. Lee received an AHRQ mentorship grant that helped her hone research skills while she studied aspects of patient preferences and cost-effectiveness in how to treat and prevent Group A streptococcus, a bacterium that can cause pharyngitis (commonly known as a sore throat) in some children. Antibiotics to treat pharyngitis are usually prescribed in the outpatient setting and account for 10 percent of total antibiotic prescriptions in the United States. Understanding how patient preferences and costs factor in to the prescribing of antibiotics can help clinicians address the concerns of patients—and their parents—while using antibiotics appropriately.
Following the completion of this initial grant, Dr. Lee received additional AHRQ funding to expand her focus to a variety of pediatric infectious diseases in the hospital setting. She led an AHRQ-funded research team that developed a new surveillance definition for pediatric ventilator-associated events (VAEs), which include ventilator-associated pneumonia. This type of pneumonia affects between 5,000 and 10,000 pediatric intensive care unit (ICU) patients annually and is one of the most common HAIs in U.S. neonatal and pediatric ICUs.
Developing a definition of VAE that is specific to pediatric patients is important, because it recognizes and addresses issues that aren’t seen in adults. This distinction is meaningful to clinicians who practice in neonatal and pediatric ICUs. As part of this work, Dr. Lee was also able to identify potential pediatric VAE intervention bundles, a set of evidence-based practices or processes that show consistently better patient outcomes. Together, these resources can help clinicians better understand and improve the quality of care for children on ventilators.
Dr. Lee, who joined Stanford University’s School of Medicine as a professor of pediatrics in 2017, is currently principal investigator on an AHRQ-funded grant that continues through 2019. It focuses on the impact of HAI-related policies from the Centers for Medicare & Medicaid Services on health outcomes and costs. Recent findings from the project, known as Preventing Avoidable Infectious Complications by Adjusting Payment, or PAICAP, suggest that although these policies may help focus hospital leaders’ attention on the issue of HAIs, the policies themselves have not had a measurable effect on infection rates.
Dr. Lee was a member of AHRQ’s Healthcare Safety and Quality Improvement Research Study Section. She also serves on the Board of Population Health and Public Health Practice of the National Academy of Medicine (formerly the Institute of Medicine).
Principal Investigator: Grace M. Lee, M.D., M.P.H., Professor of Pediatrics
Institution: Stanford Children’s Health
Grantee Since: 2008
Type of Grant: Various
Consistent with its mission, AHRQ provides a broad range of extramural research grants and contracts, research training, conference grants, and intramural research activities. AHRQ is committed to fostering the next generation of health services researchers who can focus on some of the most important challenges facing our Nation's health care system.
To learn more about AHRQ's Research Education and Training Programs, please visit http://www.ahrq.gov/training.