Creating Partnerships to Reduce Infections and Improve Cardiac Care
Donald Likosky, Ph.D.
Health Services Research and Quality
Department of Cardiac Surgery
University of Michigan
“It’s so rewarding when experts from a number of different specialties come together to solve our health system’s most complex problems.”
For health services researcher Donald Likosky, Ph.D., working in teams isn’t just a good idea, it’s a way of life. “I think the success of our work can be attributed to developing partnerships between health services researchers and clinicians. As a Ph.D. researcher, it has been incredibly important to have clinical partners available to articulate the problems they encounter. We work closely together to solve them,” says Dr. Likosky, who heads the University of Michigan’s Section of Health Services Research and Quality in the Department of Cardiac Surgery in Ann Arbor.
For Dr. Likosky, this means working alongside physicians, nurses, and other members of healthcare teams to study distinct factors that contribute to heart surgery outcomes. Heart surgery is one of the most commonly performed inpatient procedures, with processes of care and factors both within and outside of healthcare organizations influencing surgical safety and outcomes.
Dr. Likosky’s approach gets at the heart of health services research—focusing on facets of performance as they relate to outcomes for patients. This approach has led Dr. Likosky, who is also a professor of cardiac surgery at the University of Michigan, to focus on patterns of care—especially variations in process and outcomes, and their consequences. “What are the aspects of care that contribute to better or worse outcomes across hospitals and health systems?” he wonders. “Is it differences in patient risk? Is it the way care is managed in the operating room or intensive care unit?”
Dr. Likosky has received five AHRQ grants to develop a body of research that is improving the care that actually reaches patients. In 2006 with an Independent Scientist Award, Dr. Likosky worked with a small number of northern New England medical centers to identify the principal causes of brain injury following cardiac surgery. Brain injury is one of cardiac surgery’s most severe adverse outcomes. After identifying successful strategies to reduce cardiac surgery-related brain injury, Dr. Likosky shared these findings with clinicians across other hospitals involved in the Northern New England Cardiovascular Disease Study Group, and partnered with them to implement these strategies more broadly.
With funding he received from AHRQ in 2011, Dr. Likosky developed the IMPROVE Network, a network of physician-led, regionally based collaboratives focused on improving the quality of cardiovascular surgical care. He is still director of the network, which convenes annually to advance the quality and safety of cardiac surgical care across the approximately 100 represented hospitals. “These collaborative organizations are committed to working together—not because they’re in close proximity, but because they share the same mission,” he says.
Dr. Likosky expanded his AHRQ-funded research in 2013 when he started investigating healthcare-associated infections (HAIs). HAI rates vary widely after coronary artery bypass graft surgery (CABG). Leveraging the Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative’s learning model, Dr. Likosky and his team reduced post-CABG pneumonia in hospitals throughout Michigan. Details from this study were published in the November 2018 issue of Circulation Cardiovascular Quality and Outcomes.
Then, in 2014, he received another AHRQ grant to study variability in cardiac surgery-related blood transfusions, which are associated with higher death and illness rates. In this research, Dr. Likosky and his team developed a risk prediction model that provides a patient-specific estimate of the need for transfusion and offers clinicians a guide for evaluating blood management strategies. This risk prediction model was detailed in a study published in March 2017 in Annals of Thoracic Surgery.
Currently, Dr. Likosky is leading a multidisciplinary team of researchers to find ways to reduce HAIs among patients who receive an implanted mechanical pump called a left ventricular assist device, or LVAD. LVADs help a weakened heart pump blood, but almost 30 percent of patients develop an HAI within 90 days of having the device inserted. Initial data in this project, which will be completed in 2023, indicate wide variation in HAI rates for patients with LVADs. Dr. Likosky’s team includes quantitative and qualitative scientists as well as clinicians to understand what leads to differences in hospital HAI rates after LVAD implantation.
Principal Investigator: Donald Likosky, Ph.D.
Institution: University of Michigan
Grantee Since: 2006
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 https://www.ahrq.gov/training.