Making Healthcare Quality Count

By Angela Young 6 months ago

Following are examples of research now in progress that focuses on improving health care quality.

Bringing evidence-based medicine to the hospital bedside. Researchers at the University of Iowa are carrying out a 3-year randomized study at 12 hospitals in Iowa, Missouri, and Illinois to evaluate the effectiveness and cost-effectiveness of implementing an evidence-based acute pain management guideline for hospitalized elderly hip fracture patients. The intervention targets both nurses and prescribing physicians and includes training, computerized learning modules, the use of opinion leaders, the use of feedback and reminder cards, and system interventions for modifying chart forms and institutional policy. The goals are to determine whether a multidimensional organizational intervention alters nurse and physician behaviors and whether institutional barriers to change are reduced.

Evidence-based reminders in home health care. These researchers are comparing the effectiveness of two alternative information-based strategies intended to improve provider performance and promote adherence to evidence-based guidelines among home health care nurses. The study uses a randomized design that assigns nurses to one of two treatment groups or a control group (usual care).

Nurses in the basic intervention group receive "just in time" E-mail reminders highlighting six condition-specific practices they should follow for patients with either heart failure or cancer pain. Nurses in the augmented intervention group receive the same E-mail reminders along with additional information and consulting services from an expert peer.

Understanding variability in community mammography. This community-based, multicenter observational study involves a unique collaboration among three geographically distinct breast cancer surveillance programs in the States of Washington, New Hampshire, and Colorado. The investigators are collecting breast cancer outcomes and interpretive data on more than 500,000 mammograms from 91 facilities and 279 radiologists. The goal is to identify reasons for variability in the interpretation of mammograms and determine how the quality of mammography can be improved.

Racial and ethnic variation in medical interactions. In this 5-year program, researchers at the Baylor College of Medicine and the Houston VA are developing and testing interventions to improve doctor-patient communication patterns to reduce racial and ethnic disparities in use and outcomes. Both clinicians and patients are participating in the project, which also includes an information dissemination component to translate research findings into practice as rapidly as possible.

Otitis media: Parent education to avoid antibiotic use. Acute otitis media (AOM) continues to be a major child health problem. The average child experiences 2.6 AOM episodes per year in the first 2 years of life. The overuse of antibiotics for AOM has led to the emergence of multi-drug resistant pathogens, even though research has shown that 80 to 90 percent of children with AOM will recover without antibiotics.

This randomized controlled trial is evaluating the safety, efficacy, cost to parent, and acceptability of an intervention consisting of parent education, nonantibiotic symptomatic therapy, and careful followup of children with mild AOM. The goal is to establish the safety of withholding antibiotics from children with mild AOM and change parents' expectations about universal antibiotic treatment of AOM.

Benefits of regionalizing surgery for Medicare patients. In this ongoing study, researchers at Dartmouth Medical School are using Medicare data and data from AHRQ's National Inpatient Sample (NIS) to investigate the potential benefits of regionalizing patients who have certain high-risk procedures.

For example, in the April 11, 2002, issue of the New England Journal of Medicine, they reported a 12 percent difference in survival for patients being treated for cancer of the pancreas at high- and low-volume hospitals. Only 4 percent of patients treated at the highest volume hospitals died, compared with 16 percent at the lowest volume hospitals. Indeed, they found that elderly patients undergoing treatment for any 1 of 14 high-risk cardiovascular or cancer operations were more likely to survive if they were treated in high-volume hospitals.