Live from Las Vegas! Submitted by Lesley Smith, RRT-NPS, RPFT
Carolyn M Clancy, M.D., Director U.S. Health and Human Services
Agency for Heathcare Research and Quality,
Washington, D.C.
Dr. Clancy speaks on gaps in healthcare, quality, where we are doing well, and what steps need to be taken to ensure the best quality care for all Americans.
The U.S. leads the world in biomedical science, but not in h.c. delivery. “We don’t do what we know!”
The AARC is on the cutting edge for getting information about lung health out to the public. Even the NHLBI is launching a new campaign for COPD awareness.
How do we help the greatest possible # of people on the scale that we need? In discussing disparities of delivery, let’s look @ disparities on asthma & hospitalization. Ethnicity, geography, and social status are common denominators. The gaps are enormous.
Dr. Clancy related the recent loss she experienced of her dad who had severe emphysema and the great work she observed being done by our profession.
Our mission is to improve the quality, safety and effectiveness of health care for all citizens. The AHRQ is a research organization, so they depend on others to give them the information they need to drive changes.
“Patient centered outcomes research” is part of the recent Recovery Act and is one of the methodologies of determining where we need to apply our great knowledge to the care of patients – not just the “what” we are doing to take care of our patients, but the “how.” 1.1 billion dollars was awarded towards this ongoing research.
The AHRQ’s future research plans look first at “here’s what we know, here’s where the evidence stops, and here are where the gaps are going forward.” They can’t do it without the input from patients and front line caregivers such as ourselves.
There is a provision (among others) for creating a system for the “science of improvement.” It’s a whole new idea, is funded by public and private sector funds, and is also called “stake holder of governance.”
Strategy needs to be a key idea behind all ongoing efforts. So far, confusion has prevailed in the public’s attempts to access information about quality from any federal government website.
The Keystone Project via the MHA was instrumental in setting up easy guidelines to achieve a “big homerun” in health care and quality. Originated by Peter Pronovost, even after the end of data gathering for the project, the participating hospitals have been successful in sustaining their low rates of CRBSI and VAP.
Our professional aspirations should be for all patients to receive the best possible care. Per Don Berwick, former head of the IHI (and now CMS), “Only those who provide care can improve care.”
The AHRQ website contains over 800 projects, none of which have been submitted by Respiratory Therapists. Dr. Clancy urges all RCPs to go to the AHRQ website and participate. They want to hear from us! Let them know what kind of research and projects we’d like to see!
Only 50% of patients currently have an asthma management plan. Go to Guideline.gov for current respiratory related quality measures.
An interactive kiosk for patients to get education prior to going home has been implemented by Boston Medical Center, and it’s called “Project Red.” It’s individually based and is being implemented by hospitals nationwide in the effort to improve the discharge process and decrease readmissions, our next big challenge.
How we proceed to success with improvement will be based on our engagement of the patients prior to discharge – giving them tools to avoid a return trip. Two key take home points:
1. The importance of “readback.” Say this “tell me what you heard” to the patient to improve their understanding and reduce their return trip. Observe what happens @ Starbucks!
2. Information is helpful, but not the end game!
What can you do? Apply EBM, ask questions, recommend, find evidence to support, if not available, submit a request to the AHRQ.
Are we doing more harm than good? Measures to determine this need to be applied on a broader, more consistent base.
Let’s all ask “what is the game plan for each patient?” Stay on the plan for each patient with all of your colleagues.
Let’s make care as safe as possible for all patients everywhere.
Transforming health care will not be easy or straightforward. Keep asking “who’s on first?”
Only those who provide care can improve it!