For more than a decade, surgeons doing open-heart surgery have competed for patients with interventional cardiologists, who implant stents. And the surgeons have been losing ground, the Philadelphia Inquirer reports: Since 1997, the number of heart bypasses in Philadelphia and the four Pennsylvania suburban counties has fallen nearly 57%, to 2,602 in 2008, an analysis of hospital billings found. In the same period, the number of procedures that implanted one or more stents rose nearly 24%, reaching 10,611 by 2008. But some doctors say hybrid heart procedures, which can be done on one day or in stages over several weeks, offer the best of both approaches.
A divided Michigan Supreme Court has issued an order creating new deadlines for healthcare providers being sued for malpractice, the Associated Press reports. Under the order, those accused of malpractice must challenge a notice of intent to sue within 63 days. Propenets say the change brings malpractice cases into line with other civil suits.
As consumers continue to flock to the internet and social media sites, so do physicians. In fact, 86% of U.S. physicians said they use the Internet to gather health, medical or prescription drug information, according to a recent Google study. But unlike ordinary consumers, physician internet and social media use comes with risks.
How long do you think it takes for the latest evidence-based research findings—new data on heart disease treatment or ways to reduce emergency room waiting time—to make their way into clinical practice?
Most people are surprised to learn that it's an average of 17 years. That lag time would be troubling for any industry aiming to improve its performance. But it poses a crucial problem in healthcare, where costs and quality issues are under close scrutiny.
Why is the journey from findings to practice epic in length?
Research information is typically shared among selected audiences, often leaving the groups that could benefit the most, such as patients, healthcare providers, or health purchasers, without information they could put to use. Too often, the status quo or more expensive, but not necessarily better, option wins the day.
Changing this dynamic does not happen overnight, but it can be done.
Using evidence-based research conducted in universities, hospitals, and health systems around the country, the federal Agency for Healthcare Research and Quality (AHRQ) creates practical resources and tools that are ready to be used on the front lines of care. Long known for its focus on healthcare data, patient safety, and quality improvement, AHRQ, part of the U.S. Department of Health and Human Services, has expanded its portfolio of work to include comparative effectiveness research and health information technology.
Social marketing can increase research uptake
Along with traditional and new media outreach, AHRQ uses social marketing techniques to identify and address the needs of targeted audiences, including clinicians, hospitals, pharmacists, healthcare purchasers, public policy decision-makers and patients. Social marketing has a decades-long and accomplished track record in public health improvements such as reducing tobacco use, heightening awareness of the dangers of drinking and driving, and preventing teen pregnancies.
Using social marketing to increase awareness and uptake of health services research findings, which is AHRQ's area of expertise, is at an earlier stage. Early work shows it holds significant promise.
AHRQ uses social marketing techniques to position its tools and resources to address audiences' various information needs. Tactics—which range from face-to-face "academic detailing" with state hospital associations and quality improvement groups, to relationship marketing with state policymakers, to national media campaigns for consumers—reflect the specific information needs and tailored approaches for these audiences.
Targeting information
Not long ago, the term "detailing" referred exclusively to the personal visits and free samples that drug company representatives provided to doctors. That method of awareness and uptake has been expanded. Today, the practice of "academic detailing" is used by government agencies and others to refer to educational interactions among doctors and pharmacists on a variety of issues, including potential drug-drug interactions, the effective use of generic medicines, and the promotion and awareness building about quality improvement tools.
Using the principles of academic detailing, AHRQ has reached out to state hospital associations and quality improvement organizations to teach them about tools and resources to enhance patient safety and to help share that information with their members. Tactics include face-to-face training sessions, Web tutorials, audio conferences, and other educational activities.
For example, AHRQ provided face-to-face training sessions and Web tutorials in late 2009 to give organizations representing 30 states guidance on how to use TeamSTEPPS, a system developed by AHRQ and the Department of Defense to improve communication and teamwork among healthcare professionals. The curriculum is rooted in more than 20 years of research and lessons about the application of teamwork principles. More than 1,100 master trainers in the United States, Japan, Taiwan, Australia, and The Netherlands have trained an estimated 12,000 healthcare professionals using the tools.
In January 2010, a Web tutorial for state hospital and quality improvement groups provided information about an AHRQ-funded project to re-engineer the hospital discharge process to reduce readmissions at a major Boston medical center. Called Project RED (for Re-Engineered Discharge), the initiative focuses on improving patient education and providing clear information before, during, and after the hospital discharge process.
Working with State Governments
State Medicaid directors are a key audience for AHRQ research findings on quality improvement. As the Federal/State health insurance program for low-income and disabled Americans, Medicaid covers nearly 58 million people, according to the Centers for Medicare & Medicaid Services. The economic recession has put added pressure on State Medicaid programs to spend dollars wisely.
To forge a common ground for sound policymaking, AHRQ has created a Medicaid Medical Directors Learning Network. The Learning Network provides a forum for clinical leaders of State Medicaid programs to discuss their pressing needs as policymakers and to use relevant AHRQ products to address their concerns.
Twenty State Medicaid medical directors reported that they used AHRQ's Effective Health Care (EHC) program resources during 2008 in a variety of ways. The EHC program produces comprehensive reports of scientific studies on topics such as treatment options for prostate cancer and diabetes to allow doctors, patients, and policymakers to make head-to-head comparisons of different healthcare interventions. The reports also identify where further research is needed.
Findings from the EHC program are being used by States to help develop clinical treatment option recommendations as part of health plan educational materials, and to help inform policy for coverage decisions.
Consumer outreach
AHRQ research has shown that asking questions of doctors and hospitals is a simple but effective way to improve quality and safety. Patients who get more involved in their healthcare can improve their care, but they are often unsure of how to go about this.
To help consumers become more proactive, AHRQ joined with the Ad Council in 2007 to launch a national public service ad campaign called "Questions are the Answer."
Using a light-hearted approach, one ad features a man asking detailed questions about a new cell phone and another shows a woman querying her waiter about choices on a menu. When it comes time to ask their doctor questions, however, both clam up. The takeaway: Ask questions of your doctor to get the healthcare you need.
The campaign generates an average of 30,000 visitors to the "Questions Are The Answer" section of AHRQ's Web site each month. Ad spots continue to appear on radio, network and local cable TV, newspapers, Web sites, and outdoor billboards and bus shelters and have garnered nearly $70 million in free, donated media placements to date.
Conclusion
There are no easy solutions to give patients and healthcare providers the best and most recent information available. The U.S. healthcare system is too complex, diverse, and vast for that.
That's why AHRQ believes strongly in the value of social marketing to accelerate learning among patients and translate research findings into practice among providers. Based on our results to date, we will continue to forge findings into usable tools and products, provide technical assistance where needed, and measure the results of our efforts.
Allan J. Lazar is Director of AHRQ's Office of Communications and Knowledge Transfer, Rockville, MD.
For information on how you can contribute to HealthLeaders Media online, please read our Editorial Guidelines.
The White House hinted that President Obama might post his own health reform bill on the Internet before the bipartisan healthcare summit he is planning for next week, the New York Times reports. Obama has announced the health summit to try breathe life back into the legislation and has promised to put the Democrats' bill online before the session. During a news conference, President Obama said he envisioned posting a merged House-Senate bill that would address his goals of controlling costs and expanding coverage, the Times reports.
Emergency room doctors and on-call specialists treating poor, uninsured patients at private hospitals in Los Angeles County had their reimbursement rate slashed by county supervisors. The rate cut could lead private hospitals to close emergency rooms and send more patients to crowded county hospitals, officials said. Los Angeles County reimburses doctors 27% of estimated fees for patients' first three days of care at private hospitals under the Physician Services for Indigents Program. Supervisors voted unanimously to reduce the rate to 18% as of July 1, the Los Angeles Times reports.