Moving to the Next Stage: Quality and Efficiency Improvement Jerome H. Grossman, MD Director Health Care Delivery Policy Program Harvard University JFK School of Government Presentation.
Download ReportTranscript Moving to the Next Stage: Quality and Efficiency Improvement Jerome H. Grossman, MD Director Health Care Delivery Policy Program Harvard University JFK School of Government Presentation.
Moving to the Next Stage: Quality and Efficiency Improvement Jerome H. Grossman, MD Director Health Care Delivery Policy Program Harvard University JFK School of Government Presentation to Mayo Clinic January 22, 2004 Scanning the Environment - Costs • Increasing at steep rate • Increased uninsured – increased middle class concern • Employers pass increasing cost to employees • Employers pass increase onto retirees – not new employees • Government passes increase onto retirees and states (Medicaid) • Medicare Bill includes medical savings account • The beginning of health 401(k) • Employers/govt. decreasing responsibility for health insurance Quality • Quality focus dominates media and legislation • However progress stays in neutral - Scattered successes balanced by new revelations of error • Strategy shifting from projects to “systems thinking” • Lack of transparency and safety oversight becoming larger issue - Finance has SEC - Civil Air Transport has FAA - Health has JCAHO – malpractice (mainly self-regulation) Implications • Transition coming - From professional determined public good (civil right) - To market-based service industry • Tightly integrated orgs. like Mayo have first mover advantage -Have been working together on quality, information systems and service since inception (most intensely in the past decade) - High level “Brand” remains quality measure “but” . . . There is a new challenge coming! Productivity • Why is medicine a special case? • Up to now, many actors, little data, many outcomes • Advances in medical information and economic methods (for service industry) make research possible KEY RESULT: • Integrates Costs and Quality For Example Clinical Condition “Input” Quality “Output” Arthritis of Hip - with surgery - without surgery • mild • moderate Medical Surgical Rehab - Technical - Functional - Trust • severe - Service All Resources ($) Used Research Projects at Harvard Studying the History of Treatment Innovation • Acute medical - AMI • Chronic medical -Diabetes -Pediatric asthma -Congestive heart failure • Surgical – minimally invasive surgery • Preventive – colon cancer screening An Engineering Agenda to Help Realize the IOM Vision Two Major Interconnected Opportunity Sets for Engineering and Medicine 1. Information and information/communication technologies and associated research to advance connectivity, information flow, coordination. 2. System design, analysis and control tools & associated research to advance understanding of processes and system interactions; and improve/optimize dimensions of system performance in face of constraints. Information and Information/Communication Technologies Information and information/communication technologies and associated research to advance: • Connectivity • Information flow • Coordination For Example Wris t Blood Pressu re Mon itor 120 80 Il lustration of a se lf contai ned, wrist worn bl ood pre ssure de vice si mi lar to that marketed by O MRO N Inc (~$75 US) Data Monitoring PTT Signals f rom the ECG and pulse pressure changes provide different physiologic inf ormation and can be used together to gain additional data such as the pulse transit time (PTT). Rapid pulse timing can be from a pulse pressure monitor or from a pulse oximeter in the ref lectance mode or conventional transmission mode. Wireless Endoscopy Capsule Endosc ope 11 mm x 26 mm Data Recor der with B atery pack which can be downloade d onto laptop compute r Antennae Wi re le s s e ndoscopy usi ng a dis posabl e s e lf containe d cam e ra in an avai labl e capsul e (11m x 26mm ) whi ch is tracke d by an ante nnae array faste ne d to the torso (GIVEN IMAGING Ltd., http://www.gi ve nim agi ng.com/usa). Biomonitoring Techniques Biomonitoring GPS A. Chemistry chip pendant (saliv a sampling ) B. Skin electrodes A (cardiac & respiratory) B C. Strain guage & Heart Rate Monitor C D. Accelerometer D, F, H D, E, G E. Phone / Camera / GPS F. Chemistry (p02, pCO2, suga r) G. Local area network H. Pulse Pressure D Systems Design and Implementation System design, analysis and control tools and associated research to: • Advance understanding of processes and system interactions • Improve/optimize dimensions of system performance in face of constraints Health Care System Quality Process •Protocols • Procedures • Best Practices Patient Inputs • Severity • Comorbidities • Age/Sex • Socioeconomic Status • Compliance • Genetics • Expectations • Attitude •Safety • Service • Timely Patient Outcomes Infrastructure • Credentialing • EMR • Staffing • Facilities • Volume • Integrated Practice • CPOE • Educational Environment • Teamwork • Innovation • Patient-Centered • Systems Engineering • Mortality • Morbidity • Functional Status • Quality of Life • Cost of Care • Satisfaction Source: Jim Naessens, Thesis Work Integration of Multiple Subsystems PCP Triage Lab Surgery Admitting ICU ED Patient Ed. Nursing Library Post-OP Specialist For Example ←FROM: Computerized Physician Order Entry ----Process Distribution ←TO: Computer Aided Design (CAD) ----Computer Aided Manufacture (CAM) DESIGN AUTOMATED PROCESS MANAGEMENT Orders What First? What to Do When Evidence Based Medicine Caretaker “Alters” Process What Next? When to Interfere Due to Delay Send Message to “Delay Factor” Reset Process Solving the Simultaneous Equations Government Consumers Employers Consumer Aggregators Insurers/Risk & Disease Management Regulation Delivery Aggregators Safety (FED, FAA) Transparency (SEC) Practices Hospitals Drugs Integrated Systems Productivity •Better •Cheaper •Faster