What can you do with a quarter of a million dollars? In some places, that amount can buy a home that can shelter a family for decades. In other places, it is enough to pay annual malpractice insurance premiums for physicians practicing in high-risk specialties—with a little left over.
But if you wanted to use that money for an enduring healthcare project that would provide the most good for the most people, how would you do it? Hospitalists can look to the Agency for Healthcare Research and Quality (AHRQ) for stellar examples of well-invested dollars with excellent return.
With a staff of approximately 300, the tiny AHRQ is the lead federal agency charged with improving the quality, safety, efficiency, and effectiveness of healthcare for all Americans. It creates a priority research agenda annually, and funds studies in areas where improvement is deemed most needed. These include patient safety, data development, pharmaceutical outcomes, and other areas described on its Web site (www.ahrq.gov/).
In 2005, AHRQ announced its Partnerships in Implementing Patient Safety (PIPS) and committed up to $9 million in total costs to fund new grants of less than $300,000 per year, lasting two years. AHRQ indicated that eligible safe practice intervention projects would be required to include “tool kits,” and a comprehensive implementation tool kit to help others overcome barriers and allay adoption concerns. AHRQ’s goal was and is to disseminate funded projects’ perfected tools widely for adaptation and/or adoption by diverse healthcare settings.
AHRQ asked that principal investigators (PIs) be experienced senior level individuals familiar with implementing change in healthcare settings. Their expectation was that PIs would devote at least 15% of their time to the project for its duration. Thus the competitive challenge to potential PIs was great:
- Select a worthy project from among the endless areas where healthcare needs improvement, and then plan specific, realistic, achievable interventions that could create measurable improvement over two years;
- Implement the program; and
- Develop a plan and tools so basic and user-friendly that they could feasibly be applied in not just the local practice setting, but in other healthcare settings.
Although the size and duration of the awards varied, many of the 17 projects they funded received slightly more than a quarter of a million dollars. Among the funded projects, two boast hospitalists as their PIs and address areas of obvious concern in most healthcare settings. Greg Maynard, MD, MS, at the University of California, San Diego, was funded to implement a venous thromboembolism (VTE) intervention program. And Mark V. Williams, MD, FACP, professor of medicine, Emory University School of Medicine, Atlanta, and editor of the Journal of Hospital Medicine, was funded to implement a discharge bundle of patient safety interventions respectively.
Stalking the Silent Killer
Dr. Maynard’s project, “Optimal Prevention of Hospital Acquired Venous Thromboembolism,” focuses on eliminating preventable hospital-acquired VTE at an academic healthcare facility that has a large population of Hispanic patients.
The project’s timeliness and utility is clear: Although the exact incidence of VTE is unknown, experts estimate that approximately 260,000 are clinically recognized annually in acutely hospitalized patients.1 Pulmonary embolism (PE) resulting from deep vein thrombosis (DVT) is the most common cause of preventable hospital death, the majority of hospitalized patients with risk factors for DVT receive no prophylaxis, and the rate of fatal PE more than doubles between age 50 and 80.2,3 The problem is easily recognizable, but “Getting people to do what they need to do to prevent VTE can be hard,” says Dr. Maynard.