At Emory University School of Medicine in Atlanta, Jason M. Stein, MD, and his team are working on a quality improvement (QI) strategy they hope will transfer to any hospital, anywhere. “That is where QI research lives right now,” says Dr. Stein, co-director of Emory’s hospital medicine quality improvement research program and co-chair of the department of medicine’s quality committee.
The Emory “blueprint” lays out what ideal care looks like and how physicians can provide that care. Dr. Stein’s team already has completed three successful pilot projects: preventing hospital-acquired venous thromboembolism (VTE); reducing catheter-related bloodstream infection; and improving management of hyperglycemia. “We are a mile down the road in the QI marathon,” Dr. Stein says.
Everywhere—not just in large academic medical centers, but in community hospitals and hospital medicine groups, as well—hospitalists are responding to an increased demand from government regulators, payers, and consumers to show demonstrated quality improvements. Even hospitalists on the sidelines are watching closely the experiences of others, in the hopes of marshaling their own resources and working collaboratively.
“The patient experience needs to improve at a pace we haven’t seen before in healthcare,” says Lakshmi Halasyamani, MD, vice president of quality and systems improvement at Saint Joseph Mercy Health System in Ann Arbor, Mich. Hospitalists, she says, are uniquely qualified to meet these demands.
The New Look of QI
The existence of hospitalists has changed the dynamic of QI research, Dr. Stein explains. “Before hospitalists, almost never was a clinician in charge of improving quality hospitalwide. Now, we have hospitalists who can generate and implement quality research.”
For hospitalists, QI research is rewarding and a good career move, he says. “If you fix something that’s broken today, it won’t be broken tomorrow. It’s doing something that makes a difference on a scale that’s way beyond what you normally do every day.” Plus, he adds, the demand for hospitalists with experience in quality improvement will continue to increase as more hospitals try to demonstrate their improvement efforts.
However, the increased demand could, in some cases, be a barrier to research, says hospitalist program consultant Ken Epstein, MD, MBA, former director of medical affairs and clinical research at IPC: The Hospitalist Company in North Hollywood, Calif. “There is more clinical work for hospitalists than there is time in the day, or that there are enough hospitalists to handle,” he explains. “Many hospitalists would like to do QI research, but are too busy clinically.”
That can change, but only with the support of employers. For example, academic medical centers build in time away from clinical duties and provide staff and information systems support. That’s harder to come by in community hospitals.
Funding is an issue, too. More medical schools are competing for a rapidly decreasing pool of research dollars, Dr. Stein says. That means it will be necessary to get more help from private foundations and drug companies to adequately fund quality improvement. Some hospitals are digging into their operating budgets to fund QI research.
Hospitalists in Action
Despite the barriers, hospitalists are changing the course of QI research in a variety of settings. Dr. Stein’s team at Emory is just one example. In Michigan, Saint Joseph Mercy Health System is creating a multidisciplinary practice council with teams established to study heart failure, acute coronary syndrome, and glycemic control—taking the first steps in its research efforts. “When we think about improving care, we need to think in teams, so you don’t have folks wanting to take care of one intervention that creates issues for another member of the team,” Dr. Halasyamani says.