After reading the National Journal’s (October 29, 2007) synopsis of the plans unveiled by presidential hopefuls I had to wonder. Who knows that there is a government agency in operation since 1989 with a budget this year of 269+ million dollars with the mission to “sponsor and conduct research that provides evidence-based information on healthcare outcomes; quality, and cost; use and access”? Its mission is to find information that “helps health care decision makers – patients, clinicians, health systems leaders, purchasers, and policymakers – to make more informed decisions and improve the quality of health care delivered.”(www.ahrq.gov)
Per plans outlaid in their campaign literature Senators Edwards, Obama, and Clinton are each interested in establishing a new federal organization to identify, research and follow, “best practices”. Though outlined in some slight variation, for the most part McCain, Giuliani and Romney share the common goal of electronic medical records and data monitoring which could be invested through private/public partnerships. Ironically, whether democrat or republican, their slightly varied plans though share a common theme. Each would advise using government resources to create new entities to research, monitor, implement, review, and/or discuss treatment effectiveness, best methods of providing care, and dissemination of the most useful information to the appropriate front line caregivers and patients. That sounds like it could have come off the a website I discovered after dedicating myself to health care safety in the wake of my son’s death due to preventable medical errors.
We already have what they want to give us. Though it certainly needs some dusting and weeding. It is available at a number of private non-profit organizations as well as within the current government. The Agency for Healthcare Research and Quality (www.ahrq.gov) works under the Department of Health and Human Services.
Established in 1989 as a public health agency, it operates with a more than a quarter billion dollar budget. At any health care symposium, colloquium, training, or major event a representative of AHRQ (pronounced “ark”) will be in attendance and be a sought after one at that.
AHRQ has either helped or cooperated on the development of many non-profit organizations committed to ongoing research and improvements in the delivery of health care in the United States. These organizations are behind many of the state level improvements and programs federal programs become modeled after. Many of the organizers of these programs will quickly share the opinion that AHRQ is powerful and has reach that is unfortunately under-utilized. At times, AHRQ struggles to follow through with all it has promised.
Alas, AHRQ has a sister-organization in these lofty goals. The Department of Veterans Affairs has a significant investment, reach and expertise in the subject. The VA actually enjoys a reputation as a successful innovator and leader in safe medical care. Mark Graber, MD, FACP, Chief Medical Service of the Northport NY VA points to just a few of the most well-known examples of the organization's successes:
- “The VA’s electronic medical record is an elegant and comprehensive product that allows healthcare for our patients to be coordinated and documented over time and space.
- To improve patient safety, the VA instituted one of the first anonymous medical error-reporting systems in the US, the VA Patient Safety Reporting System
- The VAs National Center for Patient Safety is regarded as a model for healthcare systems in terms of prioritizing safety issues and coordinating safety-improvement efforts. Examples include the excellent NCPS resources on how to perform RCA’s, HFEMA’s, etc (analyses to understand why errors have occurred or will occur). NCPS is an award-winner of the Ford Foundation’s\Kennedy School’s “Innovation in American Government process.
- The VA’s performance measurement system tracks the ability of each individual medical center to meet national goals on literally dozens of measures involving quality, safety, and patient-satisfaction. Many of these are also measured under the “HEDIS” system outside the VA, and in essentially every category the VA exceeds the non-VA HEDIS counterpart.”
The majority of universal coverage proposals are modeled after one recently implemented in Mitt Romney’s Massachusetts. Massachusetts enjoys a plethora of devoted best practices – minded groups and individuals. The Harvard School for Public Health, The Institute for Healthcare Improvement (www.ihi.org), The National Patient Safety Foundation (www.npsf.org), and the Medically Induced Trauma Support Services (www.mitss.org) are all headquartered there. These among many others work nationally and internationally to ensure quality care for all – not just Massachusetts residents. Because of proximity they are the first to benefit.
Pennsylvania has been successful in initiating acclaimed practices for health care safety. The Pennsylvania Patient Safety Authority, Pennsylvania Health Care Cost Containment Council and Governor’s Office for Healthcare Reform are just a few of its leading organizations for data collection and researching and monitoring safe care. The persons involved in their creation were also formative in the NPSF and Joint Commission.
Illinois has the Joint Commission and Minnesota/Wisconsin have Consumers Advancing Patient Safety (www.caps.org) as well as Patients for Patient Safety (www.p4ps.org). Internationally, health care leaders and patients are guided by the World Health Organization. There are many others.
Does AHRQ need another institute/organization to partner with? Do we need to curtail our Department of Health and Human Service’s spending and budget to find more money for another institution that may, in fact, take lessons learned and created by to re-invent the wheel? Instead of creating a new entity to achieve what so many others are already working on perhaps unifying a coalition of all these dedicated stakeholders would promote the most effective outcome while saving precious funds for the direct safe care of patients and reimbursements of the doctors implementing such practices. That will save patient lives and provider livelihoods.
Maybe the years that I have spent penny-pinching post adverse-event make me a naïve coupon- clipping taxpayer. When I visit my son’s grave I have to go to the dollar store to find something I can place there within my budget. If legislators understood the real cost of preventable errors on their constituents, they’d be as interested in creative finances as I. In the wake of unexpected tragedy came medical bills, two lost jobs, a rented home instead of one owned, an empty savings account, among other challenges that would not have been present before the error. I am a mom and a teacher. And the proud parent of a child left to survive a broken health care system. He didn’t make it. Will you? Will yours?
Reading about these health care “initiatives” was at my mind’s forefront when I visited my son’s grave. The grounds men were “clearing”. The ritual of removing grave items regardless of meaning, worth, condition, or age. Some items were still viable and calendar-appropriate. Gravediggers were throwing pumpkins, flowers, and baby’s breath in piles. Then I heard a fellow mourner call out to her elderly male companion, “Hey that’s Moms!” There was a woman bending over another pile of heap one section over. “Do you think I should just put it back? It is still new.”
Well, I found my son’s pumpkin and put it back. I can’t afford to buy a new one. It is in perfect condition and is still timely as Thanksgiving approaches.
So on it goes. Instead of weeding out the weather-worn, old, and not so fresh flowers, the cemetery staff does a clean sweep. Out it all goes. The good and the bad.
Is that how the presidential hopefuls are viewing health care?
Just dump it all, open the taxpayers’ checkbooks and create some new entity while the other lies capable but dormant? It seems like elementary busy work at its best.
Instead of spending more money and attempting to reinvent the wheel, investment in the successes already delivered would truly build a better health care system. Of course, everyone needs to know what is already available and how to best use the resources and information appropriately. Weeding out the not-so-great and less-than-improved will always be a requirement to maintain healthy medical care. Not indiscriminately making a new pile.
Mary Ellen Mannix
November 19, 2007
