QUALITY IMPROVEMENT: Clinicians May Hold The Key
Two studies in this week's Journal of the American Medical Association conclude that educating key doctors to whom colleagues turn for advice can improve medical care and play an important role in introducing physicians to new treatment standards. In one "study of 45 Minnesota hospitals and their staffs, the researchers showed that educating the right doctors increased the number of times patients were effectively treated with aspirin" and beta blockers. At the same time, the "routine use of lidocaine, a heart-calming drug that can kill more patients than it saves when used incorrectly, dropped by half, the Minneapolis Star Tribune reports. As the result of the pilot program, "chances of survival for heart attack patients have improved in Minnesota." For the study, "researchers identified doctors they called 'quality champions' in communities" and "encouraged them to advise other doctors on how to use the latest heart attack therapies and to advise their hospitals on how to change to more modern, effective routines" as outlined in guidelines approved by the American College of Cardiology and the American Heart Association (Slovut, 5/6). Dr. John Eisenberg, the administrator of the Agency for Health Care Policy and Research, which funded the study, said, "This study clearly shows that the role of professional leadership is one of the most important in improving health care quality" (release, 5/5). In an accompanying editorial, Dr. David Naylor of the Institute for Clinical Evaluative Sciences at Sunnybrook Health Science Center, notes that the "educationally influential clinicians" identified in the study "may not be physicians in managerial or formal leadership positions," so "administrators must try to understand the sociology of local practice before they launch quality improvement initiatives" (JAMA, 5/6 issue).
The second study looked at a pilot program in four states in which "doctors received coaching from physicians hired by the government to ensure optimum Medicare treatment." In addition, doctors were provided with "regular data on survival of their Medicare patients treated for heart attacks." The study found that "after the programs were under way, 0.9% fewer patients" died of heart attacks, which could translate to "2,700 lives saved annually," the AP/Los Angeles Times reports (Coleman, 5/6). In his editorial, Naylor notes that the studies "highlight the need for better health information systems." He also notes, "We still know too little about which practice improvement strategies are most effective and efficient in particular contexts or clinical conditions ... the quality of medical care can be measurably improved by knowledge-based interventions (JAMA, 5/6 issue).