The State of Quality Improvement and Implementation Research Expert Views: Workshop Summary (2007) / Chapter Skim
Currently Skimming:
5 Spread and Implementation of Research Findings
5 Spread and Implementation of Research Findings
Pages 29-40
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 29... ...
HEALTH PLAN PERSPECTIVE This session focused on what is known about spread and implementation from health plans. While other perspectives are important, such as those of small providers and nursing homes, the planning committee chose to focus on health plans due to their leadership in this area and unique organizational structures.
|
From page 30... ...
Another core value is that all of Kaiser's physicians work for the Permanente Medical Groups and operate under capitated payment agreements with the Kaiser health plans, allowing for creative methods to pay for care innovations. The Permanente Medical Groups are multispecialty medical groups where specialists work closely with primary care physicians on a regular basis.
|
From page 31... ...
Using Archimedes, a modeling and simulation program developed by David Eddy, it was found that a new drug combination regimen was more effective in preventing major cardiovascular events in diabetics than the traditional approach of focusing primarily on diabetes glucose management. Using the results of the model, a financial case was made that prescribing generic aspirin, lisinopril, and lovastatin together could decrease cardiovascular death, myocardial infarctions, or stroke in high-risk patients, such as diabetics older than 50 years old, saving approximately $600 per person per year.
|
From page 32... ...
As a result, Aetna's maternity care program became more comprehensive, offering a full range of maternity services for families contemplating or expecting children. In addition, Aetna has developed programs aimed at addressing quality and efficiency in neonatal intensive care unit care.
|
From page 33... ...
It was found that anesthesiologists did not need to be present for certain routine procedures and that the proper adjustment to staffing could greatly decrease costs without negatively impacting patient safety during the procedure. Improving quality while also improving efficiency is a concept at the heart of Aetna's medical management philosophy and one does not have to be sacrificed for the other, Pryor said.
|
From page 34... ...
One method for internal sharing is Aetna's internal website, where new information is posted daily. Externally, Aetna participates in a variety of industry associations, such as America's Health Insurance Plans and the Disease Management Association of America.
|
From page 35... ...
From a systems perspective, a balance between inside-out and outside-in innovations should be sought. Rouse bridged four lessons from other industries into health care.
|
From page 36... ...
The last method suggested was use of process controls to limit variations in subjects. Organizational Change Simple behavioral changes, such as folding your arms the other way, are awkward to make, said Newton Margulies of the University of California, Irvine.
|
From page 37... ...
Another set of change categories presented was incremental and framebreaking change. Incremental change consists of making small improvements, whereas framebreaking change requires major shifts in the mission, value, and process of an organization, leading to a different culture.
|
From page 38... ...
The biggest failure in change implementation is the lack of careful transition planning, Margulies noted. The fifth tip stated that engaging participation from those affected by change is critical.
|
From page 39... ...
One question posed to Pryor and Wallace asked how grassroots participation is integrated into management to sustain change, given Aetna's limited control of its affiliated independent physicians as well as Kaiser's group and top-down constructs. At Aetna, engagement at the physician specialty group level is critical.
|
From page 40... ...
One speaker noted the difficulty in publishing articles if data are collected from multiple sites around the country because approval from multiple IRBs would need to be obtained. For the effort required to publish articles, given the questionable value added to nonacademic institutions, the marginal costs would likely be substantial.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.