Helping Fix the Broken Health Care System
To help fix the broken United States health care system, Mayo Clinic has opened its Center for the Science of Health Care Delivery. Researchers will use in-depth medical records studies, informatics, epidemiology and systems engineering to design and validate the most efficient and effective medical practices that can be shared and replicated throughout the U.S.
It's a familiar opinion in the national health care debate: Mayo Clinic manages to deliver high-quality, low-cost care; but Mayo's model can't be replicated. To that, Veronique Roger, M.D., has a simple response: "Why not?"
"The assumption that we're irrelevant because our pattern of care is somehow unique is overstated," says Dr. Roger (Roe-ZHAY). A Mayo physician-researcher who is steeped in evidence-based medicine, she adds with a wry smile: "I don't think this hypothesis has really been tested."
It will be soon. As the director of the new Center for the Science of Health Care Delivery, Dr. Roger is helping to lead Mayo's efforts to fix the broken health care system. Researchers at the Center will use in-depth medical records studies, informatics, epidemiology health services research and systems engineering to design and validate the most efficient and effective medical practices. The results will be shared with other providers and could prove "transformational" for U.S. health care, says Dr. Roger.
"The needs of the patient come first. We live by this at Mayo," she says. "But part of meeting the patient's needs is to find the strongest evidence we can for the care we provide."
In an era of rising costs and increasingly complex health care, the Center will combine the talents of physicians and process-design engineers. "We're building an infrastructure to help Mayo move more quickly into the future — to drive costs to a lower level and to improve quality for patients," says Mark Hayward, the Center's administrator. "By sharing what works at Mayo, we're hoping to help others do the same."
Finding the sweet spot between technology and patient care
Discussions of health care delivery can devolve into noisy exchanges of opinion and rhetoric. With the new Center, Mayo intends to shift the focus to science. The commitment to rigorous research and patient care, which has long driven Mayo's discoveries about disease, is now being directed toward health care delivery. "It is definitely a strategic priority for Mayo," says Douglas Wood, M.D., a Mayo cardiologist and health policy expert. "Mayo is one of the few organizations in the country that can implement delivery-system changes of the scale that can be studied."
For Mayo, this intersection of technology and patient care is familiar ground. A century ago, Dr. Henry Plummer, a physician hired by Dr. Will Mayo, invented the individual dossier-style medical record and an interconnecting telephone system for consultation among Mayo doctors. "Mayo Clinic has a robust legacy of weaving engineering techniques into delivery of care," notes Dr. Roger.
Validating best practices
Mayo also has a strong tradition of "team medicine," in which doctors from different specialties work together along with scientists to treat all of a patient's needs. This type of collaboration is especially important in managing chronic conditions such as diabetes, asthma and heart disease. Treatment for chronic disease accounts for 70 percent of U.S. health care spending and is one of the biggest drivers of cost. Chronic disease can cause numerous complications across medical specialties. For example, poorly managed diabetes, which costs the U.S. $22 billion a year, can affect the heart, kidneys and eyes in addition to the endocrine system.
Methods for treating chronic disease vary widely. Although data exists for the cost and effectiveness of individual treatments, comparative studies are rare. Researchers at the Center will undertake such studies assessing, for example, the long-term cost and results of diabetes treatments. "It will be important to have good data on utilization rates, cost and outcomes. We can find out what truly is the highest value care," Mr. Hayward says.
Delivering best practices
Amassing evidence for best practices is one component. Equally important is finding ways to deliver health care reliably and efficiently. Mr. Hayward, who was originally educated as an engineer, says efficiency needn't sacrifice quality; in fact, it can reinforce quality.
"In manufacturing, you want to be efficient so you can deliver a low-cost product. But you also want to be reliable and within product specifications," he says. "We have a lot of complexities and variables in health care. But it isn't all that different. If you know the best way to provide care, you want to build systems that drive consistent reliability and quality experiences each time. 'Value' is not just about how much a test costs."
Mayo's successful use of engineering to deliver high-value health care is evident in its telestroke network. Launched in 2007 at Mayo Clinic in Arizona, the system gives patients in outlying areas access to the latest stroke expertise and treatment. The network's hub is located at Mayo Clinic Hospital in Phoenix. Mayo neurologists trained in telemedicine are connected via audiovisual telemedicine cameras, carts, robots, smartphones, tablets and other technology to smaller hospitals throughout Arizona. The Mayo doctors remotely evaluate patients who have had acute strokes, and make treatment recommendations to emergency medicine doctors at the other sites. For patients in rural Arizona, the prompt neurological evaluation increases the likelihood of receiving clot-dissolving treatments in time to reduce disability resulting from stroke.
A 2010 Mayo Clinic study found that stroke telemedicine improves treatment decision making. The 276 patients studied were randomly assigned to stroke consultation using a digital observation camera versus telephone consultation. Correct emergency stroke treatment decisions were made 96 percent of the time with stroke telemedicine technology; but only 83 percent of the time with telephone consultation.
"Telemedicine is an ideal consultative tool," says Bart Demaerschalk, M.D., the Mayo Clinic neurologist who developed the stroke telemedicine network. "Telestroke networks can provide safe and effective emergency stroke care without costly ground or air ambulance transfer in most instances." Mayo Clinic in Florida launched a stroke telemedicine network in 2010, and planning is under way for a network in Minnesota.
Mayo has had similar success in improving quality and safety — as well as lowering costs — in intensive care units. Ognjen Gajic, M.D., a critical care specialist at Mayo Clinic in Rochester, Minn., leads a laboratory team that researches intensive care unit (ICU) practices. ICU care is complex and time sensitive. Poor decision making can result in patients experiencing complications that prolong costly hospital stays and lead to disability and long-term care. Innovations from the Gajic lab include enhanced use of information technology and medical data, and new protocols for ICU staffing and patient care.
With these new ICU practices, Mayo has seen a decrease in complications from critical illness such as acute respiratory distress syndrome (ARDS). Dr. Gajic cites examples of smaller, regional hospitals that have had similar improvements in critical care outcomes. "Understanding health care delivery as a science is critical," he says. "We need a patient-centered, multidisciplinary approach to prevent complications of severe disease. I'm optimistic that we are all making progress."
Sharing best practices
In a further effort to improve health care delivery, Mayo is partnering with five other leading health care providers to share data on patient outcomes, treatment quality and costs for a range of common conditions and treatments. The Dartmouth Institute for Health Policy and Clinical Practice will quickly disseminate its pooled information to other U.S. health providers, in a first-of-its-kind collaboration to lower costs and improve care nationwide.
"The goal is to look at best practices," Dr. Roger explains. "Six flagship institutions in the U.S. will get together and analyze their data. Maybe Mayo is doing better on diabetes, but someone else does better on another condition. We can learn from one another. We realize we can't do this alone."
Originally from France, Dr. Roger has spent her professional career at Mayo practicing cardiology and researching the epidemiology and outcomes of cardiovascular diseases. She will continue that work, while bringing to her new role at the Center a deep understanding of patients' needs and the complexities of modern health care.
"We have so many wheels that have to turn," Dr. Roger says. "As a physician, I can go to the hospital every morning to do rounds, but there are many, many systems that must align to deliver the care that our patients need. Delivery of care is becoming more complex. We need evidence that we are providing the best care for patients."
— April 2011