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June 2009

Comparative Effectiveness Research Discussions Begin in Earnest

The American Recovery and Reinvestment Act devotes $1.1 billion to support comparative effectiveness research.  The U.S. Department of Health and Human Services will split the funds between the Office of the Secretary, the Agency for Healthcare Research and Quality and the National Institutes of Health.  The working definition for comparative effectiveness research is "is the conduct and synthesis of systematic research comparing different interventions and strategies to prevent, diagnose, treat and monitor health conditions."

How each agency focuses its use of the funds is being determined by a Federal Coordinating Council for Comparative Effectiveness Research, which released Monday its recommendations for the Office of the Secretary suggesting that it focus investing in the data infrastructure and patient registries that can support comparative effectiveness research. 

Today, the Institute of Medicine released its recommendations for for the top 100 priority areas for comparative effectiveness research.  Their suggestions are as far ranging as comparing effectiveness of treatments for hearing loss in adults and children to strategies for reducing health care-associated infections and unintended pregnancies.

There is no doubt that the health care system, and most stakeholders participating in it, could benefit from rigorous examinations of how we spend our money and choose to seek and deliver care.  That there will be politics and debates surrounding how this money is spent is just as certain.

Hospitals Wise to Cut Spending on Infection Control? -- by Suzanne Delbanco, Ph.D.

7322389 Does it make sense to cut spending on infection control when certain hospital-associated infections are on the rise and pressure is mounting to curb such infections?  Logical or not, a new study released today by the Association for Professionals in Infection Control suggests that hospitals are cutting staff, resources and educational efforts.

Almost 2,000 infection preventionists responded to the 2009 APIC Economic Survey.  Of those, 41 percent said that their budgets had been cut in the last year and half, due primarily to the economic downturn.  Among those who experienced cuts, three-quarters lost training money, and half had cuts for infection prevention resources like technology, staff, and equipment.  One in three of the survey respondents say that cuts in resources and staffing have restricted their capacity to focus on infection prevention.  On a related note, one quarter say they have cut back on surveillance activities to detect, track and manage hospital-associated infections. 

While infection prevention is not a source of revenue, APIC points out it can help reduce costs significantly.  The U.S. Agency for Healthcare Research and Quality estimates based on its Health Cost and Utilization Project (HCUP) data that acquiring an infection with methicillin-resistant Staphylococcus aureus (MRSA) during a hospital stay can double a patient's length of stay and almost double the cost of the stay (from $7,600 to $14,000).  Perhaps hospitals will get a chance to see the return on investment for infection prevention more clearly when they reduce the investment and need to live with the financial consequences.

Suzanne Delbanco is President, Health Care Division, Arrowsight, Inc.

IOM Vision for Reducing Medical Errors Not Yet Realized

Has the U.S. made any progress on patient safety since the Institute of Medicine (IOM) released To Err is Human in 1999?  According to Consumers Union, few of the IOM’s recommendations have been implemented.  In a recently released report, Consumers Union's Safe Patient Project highlight’s the following areas as falling short of the IOM’s recommendations for tackling preventable medical mistakes:


Prevention of medication errors:  Only a minority of hospitals has implemented computer physician order entry systems, the Food and Drug Administration has not reviewed and changed enough confusing and sound alike drug names, and there is not yet a system for reporting medication errors by facility.

Transparency:  There are still 24 states that do not require public disclosure of infections or other quality and safety data.


Measurement: the Agency for Healthcare Research and Quality estimates that patient safety has actually declined year after year, but still has too little data to make accurate assessments.


Standards for Competency: Efforts to boost the competency of health care providers have been scattered and criticized.

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