For the past three years, Aetna U.S. Healthcare has been doling out big bucks in support of outcomes-improvement research. Now, encouraged by public interest in quality improvement, it's upping the ante. This year Aetna will spend an extra $1 million for research on patient safety.
"The timing of this program is related to the Institute of Medicine announcement last month," said John Kelly, M.D., Aetna's director of physician relations. He referred to the IOM's report that 44,000 to 98,000 Americans die each year as a result of medical errors. "We see tremendous opportunity to help improve patient safety," said Kelly. "We agree with the importance the institute attaches to the issue."
So do a lot of people. All of a sudden, major organizations are opening their wallets to pay for research on medical errors and healthcare quality. For instance, the federal Agency for Healthcare Research and Quality (AHRQ), formerly the Agency for Health Care Policy and Research, announced late last month that it will award $2 million in 2000 to support four to six projects on best practices for patient safety.
"That's sufficient evidence to say that people have renewed their commitment to do research in this area, which is great," said David Nash, M.D., a healthcare quality investigator at Thomas Jefferson University in Philadelphia. "People who work in this area are thrilled that there might be some resources to study this material and improve outcomes."
The IOM's December report "To Err Is Human" unleashed a torrent of public and professional interest in the problem of medical errors.
It got the attention of General Motors Corp. The automaker extrapolates from the IOM's numbers that each day preventable medical errors kill 1.3 of the 1.25 million people GM insures. The Leapfrog Group, a large-industry purchasing coalition that GM helped start, has secured $500,000 from the Business Roundtable to set up purchasing guidelines specifically to reduce medical errors.
Bruce Bradley, GM's director of managed care, said the company wants to see proven solutions to medical errors put into practice. If it's known that computerized drug dispensing systems save lives, Bradley said, then why isn't everybody using them?
A news poll conducted by the Kaiser Family Foundation and the Harvard School of Public Health found that 51% of all Americans followed the story about the IOM report. That compares with 56% who followed the World Trade Organization riots in November and December in Seattle and 73% who followed the Oct. 31, 1999, crash of EgyptAir Flight 990.
Is the interest a passing fad that caught the public's attention in a slow news month? Are companies trying to climb on a public-relations bandwagon?
The answer to both questions is no, said Anne Shea, executive director of the National Patient Safety Foundation in Chicago. "A lot of people said, `This isn't anything new.' But the IOM is so well-respected, it moved it to a different level of awareness in this country."
At the National Patient Safety Foundation, which was founded in 1997 by the American Medical Association, CNA HealthPro, Schering-Plough Corp. and 3M, "the IOM report has increased the interest tremendously," Shea said. "We continue to get calls asking us to partner with various individuals and organizations on patient safety."
Last week the foundation issued an invitation for letters of intent on patient safety research. It is offering four grants of $100,000 each. Proposals are due by March 29. This is the third year it has offered grants to healthcare quality researchers.
More money may become available. As part of its reauthorization by Congress, AHRQ's budget got bumped to $205 million in fiscal 2000 from $171 million in 1999, a significant increase for a once-beleaguered agency.
It's amazing what a new honey pot of federal money will do for a relatively small field.
John Burke, chief executive officer of the Accreditation Association for Ambulatory Health Care in Wilmette, Ill., said his group wants to make quality improvement affordable for ambulatory surgery centers, group practices, HMOs, small clinics and student health centers. The association has a performance-measurement initiative for small shops.
"The studies have to be meaningful to the organizations themselves, and they also have to be cost-effective. They can't afford these huge fees from outside quality-measurement firms," Burke said.
"AHRQ has got a good bit of money now," Burke noted. "We would like to work with them on some aspect of this."
Aetna, the nation's largest health insurer, will administer its $1 million grant through a consortium of 46 academic medical centers with which it works on quality issues. In February Aetna's advisory group will post a list of the most promising research areas. An invitation for proposals will follow.
The second part of Aetna's program is creating hospital profiles similar to its physician profiles. For several years the insurer has been giving its network physicians feedback on how well they're managing patients with asthma, congestive heart failure, diabetes and other chronic illnesses.
"I wouldn't be surprised if someone else starts a big initiative," said Andrew Balas, M.D., director of the University of Missouri Center for Health Care Quality. Balas thinks certain major national healthcare foundations may want to join the parade.
Still, he cautioned that this change in research directions and priorities is unlikely to solve the problem directly. "I am not entirely impressed by the idea that the change will come from pumping a little research money into this field," he said. It is very hard to make research results filter down to the patient floor and the doctor's office and change the way practitioners behave, he said.
The best way to alter behaviors, Balas suggested, is for patients to gain more power in the system.
"The system should become more transparent," he said. "People should know more about things that happen to them," rather than let healthcare experts tell them what they ought to know.
"This error report, this should come from the patients," Balas said. "Patients should protest in front of the hospitals."