If healthcare facilities want to know whether standardized documentation and action reports can help reduce their pressure ulcer rates, they can turn to research available on the Health Care Innovations Exchange Web site.
On the site, providers trying to find methods to stop the skin breakdowns that lead to infection and poor health conditions can see how International Severity Information Systems, a health services organization, implemented a three-year pilot that uses standard documents in nursing homes to track a patients care and improve communications among personnel. The study demonstrated a more than 5 percentage point reduction in pressure ulcer ratesan outcome that might have providers reaching for the phone to hear more from the organization about how to implement similar procedures at their facilities.
And if that happens, the Agency for Healthcare Research and Quality will consider its fledgling Innovations Exchange program a success.
The Innovations Exchange is a site developed by AHRQ to foster the dissemination of best practices among healthcare facilities and encourage providers to get in touch with one another in an effort to accelerate quality improvement in care delivery. With more than 200 innovations already in its database, the 6-month-old site has been slow to draw attention from clinicians who might not realize its available, but AHRQ hopes to continue to bolster submissions to and use of the site as practitioners become more aware of its existence.
The goal is to present resources in a standardized format that shows whats happening on the front lines of care, said Mary Nix, a project officer for AHRQ. We thought folks would really want to get their story out, she said. The agency sees this as one of many tools for doing that.
The pressure ulcer program created by International Severity, a Salt Lake City-based developer of clinical decisionmaking tools, was funded through an AHRQ grant and designed to reduce the number of documents that certified nursing assistants manage for each patientfrom nutrition and behavior forms to skin reports, said Susan Horn, senior scientist with International Severitys Institute for Clinical Outcomes Research and vice president of the company.
Once those reports were streamlined into one document, workflow became easier and staff was able to better identify patients at risk for ulcer development. The pilot showed pressure ulcers decreased to 8.7% for high-risk nursing home patients from 14% over the three years, Horn said.
The detailed innovation report has been posted on AHRQs Web site since August. Horn hopes others will see it and contact her about doing something similar. Discovering whats best is only half the story. The second half is: How do we implement this into practice? she said.
AHRQ is the HHS agency designated for research and development of best medical practices. In developing tools for providers, the agency recognizes that it can cull novel approaches from what is already being done in the field, Nix said. The Innovations Exchange program concentrates on overcoming the silo effectwhen a practice might be developed in one healthcare setting but few in other facilities know the process could work there as well. As a result, providers often are repeating practices that have been tested elsewhere and have proved to be ineffective, which limits knowledge sharing, she said. The information is available free on the site.
The Innovations Exchange program requires practitioners to submit their ideas in a standardized way that provides an outline of the medical issue addressed, a description of the idea tested, journal references that support the concept and results of the idea when put into practice. The innovation also includes a guide for how the idea was implemented and the resources needed for others to try it. AHRQ labels each innovation with an evidence rating that demonstrates how effective the idea likely will be. Some failed processes are also posted under the heading innovation attempt, so providers can learn about what doesnt work.
AHRQ contracts with Westat, a Rockville, Md.-based company that supports various government departments with research. In 2006, Westat was awarded a $9 million, three-year contract to operate the Innovations Exchange Web site and conduct rigorous testing of the research behind each innovation.
By taking a coordinated, comprehensive and interactive approach to presenting the innovations, AHRQ can foster communication among busy providers and break down that silo effect, said Kathleen Stevens, professor and director of the Academic Center for Evidence-Based Practice at the University of Texas Health Science Center, San Antonio. Those three things make it synergistic.
Stevens is under contract with Westat and sits on the Innovations Exchange editorial board, which scrutinizes the innovations submitted. In addition to presenting the ideas in a standardized format, the agency has compiled a database for people to search by medical topic or innovation subject. AHRQ is aiming to give all its innovations information the look and feel of peers talking to one another, much as they might in their healthcare settings as they work through issues, she said.
Every two weeks, AHRQ distributes an electronic newsletter highlighting innovations and quality-improvement tools. The Innovations Exchange program also includes commentary on a range of quality and research issues from its group of expert panelists who oversee Web site updates. Now that the site has been operational for six months, AHRQ is trying to increase awareness of the depth of information available through the program, Nix said. The agency recently released a request for information asking providers to submit their research that has the potential to accelerate the adoption of processes that improve healthcare in hopes of bringing more attention to the site.