In the seven months since Gilfillan was named to his newly created post, his most significant accomplishment was helping to launch the Partnership for Patients initiative in April, he says.
“Right now, that is the flagship of the effort that the innovation center is working on,” Gilfillan says of the $1 billion patient-safety and cost-control initiative. “We thought that the opportunity and the No. 1 need was to make sure that we focused on improving the safety for people who are receiving care.”
Another Washington official in the top 10 was Dr. Carolyn Clancy, director of the Agency for Healthcare Research and Quality, who retained her 2010 rank at No. 3. Like most federal healthcare agencies, AHRQ is assisting in the new patient-safety initiative. The agency's contribution to the campaign includes a series of patient-safety tools and products it helped to develop.
Clancy is followed in the rankings by Dr. Regina Benjamin, U.S. surgeon general. Like Berwick, Benjamin sought to downplay the political conflict in which the law remains embroiled, even as she praised the promise of its various components.
“I've been promoting prevention, and while I tend not to use the job for political things—I don't get involved in advocating for a particular bill or anything—the Affordable Care Act did establish a national prevention council, and this is the first time that anything like that has happened,” Benjamin says. “And it fits right in with my prevention goals and objectives.”
The National Prevention, Health Promotion and Public Health Council was created by the reform law to coordinate the prevention efforts of 17 federal departments and agencies and produce a national prevention strategy.
The No. 5 physician leader is another federal illness prevention guru: Dr. Thomas Frieden, director of the Centers for Disease Control and Prevention.
“The CDC has a fundamental role in prevention,” Frieden says in an interview about his agency's recent efforts to help reduce bloodstream infections in hospitals by 60%, which it estimated will save 27,000 lives and cut $2 billion in medical costs.
Such efforts to reduce hospital infections were praised by Berwick, who expressed little surprise in the findings of an April Health Affairs study that concluded one in three hospital patients is the victim of a medical error and 90% of such errors go unreported. Berwick had found similarly higher-than-anticipated rates of medical complications in his earlier research.
“He included injuries that would be classified as somewhat more minor, although you wouldn't want one,” Berwick says of the study led by Dr. David Classen, a professor at the University of Utah School of Medicine and an expert in infectious disease. “So the harder you look, the more you find.”
Another leading prevention focus of the CDC is cutting the nation's rates of cardiovascular disease, including the 1 million heart attacks and 700,000 strokes that occur nationally each year.
“The most important thing the healthcare system should do, in terms of prevention, is control blood pressure,” Frieden says, noting that among those suffering from hypertension, only 46% have their blood pressure under control. It's a number Frieden says his agency is working to increase.
Frieden also touted the benefits of the 2010 healthcare law, including its provision of community transformation grants, which fund local initiatives on diabetes prevention and prescription drug abuse prevention.
“The pendulum swung drastically toward more use of prescription opiates with the idea that we were underdosing people and now it is clear that it needs to swing in the other direction while still ensuring that anyone with pain—such as those with cancer in palliative care—get adequate pain control to be pain-free,” Frieden says. “But there is a big problem with how opiates are being prescribed today in this country.”
The role of Dr. Francis Collins, as director of the National Institutes of Health, continues to garner national attention, landing him at No. 6 on this year's ranking. In an interview, Collins credits his continued high ranking (he was No. 4 last year) to the NIH's role as the largest supporter of biomedical research in the world.