In 2001, Dr. Peter Pronovost at Johns Hopkins Medicine developed a step-by-step checklist to prevent line infections in catheters inserted into a vein to supply a patient with nutrients and medicine. That year, 43,000 ICU patients in the U.S. had central line-associated bloodstream infections, which kill 12% to 25% of victims and cost an average of $70,000.
Pronovost's list reminded doctors of the fundamentals when they inserted these lines, including washing their hands with soap and wearing a sterile mask, hat, gown and gloves. Infection rates in the ICU slowly dropped to zero, and Pronovost began considering how to expand this tool beyond Johns Hopkins.
The Agency for Healthcare Research and Quality funded Pronovost's early efforts at $500,000 a year for two years to spread the program across Michigan. To spread it further, state by state, the efforts received additional funding from the American Hospital Association and some philanthropic support. By 2009, central line-associated bloodstream infections in ICU patients in the U.S. had dropped to 18,000.
AHRQ—pronounced “arc” by wonks—is quietly lauded by fans and vocally scorned by detractors. Its mission of figuring out how to improve the healthcare system is all the more daunting for its relatively puny annual budget that for several years has hovered around $430 million.
But research supported by AHRQ, sometimes solely so, has transformed the underpinnings of a sector that not only directly manages life and death but also encompasses nearly one-fifth of the U.S. economy. The HHS agency's anonymity might be inherent in the nature of its work, but its obscurity has serious implications as federal healthcare policy is thrown into tumult with the election of Donald Trump to the presidency.
“If an airbag goes off in your car, you know it saved your life,” said Michael Millenson, a national healthcare consultant who also teaches at Northwestern University's Feinberg School of Medicine. “If a physician does a checklist before your surgery and finds a problem that could've killed you, not only will you not see it because you're asleep, but nobody will attribute that to a government effort to get checklists used in operating rooms.”