Over the past three years I’m sure we have all asked: When will the pandemic end? Now, in just a matter of weeks, the federal public health emergency for COVID-19, which gave healthcare providers and payers broad flexibilities to care for patients in a time of crisis, will expire—effectively marking the close of this urgent response phase of the pandemic as we have known it. But even as we are tempted to breathe a collective sigh of relief, another related health crisis is rearing its head: worsening patient outcomes.
Perhaps we shouldn’t be surprised. The pandemic completely overturned our system of care, demanding an all-in mentality. But as we got better at managing COVID—developing lifesaving vaccines at breakneck speed and treatments that slow its deadly pace—patients have grown sicker and illnesses more acute from delayed care and worsening chronic health conditions. Nationwide, emergency departments and patient floors are still often overflowing, and we are reminded every day how difficult it has become to provide safe care to patients amid these circumstances.
As COVID kept patients away from the care they needed, preventive care and diagnostic screenings fell off dramatically. Between 2019 and 2021, about 1 million fewer people were screened for breast cancer, 4.4 million for cervical cancer and about 700,000 for prostate cancer. And adverse patient safety events—which were declining before the onset of the pandemic—began to rise again.
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In Massachusetts, which has some of the best healthcare in the world, we are unfortunately no exception. A recent study led by investigators from Mass General Brigham identified at least one adverse event in nearly a quarter of hospital admissions. Whether related to medication, surgery or infection, many were preventable and often resulted in a more serious condition. Also, mortality rates among Black residents in Boston increased for non-COVID causes of death such as diabetes and hypertension.
As one of the country’s oldest institutions, the spirit of discovery and breakthrough is central to our identity and success—as it is for many of the best healthcare systems. But we all must also provide the highest quality of care to every patient who walks through our doors. As we continually look to find ways to better serve our patients, it’s clear our hospitals must harness that same ingenuity to reduce the risk for the most common, deadly diseases, boost healthcare quality, ensure equity and improve patient outcomes.
Over the years, researchers and clinicians across the country have accomplished myriad breakthroughs we never thought possible—performing life-saving transplants, using innovative treatments like CAR T-cell therapy for cancer patients and incorporating artificial intelligence to keep us on the cutting edge of medical advancement.
Why shouldn’t we be able to bring the same innovative approaches to controlling high blood pressure for the 10 million people who die from hypertension-related conditions in this country each year, following up with every patient after a lab result without fail, or guaranteeing an appointment with a physician in a timely manner? While guaranteed appointments may sound mundane, they’re certainly not when that routine screening exam may identify a fast-growing tumor while the condition is more treatable. Then, they’re life-changing and lifesaving.
This is the new challenge facing healthcare, at a time when our patients need us the most.
What can we do?
At Mass General Brigham, it starts with taking care to the community—and into people’s homes. We are ramping up telehealth visits catalyzed by the pandemic and converting our fleet of COVID-19 testing and vaccination vans to increase preventive care and screenings for chronic disease and substance use disorder in some of the highest-need neighborhoods in Boston.
We’re also using data in smarter ways, building an enterprise advanced analytics team to push forward the science of quality measurement and translate knowledge directly into clinical programs to improve patient outcomes. We are not in search of a moonshot. We will focus on relentless incremental quality improvement, avoiding the trap of reinventing the wheel when other health systems have designed successful solutions, yet bringing our innovative spirit to the table to shine a new light on the most challenging problems. This is the recipe that helped us in our battle during the darkest days of the pandemic, and we learned. We learned how an integrated academic medical center can solve the most common problems, in addition to the most complex.
So, too, must we fight to end disparities in healthcare. Our United Against Racism initiatives brought vaccines and essential care to the communities that needed them the most. We are now using that approach to help more people get their blood pressure under control and improve pregnancy outcomes for high-risk mothers.
We will probably never stop thinking about COVID and what we need to do to hopefully one day eradicate it. But during the pandemic, we learned that things we all assumed couldn’t be done were not only possible but often transformational. Until we make the quality and consistency of the healthcare we provide to every patient as important as the discovery of new treatments, our job won’t be done. We must all start today.
