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Beth Israel Deaconess Medical Center Promotes Research On How To Improve Health Care Delivery

Internal grants seek to foster creative solutions

BOSTON - Beth Israel Deaconess Medical Center has launched an internal effort aimed at improving the quality, safety and value of health care, kicking it off with Innovation Grants to foster rigorous, high-quality science to the evaluation of real-world solutions.

The new Center for Healthcare Delivery Science awarded three one-year grants totaling nearly $150,000 for proposals to improve operating room scheduling, methods for moderate sedation, and care for patients with chronic kidney disease.

"It's an interesting paradox," says Michael Howell, MD, MPH, the center's executive director and an intensive care specialist who leads BIDMC's critical care quality efforts. "We know more today about predicting, diagnosing and treating human disease than at any time in human history - as a result of the groundbreaking basic, clinical and translational research. But the science of how we actually deliver that care to real patients, right now, is just emerging.

"What we have not done - until now - is work systematically to combine the two: research and operational innovation. Although it is true that we have had several definite pockets of success in this arena, it is also true that researchers, administrators and clinicians have not had an obvious mechanism or the infrastructure to work together on common problems in a way that applies research-quality methods to real-world operational problems."

The initial grants, funded by support from a private philanthropic group and the Office of the Chief Academic Officer Vikas Sukhatme, MD, PhD, are aimed at translating that research into programs that will directly benefit patient care.

One grant, to a team led by Brett Simon, MD, PhD, Chair of BIDMC's Department of Anesthesiology, Critical Care and Pain Medicine, will enable a collaboration between perioperative services and the Leaders for Global Operations program at MIT to expand a pilot program applying innovative processes used by industry to increase access and optimally use operating rooms.

"In spite of the fact that tens of thousands of operations are performed at BIDMC each year, and that OR time is one of the most expensive resources in the modern hospital, the process for scheduling surgical cases has been essentially unchanged for over 30 years," says Simon.

"This situation results in underutilized OR time during some periods, increased overtime required for staff during other periods, and even the inability to confirm some patients' procedures until literally the day prior to surgery."

This project engages quantitative operations research scientists at MIT to implement leading-edge decision support tools to predict future OR availability and staffing needs, allowing managers to dynamically visualize differently optimized OR schedules and market available OR time to surgeons in need of scheduling cases outside their usual block time.

A second project, led by Daniel Leffler, MD, Director of Clinical Research at The Celiac Center at BIDMC, and Sheila Barnett, MD, Director of Gastrointestinal Anesthesia, aims to improve the administration of moderate sedation to patients undergoing non-operative interventional endoscopic procedures like colonoscopies.

"Every year at BIDMC, about 30,000 patients receive moderate sedation during invasive procedures. Surprisingly, no validated tools exist to allow monitoring of moderate sedation quality from the provider's or patient's perspective. Even small improvements in this area could have major impacts on quality, satisfaction, and throughput, but we have no standard way to measure this common and costly intervention," say Leffler and Barnett.

This project aims to develop standardized tools to assess the quality of sedation in procedure areas from both patient and provider viewpoints; defining benchmarks for moderate sedation quality; and studying procedural, physician, nursing, medication, and patient factors associated with sedation-related outcomes.

A third grant will enable Ali Poyan Mehr, MD, a fellow in nephrology, to develop KidneyTracker, a patient-centered approach to improve care of patients with chronic kidney disease.

Up to 8 percent of the US population has moderate to severe chronic kidney disease, leaving them at high risk for progressing to dialysis, having high one-year mortality rates and extremely high health care costs.

"This project proposes to develop a CKD-specific, automated visit summary that is shared with patients and providers at the beginning of their renal visit to drive practice in this arena," says Mehr. "The KidneyTracker focuses on four key elements of care in this population and performance will be compared both to historical controls at BIDMC and, to assess for BIDMC-specific effects unrelated to the intervention."

Beth Israel Deaconess Medical Center is a patient care, teaching and research affiliate of Harvard Medical School, and currently ranks third in National Institutes of Health funding among independent hospitals nationwide. BIDMC is clinically affiliated with the Joslin Diabetes Center and is a research partner of Dana-Farber/Harvard Cancer Center. BIDMC is the official hospital of the Boston Red Sox. For more information, visit www.bidmc.org.