By Ann Bonham
The Affordable Care Act recast a bright spotlight on the decade-old recommendations of the Institute of Medicine report, Crossing the Quality Chasm, which called for transforming our fragmented health care delivery system into one that is safe, effective, patient-centered, timely, and equitable.
As a result, academic medical centers have conscientiously invested in various strategies — process reengineering, total quality management, bundling, and other practices — to improve quality and safety and to reduce costs. With these massive investments in new care delivery models, processes, management strategies, and various other “innovations” — all aimed at improving patient outcomes — the question is: Will we have rigorous evidence that they have changed both practices and organizational behavior to provide real and sustainable improvements in patient outcomes and lower cost?
Clinical effectiveness research, combined with implementation science, will be critical to answering the question and ensuring an evidence base for what works best for whom, why and in what settings.
Implementation science — a relatively new term in the United States — is a methodology to study and analyze the critical factors (bottlenecks and facilitators) in the successful adoption and dissemination of evidence-based innovations. In our field of health and health care, implementation science is intended to help health care providers, organizations, patients, and families make the most reliable health care decisions that incorporate the best evidence with the values and needs of patients and their families. Increased funding streams from the Patient-Centered Outcomes Research Institute, the Center for Medicare and Medicaid Innovations, the Agency for Healthcare Research and Quality, as well as from the National Institutes of Health and from non-federal funders demonstrate a growing national recognition of the need to build robust support for implementation science.
One example of using implementation science to improve care occurred at Northwestern Memorial Hospital, resulting from a study conducted by Grobman and colleagues at the Feinberg School of Medicine. Using an observational method to study the problem of injuries sustained during labor in cases of shoulder dystosia, the obstetrics team examined their delivery processes, re-engineered their protocol, and successfully implemented the improved routine. Rates of shoulder dystocia, a non-preventable condition remained stable, but both maternal and perinatal morbidity plummeted. J Obstet Gynecol. 2011 Dec;205(6):513-7
Academic medicine played a leading role in advancing basic and clinical research in the 20th century. The emerging health care needs of our communities in a time of severe economic constraints mean that leaders of medical schools and teaching hospitals must build on their traditional research strengths to develop clinical effectiveness research and implementation science capacity. That capacity in turn will ensure the development of sound, significant, and sustainable improvements in patient outcomes at reduced costs and that can be adopted locally and spread nationally.
Patients receiving health care in the United States deserve the same scientific rigor to determine the effectiveness of new strategies and models for providing care that has been applied to the research that has so successfully deciphered the human genome, created new treatments for cancer, and discovered new vaccines — and with the rapidity required by a responsive health care delivery system.