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Taking Action Against Hospital Acquired Infections
INDIANAPOLIS — Patients enter hospitals every day for a variety of reasons but usually without the thought of developing a new health problem. Yet every year thousands of hospitalized Americans acquire infections during hospital stays, causing risk of complications, prolonged stays and an increased burden on the health-care system.
With fast track funding by the U.S. Agency for Healthcare Research and Quality, five research collaboratives comprised of over 70 academic medical centers, community hospital systems, and other health-care organizations from across the nation are investigating various strategies to prevent these infections, which can range from bothersome to deadly. But what approaches work the best and in what settings? And how can effective change be implemented and spread?
Researchers at the Indiana University School of Medicine, the Regenstrief Institute, Inc., the Roudebush VA Medical Center and the Indiana University-Purdue University Indianapolis School of Engineering and Technology have been tapped by AHRQ to serve as the national resource center for its multiple collaborative work to prevent hospital acquired infection. Indiana researchers will work to develop data collection tools and collect information to provide technical assistance as well as to identify effective implementation strategies developed by the five hospital acquired infection prevention collaboratives.
The Indianapolis-based team will use their expertise with the tools of evidence-based medicine, informatics and systems engineering to help the hospital-acquired infection collaboratives determine what are the best practices and how best to implement these practices at hospitals large and small, urban and rural, public and private.
"We are excited to have the opportunity to learn from the efforts of multiple collaborative groups to find out what works in actual practice and how to implement these solutions," said Bradley N. Doebbeling, M.D., M.Sc., who leads the group which will be evaluating the collaboratives' recommendations. He is director of Health Services Research at the Regenstrief Institute, Inc.; director of the Indiana University Center for Health Services and Outcomes Research; professor of health services research and medicine at the Indiana University School of Medicine; and director of the VA Health Services Research and Development Center of Excellence, Indianapolis VA Medical Center.
Dr. Doebbeling is joined in this effort by Jaime Workman, M.S., associate professor of technology, School of Engineering and Technology, IUPUI; Heather Hagg, M.S., research scientist at the VA Center of Excellence; Mindy Flanagan, Ph.D., research scientist, IU Center for Health Services & Outcomes Research, Regenstrief Institute, Shawn Hoke, B.A., senior program manager, Regenstrief Institute, and others.
"So often collaboratives are formed to improve health care, recommendations are made and then carried out but no evaluation is completed, so lessons about what works remain unlearned," Dr. Doebbeling noted. "Over the next 18 months our health services researchers, systems engineers, informaticists, infectious disease experts, doctors and nurses will help the collaboratives collect data in forms that will enable our multi-expertise team to compare apples to apples so we can effectively evaluate different approaches to infection control at the 72 health-care institutions studied by the five collaboratives. This is an exciting opportunity to use this funding from AHRQ to support and learn from the multiple collaboratives of hospitals, clinicians and researchers working together to prevent hospital acquired infections across the United States."
The ultimate goal is to share lessons learned about successes, barriers and challenges in implementing and maintaining strategies that decrease the likelihood of patients acquiring an infection during a hospital stay.
New Indiana ACTION Collaborative
It takes about seventeen years for lessons soundly learned in research to find their way into actual patient care. But now a national push to bring research findings into practice quickly is shrinking the traditional delay between publication of scientific evidence and implementation. The Agency for Healthcare Research and Quality (AHRQ)* is fast tracking federal funding to a few recipients around the country chosen for their ability to define innovative care strategies, then bring them smoothly to scale.
The Indiana ACTION Collaborative is one of 15 sites selected for Accelerating Change and Transformation in Organizations and Networks (ACTION)*. The Center of Excellence in Implementing Evidence-Based Practice coordinates Indiana ACTION and serves as its headquarters.
Indiana ACTION interlinks six healthcare systems, all of which use an electronic health record, with the more than 30 years of clinical and laboratory data stored in the Regenstrief Medical Records System*.
ACTION overhauls the usual mechanism for federal funding, paring a process that typically requires a year down to a mere nine weeks. AHRQ first puts forth a rolling series of topics targeted at improving care delivery, patient safety, expansion of health information technology, and healthcare costs. Then, ACTION Collaboratives around the country bid to carry out on-the-ground field research and implementation.
AHRQ welcomes ideas for important ACTION research topics from everyone. Make your suggestion by sending a short rationale to ACTION Program Officer Cynthia Palmer: cynthia.palmer@ahrq.hhs.gov.
"From our partnerships with researchers and healthcare delivery systems," says Center director Brad Doebbeling, "we can put teams together, respond right away and put in a bid to get projects started quickly."
A small committee reviews the bids, and makes awards within an astonishing 2 days to 3 weeks.
ACTION's potential for large scale impact is suggested by past succeseses of pilot AHRQ rapid cycles. One is a web-based tool originally made to handle communications between hospitals and home health teams when transferring cardiac patients to home. It is now implemented across New York State for cardiac and general medicine, HIV, and geriatric patients alike.
In all, the network of ACTION centers delivers health care to 100 million Americans. It links large health systems with top health services researchers to respond to problems people working in medicine encounter on a daily basis.
The result is applied, demand-driven research whose results reach the real world at unprecedented speed.
More Indiana ACTION partners:
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