Improving Safety — 55,000 Errors at a Time
In 2008, NEHI’s multi-year initiative with the Massachusetts Technology Collaborative to combat hospital medication errors resulted in significant policy changes in both the public and private sectors in Massachusetts. Our groundbreaking research, Saving Lives, Saving Money, showed that one in every ten patients at Massachusetts community hospitals experienced a serious but preventable medication error and that statewide adoption of computerized physician order entry (CPOE) could prevent 55,000 of those errors and save $170 million annually.
Following the release of this research, private payers in Massachusetts established new incentives for hospitals to reduce errors by computerizing orders, and the Commonwealth of Massachusetts enacted a law making the adoption of the technology a condition of hospital licensure by 2012. These findings, which have been disseminated to policymakers across the country, have set a new standard for protecting patients from serious medication errors.
Weeding out Waste
Experts have long known that waste in clinical health care was consuming a huge chunk of our annual health care spending. But there was little evidence of exactly where those wasted dollars were going. In 2008, NEHI published three reports that, for the first time, identified the key sources of the $800 billion in wasteful spending in clinical care. The findings — which include unexplained variation in the intensity of medical services, misuse of drugs and treatments resulting in avoidable adverse events, and overuse of non-urgent emergency department care — were distributed to over 800 federal, state and private policymakers, health care leaders and the media, and key federal policymakers were briefed on how our research can be incorporated into national health reform.
Compared to What?
Comparative Effectiveness Research (CER) is expected to be implemented in the United States in some form by the new Administration and Congress. Since innovation is central to the development of new treatments in our health care system, NEHI launched a project in 2008 to ensure that CER legislation supports continued innovation. Through focus groups and an executive roundtable with key thought leaders, NEHI identified critical considerations for policymakers in crafting CER legislation that safeguards the role of innovation in U.S. health care. These findings will be released in a NEHI white paper in early 2009, and will be the foundation for briefings with policymakers as they debate how to implement CER as part of national health reform.
Healthier People, Healthier State
Massachusetts boasts some of the world’s most renowned medical resources — and yet our population is more susceptible to preventable chronic disease than the rest of the nation, taking a toll not only on our public health but on our economic competitiveness as well. In 2008, NEHI continued its partnership with The Boston Foundation to identify strategies for stemming this rising tide of chronic disease, focusing particularly on obesity and diabetes. Together, we developed a blueprint that will serve as a strategic planning document for communities, schools, local governments and the nonprofit sector to collaborate on promoting wellness efforts. As part of the initiative, NEHI Executive Director Valerie Fleishman testified before the Massachusetts Legislature’s Joint Committee on Public Health on how worksite wellness programs can be more widely adopted in the Commonwealth.
“Always-on” Intensive Care
The combination of a severe shortage of intensive care specialists and changes in demographics creating sicker, older patients is putting pressure on intensive care units (ICUs) across the country. In 2008, NEHI began a demonstration project with the University of Massachusetts Memorial Medical Center (UMMMC) to study the ability of tele-ICUs — a suite of technologies through which intensivists can remotely monitor patients — to decrease the cost and improve the quality of ICU care. Initial results are highly encouraging, with full results anticipated in 2009. ICUs account for six percent of U.S. health care spending, so improving their efficiency and quality is a critical component of reforming the delivery of health care.
ED Overuse: A Costly Non-Emergency
Nonurgent use of emergency departments (EDs) costs the U.S. health care system up to $32 billion annually. Though the uninsured were long thought to represent the majority of ED overuse, it is now known to be a problem across all populations, including those covered by privately and publicly sponsored insurance. In 2008, NEHI launched a project to examine the factors driving patients to the ED for non-emergent conditions, and to identify strategies to redirect these visits to primary care and other appropriate settings. Our research has identified several critical drivers and a series of promising strategies including better case management for frequent ED users, the use of telemedicine consultations in lieu of a trip to the ED, and improving chronic disease prevention and management in the primary care setting. The strategies will be pilot tested by our partner, the Institute for Healthcare Improvement, in the second phase of the project this year. Additionally, NEHI is establishing a Council on Primary Care to examine ways to strengthen and promote primary care medicine in the United States.
NEHI in the News
“Reps Push Wellness Program to Cut Down on Health Costs”
By Kyle Cheney, State House News Service
The Daily News Tribune, December 18, 2008
“Changing the Cost of Healthcare”
By Cleve Killingsworth
The Boston Globe, December 1, 2008
“Breaking the Cycle of Waste in Healthcare”
By James Roosevelt Jr.
The Boston Globe, October 22, 2008
“Working Toward Wellness”
By Wendy Everett
WBUR's CommonHealth Blog, September 29, 2008
“The ER's in Urgent Need of a Fix”
By Scott Kirsner
The Boston Globe, August 25, 2008
“1 in 10 Patients Gets Drug Error”
By Patricia Wen
The Boston Globe, February 14, 2008
2009: Coming Attractions
Winter/Spring 2009
Comparative Effectiveness Research
• White paper on the impact of CER on innovation
• CER policy forum in Washington, DC
Telemedicine and Chronic Disease
• Report on top telemedicine technologies for chronic diseases
• Webinar on telemedicine technologies
Prevention and Wellness
• Blueprint for Wellness in Massachusetts
Spring/Summer 2009
Tele-ICU
• Results of NEHI’s tele-ICU demonstration project with UMMMC
Year-Round
Patient Safety
• Continuing work on implementing CPOE across Massachusetts
• Exploring federal policies to speed CPOE adoption nationally
Primary Care Redesign
• Researching the root causes of the primary care crisis
• Creation of Council on Primary Care
Waste and Inefficiency
• Working with policymakers to make weeding out waste part of national health reform
ED Overuse
• Pilot-testing strategies for reducing ED overuse with the Institute for Healthcare Improvement
New Members 2008
During 2008, NEHI welcomed the following organizations to our growing list of members: Baxter, Caritas Christi, D2Hawkeye, Harvard Stem Cell Institute, McKinsey & Co., Organogenesis and Scientia Advisors.
Remember to request your 2009 Membership Directory (for current members only) by sending an email to membership@nehi.net.
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