'5 Million Lives' Campaign Makes Solid Progress in First Year

ORLANDO, Fla.—With more than 3,700 U.S. hospitals participating in an effort to avoid five million preventable episodes of harm in a two-year period and sister programs underway in four other nations, it might be tempting to call the 5 Million Lives campaign an unqualified success at the halfway point.

“I think I would characterize our first year as solid,” said the campaign’s manager, Institute for Healthcare Improvement (IHI) vice president Joseph McCannon, while attending the Institute for Healthcare Improvement’s 19th annual forum on healthcare quality, held in Orlando this week. But the final verdict remains out, in part because of the extreme difficulty of measuring results in an industry where transparency is not the norm. “Designing our harm study has been a challenge,” McCannon said.

For one thing, participation is voluntary. “The submissions have been very spotty,” concedes Andy Hackbarth, who oversees data collection for the campaign.

And then there is the glaring lack of advanced clinical information systems capable of collecting outcomes data in America’s hospitals.

“We’re telling our members to build models and test them and then share what works,” said Susan DeVore, chief operating officer of hospital purchasing and quality-improvement collaborative Premier. “There’s not the database in the sky to draw from.”

DeVore said that members of San Diego-based Premier want to expand what they learned from a Centers for Medicare and Medicaid Services (CMS) pay-for-performance pilot. “We learned a lot in the CMS P4P demonstration about the importance of efficiency in the improvement of care,” DeVore reported.

The U.S. Indian Health Service (IHS) not only can vouch for how efficiencies can improve care, but might also teach other healthcare providers about how an electronic health record (EHR) can provide efficiencies, including in the realm of clinical data collection.

“It helps greatly, greatly with measurement,” said Assistant U.S. Surgeon General Charles Grim, a senior executive policy advisor to and former director of the IHS. “It’s really helped us be accountable to taxpayers and to our patients,” added Grim, a dentist who joined IHI and Premier leaders here for a news conference Tuesday during IHI’s 19th annual forum on healthcare quality improvement.

IHI launched the 5 Million Lives Campaign at the same venue a year ago, in the wake of a successful previous campaign to prevent 100,000 hospital deaths in an 18-month period. (See “IHI Issues Challenge: Prevent 5 Million Harmful Events in Next 24 Months.”) Hackbarth says that mortality data is much easier to obtain, resulting in reporting by almost 85 percent of participating organizations.

The accountability that Grim touts makes IHI President and Chief Executive Donald M. Berwick, M.D., very happy. “I’m an absolute nut on transparency,” Berwick said. “The more we turn the lights on, the better.”

Earlier, in his keynote address to this gathering of 6,500 people, joined by an estimated 15,000 additional viewers of a live satellite broadcast, Berwick said that the quest to adhere to evidence-based medicine has led to oversimplification of innately complex systems in healthcare. He argued that cold, hard scientific facts need to be combined with “social factors” to provide context. 

“Try to make your marriage better with a randomized trial,” Berwick quipped.

While not specifically referencing health-IT in his speech, Berwick apparently struck a chord with at least one technology-focused attendee. Jason Maude, co-founder of diagnostic support engine Isabel Healthcare, mentioned to Berwick that he encounters people looking for simple, linear answers all the time when making sales calls. “Systems are very complex,” Maude says. “Medical diagnoses don’t happen in isolation.”

Implicit in that statement is the notion that computers can help bring all the pertinent factors together at the point of care. Indeed, McCannon said network building—both social and technical—is one of three areas of emphasis for the second year of 5 Million Lives.

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