Health Policy Institute launches nationwide hospital study

In response to a 2001 Institute of Medicine (IOM)report identifying severe failures and shortcomings in the U.S. health-care system and recommending significant changes, BU’s Health Policy Institute (HPI) developed a first-of-its-kind study to examine the current state and impact of quality improvement (QI) activities undertaken by U.S. hospitals since the report was issued.

The seminal IOM report, Crossing the Quality Chasm called for overhauling the way health care is delivered in the United States, suggesting a redesign to become better able to deliver care that is safe, effective, timely, patient-centered, efficient, and equitable to all. Numerous public and private organizations heeded this call by developing and supporting broad-based quality improvement and patient safety initiatives. The HPI survey is studying those initiatives and the results, as well as hospital executives’ and front-line clinicians’ perspectives on quality, to determine progress made since the study’s publication. Funded by a $326,195 grant from the Commonwealth Fund, the project began September 1 and will conclude in November 2006.

“It is widely known that our country is experiencing a health-care system crisis,” says Joseph Restuccia, a School of Management professor, who is lead co-investigator of the survey. “Our research should lead to the development of tools that hospitals can use to enhance the quality of their patient care while also achieving efficiency goals.”

Fellow lead co-investigator Professor Alan B. Cohen, of the Health Policy Institute, says the grant will allow close examination of the quality of patient care and efficiency improvements under way at U.S. hospitals “both objectively and through the eyes of clinicians, whose perceptions of the impact of improvements and of plans for the near future should be very revealing.”

HPI staff, comprising Cohen, Restuccia, and SMG Professor Michael Shwartz, in collaboration with the Health Research and Educational Trust, a research and education affiliate of the American Hospital Association, will design and conduct two complementary surveys in a sample of at least 500 hospitals organized by key characteristics such as bed size, census region, teaching status, and ownership.

They first will use the Hospital QI Activities Survey to document the nature and extent of QI efforts undertaken by hospitals and assess the importance of leadership, organizational culture, workforce strategies, and the use of information technologies. The researchers then will query at least 3,000 front-line physicians and nurses in the same hospitals regarding their assessments of the quality of care and the quality improvement activities taking place in their organizations, using the Clinicians’ Perceptions of Quality Survey, which is based on a survey developed by a BU study team in an evaluation of the Robert Wood Johnson Foundation’s Pursuing Perfection program.

In addition, they will use quality-of-care measures from the Centers for Medicare and Medicaid Services and the Joint Commission on Accreditation of Healthcare Organizations to analyze the relationship between quality improvement activities and quality of care.

“This study is very timely, and results will help inform health-care stakeholders about the types of quality improvement activities that hospitals are currently undertaking,” says Anne-Marie Audet, Commonwealth Fund vice president for quality improvement and efficiency programs. “More importantly, it should also shed light on which of these activities are associated with good performance, and thus provide insights into promising approaches and future areas for improvement.”

Since its founding in 1975, the Health Policy Institute, under the direction of Richard H. Egdahl, a UNI professor, has conducted numerous health policy research studies, functioning as a laboratory for developing and testing innovative solutions to health system problems.