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A Word from the President: Answering the Call for Quality Care

AAMC Reporter: June 2012

I never cease to be amazed by the innovative work taking place at our teaching hospitals to improve the quality and safety of health care. While I and my AAMC colleagues have the privilege of seeing your efforts firsthand, the public and policymakers may be more familiar with the confusing barrage of headlines they read related to the quality of care provided at teaching hospitals, such as last February’s Washington Post story, “Medicare Study Finds Teaching Hospitals Have Higher Risk of Complications; Findings Disputed,” or the September 2011 HealthLeaders article “Joint Commission Top Hospitals List Shuns Academic Medical Centers.”

Our community knows teaching hospitals and their medical school faculty physicians have a long tradition of pioneering the innovations that improve health, from organ transplants to minimally invasive surgery. But over the last few years, as policymakers have explored variations in the cost of care and sought different ways to measure the effectiveness of care, many have simply assumed that teaching hospitals are inefficient.

A new study has demonstrated what our community has long known—teaching hospitals provide higher-quality patient care and have better outcomes than nonteaching hospitals at similar costs.

Published online in the April issue of Academic Medicine, the study found that teaching hospitals, particularly members of the AAMC’s Council of Teaching Hospitals and Health Systems, more often fully complied with recommended safety and process-of-care measures, achieved better results on complex surgical procedures, and were less frequently associated with higher readmission rates for certain illnesses than nonteaching hospitals. The study, by Dr. David M. Shahian and colleagues, analyzed data from nearly 5,000 hospitals to assess differences in performance based on the level of teaching intensity.

Recent analyses also find that teaching hospitals provide high-value care. While some contend that teaching hospitals spend too much on the care they provide, new findings reinforce that—once adjusted for the more severe level of illness in their patients—AAMC-member hospitals perform well. This was reinforced by the release of new Centers for Medicare and Medicaid Services (CMS) efficiency measures that evaluate Medicare spending per beneficiary. Updated last month, the measures found less variation across AAMC members’ performance compared with all other hospitals.

These results will not be surprising to those caring for patients in an academic medical center. Medical schools and teaching hospitals are where tomorrow’s health care professionals are trained, where new treatments are created, and where cures are discovered. Similarly, innovations in health care quality improvement are pioneered in our institutions, where health services researchers can evaluate their effectiveness and where faculty can teach the next generation of health care professionals to take this knowledge with them wherever they practice.

The role that medical schools and teaching hospitals play in improving health care quality has been noticed by the federal government in two important ways as it works to implement the Affordable Care Act.

First, the Department of Health and Human Services (HHS) selected 12 AAMC-member institutions to serve as pioneer accountable care organizations (ACOs) late last year. Those chosen for this important pilot program will innovate and test alternative payment models in order to provide higher-quality care to Medicare beneficiaries while reducing costs. The pioneer ACO institutions could save the nation up to $1.1 billion over five years, according to HHS.

The federal government also has partnered with academic medicine through the CMS Health Care Innovation Awards—half of all the grants announced last month went to academic medical centers. The recipients of these grants were recognized for their potential to improve quality and cut costs for Medicare, Medicaid, and Children’s Health Insurance Program beneficiaries. In addition to improving the health of their patients, these academic medical centers will save an estimated $121 million over three years, create new jobs, and retrain thousands of health care workers with the skills needed to practice in a changing health system.

For our part, the AAMC also is working directly with our members to help improve quality of care.

Through our Best Practices for Better Care initiative, a collaborative effort with University HealthSystem Consortium, medical schools and teaching hospitals are working to implement checklists, standardize protocols, and apply other best practices to make even the most complex surgery safer, reduce infections, and decrease hospital readmissions. Because of its link to medical education, this initiative is strengthening the culture of medicine by ensuring quality and safety are part of medical education from day one. Participating institutions will continue to refine these best practices through research and evaluation, discovering new ones and sharing knowledge with others to improve health care.

Through performance-improvement collaboratives, data collection, and educational webinars, the Best Practices for Better Care participants are beginning to track their performance and identify quality-improvement strategies. The Frontline Staff Survey, which will be held twice annually and was completed for the first time this spring, will inform efforts moving forward by identifying areas of best practice in participants’ organizations and opportunities for improvement in practice and training.

Earlier this month, more than 260 health care leaders working to advance quality and patient safety met at the AAMC’s fourth annual Integrating Quality Meeting. This year’s program had an expanded focus on interprofessional approaches to quality improvement and health professions education, and was planned in partnership with our colleagues from the nursing, osteopathic medicine, pharmacy, dentistry, public health, and physician assistant education associations. Participants shared local and national strategies for advancing quality through team-based care, innovative educational approaches across the continuum, and faculty and leadership development programs.

As we await the Supreme Court’s decision on the Affordable Care Act later this month, one thing is certain: Academic medical centers will continue to innovate new approaches to improve the quality and safety of patient care, pass on the important knowledge and lessons to the students we educate, and research, evaluate, and share best practices so all patients we treat receive the high-quality care they expect and deserve.

Darrell G. Kirch, M.D.
AAMC President and CEO