WIHI - A Podcast from the Institute for Healthcare Improvement

Date: December 1, 2015

Featuring:

• Mark Graber, MD, FACP, President, Society to Improve Diagnosis In Medicine; Senior Fellow, RTI International

In September 2015, the Institute of Medicine issued a landmark report on diagnostic errors in the US, and the news wasn’t good: one in 20 adults suffers a diagnostic error every year. The report offers a two-part definition of diagnostic error: “the failure to (a) establish an accurate and timely explanation of the patient’s health problem(s) or (b) communicate that explanation to the patient.” And it shines a light on the multiple factors that cause diagnostic errors – ranging from cognitive failures on the part of diagnosing physicians, to system failures for tracking and managing test results, to lack of teamwork and communication.

Date: November 19, 2015

Featuring:

• Kate Lally, MD, FACP, Director of Palliative Care, Care New England; Hospice Medical Director, VNA of Care New England; Clinical Assistant Professor of Medicine, Alpert Medical School of Brown University

On October 30, the US Centers for Medicare & Medicaid Services (CMS) announced that, starting January 1, CMS will reimburse physicians and other practitioners for talking with any Medicare recipient about their health care preferences at the end of life – also known as advance care planning. Caught up in a political maelstrom several years ago, CMS has now caught up with a growing desire of patients and loved ones to express, and have health care respect, their wishes. Talking with a trusted provider, before one is faced with a terminal illness, can be an important part of the process.

The good news is that more people today appreciate the need to articulate their preferences regarding end-of-life care. We know this from surveys and our own experiences, and because multiple initiatives, including Respecting Choices and The Conversation Project (TCP), have tapped into a groundswell of interest in tools and resources to conduct discussions about end-of-life care wherever they can occur… around the kitchen table, at family gatherings, at community centers, and in the workplace. The next frontier is for health care to reliably “receive, record, and respect” everyone’s stated wishes.

Will the new CMS payment options make advance care discussions more likely and encourage health professionals to gain the necessary skills? That’s certainly the hope, and we sorted through the latest developments on this WIHI.

Date: November 12, 2015

Featuring:

• Bruce Spurlock, MD, President and CEO, Cynosure Health Solutions

Date: October 29, 2015

Featuring:

• Kimberlydawn Wisdom, MD, MS, Senior Vice President of Community Health & Equity and Chief Wellness and Diversity Officer, Henry Ford Health System

Health and health care improvement communities in the US are focusing on equity and racial disparities in some important new ways. Frustrated by the slow progress of closing gaps (despite decades of research and documentation of the problems), many are forging ahead to create more equitable access to care and better outcomes wherever and whenever they can. The new learning is coming from the “doing,” often making use of existing data that already tell a powerful story of persistent inequities (e.g., in cancer diagnosis and treatment, heart disease, and diabetes care) and highlight where there are opportunities to intervene.

These aren’t just pie-in-the-sky ideas. They’re being spearheaded by organizations such as Methodist Le Bonheur Healthcare in Memphis and the Henry Ford Health System in Detroit. There are numerous other examples — but still, not nearly enough.

Date: October 15, 2015

Featuring:

• Durrell J. Fox, BS, Community Health Worker & Health Equity, Public Health Consultant

Of all the people who can make a difference in the lives of patients these days, one group that’s rising in importance is community health workers, or CHWs. CHWs are increasingly being utilized by community health centers, office practices, and hospitals to bridge gaps for patients between health care, home, and the community. Since many CHWs come from the same neighborhoods as the patients themselves, there’s a lot of mutual trust right off the bat. This is true whether a CHW is helping a patient manage a chronic illness, develop healthier behaviors, or act on information from a medical appointment that might otherwise be misunderstood or forgotten.

For community health workers and the patients and populations they serve, the questions are many. What are the particular skills and training needed to be an effective CHW? How can CHWs gain greater professional recognition? Largely grant-funded now, how can the work of CHWs become part of standard reimbursement? Where is research underway on the best deployment of CHWs and the contribution they can make to population health? What can be learned from the use of CHWs in other countries?

The growing interest in CHWs is sparking some important discussions and the development of innovative programs. We explored both on this WIHI.

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• ​Shannon Brownlee, MS, Senior Vice President, Lown Institute; Visiting Scientist, Harvard T.H. Chan School of Public Health

There’s growing awareness of the need to curb health care’s overuse of interventions that lack a strong evidence base, unnecessarily subject patients to potential harm, and are more expensive than equally effective, cheaper alternatives. Initiatives like Choosing Wisely and Costs of Care have done a great job sounding the proverbial alarm about particular treatments and procedures doctors have grown too accustomed to prescribing automatically; antibiotics, certain screenings, and imaging tests often top the list. Costs of Care has put the spotlight on the financial harm of overtreatment on individual patients themselves, many of whom are now shouldering a larger and larger share of the health care bill. 

Against this backdrop, a new initiative called the RightCare Alliance encourages providers to take action to eliminate practices and procedures of little benefit to patients. They’re currently crowdsourcing a number of ways care providers across the US can engage in more thoughtful interactions with patients that can result in better treatment decisions. The most-favored suggestions will get top billing during RightCare Action Week, October 18-24. We explored those suggestions and more on this WIHI. 

​Date: ​September 17, 2015

Featuring:

• James Moses, MD, MPH, Medical Director of Quality Improvement (QI), Boston Medical Center; Academic Advisor, IHI Open School

• The ​IHI Open School

Date: July 23, 2015

• L. Nneka Mobisson-Etuk, MD, MBA, MPH, Executive Director of African Operations, Institute for Healthcare Improvement

Date: July 9, 2015

• Sanjeev Arora, MD, FACP, FACG, Director, Project ECHO (Extension for Community Healthcare Outcomes), Department of Internal Medicine, UNM School of Medicine

Date: June 25, 2015

Featuring:

• John Whittington, MD, Lead Faculty, IHI Triple Aim; Senior Fellow, IHI