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ROCHESTER, Minn. — A Mayo Clinic review of 47 studies found that 30-day readmissions can be reduced by almost 20 percent when specific efforts are taken to prevent them. Key among these are interventions to help patients deal with the work passed on to them at discharge. The results of the review are published in this week’s issue of JAMA Internal Medicine.
Journalists: Sound bites with Dr. Leppin are available in the downloads.
ROCHESTER, Minn. — New research from Mayo Clinic shows that implementing a uniform method to care for lower-risk cardiac surgical patients improves outcomes, reduces patients’ time in the hospital and lowers overall per patient costs by 15 percent. The study is published in the May issue of Health Affairs.
Journalists: Sound bites with Dr. Cook are available in the downloads.
“In the high-acuity, full-service hospital, individual clinical judgment remains key, and some medical care demands this,” says David Cook, M.D., a Mayo Clinic anesthesiologist and primary author of the study. “But if this philosophy is applied universally, the same medical problem could be approached in 10 different ways by 10 different physicians, leading to unwarranted variability in costs, quality and outcomes.”
The Institute for Operations Research and the Management Sciences (INFORMS) named Mayo Clinic the winner of the 2014 INFORMS Prize, an award given to one organization that has applied operations research and management science disciplines in pioneering, varied, novel and lasting ways.
“Operations research is deeply rooted in our organization,” says Mayo Clinic President and CEO John Noseworthy, M.D. “It started with Henry Plummer’s work on an integrated paper medical record more than 100 years ago and continues today through the sophisticated analytics and operations research infrastructure that we use to improve the work we do for patients.”
Current examples include blood management, cardiac care redesign and forecasting efforts to improve patient access. Mayo Clinic employs more than 500 OR/MS practitioners who use methods such as optimization, forecasting and mathematical modeling to enhance strategic planning, care process redesign, inventory management and project management.
ROCHESTER, Minn. — Feb. 4, 2014 — Clinicians and patients should use shared decision-making to select individualized treatments based on the new guidelines to prevent cardiovascular disease, according to a commentary by three Mayo Clinic physicians published in this week’s Journal of the American Medical Association.
Journalists: Sound bites with Dr. Montori are available in the downloads.
ROCHESTER, Minn. — Jan. 15, 2014 — A study published in the January issue of Mayo Clinic Proceedings shows that most clinical practice guidelines for interventional procedures (e.g., bronchoscopy, angioplasty) are based on lower-quality medical evidence and fail to disclose authors’ conflicts of interest.
“Guidelines are meant to create a succinct roadmap for the diagnosis and treatment of medical conditions by analyzing and summarizing the increasingly abundant medical research,” write Joseph Feuerstein, M.D., and colleagues from Beth Israel Deaconess Medical Center. “Guidelines are used as a means to establish a standard of care … However, a guideline’s validity is rooted in its development process.”
Journalists: Sound bites with Dr. Talwalkar are available in the downloads.
ROCHESTER, Minn. — Mayo Clinic announced today that benefactors Robert and Patricia Kern have given $100 million to Mayo, with more than $87 million dedicated to the Center for the Science of Health Care Delivery, a strategic initiative that uses quality and engineering principles to improve the way patients experience health care. To honor the Kerns, Mayo Clinic will name the center the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery.
JOURNALISTS: For multimedia resources and membership, visit the Mayo Clinic News Network.
"Our desire is that the center will establish new standards for more effective, efficient care — bringing the dream of health care for all to reality," says Mr. Kern.
In 2011, the Kerns gave Mayo Clinic $20 million to launch the Center for the Science of Health Care Delivery. The Kerns' recent gift is more than $67 million. The Kerns also have supported neuroscience research and education at Mayo Clinic.
The Kerns' gift will expand center operations, endow five scientific director positions and create online education offerings. A portion of this new gift will support concerted efforts to share the center's portfolio of scientifically proven, high-value models of care with health care providers throughout the United States.
"This changes everything," says John Noseworthy, M.D., president and CEO of Mayo Clinic. "With the Kerns' support, Mayo Clinic will re-engineer health care to improve safety, quality and value. Importantly, the Kerns' gift empowers us to share these findings with hospitals, clinics and nursing homes across the country so that patients everywhere get the high-quality, high-value care they need and deserve."
Led by Véronique L. Roger, M.D., M.P.H., a cardiologist, epidemiologist and outcomes researcher, and Mark Hayward, a senior administrator at Mayo Clinic, the Mayo Clinic Kern Center for the Science of Health Care Delivery is home to leading physicians, researchers, systems engineers, social scientists and other experts who pool collective knowledge to improve diagnosis, treatment and care of patients. For example, center experts are using telemedicine to provide care to rural stroke patients, studyinghow to reduce surgical site infections, and creating smart technology that synthesizes and prioritizes medical record information about the sickest patients in the hospital.
The Kerns' relationship with Mayo Clinic stretches back more than 80 years. Mr. Kern first came to Mayo Clinic in 1930 at age 5. A mechanical engineer with an affinity for innovation, Mr. Kern harnessed silicon technology to start his own business, Generac Power Systems, in 1959. Based in Waukesha, Wis., the company grew from a two-person operation run from the Kerns' garage into what eventually became one of the largest manufacturers of generators in the world.
The Mayo Clinic Kern Center for the Science of Health Care Delivery builds upon more than a century of health care delivery research at Mayo Clinic. The goal of the center is to focus and coordinate resources to analyze, evaluate and implement care delivery models that improve value for patients.
About Mayo Clinic
Journalists can become a member of the Mayo Clinic News Network for the latest health, science and research news and access to video, audio, text and graphic elements that can be downloaded or embedded.
ROCHESTER, Minn. — June 26, 2012. Preventive mammography rates in women in their 40s have dropped nearly 6 percent nationwide since the U.S. Preventive Services Task Force (USPSTF) recommended against routine mammograms for women in this age group, a Mayo Clinic analysis shows. That represents a small but significant decrease since the controversial guidelines were released, the researchers say. Their findings are being presented at the Academy Health Annual Research Meeting, June 24-26, in Orlando, Fla.
VIDEO ALERT: Video resources, including an interview with Sandhya Pruthi, M.D., are available for journalists at the Mayo Clinic News Network.
"The 2009 USPSTF guidelines resulted in significant backlash among patients, physicians and other organizations, prompting many medical societies to release opposing guidelines," says co-author Nilay Shah, Ph.D., a researcher at the Mayo Clinic Center for the Science of Health Care Delivery. "We were interested in determining the impact that the recommendations and subsequent public debate had upon utilization of mammography in younger women."
Using a large, national representative database of 100 health plans, researchers identified the number of screening mammograms performed between January 2006 and December 2010, and compared rates before and after the task force report. Nearly 8 million women ages 40 to 64 were included in the analysis.
Comparing mammography rates before and after publication of the new guidelines, researchers found that the recommendations were associated with a 5.72 percent decrease in the mammography rate for women ages 40-49. Over a year, nearly 54,000 fewer mammograms were performed in this age group.
"For the first year after the guidelines changed, there was a small but significant decrease in the rate of mammography for women ages 40–49," Dr. Shah says. "This is consistent with the context of the guidelines change. A modest effect is also in line with the public resistance to the guidelines change and the subsequent release of conflicting guidelines."
ROCHESTER, Minn. — June 20, 2012. Mayo Clinic and its collaborators have been awarded nearly $60 million from the Center for Medicare and Medicaid Innovation (CMMI) to improve health care delivery. The grants will improve critical care for Medicare and Medicaid beneficiaries in intensive care units, improve care and outcomes for patients who have depression and diabetes or cardiovascular disease, and work with patients with chronic conditions and their families to better engage them in medical decisions.
"We're grateful that CMMI has recognized the commitment of our physicians, scientists and collaborators to drive patient-centered, high-value care," says John Noseworthy, M.D., president and CEO of Mayo Clinic. "Our commitment to innovation and patient-centered, high-value care will continue regardless of how the Supreme Court rules on the Affordable Care Act or how health care reform evolves politically. What will remain constant is our unfailing focus on meeting the needs of patients."
The Health Care Innovation Awards fund up to $1 billion in grants to applicants who will implement compelling new ideas to deliver better health, improved care and lower costs to people enrolled in Medicare, Medicaid and Children's Health Insurance Program, particularly those with the highest health care needs.
"These grants provide the funding needed to transform the way patients in the United States experience health care," says Veronique Roger, M.D., M.P.H., director of Mayo Clinic's Center for the Science of Health Care Delivery, which rigorously studies, validates and implements innovative health care delivery models. "At the end of the day, health care is about treating patients in a manner that delivers optimal outcomes and quality of life in the most efficient way possible."
Project I: Patient-centric electronic environment for improving acute care performance
Mayo Clinic Lead Investigators: Ognjen Gajic, M.D.; Brian Pickering, M.B., B.Ch.
Geographic Reach: Minnesota, Massachusetts, New York, Oklahoma
Funding Amount: $16,035,264
Estimated Three-Year Savings for Government Programs: $81,345,987
Summary: Mayo Clinic, in collaboration with US Critical Illness and Injury Trials Group and Philips Research North America, is receiving an award to improve critical care performance for Medicare and Medicaid beneficiaries in intensive care units (ICUs). Data show that 27 percent of such Medicare beneficiaries face preventable treatment errors due to information overload among ICU providers. Mayo Clinic's model will enhance effective use of data using a Cloud-based system that combines a centralized data repository with electronic surveillance and quality measurement of care responses. As a result, Mayo expects to reduce ICU complications and costs.
Over a three-year period, Mayo Clinic will train 1,440 existing ICU caregivers in four diverse hospital systems to effectively use new health information technologies to manage ICU patient care.
Mayo Clinic's expertise: Mayo Clinic brings informatics expertise to translate data into actionable clinical knowledge. Other grant-supported Mayo Clinic initiatives that rely heavily on informatics include the Rochester Epidemiology Project, Beacon, Strategic Health IT Advanced Research Projects (SHARP) Program and the Mayo Clinic Center for Translational Science Activities.
ROCHESTER, Minn. — May 14, 2012. Brad Anderson, retired CEO of Best Buy, and Thomas Zeltner, M.D., former Swiss Secretary of State for Health, will keynote the Mayo Clinic Quality and Systems Engineering Conference on May 14–16, at Mayo Civic Center, Rochester, Minn.
Anderson, who started at Best Buy as a commissioned salesperson and rose to the company's highest position, will discuss how staff at all levels can lead. Dr. Zeltner, an expert in international health reform and patient safety, will address quality improvement and health equity.
Participants choose from four tracks — systems engineering, quality, hot topics and the needs of the patient — to customize their conference experience. Sessions include:
- La Crosse Area Collaborative to Improve End-of-Life Care
- Global Bridges: An international collaborative to decrease tobacco use
- Diffusing ideas from high-performing practices across the country
- Provider-specific performance measurement
- Bedside patient rescue
This year's conference offers participants an opportunity to hear directly from patients about their experiences with the health care delivery system. More than 20 patients will share both positive and negative stories about seeking care for themselves or a family member. For example, Jill Keach will share the story of her fifth-grade daughter's diagnosis of leukemia and subsequent treatments at Mayo Clinic. Attendees will interact with Keach and other patients via roundtable discussion, first identifying key lessons from the patient's story and then brainstorming potential solutions to any unresolved problems.
Lebanon, NH, and ROCHESTER, Minn. — May 10, 2012. Five leading health systems are changing aspects of how they perform total knee replacements, as a result of data they collected that showed variations in length of stay, length of operating room time, and in-hospital complications. The voluntary testing of clinical measures and processes they identified as potential "best practices" is a step toward their goal of higher quality care, at lower cost.
Founding members of the High Value Healthcare Collaborative (HVHC) are Cleveland Clinic, Dartmouth-Hitchcock, Denver Health, Intermountain Healthcare, Mayo Clinic, and The Dartmouth Institute for Health Policy and Clinical Practice (TDI). In a paper released by Health Affairs as a Web First on Wednesday, May 9 at 4PM ET, the HVHC outlined the first results from their study of nearly 11,000 total knee replacements performed across the five health systems. Comparison data showed "considerable" differences among the institutions in procedures and outcomes, the authors report. These included:
- A difference of more than one full day in length of stay between the system with the shortest average length of stay (3 days) and that with the longest (4.2 days)
- A difference of 25 minutes in the time spent in surgery, ranging between 80 and 105 minutes
- A rate of readmissions ranging from 2.2 percent to 4.6 percent
Data gathered by the HVHC teams examined factors including demographics and previous health conditions of the subject patient populations, the experience and caseload of physicians performing the surgery, make-up of the care teams, and patient care information from pre-admission through one-year post-discharge.
In addition to the variations above, findings revealed that surgeons who perform higher numbers of total knee replacements (TKR) tend to have shorter operating times, shorter lengths of stay, and fewer in-hospital complications. Patients who were older and sicker generally had longer lengths of stay and more in-hospital complications. Almost 90 percent of the patients — aged 18-89 — were overweight, obese, or morbidly obese.
ROCHESTER, Minn. — April 10, 2012. Patients who went to the emergency room with chest pain but were at low risk for a heart attack were less likely to seek more tests after their conditions were explained to them using an educational tool known as a decision aid, a Mayo Clinic study found. The findings are published in Circulation: Cardiovascular Quality and Outcomes, an American Heart Association journal.
Chest pain is the No. 2 reason people seek emergency care at U.S. hospitals. It accounts for about $8 billion in health care costs annually, researchers estimate.
"To avoid missing a diagnosis of heart attack — which could have substantial medical and legal implications — emergency physicians often admit patients to observation units for stress testing, even though patients are at a very low risk for heart attack," says lead author Erik Hess, M.D., a Mayo Clinic emergency room physician. "This results in false-positive test results, unnecessary additional procedures, exposure to radiation and increased cost."
Researchers randomly assigned 204 chest pain patients at low risk of heart attacks additional counseling through a decision aid — a tool that summarizes the evidence and helps educate and engage patients in making decisions about their care — or the typical care. The decision aid included initial results of the patient's chest pain diagnosis, the patient's personal risk for heart attack within the next 45 days and a menu of evaluation options ranging from urgent cardiac stress testing to making an appointment with a primary care doctor within 72 hours.
Both patient groups were followed for 30 days, and no acute heart problems occurred in either group after leaving the hospital.
"In this study, we found that low-risk chest pain patients who participated in shared decision making often chose less extensive testing once it was clear that they weren't having a heart attack," says co-author Victor Montori, M.D., director of the research program within Mayo Clinic's Center for the Science of Health Care Delivery.
Researchers surveyed both groups of patients immediately after the ER visit to test their knowledge and analyze their involvement in decision making. Findings include:
- Decision-aid patients decided to be admitted to the observation unit for stress testing 58 percent of the time, compared to 77 percent for patients in the traditional care group.
- Patients in the decision-aid group were significantly more knowledgeable about their heart attack risk and options than those in the traditional care group.
- The degree of involvement in care decisions in patients who received the decision aid was four times greater than those who didn't receive the decision aid.
- Patients in the decision-aid group said the information was clear and helpful, and 3 of 4 surveyed said they would recommend it to others.