Our expert answers 3 Questions
Much of health services research focuses on examining and characterizing variations in care; I am interested in how to move from simply describing variations in care toward translating such observations into solutions that help patients get the best care possible across diverse clinical settings. I think quality improvement collaboratives provide an important opportunity for progress in this area.
Quality improvement collaboratives engage key stakeholders: payers, physicians - and even patients - to achieve sustained and meaningful changes in care delivery. There are a number of these collaborative initiatives ongoing in the state of Michigan. One example that I am involved with is the Michigan Urological Surgery Improvement Collaborative (MUSIC - a partnership with Blue Cross Blue Shield of Michigan), which is using strategies built around comparative performance feedback and clinical guideline dissemination to improve the quality and value of prostate cancer care for men across the state.
As one example, many men with low-risk prostate cancer undergo staging evaluations with CT scans and/or bone scans. We have collected data in the MUSIC showing that there is substantial variation in the use of these studies across Michigan, but that these imaging tests almost never show evidence for spread of the cancer, or other findings that would change treatment decisions. Informed by these data, we partnered with colleagues from Industrial and Operations Engineering to develop better criteria for selecting patients for imaging, and we are now using tools to developed in the field of implementation science to apply these evidence-based recommendations across many, diverse clinical settings.