A Coordinated Effort to Improve Health Care

Dr. Laura Petersen directs both the BCM Health Services Research Center and the Houston VA Health Services Research and Development Center of Excellence, encouraging collaboration and teamwork among her colleagues.

On an average day in the offices of Baylor College of Medicine's health services researchers, you could encounter a basic scientist, a primary care doctor, a computer scientist, an industrial psychologist, a psychiatrist or other medical subspecialist, a social worker, a biostatistician, a nurse, or a communications professional—all teaming up with the goal of studying how to deliver health care with the highest quality and efficiency.

A combined BCM department of medicine section and the Houston VA Health Services Research and Development Center of Excellence, the Center, directed by Dr. Laura Petersen, associate professor of medicine at BCM, tackles some of the toughest issues in health care delivery and technology integration facing the United States today. The researchers from Baylor College of Medicine and the Michael E. DeBakey Veterans Affairs Medical Center make up one of 13 competitively awarded national centers.

"The most difficult and challenging problems in health care today cannot be solved by any single individual," said Petersen. "Take one of the highest stakes issues facing health care right now—the payment system. Most agree that major reform is needed. To accomplish this goal, we need a health economist who understands financial incentives; clinicians and with health care administrators who bring their unique perspectives about health care delivery; industrial/organizational psychologists who can help us understand health care workers in the delivery system; and anthropologists and psychologists who can assess the impact of these changes on patients; and finally measurement experts and methodologists assessing the outcomes of interventions. "

Emphasis on collaboration

In the Center, investigators form scientific programs that focus on health decision-making and communication, clinical epidemiology and outcomes, health services delivery and organization and health policy and quality.

The programs are organized to leverage strength in a variety of areas and to foster mentorship, another important concept of the group, Petersen said.

The programs are led by Dr. Richard Street, professor of health communication and of interpersonal communication at Texas A&M University in College Station; Dr. Hashem El-Serag, professor of medicine and chief of gastroenterology and hepatology at BCM; Dr. Mark Kunik, professor of psychiatry and behavioral sciences at BCM; and Petersen, an associate professor of medicine.

Within the programs, investigators team up into small groups to work on projects that build on the overall objectives of their research focus. Out of this collaboration and unique structure come important new findings that have the potential to greatly affect our current health care system and inform the ongoing debate on much-needed reform.

Right way to pay for care

The Wall of Fame spotlights important research published by investigators in the Health Services Research Center.

"Health care cost inflation is tremendous and almost non-sustainable at this point," said Petersen, who leads the program involved in this area of research. "We are trying to understand the right way to pay for care to get high quality and achieve good outcomes."

One of her current projects pertains to the pay-for-performance system or physician reimbursement based on the quality of care provided.

In a recent study of patients with high blood pressure, Petersen and colleagues found that the pay-for-performance system may work well for physicians caring for patients with multiple health problems. The work appeared in the journal Circulation in Feb. 2009.

"We need to figure out what systems work best, so that we can translate that information for policy makers," said Petersen.

Doctor-patient interaction

Under the leadership of Street, the health decision-making and communications program is looking at ways to improve doctor-patient interaction.

Dr. Aanand Naik and Dr. Petersen confer over collaborative research that seeks to figure out what systems work best in providing health care.

"There are a lot of structural barriers in the doctor-patient relationship that are not effective," said Dr. Aanand Naik, assistant professor of medicine at BCM and a member of Street's health decision-making and communication program. "We want to analyze how patients look at encounters with their doctors to see how we can improve communication and the patient's decision-making abilities."

In a recent study, Street and Naik teamed up with Kunik, who is part of the health services delivery and organization program, to see how patients and doctors communicate about controlling their blood pressure, define treatment targets and interact over monitoring and adjustment of medication.

The team found that the more the doctor and patient collaborate in treatment planning and then communicate precisely about the ongoing results of their decisions, the more likely it is that there will be good outcomes, and patient satisfaction. In the final analysis, this improves quality of care, said Naik.

"These decisions are complicated and they occur over a long period of time," said Naik. "The patient is the one who has to take the treatment, measure blood pressure and follow a diet."

The research, Naik said, should motivate policy makers to re-think the way doctors and patients engage because there are profound implications on health policy.

"Changes in health care financing can encourage a more user-friendly system," said Naik. "We need to better understand the factors that define high quality doctor-patient interaction and use changes in health care financing to support them."

Patient safety and information technology

Research regarding patient safety and effective electronic medical record use is also a focus of the Center.

Dr. Thomas Giordano, who concentrates on research involving care of patients with HIV/Aids, participates in one of the group's regular conferences.

In Oct. 2007, the VA National Center for Patient Safety funded a program within the health services research group focused on this area, which is of growing national importance. This program uses a multidisciplinary approach to improve communication in the electronic medical record and includes physicians, medical informaticians, a computer engineer and an industrial-organizational psychologist.

"Breakdowns in communication of vital patient information can occur even when state-of-the-art electronic medical records are used," said Dr. Hardeep Singh, director of the patient safety program and an assistant professor of medicine at BCM. "One area we are focusing on is improving communication of abnormal diagnostic test results in the outpatient setting."

"There are a lot of different elements we factor in," said Singh. "We look at this from a fairly broad systems-based perspective—analyzing not only technology, but also organizational structure, policies and procedures regarding electronic communication, work environment, clinical workflow, etc." Fixing the issue will take a concerted, coordinated effort, he said.

Relationship with the VA

The Health Services Research group benefits invaluably from its relationship with the Michael E. DeBakey Veterans Affairs Medical Center. Affiliation with that Center provides researchers access to national health care data, which is critical to good research that has far-reaching implications.

"The VA is the largest integrated health care system in the U.S.," said Petersen. "We have access to data for a large group of patients over a long period of time, and we can get data from the whole health care spectrum. We have at our finger tips, for example, 10 years of data in patients with high blood pressure or diabetes."

Additionally, the VA's long-term use of electronic medical records strengthens the group's research capacity as the data are constantly updated in a central location.

The Center is funded by the Health Services Research and Development Service of the Veterans Health Administration. "Every day is different with this group, but we have one main goal," said Petersen. "To make a positive impact on health delivery and quality—the most positive impact that we can."

Emphasis on collaboration

Right way to pay for care

Doctor-patient interaction

Patient safety and information technology

Relationship with the VA

Features

News

Spotlight

Briefs

Development/Alumni

Development Briefs

Volume 5, Issue 1, Winter 2009


	A Coordinated Effort to Improve Health Care by Glenna Picton Dr. Laura Petersen directs both the BCM Health Services Research Center and the Houston VA Health Services Research and Development Center of Excellence, encouraging collaboration and teamwork among her colleagues. On an average day in the offices of Baylor College of Medicine's health services researchers, you could encounter a basic scientist, a primary care doctor, a computer scientist, an industrial psychologist, a psychiatrist or other medical subspecialist, a social worker, a biostatistician, a nurse, or a communications professional—all teaming up with the goal of studying how to deliver health care with the highest quality and efficiency. A combined BCM department of medicine section and the Houston VA Health Services Research and Development Center of Excellence, the Center, directed by Dr. Laura Petersen, associate professor of medicine at BCM, tackles some of the toughest issues in health care delivery and technology integration facing the United States today. The researchers from Baylor College of Medicine and the Michael E. DeBakey Veterans Affairs Medical Center make up one of 13 competitively awarded national centers. "The most difficult and challenging problems in health care today cannot be solved by any single individual," said Petersen. "Take one of the highest stakes issues facing health care right now—the payment system. Most agree that major reform is needed. To accomplish this goal, we need a health economist who understands financial incentives; clinicians and with health care administrators who bring their unique perspectives about health care delivery; industrial/organizational psychologists who can help us understand health care workers in the delivery system; and anthropologists and psychologists who can assess the impact of these changes on patients; and finally measurement experts and methodologists assessing the outcomes of interventions. " Emphasis on collaboration In the Center, investigators form scientific programs that focus on health decision-making and communication, clinical epidemiology and outcomes, health services delivery and organization and health policy and quality. The programs are organized to leverage strength in a variety of areas and to foster mentorship, another important concept of the group, Petersen said. The programs are led by Dr. Richard Street, professor of health communication and of interpersonal communication at Texas A&M University in College Station; Dr. Hashem El-Serag, professor of medicine and chief of gastroenterology and hepatology at BCM; Dr. Mark Kunik, professor of psychiatry and behavioral sciences at BCM; and Petersen, an associate professor of medicine. Within the programs, investigators team up into small groups to work on projects that build on the overall objectives of their research focus. Out of this collaboration and unique structure come important new findings that have the potential to greatly affect our current health care system and inform the ongoing debate on much-needed reform. Right way to pay for care The Wall of Fame spotlights important research published by investigators in the Health Services Research Center. "Health care cost inflation is tremendous and almost non-sustainable at this point," said Petersen, who leads the program involved in this area of research. "We are trying to understand the right way to pay for care to get high quality and achieve good outcomes." One of her current projects pertains to the pay-for-performance system or physician reimbursement based on the quality of care provided. In a recent study of patients with high blood pressure, Petersen and colleagues found that the pay-for-performance system may work well for physicians caring for patients with multiple health problems. The work appeared in the journal Circulation in Feb. 2009. "We need to figure out what systems work best, so that we can translate that information for policy makers," said Petersen. Doctor-patient interaction Under the leadership of Street, the health decision-making and communications program is looking at ways to improve doctor-patient interaction. Dr. Aanand Naik and Dr. Petersen confer over collaborative research that seeks to figure out what systems work best in providing health care. "There are a lot of structural barriers in the doctor-patient relationship that are not effective," said Dr. Aanand Naik, assistant professor of medicine at BCM and a member of Street's health decision-making and communication program. "We want to analyze how patients look at encounters with their doctors to see how we can improve communication and the patient's decision-making abilities." In a recent study, Street and Naik teamed up with Kunik, who is part of the health services delivery and organization program, to see how patients and doctors communicate about controlling their blood pressure, define treatment targets and interact over monitoring and adjustment of medication. The team found that the more the doctor and patient collaborate in treatment planning and then communicate precisely about the ongoing results of their decisions, the more likely it is that there will be good outcomes, and patient satisfaction. In the final analysis, this improves quality of care, said Naik. "These decisions are complicated and they occur over a long period of time," said Naik. "The patient is the one who has to take the treatment, measure blood pressure and follow a diet." The research, Naik said, should motivate policy makers to re-think the way doctors and patients engage because there are profound implications on health policy. "Changes in health care financing can encourage a more user-friendly system," said Naik. "We need to better understand the factors that define high quality doctor-patient interaction and use changes in health care financing to support them." Patient safety and information technology Research regarding patient safety and effective electronic medical record use is also a focus of the Center. Dr. Thomas Giordano, who concentrates on research involving care of patients with HIV/Aids, participates in one of the group's regular conferences. In Oct. 2007, the VA National Center for Patient Safety funded a program within the health services research group focused on this area, which is of growing national importance. This program uses a multidisciplinary approach to improve communication in the electronic medical record and includes physicians, medical informaticians, a computer engineer and an industrial-organizational psychologist. "Breakdowns in communication of vital patient information can occur even when state-of-the-art electronic medical records are used," said Dr. Hardeep Singh, director of the patient safety program and an assistant professor of medicine at BCM. "One area we are focusing on is improving communication of abnormal diagnostic test results in the outpatient setting." "There are a lot of different elements we factor in," said Singh. "We look at this from a fairly broad systems-based perspective—analyzing not only technology, but also organizational structure, policies and procedures regarding electronic communication, work environment, clinical workflow, etc." Fixing the issue will take a concerted, coordinated effort, he said. Relationship with the VA The Health Services Research group benefits invaluably from its relationship with the Michael E. DeBakey Veterans Affairs Medical Center. Affiliation with that Center provides researchers access to national health care data, which is critical to good research that has far-reaching implications. "The VA is the largest integrated health care system in the U.S.," said Petersen. "We have access to data for a large group of patients over a long period of time, and we can get data from the whole health care spectrum. We have at our finger tips, for example, 10 years of data in patients with high blood pressure or diabetes." Additionally, the VA's long-term use of electronic medical records strengthens the group's research capacity as the data are constantly updated in a central location. The Center is funded by the Health Services Research and Development Service of the Veterans Health Administration. "Every day is different with this group, but we have one main goal," said Petersen. "To make a positive impact on health delivery and quality—the most positive impact that we can."		Search all issues: Features Giving Elephants a Fighting Chance Facilitating a Vision for Research Integrating Care Around the Patient Baylor Flu Fighters Take On the Wily "Novel H1N1" (Swine) Flu Virus News New Board Chair has High Hopes for BCM Lynch: A Physician-Teacher with a Humanitarian Twist Spotlight Dr. Sean McGuire: Translating Early Lessons into Tomorrow's Treatment Simulated Patient Program Important Part of Medical Training Adding Value to Medical School Training Catalyzing Innovative Research is Mantra for BCM Diabetes Center A Coordinated Effort to Improve Health Care Briefs BCM Researchers Top Texas List of Stimulus Funds Recipients Wang Recognized for Contributions to Genetic Research Dr. Brendan Lee Receives Director's Transformative R01 A Cocaine Vaccine 'Pioneer' Studies Bacteria to Understand Cancer Dr. Mark Kline Selected Chair of Pediatrics Herding DNA to a New Understanding of Cows Development/Alumni Baylor Alumni Help Ease the Financial Burdens of Current Students Development Briefs Alkek Eye Center Celebrates 20th Year Partnership Gala To Fund DeBakey Heart Center® of Baylor College of Medicine Breast Center Advisory Council Funds Imaging Fellow Bra Art Displayed as Fundraiser Promise of Research Solid in Baylor's Future

	Volume 5, Issue 1, Winter 2009



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