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How wise investments in research can
save lives and reduce healthcare costs

   Peter Pronovost, MD, PhD, FCCM
   Johns Hopkins University
CLA-BSI Rate for All ICUS at JHH:
                         1998 - Q2 2012
                                   13.00
CLA-BSI Rate Per 1,000 CL. Days




                                   12.00
                                   11.00
                                   10.00
                                    9.00
                                    8.00
                                    7.00
                                    6.00
                                    5.00
                                    4.00
                                    3.00
                                    2.00
                                    1.00
                                      -
                                           1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
                                  All ICUs 11.8 7.51 6.86 7.90 4.24 2.53 2.25 2.33 2.73 1.67 1.34 1.22 1.59 0.88 0.90
CLA-BSI Rate for all Michigan ICUs
2004-2012
Impact of MI project on hospital mortality
                           for Medicare Patients
                          Lipitz: BMJ 2011

                 1.1




                      1




                 0.9
Adjusted Odds Ratio




                 0.8




                 0.7
                           Pre-implementation (12      Project Initiation (5 months:   Implementation (12 months:   Post-implementation (12    Post-implementation (12
                           months: Oct 02 - Sept 03)         Oct 03 - Feb 04)               Mar 04 - Feb 05)        months: Mar 05 - Feb 06)   months: Mar 06 - Dec 06)
CLA-BSI rates from 1100
Hospitals from 44 states




             Armstrong Institute for Patient Safety   7
                         and Quality
AIRPLANES




        Armstrong Institute for Patient Safety   8
                    and Quality
Hospitals in general, and
especially ICUs




                      Current Version –
  Early 1980’s             Worse
What Might you Do


• Support Health Services Research
• Fund the development, implementation
  and spread of safety programs
• Support the development of outcomes
  researchers and safety leaders
• Fund Learning Labs to create an ICU
  system

10/25/2012   Armstrong Institute for Patient Safety   10
                         and Quality
Selected References
Berenholtz SM, Pronovost PJ, Lipsett PA, Hobson D, Earsing K, Farley, JE, Milanovich S, Garrett-Mayer E, Winters
BD, Rubin HR, Dorman T, Perl TM. Eliminating catheter-related bloodstream infections in the intensive care unit.
Crit Care Med 2004;32:2014-2020.

Pronovost PJ, Goeschel CA, Colantuoni E, Watson S, Lubomski LH, Berenholtz SM, Thompson DA, Sinopoli D,
Cosgrove S, Sexton JB, Marsteller JA, Hyzy RC, Welsh R, Posa P, Schumacher K, Needham D. Sustaining
reductions in catheter related bloodstream infections in Michigan intensive care units: Observational study. British
Med J 2010;340:c309.

DePalo VA, McNicoll L, Cornell M, Rocha JM, Adams L, Pronovost PJ. The Rhode Island ICU Collaborative: A
model for reducing central line-associated bloodstream infection and ventilator-associated pneumonia statewide.
Qual Saf Health Care 2010;19:555-561.

Berenholtz SM, Pham JC, Thompson DA, Needham DM, Lubomski LH, Hyzy RC, Welsh R, Cosgrove SE, Sexton
JB, Colantuoni E, Watson S, Goeschel CA, Pronovost PJ. An intervention to reduce ventilator-associated pneumonia
in the ICU: Collaborative cohort study. Infect Control Hosp Epidemiol 2011, in press.

Sexton JB, Berenholtz SM, Goeschel CA, Watson S, Holzmueller CG, Thompson DA, Hyzy RC, Marsteller JA,
Schumacher K, Pronovost PJ. Assessing and improving safety climate in a large cohort of intensive care units. Crit
Care Med Feb 2011.

Lipitz-Snyderman A, Steinwachs D, Needham DM, Colantuoni E, Morlock LL, Pronovost PJ. Impact of a statewide
intensive care unit quality improvement initiative on hospital mortality and length of stay: Retrospective comparative
analysis. Brit Med J 2011;342:d219.

Pronovost, PJ, Marsteller JA, Goeschell CA. Preventing Bloodstream Infections: A Measurable National Success
Story: Health Affairs 2011;20:628-634

Dixon-Woods, M, Bosk, C, Goeschel CA, Pronovost PJ. Explaining Michigan: Milbank Quarterly 2011

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How Wise Investments in Research can Save Lives and Reduce Health Care Costs

  • 1. How wise investments in research can save lives and reduce healthcare costs Peter Pronovost, MD, PhD, FCCM Johns Hopkins University
  • 2.
  • 3. CLA-BSI Rate for All ICUS at JHH: 1998 - Q2 2012 13.00 CLA-BSI Rate Per 1,000 CL. Days 12.00 11.00 10.00 9.00 8.00 7.00 6.00 5.00 4.00 3.00 2.00 1.00 - 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 All ICUs 11.8 7.51 6.86 7.90 4.24 2.53 2.25 2.33 2.73 1.67 1.34 1.22 1.59 0.88 0.90
  • 4. CLA-BSI Rate for all Michigan ICUs 2004-2012
  • 5. Impact of MI project on hospital mortality for Medicare Patients Lipitz: BMJ 2011 1.1 1 0.9 Adjusted Odds Ratio 0.8 0.7 Pre-implementation (12 Project Initiation (5 months: Implementation (12 months: Post-implementation (12 Post-implementation (12 months: Oct 02 - Sept 03) Oct 03 - Feb 04) Mar 04 - Feb 05) months: Mar 05 - Feb 06) months: Mar 06 - Dec 06)
  • 6.
  • 7. CLA-BSI rates from 1100 Hospitals from 44 states Armstrong Institute for Patient Safety 7 and Quality
  • 8. AIRPLANES Armstrong Institute for Patient Safety 8 and Quality
  • 9. Hospitals in general, and especially ICUs Current Version – Early 1980’s Worse
  • 10. What Might you Do • Support Health Services Research • Fund the development, implementation and spread of safety programs • Support the development of outcomes researchers and safety leaders • Fund Learning Labs to create an ICU system 10/25/2012 Armstrong Institute for Patient Safety 10 and Quality
  • 11.
  • 12. Selected References Berenholtz SM, Pronovost PJ, Lipsett PA, Hobson D, Earsing K, Farley, JE, Milanovich S, Garrett-Mayer E, Winters BD, Rubin HR, Dorman T, Perl TM. Eliminating catheter-related bloodstream infections in the intensive care unit. Crit Care Med 2004;32:2014-2020. Pronovost PJ, Goeschel CA, Colantuoni E, Watson S, Lubomski LH, Berenholtz SM, Thompson DA, Sinopoli D, Cosgrove S, Sexton JB, Marsteller JA, Hyzy RC, Welsh R, Posa P, Schumacher K, Needham D. Sustaining reductions in catheter related bloodstream infections in Michigan intensive care units: Observational study. British Med J 2010;340:c309. DePalo VA, McNicoll L, Cornell M, Rocha JM, Adams L, Pronovost PJ. The Rhode Island ICU Collaborative: A model for reducing central line-associated bloodstream infection and ventilator-associated pneumonia statewide. Qual Saf Health Care 2010;19:555-561. Berenholtz SM, Pham JC, Thompson DA, Needham DM, Lubomski LH, Hyzy RC, Welsh R, Cosgrove SE, Sexton JB, Colantuoni E, Watson S, Goeschel CA, Pronovost PJ. An intervention to reduce ventilator-associated pneumonia in the ICU: Collaborative cohort study. Infect Control Hosp Epidemiol 2011, in press. Sexton JB, Berenholtz SM, Goeschel CA, Watson S, Holzmueller CG, Thompson DA, Hyzy RC, Marsteller JA, Schumacher K, Pronovost PJ. Assessing and improving safety climate in a large cohort of intensive care units. Crit Care Med Feb 2011. Lipitz-Snyderman A, Steinwachs D, Needham DM, Colantuoni E, Morlock LL, Pronovost PJ. Impact of a statewide intensive care unit quality improvement initiative on hospital mortality and length of stay: Retrospective comparative analysis. Brit Med J 2011;342:d219. Pronovost, PJ, Marsteller JA, Goeschell CA. Preventing Bloodstream Infections: A Measurable National Success Story: Health Affairs 2011;20:628-634 Dixon-Woods, M, Bosk, C, Goeschel CA, Pronovost PJ. Explaining Michigan: Milbank Quarterly 2011