Federally funded "beacon" communities are tackling the problem of hospital readmissions and other tough health care challenges by testing the effectiveness of multiple treatment strategies simultaneously instead of taking the traditional approach of testing one treatment at a time, according to the program's director.
The model communities, which have already embraced electronic health records and information exchange, are working to determine which specific treatments best improve patient outcomes for their region's health care goals. They would then share those results with other communities.
"No one specific intervention in each community is designed to be the thing that will lead to improved health goals," said Aaron McKethan, director of ONC's Beacon program in the Office of the National Coordinator.
"There are a lot of things happening in service to a specific aim in each of these communities," he said at an Oct. 19 conference on innovation sponsored by the Brookings Institution.
For instance, the beacon in the North Carolina Piedmont region around Charlotte is focused on identifying effective strategies to reduce emergency room visits, he said.
And the Indianapolis beacon community, made up of public and private providers, insurers and employers connected via the Indiana Health Information Exchange, is trying to reduce readmissions of people with chronic conditions through telemonitoring their status after hospital discharge.
The Beacon effort engages payors to use incentives as a tool to advance health care goals, set up care management and physician reporting and performance feedback systems, McKethan said.
At the same time, it is difficult to evaluate the effectiveness of each line of action taken by a beacon community. "It's not clear whether it was the care manager working in the hospital calling the patients to make sure they had their meds reconciled upon discharge or some other activity that led to the results," he said.
However, beacon participants have developed a comfort level with research designs that call for mounting multiple clinical and administrative strategies at the same time. "We are not going to incrementalize our way to substantial improvements in performance, quality, and population health," McKethan said.
Also, data on intervention failures often can be as useful as successes, he noted. When a plan of action is tested, measured and found not to be effective, the data will provide a sense of how to make course corrections.
Achieving each community's health care objective is a coordinated process, with clear goals and performance measures to back them up, and a range of steps and treatments to accomplish it.
"We view the beacon communities as on a glide path to improvements where financing ultimately becomes a key part of reinforcing the performance improvement gains," McKethan said.
Noted
The Office of Personnel Management plans to create a database from which it can analyze and track health trends and costs based on medical claims submitted by physicians and hospitals for federal employees and others covered by federal health plan options. Analysis from the claims will enable OPM to develop statistical models, such as for methods to reduce risk in patients and improve outcomes, track pharmacy pricing, better prepare for health plan negotiations and make health care program changes.
The U.S. Air Force recently completed a four-year-long rollout of its integrated digital dental radiography system, a project that will zap digital dental images across nearly 80 Air Force dental offices treating active-duty and Air Reserve and Air National Guard personnel worldwide. The new system completely replaces film-based x-rays with digital radiography, which means that Air Force dentists will be able in near real-time to store patient radiographs and access them later or share them with other dental providers and specialists across the service.
The Office of the National Coordinator has begun a study on how to overcome the privacy and security risks of using health information that has otherwise been stripped of personal identifiers such as a patient's name and address. One danger is that the data might be able to be re-identified through the use of additional records publicly available on the Internet, according to Dr. David Blumenthal, the national health IT coordinator. ONC wants to come to a "consensus on what risk we can tolerate for identification and then what level of removal, what kinds of removal of information, are required to get to that level of risk," he told a congressional hearing.
