This Foundation Wants to Help Doctors Practice the Best Medicine

When it comes to medical research in the laboratory, we want bold, innovative approaches and ground-breaking experiments. But when it comes to our own health care in the doctor's office or the hospital, we want the absolute least original thinking: We want the method or medicine that has demonstrated the best outcome over thousands of cases.

Naturally, we expect our doctors to be familiar with medicine's best practices for any given condition or procedure, and to employ them when they treat us. You probably assume this is already the case. It's not. And some foundations want to change that. 

First, though, a little more background. 

Standards of care aren't particularly standardized in this country, which results in unnecessary medical complications and costs in a business that really can't and shouldn't tolerate either one. But medical industry traditions in this country didn't encourage or assist the adoption of best practices.

Until recently, most doctors were self-employed and most hospitals community-based. Like most people with difficult and high-pressure jobs, doctors and other health care providers prefer to use familiar techniques, drugs, devices and tools, and can be reluctant to change and go back to the bottom of the learning curve.

But the rise of huge, nationwide health care systems is changing all that. And while this shift away from private practice isn't painless, it is helping to create opportunities to raise the standards of care far more efficiently than ever before.

The Laura and John Arnold Foundation (LJAF) is tackling the best practices problem with a recently announced $5.49 million grant to the High Value Healthcare Collaborative (HVHC). The organization is a consortium of 17 health care systems that, combined, serve fully one-fifth of the U.S. population.

"The way care is currently delivered to patients varies widely from hospital to hospital and even from physician to physician," said the LJAF. "That means some patients may receive treatment for a common condition such as diabetes or congestive heart failure that is less effective or more costly than other treatment approaches."

Yet there is no national framework for implementing broad-scale changes once best practices are identified, leading to years-long gaps before new treatments or practices are widely adopted.

The goal of the LJAF-supported program is "to develop a first-of-its-kind learning network for disseminating best practices across HVHC’s member health systems." It will design strategies to accelerate the spread of best practices by providing clinicians from the HVHC's 17 health care systems with access to the latest information and resources about best practices.

One of the program's first targets of study is procedures for patients with sepsis, a potentially fatal complication that's the leading cause of death in U.S. hospitals. Unfortunately, sepsis can be hard to diagnose, and once diagnosed, must be treated within a specified time frame.

Of course, the efficient dissemination of best practices in health care can't be restricted to just one health care system, no matter how big. It has to be nationwide. And, in fact, it's a core tenet of the Affordable Care Act. For a great read about the benefits of efficient spread of best practices in medicine, take a look at this New Yorker article by physician-journalist Atul Gawande, titled "Big Med."

There may, indeed, be problems and challenges associated with the consolidation of the medical industry into a small number of giant corporations, but it will undoubtedly make it easier to accelerate the spread of evidence-based best practices in medical care. That will shorten illnesses and recovery times, and save money and lives.

We should note that this new grant by LJAF is part of a broader push by the foundation to improve U.S. health care. As we reported earlier this year, LJAF is also funding an interdisciplinary Health Care Markets and Regulation Lab in Boston that is looking at issues such as payment reform, delivery of services, patient engagement and the quality of care offered. And LJAF is funding the Center for Healthcare Transparency in San Francisco, which is involved in a five-year plan to collect reliable, meaningful health care performance data and make it accessible to the public. The foundation is backing other work, too, aimed at improving quality and controlling costs in the nation's $3 trillion health care system.

Of course, a number of other funders are also pursuing this same goal, including Peter Peterson, who recently committed $250 million to a new center of health care.