Turning research into lower medical costs

It can be tricky to get doctors and nurses to follow the best and most cost-effective protocols. Researchers in Philadelphia are turning to computers to nudge care-givers in the right direction

Researchers at Penn Medicine say they’ve dusted off their science journals and found a way to bring the best medical evidence to the bedside more quickly.

The federal government is pouring hundreds of millions of dollars into comparison research to figure out which medicines and treatments work best.

While national health officials try to make those answers easily accessible for everyone, in Philadelphia, Penn Medicine already has an in-house group working.

Craig Umscheid leads Penn’s Center for Evidence Based Practice.

Umscheid: Many people go to Consumer Reports for making decisions about what TV to buy, or what washer and dryer to buy, clinical leaders here at Penn come to our center to make decisions about what drug to put on formulary, what devices to purchase.

Comparative effectiveness research is part of the national push to drive down the cost of medical care. And during the health reform debate, the government’s involvement in comparison research was sometimes villified as a bid to tell doctors how to treat their patients.

Penn’s Chief Medical Officer P.J. Brennan.

Brennan: It’s not a ploy it’s an effort to rigorously assess evidence, and come to the best decision for patients and the organization.

When Penn doctors were deciding between two kinds of germ-killing soap to fight surgery-related infections, the center took the case.

Brennan: So even though the more commonly used soap cost pennies, and the more expensive one costs about $13 per case, there was a net savings per surgical procedure of more than $16 dollar by reducing the need for treatment of surgical infections, patients benefits and the care is less expensive.

The soap switch was easy, but Brennan, but in other cases, it’s been harder to get doctors to change the way they practice.

Brennan: I thought that folks would be too embarrassed not to adopt such strong evidence and I found that it’s very difficult to embarrass doctors.

Maybe it’s the difficulty of teaching old docs new tricks, but Brennan’s team has had to find other ways to nudge health professionals.

Guidance from the research center is now hardwired Penn’s electronic medical records system — alerts and algorithms remind doctors of the best evidence each time they open a patient file.