Web forum lets peers swap ideas for health care innovation

Let's say you're having trouble with appointment scheduling at your practice, or with keeping the glucose levels of your hospitalized patients under control. To find a solution, you might brainstorm with colleagues, flip through old conference notes or search for a relevant journal article. Or you can forgo the legwork and go online to the Health Care Innovations Exchange Web site to read about how others have tackled the problem.

The site, launched in April by the Agency for Healthcare Research and Quality (AHRQ), comprises more than 150 examples of real-world efforts to improve patient care from facilities across the country. Easy-to-read profiles discuss the type of practice or facility where an innovation was implemented; the initial problem and how it was addressed; the results of implementing the innovation; and advice for adopting the innovation at one's own facility.

“This (site) is getting at ideas that can be hard to find in the literature, or hard to adapt from the literature to a particular medical setting,” said Gregory Pawlson, FACP, MPH, executive vice president of the National Committee for Quality Assurance and chair of the Innovations Exchange's 13-member expert panel. “It's done in the spirit of quality improvement and sharing.”

Submitting a profile to the site starts with sending an initial e-mail with a brief description of the innovation. If it is accepted, the innovator must agree to a phone interview and to occasional chats with colleagues seeking advice about the innovation. Profiles are crafted by writers at research group Westat, reviewed by the Innovations Exchange Project Director and vetted by the innovator. The site aims to have 200 profiles by the end of July.

Users can search or browse Innovations Exchange by disease or clinical category, such as neurology or nutrition; stage of care, such as primary or acute care; patient population, such as gender or race; patient care process, such as pre-care or after-care; or Institute of Medicine quality domain, such as efficiency and safety.

“Let's say you are having trouble getting your hypertensive patients to lower their blood pressure because of adherence problems,” Dr. Pawlson said. “You could go on the site to see what others have tried for this sort of problem by searching under the terms ‘adherence,’ ‘compliance,’ ‘access,’ or ‘hypertension’.”

Profiles currently posted on the site cover the use of open scheduling at a primary care office in suburban Indianapolis to eliminate patient wait times; the shortening of patient stays at Johns Hopkins Hospital's intensive care unit (ICU) by adhering to daily care goals; and helping Washington, D.C. seniors avoid institutional care by arranging home visits by geriatricians, nurse practitioners and social workers.

To be accepted for a profile, an innovation must impact patient care and improve health care quality, be truly innovative, and have information publicly available about the innovation. There must also be a willing spokesperson to talk about the effort, and a good reason to believe that the innovation will be effective. (Those that aren't effective may still be considered for inclusion on the site as an “innovation attempt.”)

The site also features expert commentary on innovations, as well as Web seminars, podcasts and online forums. New innovations are posted every two weeks—including some that didn't work out.

“Sometimes you can learn more from an innovation failure than a success,” Dr. Pawlson said.

Physicians and hospitals can use the site when they have an idea for an innovation, but they want to see if someone else has already tried it—and whether it worked, he added.

“There are topics here that might be appropriate for maintenance of certification,” Dr. Pawlson said. “The site is a way of finding something to do that might actually be useful, rather than starting out on your own and discovering that the first three things you try don't work.”

Innovations Exchange also incorporates AHRQ's online repository of quality improvement tools for assessing, measuring and improving care. The tools often support a given innovation, such as a transfer log spreadsheet for smoothing handoffs in the ICU, or a pneumonia severity index calculator for improving illness detection in a primary care office.

The hope is that as more people discover and use the site, the more health professionals will be inspired to submit their own stories of innovations. Small practices, in particular, would be welcome, he said.

“Larger practices and hospitals often have a more explicit process in place for doing innovation and feedback, and a person in charge of quality improvement,” Dr. Pawlson said. “We would very much like to have more examples from the smaller, ambulatory care environment.”