Microbial resistance: a Triple Aim example

To continue "Antibiotics: resistance and costs" post, given the importance of the subject, in this post I want to present the template design that may be helpful to those responsible for infection control in hospitals.

In 2007 two American scientific societies published a guide to deploying Antimicrobial Stewardship Programs (ASP) in health institutions. Five years later, three Spanish scientific societies adapted those guidelines and laid the foundations of the Programs for Optimizing Antimicrobials Use (PROA in Spanish).

These methodological developments are relevant because there is enough evidence to believe that management programs reduce antimicrobial resistance and costs. Therefore, with the rationalization (not rationing) of antimicrobial use we’re faced with a clear example of Triple Aim program. Remember that a Triple Aim program is a program that, in a balanced way, achieves three types of objectives: improved clinical outcomes, enhanced the patients’ experience and reduced costs.

When less is more: a strategic agenda

When Less Is More: Issues Of Overuse In Health Care – Health Affairs Blog http://t.co/9BabaZFFUY

— Joan Figueres Sendra (@joan_figueres) April 26, 2014

Dr. Joan Figueres, expert in the evaluation of health services, announces with his tweet, of the publication of a post signed by Shannon Brownlee and Vikas Saini, Vice President and respectively President of Lown Institute, along with Christine Cassel, President of ABIM Foundation. This post was published on the blog of Health Affairs on 25 April and in total agreement with Dr. Figueres, I also find it remarkable as I believe that the article does a good overview of the current grade of clinical waste outbreaks and suggests some strategies for engaging physicians, patients and the media in improving the situation, and I will focus on the latter:

Crystal clear knowledge for decision making

By Cristina Roure 

Excellent health care is one in which patients, professionals and managers apply the best available knowledge in decision making. Only well-informed agents can take the most appropriate decisions for an effective, safe and efficient health system. We often think that the big problem of the system is the lack of money, and only devoting more resources will solve the problems, but lack of knowledge is much more worrying than it may seem at first glance.

Sir Muir Gray, Chief Knowledge Officer of the National Health Service (NHS), uses an analogy that I find very spot on: "It takes knowledge as crystal clear as the water we drink if we want to take the right decisions." But the current reality is very different because we drink from contaminated sources of knowledge.

Medical Practice: an honest wage for an honest job

"outcomes-based reimbursement works only in a limited sector of healthcare" http://t.co/XFFymLHA8i

— Dr. Luis Ramos Neira (@lramosneira) April 29, 2014

Dr. Luis Ramos is a very professional dedicated to networking. He defines himself as a quali -  epidemiologist. Well, his tweet brings us to a post in The Health Care Blog, signed by a Swedish family physician, Dr. Hans Duvefelt, who works in a town in Maine, on the east coast of the United States. It’s a short clear post, from which I have extracted the main ideas.

We're hearing now that doctors should be paid in accordance with the clinical results of their work and of course we’re not talking about parameters such as controlling blood pressure or glycaemia, but about death, strokes, heart attacks, amputations, hospital infections, etc. But the question is: How can we measure the patients degree of involvement now that there’s so much talk about them? Should the doctor charge less if his diabetes patient is not doing well despite his good work? Wouldn’t this model lead us to the selection of patients?

Nurses: (+) training (-) workloads = (-) mortality

A few months ago, Mireia Subirana, Director of Care at "Consorci Hospitalari de Vic" explained in a post the results of her doctoral thesis that can be summarized as: "more nurses and more training (in hospital wards) was associated with better clinical outcomes". Following this thread, The Lancet has just published the results of a retrospective observational study that has explored whether the nurses training levels and workload ratios could influence the mortality of patients admitted for medium complexity scheduled surgery.

It’s an important work undertaken in 300 hospitals in 9 European countries by surveying 26.516 nurses and analysing 422.730 hospitalization surgical episodes. Despite the expected methodological difficulties of a project of this nature, it can be considered as a rigorous study.