Triple wins for the 2014 Birnbaum Award

Each year, at the Birnbaum Lecture, Group Health Research Institute (GHRI) presents the Birnbaum Award to Group Health staff who’ve made extraordinary contributions to the organization’s development as a learning health care system: a place where research improves practice and practice improves research. At the Lecture on Thursday, May 8, the award will be presented to people involved in three outstanding projects, all funded by Group Health’s Partnership for Innovation:

Better testing for bacterial infections

“Urinary tract infections are very common,” said Kim Riddell, MD, medical director of Group Health Clinical Laboratories. “And emergence of antibiotic-resistant bacteria is a major problem.” In usual care, doctors choose an antibiotic based on a “best guess”—and then wait two to three days for identification of antibiotic sensitivity. Quicker identification of bacterial substrains and their sensitivity could improve antibiotic prescribing and outcomes by decreasing patients’ exposure to broad-spectrum antibiotics. This could make prolonged and recurrent urinary tract infections less common.

Dr. Riddell, Peggy Rogers, and their team showed it was feasible to adapt a new diagnostic technology to Group Health: testing for E. coli infection at the level of the clone (substrain). This approach had previously been used only in research settings and needed to be adapted to a community lab setting. The inexpensive test quickly and accurately identified two clones that were particularly resistant to antibiotics. Ms. Rogers is former Group Health manager for microbiology, and GHRI Senior Investigator Delia Scholes, PhD, nominated the team for the award. The team is now preparing to assess a rapid-test prototype at the point of care.

“I am more than convinced that clonal typing can transform care on several levels: improving use of lab resources and antibiotics, getting better outcomes for patients, and controlling spread of infections,” Dr. Riddell said. “And this technology can be applied to other bacterial pathogens, not only E. coli.”

Reducing care that doesn’t improve health

Matthew Handley, MD, is leading an exploration of how our clinical community can improve the value of the care we provide: delivering all the evidence-based care that is required, but none of the care that is not. How? By giving clinicians and staff relevant information and tools, and evaluating the results. GHRI Senior Investigator Diana Buist, PhD, nominated Dr. Handley, Group Health’s medical director for Quality and Informatics.

It all started with Dr. Don Berwick’s 2012 Birnbaum Lecture and the national “Choosing Wisely” initiative. Since then, project members have worked closely with Group Health primary care and oncology to understand the attitudes and practice patterns that contribute to low-value care and to implement strategies to decrease unnecessary care. In the first effort, the group practice documented clinically important reductions in too-frequent Pap testing for cervical cancer. It also found that clinicians want to provide high-value care—but need more information and direct feedback about low-value care.

“Collaborating with this team has been great because they are not just about learning,” said Dr. Handley. “They are committed to making a meaningful difference for our patients and the organization. The work of this team is helping Group Health patients and accelerating the Choosing Wisely work in the broader health care community in Washington state and nationally.”

Taking chronic disease self-management online

Living Well with Chronic Conditions is Group Health’s flagship self-management program. This successful workshop helps Group Health patients with chronic illnesses—like diabetes, asthma, or depression—to create action plans and gain self-management and problem-solving skills. They also get support from each other while building confidence to take better care of their health.

But not everyone can participate in person, particularly if they have day jobs or feel uncomfortable discussing their illnesses face to face. So Group Health’s Patient Engagement team implemented and tested an online version called “Better Choices, Better Health.” More than 700 participants have used the online version, which includes a virtual learning center and a discussion forum where participants interact. They appreciate having a convenient online option and report improvements in health status and health behaviors. Now people can participate in the way that is best for them. GHRI Senior Investigator Paul Fishman, PhD, nominated the team: Kim Wicklund, MPH, Megan Kavanagh, Kathryn Ramos, and Robyn Mayfield.

“We are grateful for the support of the Institute, the Foundation, and the MacColl Center in this effort,” said Ms. Wicklund, manager of Patient Engagement. “Our team was empowered to identify and resolve a gap, patients and purchasers are now benefiting from the new program, and we have gleaned valuable learnings that can be applied to other work in the enterprise.”

by Rebecca Hughes