Dr. Steve Narang, a pediatric hospitalist in Baton Rouge, La., has a deceptively simple philosophy about delivering care to his patients: He wants them to get the best care available, even if that isn't the latest and supposedly greatest therapy.
Over the last decade, he has worked with his colleagues to apply that philosophy in hospitals in the Baton Rouge area, and he has watched quality of care improve while costs decline. Now he is working with other pediatric hospitalists to spread his quality-improvement approach to hospitals around the country.
“There's a lot of emphasis in our health care system on what is the newest drug, the newest technology,” but very little comparative effectiveness data can be tapped to help physicians judge “what makes something better to use than something else,” said Dr. Narang, who serves as the medical director for quality and safety at Our Lady of the Lake Regional Medical Center in Baton Rouge.
About 2 years ago, Dr. Narang joined forces with four other pediatric hospitalists to launch the Value in Inpatient Pediatrics (VIP) Network. The small, informal steering committee included Dr. Narang, Dr. Matthew D. Garber of the University of South Carolina in Columbia, Dr. Brian M. Pate of the University of Missouri–Kansas City, Dr. Shawn Ralston of the University of Texas Health Science Center in San Antonio, and Dr. Mark Shen of Dell Children's Medical Center of Central Texas in Austin.
The grassroots project had no funding source, but it did have a straightforward goal: “Let's ask people to share their secrets” was how Dr. Narang and the other VIP Network members expressed their intent.
They began by asking hospitals around the country that care for children to report benchmark data on one of the most common diagnoses in hospitalized children—bronchiolitis. They invited the hospitals to provide a mix of process and outcome data about such patients. They sought information on length of stay, utilization of therapies, readmission rates within 72 hours, and variable direct costs for the treatment of children with bronchiolitis.
The VIP Network members also asked hospitals to report on the percentage of such patients receiving bronchodilators, steroids, chest x-rays, respiratory syncytial virus antigen testing, and chest physiotherapy.
The project, which is now in its second year, so far has collected data on about 7,000 patients who were treated for bronchiolitis at about 30 hospitals.
The hospitals participating in the VIP Network can compare their performance with that of other institutions on a quarterly and annual basis.
But the more exciting part, Dr. Narang said, is that hospitals are beginning to form collaboratives within the network, and the best-performing hospitals are sharing how they achieved success. Dr. Narang said that he hopes that the VIP Network will be able to obtain funding and thereby continue to grow.
The network founders are applying for a grant from the Agency for Healthcare Research and Quality, which they would use to hire a paid staff member who could automate and validate the data coming from the hospitals in the network.
Although other organizations are also performing this type of benchmarking work, Dr. Narang said that the VIP Network offers something unique because it does not focus only on freestanding children's hospitals.
Approximately 75% of children are cared for outside of freestanding children's hospitals, he noted, so quality data from general hospitals are needed to find the quality gaps.
The other characteristic that makes the VIP Network stand out is that it links process and outcome data, while most databases contain information only on outcomes.
“I think the key thing that we're learning in health care is not only do you need outcome measures, you need performance drivers,” Dr. Narang said. “How and why did these things occur?”
There is very little data to help physicians judge 'what makes something better to use than something else.'
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