Last spring, the New England Journal of Medicine published results from a cutting-edge study on preventing health care-acquired infections. It is the type of study that we may look back on one day and say, "That's when things changed."
The study is also a glimpse into the mindset of Jonathan Perlin, M.D., chair-elect of the American Hospital Association. More on that in a bit; first, let's talk about the study.
Here are some basic facts: Hospital Corporation of America pulled together 74 ICUs across 43 hospitals in an effort to assess three different strategies for attacking methicillin-resistant Stephalococcus aureus — screening and isolating infected patients; screening, isolating and decolonizing those patients; and decolonizing all patients without any screening. Through a "cluster-randomized trial," each hospital followed one of the three protocols, which were embedded into the care process and implemented by front-line staff.
Groundwork for the study started in January 2009. The 18-month intervention period stretched from April 2010 to September 2011; more than 74,000 patients were involved.
The authors, one of whom was Perlin, went into the study partly because there has been little clinical evidence to guide selecting one strategy over another.
Results: Universal decolonization led to a 44 percent drop in all bloodstream infections, not just MRSA.
Beyond the clinical results, Perlin believes that the study is a prime example of how we can build a "learning health care system." In fact, that's how the study initially came about, he says, following a set of discussions HCA had with both the Institute of Medicine and the Centers for Disease Control and Prevention.
"We realized that if we could convene a number of hospitals, we could test several evidence-based strategies," he told me during a two-hour interview in his Nashville, Tenn., office in the fall. Perlin is chief medical officer and president of clinical and physician services at HCA and spearheaded the process across the system. The study construct was a great vehicle for "advancing knowledge," he says, adding that working together, clinicians and hospital leaders can learn quickly and spread best practices. "Imagine if we could tap into our collective memory and understand the difference between what really worked and what we thought would work, but didn't," he says.
If past performance is any indicator, that mantra of a learning health care system is something Perlin will bring to the AHA board. Looking back over his impressive career, he's long been an advocate not just for better care, but also for smarter care. Whether it was during his nascent clinical days when he fought to make a Virginia hospital campus a smoke-free environment, or at the Department of Veterans Affairs where he led a major transformation effort, Perlin has challenged convention and held firm to a belief that health care professionals should strive to "help individuals and communities attain their highest levels of function."
As you'll read in this month's cover story, Perlin is passionate about the role that providers can — and should — play in creating positive social change. As the delivery system continues to evolve and play a bigger role in creating healthy communities, Perlin seems well-suited to be moving into a leadership role at the AHA.
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