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There are more than 90,000 Americans awaiting an organ transplant, according to the U.S. Department of Health and Human Services. Regenstrief Center researchers are tackling challenges in donation awareness and organ allocation systems. More
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People
> Research associate leads patient safety coalition in Indianapolis. More
> New Regenstrief Center faculty member uses modeling to optimize organ transplant system. More
Projects
> Adverse event reporting may not translate into organizational change, according to enter study. More
Partners
> Research sub-center focuses on health outcomes and policy. More
Progress
> First "Brownbag Series" speaker focuses on unique Discovery Park research opportunity for undergraduates. More
> Beyond the Regenstrief Center's fall symposium - reflections from a graduate student. More
> Woodward-Hagg speaks at Deming Institute fall conference. More
Publicity
> Regenstrief Center highlighted in healthcare technology and patient safety publications. More
> Steven Witz featured on Inside Indiana Business. More
> "Revisiting Telehealth Technologies for Rural Health Delivery" in Hoosier Times. More
> "Patients Abound, But Donors Scarce" in Lafayette Journal and Courier. More
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Research associate leads patient safety coalition in Indianapolis
Each year more than 7,000 patient deaths in the U.S. can be attributed to medication errors - none of which is caused by a single element or the fault of a single practitioner. Indiana is no exception, as highlighted by the recent deaths of three newborn infants in a prestigious Indianapolis hospital. As executive director of the Indianapolis Patient Safety Coalition, Kathy Rapala, JD, RN, a Regenstrief Center research associate, is leading a consortium of six hospital systems in Central Indiana to solve the most concerning patient safety issues in a non-punitive, non-competitive setting.
“Regulators, healthcare organizations, patients and academicians have launched significant and vigorous programs to address patient safety issues, but a large amount of work remains,” said Rapala. “Patient safety cannot be effectively addressed organization by organization. Research, healthcare providers and industry must be in concert to design safe healthcare environments.”
Rapala came to Purdue in August 2006 as director of the second degree program in the Purdue School of Nursing and to pursue her doctorate of nursing practice at Purdue. She also serves as instructor in the areas of leadership, nursing issues, and nursing informatics. She was previously the director of risk management and patient safety in the Clarian healthcare system, where she built the patient safety infrastructure that included use of simulation and root cause analysis.
Rapala sought out Purdue’s School of Nursing and Regenstrief Center because of the opportunities for multidisciplinary collaboration, particularly between clinicians and engineers. “It is important to collaborate with experts outside healthcare to accelerate patient safety changes. There is much healthcare can learn from other industries, such as aerospace, that have applied engineering principles to sustain high-reliability organizations with few errors,” she said.
Rapala is currently developing two research projects with Regenstrief Center strategic partner Community Health Network, including a study of staff safety behaviors and the impact on patient care and outcomes.
“Kathy’s extensive background in patient safety is a significant asset to the center’s core research agenda,” said Steven M. Witz, Regenstrief Center director. “She contributes clinical knowledge, experience in hospital administration, connections to the Indianapolis healthcare community and key leadership to advance the center’s patient safety efforts.”
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New Center faculty member uses modeling to optimize organ transplant system
In August 2007, the Regenstrief Center welcomed Nan Kong, Ph.D., assistant professor in biomedical engineering, as a Regenstrief Center faculty member. Kong, who was previously an assistant professor at the University of South Florida, contributes his interest and expertise in theory and algorithms for integer programming, combinatorial optimization, and stochastic modeling for large-scale dynamic systems.
Kong was awarded first place in the 2007 Pritsker Doctoral Dissertation Competition from the Institute of Industrial Engineers and an Honorable Mention in the 2006 Dantzig Doctoral Dissertation Competition from the Institute for Operations Research and the Management Sciences for his work on the optimization of the United States organ transplant allocation system. “The current system is hindered by a region design that appears structured around ‘political restrictions,’ which limits the number of patients who can receive quality organs,” said Kong. “Our findings verified that expanding the regions, which is now possible due to advances in preservation technologies, can significantly increase the chance that a patient will receive a matching organ from his/her region.”
His ultimate goal is to influence a redesign of the overall transplantation policy framework. He was attracted to Purdue and the Regenstrief Center, in part, because of opportunities to collaborate with researchers across disciplines. “There are three aspects to the issue of organ donation and transplantation: donation awareness, preservation technology, and resource allocation. Susan Morgan [from Purdue’s Department of Communication] is addressing the first level, and I address the third,” said Kong. “By understanding each other’s research, we can work to impact the entire system.” (See Publicity for a recent news article on Morgan’s research).
In addition to influencing policy, Kong is interested in using modeling techniques to understand disease progression and treatment at the patient level. “We are pushing the envelope of modeling capabilities, said Kong. “We believe that efficient, data-driven modeling could help practitioners make decisions about individual patients based upon certain clinical factors. This would complement work currently done by biostatisticians to achieve the goal of personalized medicine.”
Steve Witz, the Regenstrief Center’s director, noted the value of Kong’s grounding in industrial engineering methods in advancing the center’s healthcare operations research. “Nan’s experience applying mathematical modeling and
simulation to healthcare research is a great complement to our team of Regenstrief Center faculty members. In addition, his location in the Purdue’s Biomedical Engineering Department and his previous work with researchers at the University of South Florida strengthen our center’s potential to collaborate with these colleagues,” said Witz.
Editor’s Note: Some content used with permission from the Institute of Industrial Engineers.
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Adverse event reporting may not translate into organizational change, according to center study
Despite recent state and federal legislation to increase the reporting of adverse events in healthcare organizations, human nature may be thwarting the success of these programs to identify and prevent adverse events. According to James Anderson, Purdue professor of sociology and Regenstrief Center research associate, only 5-10% of adverse events are currently reported, and this low percentage may be due to humans’ hesitancy to admit mistakes and fears of being sued, among other barriers. “In medicine, there is a culture of ‘blame and shame,’ ” said Anderson. “The fear of malpractice litigation inhibits reporting of errors, as does the diffusion of accountability in a physician culture of individual professional autonomy.”
These barriers, along with a lack of agreement of what constitutes an error, unclear return-on-investments for expensive solutions such as electronic prescribing, and a healthcare reimbursement structure that works against improving safety, are substantial deterrents to identifying problems, measuring progress and demonstrating improvement.
In addition to identifying barriers to adverse event reporting, Anderson has explored the effectiveness of certain strategies to encourage information-sharing and continuous process improvement. Working with the Pittsburgh Regional Health Initiative, he examined whether participation in an adverse event data-sharing consortium increased reporting over time, and whether reporting resulted in organizational actions aimed at reducing future adverse events.
Anderson and his research team found that while the number of reported adverse events rose steadily over one year, corrective actions taken by the hospital remained fairly constant over the same time period. When corrective actions were taken, only 15% involved system interventions such as policy changes, staffing adjustments or environment modification. Yet results of Anderson’s event-reporting simulation model indicate that root-cause analysis and system changes are the most effective interventions for long-term adverse event reduction, by as much as 70% over time.
“The results of this study carry implications for the design and assessment of data-sharing systems,” said Anderson. “In general, there is a mismatch between patient safety goals and hospital actions to reduce the risk of future medication errors. System-wide organizational changes are essential to significantly reduce adverse events.”
Anderson is looking for opportunities to implement findings from his series of patient safety studies conducted with the Pittsburgh Regional Health Initiative. He also has accepted invitations to present to the University of Victoria and the Canadian Patient Safety Institute, in addition to presentations for a number of U.S. professional associations.
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Research sub-center focuses on health outcomes and policy
The Center for Health Outcomes Research and Policy was established during fall 2007 to conduct research examining the effectiveness of treatment strategies and interventions designed to improve patient outcomes and optimize the cost efficiency of healthcare delivery. Operating as a sub-center within the Regenstrief Center, the center will be co-directed by Laura Sands, professor of nursing, and Joseph Thomas III, professor of pharmacy. Additional faculty include Bruce Craig, professor of statistics; George Avery, assistant professor of health and kinesiology; and Susan Chen, professor of agricultural economics.
In addition to pursuing new research opportunities, the center will continue work led by Thomas and Sands to develop and interpret objective evidence to help guide Medicaid policy. Recent efforts have included estimations of incremental treatment cost attributable to dementia, revealing specific opportunities for effective management of dementia related costs. Other work determines costs and outcomes associated with different methods of providing long-term care (see April 2006 newsletter).
“The center’s research is focused on gathering and interpreting knowledge about the healthcare system to prevent and treat disease and disability in ways that are effective and efficient,” said Thomas. “This focus will include state healthcare issues, and those of national and international importance.”
“The center’s research focus, opportunities for student learning, and commitment to knowledge dissemination are consistent with the Regenstrief Center’s mission to catalyze transformation of the healthcare delivery system,” said Steven Witz, Regenstrief Center director. “We are excited about the potential for this center’s research findings to provide patients, providers and policy makers with the evidence they need to make informed healthcare decisions.”
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First "Brownbag Series" speaker discusses unique Discovery Park research opportunity for undergraduates
By Jillian Jweinat, senior in Health Sciences and Regenstrief Center Student Ambassador
The first of the Regenstrief Center Brownbag Speaker Series on Friday, Sept. 14, highlighted a unique resource within Discovery Park to engage undergraduate students in multidisciplinary research. Amy Childress, intern coordinator of the Discovery Undergraduate Research Internship (DURI) program, highlighted the benefits to faculty, students and Discovery Park.
DURI involves Purdue undergraduates in cutting-edge interdisciplinary research in Discovery Park. The program offers 50 internships per academic semester, funded through the Discovery Learning Center.
Faculty benefit from the opportunity to select from a pool of highly talented and motivated undergraduates students to advance the faculty member’s research. The program also offers faculty a way to foster the exchange of ideas through mentorship and address broader impact goals.
Students benefit as well, receiving a $500 scholarship and valuable skills and real-world knowledge for research careers. They are required to enroll in a seminar series to learn how to engage in a community of fellow researchers. Students have the option of receiving additional research credits and can even earn credit toward certification in entrepreneurship and innovation.
Projects must be of an engaging, interdisciplinary nature, and should be affiliated with one or more Discovery Park centers. The program is open to all academic majors; minimum requirements are a 3.0 grade point average, sophomore standing, and six hours of project activity per week.
The Regenstrief Center is sponsoring a project to promote rural health care quality and service availability in Indiana. Other DURI projects include the production of DNA-based nanotechnology tools to control gene expression, the creation of virtual yet accurate 3-D environments of ancient Roman Forums, and the development group of autonomous unmanned aerial vehicles.
For more information about DURI, visit www.purdue.edu/dp/duri. To view the entire fall lineup for the Brownbag Speaker series, visit www.purdue.edu/rche.
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Beyond the Regenstrief Center's fall symposium - Reflections from a graduate student
By Neelu Chawla, M.S., Doctoral Student, Child Development and Family Studies, Marriage and Family Therapy Program
The Regenstrief Center’s Fall Symposium, Transforming Healthcare Delivery: Advancing Multidisciplinary Research at Purdue University, featured a wide variety of presentations topics, including the relationship between stress and back injury, research partnerships with community organizations to promote physical activity among older adults, and telehealth initiatives to support chronic disease management for rural patients.
For those of us whose identities as researchers and scientists are incipient and emerging, the RCHE conference offered a philosophy of research that was systems-driven, practical, and inspiring. Here are some principles that were clearly articulated by the varied and many research presenters:
- Follow your curiosity. A wide variety of constructs are being studied right here in our backyard. David Rollock, professor of psychological sciences, presented research on the effects of culture on emotional health. Howard Weiss, chair of the same department, shared his conceptualizations about workplace well-being, specifically the burnout and daily emotional experiences at work.
- Nudge your curiosities toward examining relevant socioeconomic problems. Exemplar presentations included Susan Chen’s research on healthcare accessibility in the state of Indiana and its relationship with the health status of a population. Dr. Greg Arling from Indiana University School of Medicine and the Indiana University Center for Aging Research has developed comprehensive measures to assess nursing-home quality in order to support the improvement of quality of life initiatives for nursing-home patients. Stacey Mobley’s work in Foods and Nutrition focuses on bone health in children and young adults and the development of individual diet recommendations to prevent osteoporosis.
- Be collaborative. Bring together community providers, university-based research departments and clinicians to develop research that produces knowledge applicable to real populations and real problems.
- Be multidisciplinary. Cleveland Shields, professor of child development and family studies, presented his intervention study to coach breast cancer patients to directly tell their doctors about their emotions, worries and concerns. The study’s multidisciplinary research team is made up of nurses, oncologists and family therapists working hand in hand.
- Be systemic. Moving from systems-oriented conceptualization to direct action involves creating a localized “culture of discovery” according to Dr. Malaz A. Boustani, director of research at the Indianapolis Discovery Network for Dementia (IDND). He described how the IDND is structurally organized to improve systems of care for persons with dementia in Indianapolis with a vision to become the international authority on unifying clinical care and clinical research about dementia.
Cleveland Shields has shared these words about academic pursuits: “Being a researcher is like throwing pebbles into a pond. If enough of us are throwing pebbles into the same pond in the same general direction, then someday we might have a place to stand in the middle of the water.” Attending the Regenstrief fall symposium was a rare chance to meet an array of researchers - engineers, nurses, economists - who are at the edge of the pond throwing pebbles of all shapes, sizes and colors into the green waters before them.
Editor’s note: PowerPoint slides from the symposium are now available at www.purdue.edu/dp/rche/fall2007.
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Woodward-Hagg speaks at Deming Institute Fall Conference
Heather Woodward-Hagg, a Regenstrief Center research associate, presented the talk, “Lessons from Deming: Creating Sustained Quality Improvement in Healthcare Organizations” at the 2007 W. Edwards Deming Institute Fall Conference on Oct. 13-14 at Purdue University.
Dr. Deming was instrumental in helping Japan rebuild its economy after World War II through dramatic quality improvement, and was a major force in the U.S. quality movement of the 1980s and 1990s.
According to Woodward-Hagg, healthcare organizations often struggle to effectively adapt Deming’s principles to create sustainable change within clinical processes, despite the success of quality improvement methodologies in manufacturing and other industries. “The difficulty of this ‘translation’ and lack of relevant case studies offered in healthcare dialect has been cited as a limiting factor for sustained adoption of these practices within healthcare environments,” she said.
Woodward-Hagg’s presentation explored the current state of adaptation and adoption of Deming’s philosophies within healthcare. She presented case studies of successful integration of these principles in creating sustained quality improvement, and discussed the impact of relevant research in this area.
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Regenstrief Center highlighted in healthcare technology and patient safety publications
Two recently published journal articles highlighted the unique approach of the Regenstrief Center on improving healthcare delivery in the United States. The first article, published in the International Journal of Healthcare Technology and Management (2007), describes the center’s business model; that is, how the center "engineers" interdisciplinary solutions using the multiple perspectives of healthcare and multiple project time scales to organize and leverage healthcare delivery transformation.
The second article, written by Kathy Rapala, J.D., R.N., Regenstrief Center research associate (see People above) and Julie Novak, DNSc, R.N., M.A., CPNP, FAANP, head of the Purdue School of Nursing and member of the Regenstrief Center executive team, focuses on Purdue’s Doctorate of Nursing Practice (DNP) Program, which emphasizes information technology, health economics, evidence-based practice, systems and biostatistics. The article points to the Regenstrief Center as a central collaborator, providing DNP students with the opportunity to participate in multidisciplinary research and applied projects.
Witz, S.M., et. al. (2007). “The Regenstrief Center for Healthcare Engineering: Designing, implementing, and sustaining interdisciplinary solutions to transform healthcare delivery systems,” International Journal of Healthcare Technology and Management, Vol. 8, pp. 399-416.
Rapala, K. and Novak, J.C. (2007). “Integrating patient safety into curriculum: The Purdue University doctor of nursing practice,”Patient Safety and Quality Healthcare, Vol. 4, Iss. 2, pp. 16-23.
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Steven Witz featured on Inside Indiana Business
| Steve Witz on Inside Indiana Business |
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Regenstrief Center director, Steven M. Witz, was featured on Inside Indiana Business on Friday, Sept 21. During the interview, Witz discussed the recent grants from the Regenstrief Foundation to fund projects in the areas of cancer care, telehealth and patient scheduling.
The foundation has invested $1.35 million in a joint Cancer Care Engineering project involving Purdue, Indiana University and the Veterans Affairs Hospital. The project brings together oncologists, health service researchers, engineers, biologists and others in the war on cancer.
The Regenstrief Center at Purdue also will receive $1.1 million to research a more systematic approach to patient scheduling to reduce no-shows at hospitals and clinics.
As part of the second grant, Purdue researchers will design a national telehealth model to treat patients in rural and underserved areas who suffer from chronic illnesses. That grant also includes funding for managing databases related to these projects.
Leonard J. Betley, Regenstrief Foundation president, said he views this new funding as an investment that will equip physicians, nurses, medical staff and researchers with a blueprint for improving how healthcare providers treat their patients. To view the interview, visit www.insideindianabusiness.com and search for “Regenstrief Center.”
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“Revisiting Telehealth Technologies for Rural Health Delivery” in Hoosier Times
Originally published August 2007. Distributed by: Healthcare Financial Management Organization. Authors: Bart Collins and Steven Witz, Regenstrief Center
"Understanding process redesign is a key component of our work at the Regenstrief Center for Healthcare Engineering at Purdue University. One of the unique focuses of our center is that we take a systems approach to healthcare delivery processes. This leads us to ask, “How can we optimize quality of care, cost-effectiveness, and access for all persons in an environment as complex as the healthcare industry?
This, more than anything else, is an engineering problem that begs for rethinking the processes behind the delivery of medicine and its integration into the healthcare organization. Healthcare quality, as it turns out, has not been a huge hurdle to overcome. Hundreds of studies across a wide range of specialties have found that health quality is maintained and often improved through telehealth. The same is true for patient satisfaction. The key is identifying areas of impact and implementing telemedicine in a cost-effective manner."
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“Patients Abound, but Donors Scarce” in Lafayette Journal & Courier
Originally published August 5, 2007. Author: Dorothy Schneider
Reprinted with permission.
Susan Morgan with her driver's
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Despite the fact that nearly 10,000 sick Americans are waiting for organ donations, statistics show fewer than half of adults in the United States are registered donors. The disparity astonishes many. But some understand, knowing they too haven’t registered as a donor on their licenses or online because of fear, personal beliefs or simply not knowing how to sign up.
“Everyone knows rationally that they’re not going to need their organs after they die, but there’s always that little thing in the back of their mind,” said Susan Morgan, associate professor in health communication at Purdue and a Regenstrief Center research associate. “It’s also very human to go ‘ick’ when they think about having some of their organs removed.”
Morgan is working with a Hollywood advocacy group hoping to present positive donation and transplant stories through television. Her new research shows that inaccurate organ donation storylines coming out of Hollywood are negatively swaying public opinion and have stopped some potential donors from registering.
Morgan’s work prompted the launch of a new organization - Donate Life Hollywood - that plans to promote correct and positive coverage of organ donation and transplant stories on television.
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