Robert M Wachter1, Peter J Pronovost. 1. Department of Medicine, University of California, San Francisco, USA. bobw@medicine.ucsf.edu
Abstract
BACKGROUND: On June 14, 2006, the Institute for Healthcare Improvement (IHI) announced that its campaign to save 100,000 lives had far surpassed its goal--by saving 122,300 lives. THE INTERVENTIONS: Although many of the campaign's six "evidence-based practices" are supported by relatively strong evidence, the use of rapid response teams (the only intervention not already required or promoted by a major federal or Joint Commission initiative) is not. THE "LIVES SAVED": Secular trends could account for many of the "lives saved," which IHI acknowledges (and could have adjusted for, resulting in a markedly lower "lives saved" estimate). Moreover, IHI's estimates of lives saved are dependent on the case-mix adjustment-accounting for nearly three out of four "lives saved." The actual mortality data were supplied without audit by the more than 3,000 participating hospitals, and 14% of the hospitals submitted no data at all. POLICY IMPLICATIONS: IHI established and promoted a set of achievable goals for American hospitals and generated unprecedented amounts of social pressure for hospitals to participate. This remarkable achievement should be studied by other organizations seeking to generate widespread change in the health care field. CONCLUSIONS: Although the 100,000 Lives Campaign succeeded in catalyzing efforts to improve safety and quality in American hospitals, the promotion of rapid response teams as a national standard is problematic, and methodologic concerns regarding the "lives saved" calculations make it difficult to interpret the campaign's true accomplishments.
BACKGROUND: On June 14, 2006, the Institute for Healthcare Improvement (IHI) announced that its campaign to save 100,000 lives had far surpassed its goal--by saving 122,300 lives. THE INTERVENTIONS: Although many of the campaign's six "evidence-based practices" are supported by relatively strong evidence, the use of rapid response teams (the only intervention not already required or promoted by a major federal or Joint Commission initiative) is not. THE "LIVES SAVED": Secular trends could account for many of the "lives saved," which IHI acknowledges (and could have adjusted for, resulting in a markedly lower "lives saved" estimate). Moreover, IHI's estimates of lives saved are dependent on the case-mix adjustment-accounting for nearly three out of four "lives saved." The actual mortality data were supplied without audit by the more than 3,000 participating hospitals, and 14% of the hospitals submitted no data at all. POLICY IMPLICATIONS: IHI established and promoted a set of achievable goals for American hospitals and generated unprecedented amounts of social pressure for hospitals to participate. This remarkable achievement should be studied by other organizations seeking to generate widespread change in the health care field. CONCLUSIONS: Although the 100,000 Lives Campaign succeeded in catalyzing efforts to improve safety and quality in American hospitals, the promotion of rapid response teams as a national standard is problematic, and methodologic concerns regarding the "lives saved" calculations make it difficult to interpret the campaign's true accomplishments.
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