Florida Team

The mission of the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery is to use data-driven science to improve the quality, safety and value of health care and create better patient experiences — the science of best practice.

Areas of focus

Health care delivery researchers at Mayo Clinic's campus in Jacksonville, Florida, operationalize the center's mission by focusing on the value aspects of that mission. They collaborate with Mayo Clinic care providers to:

  • Conduct research studies centered on value, cost and efficiency to enhance methods of health care delivery
  • Investigate questions from within Mayo Clinic's medical practice to measure and improve health outcomes
  • Quantify the value of condition-specific patient care

The Mayo Clinic Kern Center for the Science of Health Care Delivery's Florida team includes a steering group that is led by a scientific director and made up of members representing the continuum of health care delivery and administration. Steering group participants reflect a cross section of Mayo Clinic's clinical practice and research activities in Florida; many have experience in a wide array of health care delivery science. Steering group members include:

  • Quality experts
  • Nursing leaders
  • Physicians of multiple specialties
  • Administration
  • Researchers with numerous areas of expertise
  • Contracting and payer relations personnel
  • Statisticians
  • Project managers

The steering group provides guidance and prioritization of all project applications to ensure the highest quality of science and potential impact for clinical practice.

Health care delivery research by the center's Florida team draws on expertise in the following areas:

  • Quality and safety
  • Operations research and systems engineering
  • Health care management
  • Patient-reported outcomes
  • Shared decision-making
  • Economic analysis
  • Systematic reviews
  • Qualitative analysis
  • Survey research center
  • Biostatistics
  • Bioinformatics
  • Epidemiology

Past project highlights

Contrast dye in patients with kidney disease: Reducing the risk of an important diagnostic tool

There are two main contrast dyes used for diagnosing kidney disease: iohexol and iodixanol. Health care delivery researchers at Mayo Clinic's campus in Florida sought to determine what the best available option was for patients. When they reviewed the available literature, the researchers found that reported rates of contrast-induced kidney damage (nephropathy) ranged from 8 to 50 percent of the time — variability they found unacceptable when seeking evidence for best practice.

The researchers then compared the two dyes in a prospective, randomized clinical trial, focusing on a specific subset of patients at risk of contrast-induced nephropathy. In outpatients with stage III chronic kidney disease, the team found that 2 percent of patients receiving iohexol developed contrast-induced nephropathy, compared with 9 percent of those receiving iodixanol.

Although the total number of patients in the study was relatively small (102), the results were striking enough that Mayo Clinic has now changed its practice to use iohexol almost exclusively for this group of patients. Combined with the fact that iodixanol is nearly five times as expensive as iohexol, the value of this shift for patients was clear.

Read more on Mayo Clinic's Advancing the Science blog.

Read the study in Clinical Imaging.

Process analysis leads to improved outcomes, time and cost savings for patients

Hip replacement surgeries have been around for more than 100 years. Knee replacements were introduced more recently, but still have a long history. Over time, processes have been refined to the point that patients can expect to return to full function, and often participate in long-lost activities.

Mayo Clinic's Department of Orthopedic Surgery uses the most advanced technologies and procedures. Mayo Clinic orthopedic surgeons are recognized nationally and internationally for their surgical technical excellence and innovative abilities to solve both simple and difficult orthopedic problems. However, even the experts can find ways to add value for patients.

As part of their goal to identify and improve value in health care delivery, members of the Florida team conducted an analysis of quality and cost metrics for Mayo Clinic's total hip and knee replacement programs. They were able to identify several differences across the surgical practice. These differences led to identifying best practices in pain control methodology and case manager involvement. The improved processes reduce costs for patients, providers and insurers, while maintaining excellent outcomes.

The exciting news for patients includes lower pain scores, shorter inpatient recovery time and far less likelihood of needing to transfer to a skilled nursing facility after hospitalization. The end result? Back to daily activities — and more — much sooner.

Learn about one patient's experience.

Sepsis and Shock Response Team

While Mayo Clinic has long been a participant in the Society of Critical Care Medicine's Surviving Sepsis Campaign, reviewing hospital records through a quality improvement lens revealed some areas for intervention.

Researchers in the Mayo Clinic Kern Center for the Science of Health Care Delivery used the Institute for Healthcare Improvement's Failure Modes and Effects Analysis (FMEA) Tool and other quality improvement methods to review Mayo's current practices. They then developed interventions that led to a more reliable application of all appropriate elements of the Surviving Sepsis Campaign bundles (sets of elements of care that, when implemented as a group, have an effect on outcomes beyond implementing the individual elements alone).

Through quality improvement methodology, the study team was able to develop high-impact interventions, including the development and implementation of a computerized sepsis sniffer algorithm, standardized resuscitation with decision support tools in the electronic health record, and creation of a multidisciplinary Sepsis and Shock Response Team.

These interventions led to more reliable application of the Surviving Sepsis Campaign bundle, and resulted in improvement in bundle compliance within six months of project completion. Furthermore, improvements were seen in hospital mortality among all patients with sepsis, and significant improvements were seen among patients with severe sepsis admitted through the emergency department, the focus of this study's efforts.

Read the study in the American Journal of Medical Quality.

Building and sharing the evidence base

The main aim of the science of health care delivery is to build the evidence base for best practices in medicine. However, no less important, is the dissemination of this knowledge. Learn about some of the ways the Florida team of the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery is sharing Mayo Clinic's research.

Publications

Review published health care delivery science research on PubMed from faculty members at Mayo Clinic's campus in Jacksonville, Florida.

Contact

Ryan J. Uitti, M.D.

James M. Naessens, Sc.D.

Aaron C. Spaulding, Ph.D.

Lisa M. Nordan