Effecting Change in the Health Care System
By Susan A. Messina
Something she heard during a Bryn Mawr economics course planted a seed for the multifaceted career of physician-researcher Kimberly Rask ’80: “Every system is perfectly designed to get the results it gets.” She has used this simple insight to tackle difficult but crucial challenges in the delivery of health care services, such as boosting the odds that state-of-the-art clinical treatment is available to all patients, decreasing adverse drug events, and promoting patient safety.
“My driving goal is to understand how our fragmented and complex health care system works, and how you can change things to get the outcomes you want,” Rask says.
Rask is associate professor of medicine, health policy and management at the Emory University School of Medicine and Rollins School of Public Health, Atlanta, and director of the Emory Center on Health Outcomes. As Emory’s clinical adviser to Healthgate, an evidence-based medicine solutions consortium, she oversees the creation of clinical and consumer guidelines for clinical care. Rask also sees patients at Grady Memorial Hospital in Atlanta as an attending physician in the urgent care department. She notes that her time in the clinic is important, as it grounds her in the daily realities of providing care in a busy, inner-city hospital and allows her to “get a lot of good ideas and also see the fallacy of some of those good ideas.”
Making a Difference
After graduating from Bryn Mawr with a degree in economics, Rask earned an M.D. at the University of Pennsylvania in 1984. She completed a residency in internal medicine at Emory, where she rotated through several very different hospitals and began contemplating how to attack systemic problems in health care services. Rask explains, “When I entered medical school, I wanted to make a difference in individual patients’ lives. After my residency, I wanted to make a greater impact on the health care system itself, thus helping more people, even if I never saw them.”
Returning to Philadelphia, Rask earned a Ph.D. in health economics at the University of Pennsylvania’s Wharton School of Business through the Robert Wood Johnson Clinical Scholars Program, which is designed for physicians interested in examining systemwide issues.
Of all her responsibilities, Rask most enjoys being director of the Emory Center on Health Outcomes. “I thrive on thinking about big-picture problems, coming up with a framework for looking at them, and then being able to follow through,” she says.
Rask’s research focuses on health promotion and outcomes measurement; she is keenly interested in figuring out how to ensure positive health outcomes by tweaking the health care system.
Rask recently investigated whether digital handheld devices such as Palms could improve the quality of care given to patients with congestive heart failure (CHF). Her study examined a physician group that was using Palms for billing to see whether the inclusion of “quality prompts” in the handhelds would make a difference in CHF patient care. For example, as a doctor was entering a CHF billing code, a prompt would come up on the handheld screen that asked, “Did you make sure to check their left ventricular ejection fraction before they were discharged?”
The purpose of the study was to see whether physicians would be more likely to check that particular marker of heart health if prompted in this way. While the results were mostly negative, the study did yield useful lessons. One of the major ones — which Rask has seen over and over — is that a system change can have a positive impact only if it is “in the workflow” and does not require health care providers to deviate much, if at all, from their usual routine. For example, once the physician group in Rask’s study switched from the Palm to desktop computers for billing, the quality prompt embedded in the Palm became meaningless — it was no longer in the physicians’ workflow. Also, many physicians found the prompts to be annoying.
Among Rask’s other research interests, she has examined the impact of a project designed to use pharmacy claims to identify elderly patients at risk for adverse drug events — bad combinations of medications that can lead to illness and even death. As a follow-up to this study, Rask is investigating the use of pop-up reminders on pharmacists’ computer screens to encourage pharmacists to ask patients specific questions about possibly bad drug-drug interactions. She is also currently evaluating the cost effectiveness of an HIV/AIDS prevention program designed to empower young black women to make healthy choices about sexual risk reduction.
In reflecting on her work, Rask says, “The ultimate goal is to make sure everybody has the opportunity to benefit from what we know works in health care. The field of health services research is not well known, but it is an area in which there’s a lot of work to be done. It’s a good career choice for people who like looking at complicated problems.”
Susan A. Messina ’86, M.S.S. ’90, M.L.S.P. ’91, writes on health and human services issues.