Ashish Jha Strives to Make Health Care Safer and Better

"I firmly believe that the care most Americans receive is far from ideal. And, no matter who you are, you're at high risk for receiving poor quality care," says Ashish Jha, assistant professor of health policy and management at HSPH and a practicing internist at the Veterans Affairs Hospital. Jha studies how to improve quality of care and how to reduce disparities in care. He has just received the Alice S. Hersh New Investigator Award from AcademyHealth, which recognizes scholars early in their careers who show exceptional promise as researchers in health services.

Even when he was a medical student, Jha says, "I saw very quickly that there were patients who didn't get the care they needed or got care they didn't need. And it's not because we don't care or we aren't spending enough money, but because the health care system has not been modernized and performing the way it should."

It's a system that has not kept up with the complexity of modern care, he says. One result is medical errors, which are responsible for 44,000 to 98,000 deaths per year, according to an Institute of Medicine study — more deaths than car accidents, breast cancer, or AIDS. (A lead author of that groundbreaking 2000 report, To Err Is Human, is HSPH faculty member Lucian Leape.) Information technology is one solution that Jha has investigated, although he points out that 90 percent of U.S. hospitals don't even have electronic medical records. "But 2008 is an electronic world, and medicine should be, too," Jha says.

Instrumental in shaping his thinking, he says, is his mentor and HSPH department head Arnold Epstein, who impressed on him that efforts to improve performance must be evidence-based and rigorously evaluated. Jha met Epstein while undertaking his MPH at HSPH.

"As an investigator, Ashish is enormously creative and has an innate sense of what is important and what is not," says Epstein, John H. Foster Professor of Health Policy and Management at HSPH and a practicing physician at Brigham and Women's Hospital. "In just a few years, he has compiled a substantial body of work elucidating critical issues in quality of care, patient safety, and health care disparities. I am sure that he will increasingly be looked to as a national leader in health services and policy research."

In one defining study that assessed quality of care in hospitals across the country, Jha and colleagues reported in the New England Journal of Medicine in 2005 a great variability in treatment outcomes, with many hospitals failing to provide consistently lifesaving care.

Jha and Epstein have collaborated on several papers, including two over the past year that showed that care of elderly black and Hispanic Americans is concentrated in a small percentage of hospitals, which are less likely to have medical or cardiac ICUs, had much lower nurse-staffing levels, and provided a lower quality of care for these common medical conditions: heart attacks, congestive heart failure, and pneumonia.

"This suggests that even in 2008 health care is segregated de facto," says Jha. "There are a few hospitals and physicians caring for the vast majority of minority patients."

People may be surprised to learn, he says, that these are not public hospitals; many are for-profit and academic hospitals, which generally take care of poor and minority patients. "These hospitals are vulnerable to policies around reimbursement for the poor and uninsured. If the institution is financially stressed, it won't be able to take good care of anyone," he says.

Improving quality of care more uniformly across the country will help reduce disparities in care to a certain extent. "But if we want all care to be equal, we also need specific efforts targeting disparities, such as by interventions to improve care and outcomes at those hospitals that care for disproportionate numbers of ethnic minorities," says Jha.
Hospital "report cards" and other efforts to increase transparency have helped providers and payers pay attention to quality, he adds. "Quality is getting better over time, just not as quickly as we would like."

Jha remains optimistic about the prognosis for the healthcare system: "We have a real opportunity to help the next generation."

Listen to a podcast of Jha discussing hospitals and hospital rankings. Read about a paper he published this spring in Health Affairs.

—Ellen Barlow. Photo by Suzanne Camarata.