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A lauded health care reformer moves on

WASHINGTON—Dr. Kenneth Kizer's been saving lives wholesale for most of his professional life, and if his latest ideas work out he might save yours.

Chances are you've already encountered his approach. Kizer, one of America's leading health care reformers, is a big fan of such strategies as:

_ Electronic medical recordkeeping to aid and speed patient care.

_ Bar codes to unfailingly match hospital and nursing home patients to their medicines.

_ Computer-aided medical records research to determine which treatments and drugs—and which doctors and hospitals —perform best.

_ Public release of care quality report cards.

Kizer, 54, a burly and brilliant workaholic—driven, some colleagues say, by being orphaned at age 12 and surviving in a succession of foster homes—isn't alone in pushing these initiatives. But in the vanguard of medical reformers, Kizer's got a unique credential: He's already delivered in one big arena.

Moreover, Kizer did it in the `90s in what was then the most widely disparaged hospital chain in the United States: the 173-hospital system run by the Department of Veterans Affairs.

It now provides veterans with "significantly better" health care than Medicare's fee-for-service program, according to a comparison published in the New England Journal of Medicine in 2003.

That success came two professional lives ago for Kizer. More recently, he's created and run a Washington group of more than 300 physician, hospital, insurer and consumer representatives whose purpose is to agree on specific standards to measure medical care quality.

Some standards are as simple as whether a hospitalized heart attack victim gets a beta-blocker drug to ward off the harmful effects of stress hormones on the heart. Heart patients who don't get beta-blockers after heart attacks are 40 percent more likely to be dead a year later.

The blocker criterion is one of 68 hospital care quality measures endorsed by Kizer's National Quality Forum. Such standards are the essential first step to making telling comparisons in health care, according to the dean of U.S. medical care reformers, Dr. Donald Berwick, president of the Institute for Healthcare Improvement, based in Cambridge, Mass.

In the long run, well-applied quality measures, by driving out bad care, will help to deliver more good care at lower cost, reformers such as Kizer and Berwick believe. Ultimately, the U.S. health care system would pay doctors to keep patients healthy—a system called pay-for-performance—rather than to treat their illnesses.

Kizer's success in getting competing health care interests to agree on hundreds of measures of quality care was " a massive political achievement," and "a major win for the country," according to Berwick.

Kizer announced earlier this month that he'd be leaving the National Quality Forum in December to take over Medsphere Systems Corp., of Aliso Viejo, Calif., a small health information-technology company whose goal is to cut the price of electronic patient recordkeeping by using the free, publicly available open-source system that the VA devised.

About 10 percent of U.S. hospitals currently keep patient records electronically in a dynamic form that enables doctors to diagnose, monitor and manage their patients.

The difference that sophisticated health IT can make is clear in VA hospitals. When laptop-bearing personnel enter a patient's room, they can review not just the patient's latest data but the medical record of every VA medical encounter the patient's had since the mid-80s.

If the patient's been stricken while traveling, records can be transmitted instantly to or from the VA hospital the patient normally uses. Records can also be shipped to consulting VA physicians or downloaded by care-monitoring loved ones if the patient agrees.

VA doctors also enter drug orders on their computers. If they've missed a potential allergic reaction or a dangerous drug combination, the computer flags a warning. When the hospital pharmacist fills the prescription, the system spits out a strip of bar code that goes on the medicine, saying what it is, who it's for, when it's to be given, at what dose, and by whom.

G. Sue Kinnick, a VA hospital nurse from Topeka, Kan., who died last year, came up with the VA's bar code system while returning a rental car in Seattle. Drug-related mistakes contribute heavily to the medical errors that kill an estimated 44,000 and 98,000 Americans annually. Why not use the same hand-held reader with which attendants matched cars and renters to help nurses match bar-coded drugs with a bar-coded ID on the patient's wrist?

Kizer, while the VA's undersecretary for health in 1994-99, loved the idea. "It wouldn't have gone anywhere without upper management's leadership," said Russell Carlson, the nurse-consultant for the bar code system now in place in every VA hospital.

For turning around VA health care, Kizer earned kudos from lawmakers such as Sen. John Kerry, D-Mass. But he also antagonized them by reducing in-patient beds and hospital staff. After several senators put holds on Kizer's renomination to pressure him to restore some of those cuts, Kizer resigned.

Nancy-Ann DeParle, a quality forum board member, attributes Kizer's tough-minded confidence to the dire straits he grew up in.

Kizer's first daylong job was at age 5 or 6, he recalled in an interview, when he earned three cents a quart for picking strawberries. He also ironed for his mother, who took in laundry.

His father, a factory worker in Boring, Ore., outside Portland, died of a heart attack when Kizer was 6 and the two were shopping. His mother committed suicide when he was 12, leaving five children wards of the state.

In the eighth grade, Kizer attended five schools in Oregon, California and Nevada, he recalled.

He settled in Reno, Nev., for three years of high school, where he proved a successful, popular student and ultimately was class president. He learned what he called "helpful" ideals and attitudes from football and track.

The early loss of his parents and some nasty aspects of foster care, Kizer said, "made me more serious ... made me want to be successful."

Kizer won honors as a pre-med student at Stanford, where he supplemented his scholarship with jobs as an emergency room orderly, library clerk and fireman. He graduated from UCLA medical school and, facing the draft, served a stint as group medical officer for Navy ordnance disposal units headquartered in Hawaii.

Then-California Gov. George Deukmejian named Kizer to head the state's emergency medical care authority in 1983 and, later, to direct the state's Department of Health Services. There, Kizer led the most successful anti-smoking campaign in any state's history, cracked down on nursing home abuses and, at age 33, suffered the nickname "Baby Doc."

Kizer's wife and high school sweetheart, Suzanne, lives in Sacramento, to which he's commuted from Washington on weekends, often writing medical journal articles on the plane. They have two grown daughters.

For recreation, Kizer likes to dive in the South Pacific. Friends who've gone along say he relishes swimming with sharks.

Harold Gracey, Jr., the VA's chief of staff in Kizer's era, who's now retired, offered Kizer the highest of praise. "The things that are attributed to him, he really did," Gracey said. "He wasn't one of those appointees who shine other people's work up, advertise it and take credit for it."

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For more on the National Quality Forum, go to www.qualityforum.org

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(c) 2005, Knight Ridder/Tribune Information Services.

PHOTOS (from KRT Photo Service, 202-383-6099): HEALTHCAREREFORM

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