|RESEARCH AND THE
QUALITY OF HEALTH CARE
by Ben McCallister, M.D.
|The Kansas City Area Life Sciences Institute project
(KCALSI), developed by the community leaders of Kansas City, has received enthusiastic support from
clinicians who provide care for patients, as well as basic and clinical research
scientists. There are evident economic benefits to Kansas City if it can achieve a national reputation as a
leader in life
sciences research. The recruitment of new scientists, their
support staff, and the opportunity for new discoveries can
direct the expanding biotechnology industry to Kansas City.
However, from the physician's view there is a great potential for the KCALSI project to improve the health and quality of life for all Kansas Citians.
Let us look at the Mid America Heart Institute (MAHI) of Saint Luke's Hospital (SLH) as an example to demonstrate why research is critical to improving the quality of health care. Many studies have shown that medical care is superior in those hospitals with comprehensive research and educational programs. In order to perform research, physicians must be in an environment that encourages lifelong learning and scientific inquiry. In fact, an atmosphere of academic activity and research helps attract the best of physicians to a hospital staff where new devices and new drugs can be given to patients long before they are available; MAHI staff can, indeed, expect to practice on the forefront of medicine.
From the beginning of the founding of MAHI over 25 years ago, our goal was to be the leader in cardiovascular care in our region and to achieve a national reputation. Because of the commitment of the staff, administration, and Board of Directors of SLH to the triad of quality care, research and education MAHI has been successful in achieving its goal.
A few examples can illustrate the important link between research and quality care. In 1980, cardiologists at MAHI were frustrated by their ineffective ability to open a thrombosed coronary artery by so-called "clot buster drugs" in patients with an acute myocardial infarction (AMI). In response, they researched and developed a technique to use balloon angioplasty to open the occluded artery, a technique which revolutionized the management of patients with an acute heart attack and has subsequently saved thousands of lives. This procedure developed at MAHI is now considered worldwide to be the treatment of choice for an AMI.
A database was started at MAHI soon after this discovery and contains the largest experience in the world, which provides vital information about the results and long-term outcomes of patients following acute heart attacks. Physicians and researchers at MAHI continue to modify the technical equipment and drugs used in the care of AMI patients to improve their outcome. The MAHI database has subsequently grown to be one of the largest and most comprehensive cardiovascular databases in the world at a single institution.
Other research studies often in collaboration with colleagues at other leading cardiovascular centers, including Duke, Mayo, Emory, Stanford and others, have also led to new advances in the care of patients with heart disease, including those with diabetes, behavioral health problems, extensive atherosclerosis, lipid abnormalities, congestive heart failure, heart transplantation, coronary artery disease, pacemakers, rhythm problems and the prevention of cardiovascular disease, as well as our nationally recognized studies on quality of life in patients with heart disease.
In the last 20 years because of MAHI's reputation in cardiovascular research and care, the largest volume of patients with serious cardiovascular problems have come to the MAHI; three to four times that of other hospitals in the Kansas City area. Many studies have been reported in the medical literature, which have shown that there is a consistent relationship between volume, quality, and outcomes in patients undergoing most all cardiovascular procedures and care. So, the cycle of: commitment to quality care recruitment of quality staff quality research superior quality care increased reputation increased volume of patients increased research increased quality ‹ is paramount to the development of a major cardiovascular center.
It is perhaps easier to understand how clinical trials, which investigate new drugs, stents or pacemakers may affect the quality of care more than basic research, which is often performed on lower organisms and animals. However, the catalyst for many new discoveries for basic scientists are driven by real clinical problems and ultimately must be "taken to the bedside" ("translational research"). In fact, an atmosphere where clinicians and scientists have close collaboration can be most effective in developing the ideas and implementation of medical research.
Thus, the exciting potential of the Phase I of the KCALSI initiative - the "Proteomics Consortium" is apparent. The opportunity for the basic researchers at the Stowers Institute, UMKC, KUMC, MRI to collaborate with the clinicians at the Mid America Heart Institute and Children's Mercy Hospital and other clinical programs can lead to success that would never be possible by a single institution working alone.
The study of the human genome codes and the DNA sequences has opened the door to the next major step in understanding human disease. Whereas studies on DNA provide an important insight into how the cell may use its genes, the proteins and protein complexes coded for by the genes truly orchestrate the life and death of all living organisms. In fact, the life of a cell is dynamic and constantly changing the genome coded proteins and constantly modifying how they interact with other proteins, lipids, carbohydrates, etc. in healthy and diseased states. Thus, the study of Proteomics focuses on the protein products of the genome and their interactions rather than on DNA sequences. The KCALSI will help scientists at UMKC, KUMC, MRI and Stowers to develop powerful analytical tools and bioinformatic technology to study proteins potentially as has never been done before. This technology can then be used in collaboration with clinical scientists at clinical centers such as MAHI to study the fundamental changes in proteins in the blood and tissues from patients that occur in healthy or diseased conditions. This knowledge can then lead to the selection of the appropriate targets for new drug development. (Nature 404, 684, 2000; Nature Biotechnology Supplement, October 2000, volume 18)
The Mid America Heart Institute (MAHI) which is an internationally recognized Center of Excellence in Cardiovascular Care has a substantial commitment to clinical and outcomes oriented research. We will, as part of the KCALSI initiative, plan to develop an infrastructure to transform our active clinical and outcomes oriented research activities into an enormous Śclinical laboratory' that allows MAHI to collect, process and store patients' blood and tissue specimens for future proteomics and genomics research. We will provide our clinical experience with a large volume of patients and remarkable database which characterizes patients with coronary disease, heart failure, cardiac transplantation, arrhythmias and stroke so that we can work with our colleagues in the KCALSI initiative to unravel the basic mechanisms of these diseases and to develop earlier detection and innovative treatments for their eradication. This collaboration will leverage an active translational research program through partnerships with our local and national basic science colleagues and help to achieve the dream of world-class medical research in Kansas City.
Therefore, it is opportune for the physicians and scientists of the Mid America Heart Institute on its 25th anniversary to participate in the KCALSI projects and to collaborate with other colleagues in the Kansas City region. This collaboration should ensure the continued development of MAHI as a national leader in cardiovascular research and patient care.