7.13.2009

Simplicity Helps Improve AIDS Treatment Programs

One of the more counterintuitive aspects of lean is that the best approach may involve spending less money. People tend to assume the most expensive is always the best. But sometimes a simple, low-tech approach produces the most significant results.

Therefore, I was pleased to read a recent article in The Wall Street Journal describing efforts to find new ways to run AIDS treatment programs – by studying what is being done in Africa.


With health-care costs soaring in the U.S. and more than 50,000 new HIV infections every year, many are starting to ask: If it can be done over there, why can't we do it here?

The obstacles range from the complexities of insurance reimbursement to regulations designed to protect patients. Another hurdle is cultural: There is a deep-seated reluctance to accept that simpler and less expensive treatments like those used abroad might be good enough.

"We're building Cadillacs, and they're offering us VW Beetles," says William Vodra, who drafted U.S. Food & Drug Administration rules while working at the agency, and now specializes in regulatory issues involving medical products as a lawyer at Arnold & Porter in Washington, D.C.


One example cited in the article (written by Amy Dockser Marcus) involved appointment procedures at a University of Alabama AIDS clinic.


"Project Connect" is based on a program used in AIDS clinics in Zambia. In the Alabama program, patients were given appointments with doctors within five days of calling the clinic. Blood tests were taken during the first visit. A social worker did an interview, trying to identify and address any issues that might prevent patients from coming back. The no-show rate dropped from 31% in 2007 to 18% through June 2009.


Another example involved using non-medical personnel to help patients stick with treatment.


For Heidi Behforouz, it has been an education. Dr. Behforouz started running the Prevention and Access to Care and Treatment Project in Boston based on a program first used successfully in rural Haiti. PACT trains community health workers to persuade AIDS patients to adhere to treatment regimens. The hope is this will reduce rates of emergency-room use and hospitalizations, big drivers of health costs.

The strategy appears to work; according to data PACT collected, total medical expenses for 20 patients fell 40%. But PACT, which is expanding to sites in New York, still pays for the program out of private donations and fund raising, since insurers don't cover it.

Dr. Behforouz presented data to an advisory council that recommended to the Massachusetts State Legislature that community health workers be trained and reimbursed, but the process for approval is likely to take years before it is implemented, if ever. "This is still a nascent field," Dr. Behforouz says. "They don't wear white coats. Their training is different than doctors or nurses. It's hard to get them recognized as health-care workers."


In other words, the biggest obstacles standing in the way of low-tech approaches tend to be cultural. That is so often the case with lean.

By the way, while lean is not mentioned in the WSJ article, I do regard some of what it describes as lean approaches. In the Alabama example, the focus was clearly on eliminating wasted time in the appointment and intake process.

Have you ever achieved improvement with a low-tech counterintuitive approach? Share your experience below.

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