Harkness Project: Are There Lessons to be Learned from the Transformation of the Veterans Health Administration for the Quality Agenda for the NHS in England?
Mentors: Carolyn Clancy, M.D., and Daniel Stryer, M.D., AHRQ, and Sheila Leatherman, United HealthCare Corporation/University of Cambridge
Host Institution: Agency for Health Care Research and Quality and the University of North Carolina
Biography at time of Harkness Fellowship: Kathryn Rowan, D.Phil., is a health services researcher who, in 1994 as a result of her Ph.D. at the University of Oxford, established a charity (not-for-profit organization) called the Intensive Care National Audit & Research Centre (ICNARC). Rowan established ICNARC (www.icnarc.org) as a sister organization to the Intensive Care Society (the professional organization for clinicians working in U.K. critical care). ICNARC's aim is to achieve improvements in the organization and practice of critical care (intensive and high dependency care) through a broad program of comparative audit, methodological and evaluative research. Rowan is the Director of ICNARC and leads a team of fifteen to twenty audit, research, IT and administrative staff. In 2004, she was awarded the Humphry Davy Medal by the Royal College of Anaesthetists in the U.K. as a mark of distinction for her significant contribution to the College and to critical care.
Project: Rowan’s project aimed at investigating the transformation of the Veterans Health Administration (VHA) in the mid-1990s, how and why it happened, the sustainability of the changes, and the evidence on its impact on care quality. She completed a literature review on the transformation and on quality in the VHA, and carried out interviews with key informants, including VHA staff.
Career Activity Since Fellowship
Current Position : Founder and Director, Intensive Care National Audit & Research Centre (ICNARC) (1/2014)
Harvey SE, Parrott F, Harrison DA, Bear DE, Segaran E, Beale R, Bellingan G,Leonard R, Mythen MG, Rowan KM; the CALORIES Trial Investigators. Trial of the Route of Early Nutritional Support in Critically Ill Adults. N Engl J Med. 2014 Oct 1.
Wilcox ME, Harrison DA, Short A, Jonas M, Rowan KM. Comparing mortality among adult, general intensive care units in England with varying intensivist cover patterns: a retrospective cohort study. Crit Care. 2014 Aug 14;18(4):491.
Moonesnghe SR, Harris S, Mythen MG, Rowan KM, Haddad FS, Emberton M, Grocott MP. Survival after postoperative morbidity: a longitudinal observational cohort study†. Br J Anaesth. 2014 Jul 10. pii: aeu224.
Harrison DA, Patel K, Nixon E, Soar J, Smith GB, Gwinnutt C, Nolan JP, Rowan KM; National Cardiac Arrest Audit. Development and validation of risk models to predict outcomes following in-hospital cardiac arrest attended by a hospital-based resuscitation team. Resuscitation. 2014 Aug;85(8):993-1000.
Canter RR, Harvey SE, Harrison DA, Campbell MK, Rowan KM, Cuthbertson BH; [on behalf of the Selective Decontamination of the Digestive tract in critically ill patients treated in Intensive Care Unit (SuDDICU) Investigators]†. Observational study of current use of selective decontamination of the digestive tract in UK Critical Care units. Br J Anaesth. 2014 Oct;113(4):610-7.
Shahin J, Harrison DA, Rowan KM. Is the volume of mechanically ventilated admissions to UK critical care units associated with improved outcomes? Intensive Care Med. 2014 Mar;40(3):353-60.
Sadique Z, Grieve R, Harrison DA, Jit M, Allen E, Rowan KM; FIRE Study Investigators. An integrated approach to evaluating alternative risk prediction trategies: a case study comparing alternative approaches for preventing invasive fungal disease. Value Health. 2013 Dec;16(8):1111-22.
Power GS, Harrison DA, Mouncey PR, Osborn TM, Harvey SE, Rowan KM. The Protocolised Management in Sepsis (ProMISe) trial statistical analysis plan. Crit Care Resusc 2013 Dec;15(4):311-7.
Moonesinghe SR, Mythen MG, Das P, Rowan KM, Grocott MP. Risk stratification tools for predicting morbidity and mortality in adult patients undergoing major surgery: qualitative systematic review. Anesthesiology 2013 Oct;119(4):959-81.
ProCESS/ARISE/ProMISe Methodology Writing Committee, Huang DT, Angus DC, Barnato A, Gunn SR, Kellum JA, Stapleton DK, Weissfeld LA, Yealy DM, Peake SL, Delaney A, Bellomo R, Cameron P, Higgins A, Holdgate A, Howe B, Webb SA, Williams P, Osborn TM, Mouncey PR, Harrison DA, Harvey SE, Rowan KM. Harmonizing international trials of early goal-directed resuscitation for severe sepsis and septic shock: methodology of ProCESS, ARISE, and ProMISe. Intensive Care Med 2013 Oct;39(10):1760-75. Epub 2013 Aug 30.
Wilcox ME, Chong CA, Niven DJ, Rubenfeld GD, Rowan KM, Wunsch H, Fan E. Do intensivist staffing patterns influence hospital mortality following ICU admission? A systematic review and meta-analyses. Crit Care Med 2013 Oct;41(10):2253-74.
Lone NI, Seretny M, Wild SH, Rowan KM, Murray GD, Walsh TS. Surviving intensive care: a systematic review of healthcare resource use after hospital discharge*. Crit Care Med 2013 Aug;41(8):1832-43.
Barratt H, Harrison DA, Rowan KM, Raine R. Effect of non-clinical inter-hospital critical care unit to unit transfer of critically ill patients: a propensity-matched cohort analysis. Crit Care 2012 Oct 3;16(5):R179.
Shahin J, Harrison DA, Rowan KM. Relation between volume and outcome for patients with severe sepsis in United Kingdom: retrospective cohort study. BMJ 2012 May 29;344:e3394.
Soares MO, Welton NJ, Harrison DA, Peura P, Shankar- Hari M, Harvey SE, Madan JJ, Ades AE, Palmer SJ, Rowan KM. An evaluation of the feasibility, cost and value of information of a multicentre randomised controlled trial of intravenous immunoglobulin for sepsis (severe sepsis and septic shock): incorporating a systematic review, meta-analysis and value of information analysis. Health Technol Assess 2012;16(7):1-186.
Shankar-Hari M, Spencer J, Sewell WA, Rowan KM, Singer M. Bench-to-bedside review: Immunoglobulin therapy for sepsis - biological plausibility from a critical care perspective. Crit Care 2012 Dec 12;16(2):206.
Noah MA, Peek GJ, Finney SJ, Griffiths MJ, Harrison DA, Grieve R, Sadique MZ, Sekhon JS, McAuley DF, Firmin RK, Harvey C, Cordingley JJ, Price S, Vuylsteke A, Jenkins DP, Noble DW, Bloomfield R, Walsh TS, Perkins GD, Menon D, Taylor BL, Rowan KM. Referral to an extracorporeal membrane oxygenation center and mortality among patients with severe 2009 influenza A(H1N1). JAMA. 2011 Oct 19;306(15):1659-68.
Wunsch H, Angus DC, Harrison DA, Linde-Zwirble WT, Rowan KM. Comparison of medical admissions to intensive care units in the United States and United Kingdom. Am J Respir Crit Care Med 2011 Jun 15;183(12):1666-73.
Rowan KM, Harrison DA, Walsh TS, McAuley DF, Perkins GD, Taylor BL, Menon DK.The Swine Flu Triage (SwiFT) study: development and ongoing refinement of a triage tool to provide regular information to guide immediate policy and practice for the use of critical care services during the H1N1 swine influenza pandemic. Health Technol Assess 2010 Dec;14(55):335-492.
Ramnarayan P, Thiru K, Parslow RC, Harrison DA, Draper ES, Rowan KM. Effect of specialist retrieval teams on outcomes in children admitted to paediatric intensive care units in England and Wales: a retrospective cohort study. Lancet 2010 Aug 28;376(9742):698-704.
Harrison DA, Gao H, Welch CA, Rowan KM. The effects of critical care outreach services before and after critical care: a matched-cohort analysis. J Crit Care. 2010 Jun;25(2):196-204.
Huang DT, Clermont G, Kong L, Weissfeld LA, Sexton JB, Rowan KM, Angus DC. Intensive care unit safety culture and outcomes: a US multicenter study. Int J Qual Health Care 2010 Jun;22(3):151-61.
Fowler RA, Webb SA, Rowan KM, Sprung CL, Thompson BT, Randolph AG, Jouvet P, Lapinsky S, Rubinson L, Rello J, Cobb JP, Rice TW, Uyeki T, Marshall JC. Early observational research and registries during the 2009-2010 influenza A pandemic. Crit Care Med 2010 Apr;38(4 Suppl):e120-32.
Park DP, Welch CA, Harrison DA, Palser TR, Cromwell DA, Gao F, Alderson D, Rowan KM, Perkins GD. Outcomes following oesophagectomy in patients with oesophageal cancer: a secondary analysis of the ICNARC Case Mix Programme Database. Crit Care 2009;13 Suppl 2:S1.
Reade MC, Delaney A, Bailey MJ, Harrison DA, Yealy DM, Jones PG, Rowan KM, Bellomo R, Angus DC. Prospective meta-analysis using individual patient data in intensive care medicine. Intensive Care Med 2010 Jan;36(1):11-21.
Wunsch H, Linde-Zwirble WT, Harrison DA, Barnato AE, Rowan KM, Angus DC. Use of intensive care services during terminal hospitalizations in England and the United States. Am J Respir Crit Care Med 2009 Nov 1;180(9):875-80.
Harrison DA, Rowan KM. Outcome prediction in critical care: the ICNARC model. Curr Opin Crit Care. 2008 Oct;14(5):506-12.
Wunsch H, Angus DC, Harrison DA, Collange O, Fowler R, Hoste EA, de Keizer NF, Kersten A, Linde-Zwirble WT, Sandiumenge A, Rowan KM. Variation in critical care services across North America and Western Europe. Crit Care Med. 2008 Oct;36(10):2787-93, e1-9.
Harvey SE, Welch CA, Harrison DA, Rowan KM, Singer M. Post hoc insights from PAC-Man--the U.K. pulmonary artery catheter trial. Crit Care Med. 2008 Jun;36(6):1714-21.
Rowan KM, Harrison DA. Recognising and responding to acute illness in patients in hospital. BMJ. 2007 Dec 8;335(7631):1165-6.
Huang DT, Clermont G, Sexton JB, Karlo CA, Miller RG, Weissfeld LA, Rowan KM, Angus DC. Perceptions of safety culture vary across the intensive care units of a single institution. Crit Care Med. 2007 Jan;35(1):165-76.
Wunsch H, Rowan KM, Angus DC. International comparisons in critical care: a necessity and challenge. Curr Opin Crit Care. 2007 Dec;13(6):725-31.