Rebecca Linfield’s Silver Lining

If there’s a silver lining in a pandemic, no matter how thin, Stanford resident Rebecca Linfield will find it. In her case, it was a form of family unity: she presented her award-winning quality improvement poster virtually to the Northern California chapter of the American College of Physicians (ACP), and so her son Frank, then three weeks old, was able to participate in his own way, sleeping peacefully next to her just off-screen.

Of course he woke up during the second round of the conference, crying loudly, but her husband Leon Moskatel, a Headache Medicine fellow at Stanford, was able to “whisk Frank away” while Linfield presented.

Linfield is no stranger to multitasking. As a teenager, she volunteered at hospitals to “cheer patients up” beginning “a lifelong passion for serving others through medicine.” That passion led her to interests in both bioethics and infectious diseases, which in turn led to work at the Boston Consulting Group to better understand the overall healthcare system and then finally to Stanford, where she’s currently an Internal Medicine resident with an interest in interdisciplinary research and quality improvement.

Her faculty mentor, Lisa Shieh, MD, PhD, clinical professor of medicine, ended up being her attending during her first month in residency. They started to discuss projects they could work on together, and the award-winning project and poster “Cost Transparency Affected Expensive Drug Prescribing and IV to PO Substitution” (try saying that five times fast) was born.

The project is deceptively simple: if inpatient providers are shown the costs of various medications they’re thinking of prescribing to patients, would this influence them to switch to equally effective, lower-cost treatments?  The answer, naturally, was yes, but now Linfield and her team have the data to back this up.

A classic example of this, Linfield explains, would be ordering potassium orally (which is less expensive) instead of intravenously (which is both more expensive and often uncomfortable for the patient).  When providers were shown the costs, they chose the oral potassium more often.

And Linfield’s team’s data “provided the impetus for wider implementation.”  Stanford Healthcare is currently rolling out cost transparency to all medications, and a survey of house staff confirmed their eagerness to learn more about the cost of care and how to use cost transparency to provide even better patient care.

The award was “validating” for Linfield and her team, but it also spurred them on, motivating them to keep pursuing cost transparency within Stanford Healthcare. As Linfield asserts, “Quality improvement drives better value in health care - a win for patients, providers, and payers alike.”