John Meyer Eisenberg

Advocate of evidence based health care who led moves to reduce medical errors and improve patient safety The death of John Eisenberg, who was director of the United States Agency for Healthcare Research and Quality (AHRQ), leaves a void in the international healthcare research and quality movement. A man of seemingly boundless energy, John died from a brain tumour, first diagnosed over a year ago. Until the last few weeks of his life, he kept up a full workload, while his gracious family, friends, colleagues, coworkers, and people whom he had mentored in the United States and around the world came to see him. During his tenure (1997-2002) as AHRQ head in what sadly proved the twilight of his life, John's accomplishments were amazingly multifaceted (www.ahrq.gov/news/jme/index.html). He enthusiastically built a rock-solid evidence based practice centre (EPC) programme. The programme got rolling shortly after he assumed his position. At the time of his death, 12 centres in the United States and Canada had generated 56 evidence reports. As John envisaged these centres, they addressed areas in medicine marked by broad practice variation and uncertain value. He was adamant that the evidence reports should not go beyond the data and that users should take the findings to carve out their own health quality initiatives or guidelines. AHRQ's mission was to address high cost, big ticket items for Medicare. Concerned that limited healthcare dollars could be tossed to the wind, the EPC programme was one of a slew of vehicles that John used to help teach people how to disseminate best practices, identify problems in practice, and move ahead to a higher quality of care. “The force of his talent, personality, intellect, and leadership elevated both the office and the field,” said Alan M Garber, staff physician at the VA Palo Alto Health Care System and director of the Center for Health Policy at Stanford University. “By making AHRQ the federal leader in quality improvement and patient safety, he made the lives of millions of Americans better in a direct and tangible way. He was a warm and compassionate man who will be missed by all who knew him.” Richard Deyo, professor of medicine and health services and director of the Center for Cost and Health Outcomes, University of Washington, Seattle, said that his real legacy was “in restoring the trust of Congress in the agency; making it clear that good science is non-partisan; and creating an agenda with appeal to policy makers. I think he was the main reason that funding was restored and increased for the agency. His loss is a loss for all of us who do health services research.” The Agency for Healthcare Policy and Research (the predecessor to AHRQ) had sustained a large budget cut, and was almost eliminated. This was partly as a result of lobbying by spine surgeons, upset by agency-sponsored guidelines and research. Budget cutting fervour and antipathy to the Clinton health plan had also played a role. Sankey Williams, Sol Katz professor of general internal medicine at the University of Pennsylvania, and one of John's closest friends, said, “I first met John when we were medical residents at the Hospital of the University of Pennsylvania in 1974. His crowning triumph was saving the Agency for Healthcare Research and Quality from attempts by politically connected people to close the agency because they disagreed with its guidelines for some types of clinical care.” Kerr White, professor emeritus at the University of Virginia, remembers John's visionary work when they met at Penn more than 30 years ago. “He was the complete clinician,” said White. “Very few people knew all the parts: the clinical, molecular, systems, the population and the business aspects. John knew them all—and he knew the methods. He was just a lively person.” White praised John's pioneering attention to economics. “He invented the term clinical economics and he developed it further while at Georgetown and in dog-and-pony shows around the world,” observed White. John worked closely with White and Stephen Leeder, currently dean of the faculty of medicine at the University of Sydney in New South Wales, Australia. Leeder said, “He could dazzle you with his ideas, which made him very winsome and he was charismatic in a slightly impish way with quite a lot of political savvy.” Leeder and White credit John with helping build the International Clinical Epidemiologic Network, in collaboration with the Rockefeller Foundation and colleagues at Penn, Newcastle, and McMaster. John balanced work with play, family, and friends. Music was something he relished and it was an integral part of his memorial tribute held on 17 March in Washington, DC. He leaves a wife, DD Rudner Eisenberg; and two sons. John Meyer Eisenberg, director of the United States Agency for Healthcare Research and Quality 1997-2002; b Atlanta, Georgia, 1946; q St Louis, Missouri, 1971; MBA; died from a brain tumour on 10 March 2002.

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