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An Overview of the Agency for Healthcare Research and Quality

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The Patient Safety and Quality Improvement Act. William B. Munier, MD ... Patient safety improvement is hampered by the inability to aggregate data; by ... – PowerPoint PPT presentation

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Title: An Overview of the Agency for Healthcare Research and Quality


1
An Overview of the Agency for Healthcare
Research and QualityThe Patient Safety and
Quality Improvement ActWilliam B. Munier, MD
  • Michigan Health Safety Coalition Conference
  • 29 March 2006

2
Todays Agenda
  • Agency for Healthcare Research and Quality (AHRQ)
  • Center for Quality Improvement and Patient Safety
    (CQuIPS)
  • Patient Safety and Quality Improvement Act

3
AHRQ Mission
  • AHRQ is the lead Federal agency charged with
    improving the quality, safety, efficiency, and
    effectiveness of health care for all Americans
  • One of 12 agencies within DHHS
  • Supports health services research that will
    improve the quality of care and promote
    evidence-based decisionmaking

4
AHRQ Facts
  • Director Carolyn Clancy, MD
  • Staff Approximately 300
  • FY 06 Budget 318.7 million
  • Research comprises 80 of budget, invested in
    grants and contracts focused on improving health
    care

5
CQuIPS within AHRQ
Office of the Director
Center for Primary Care, Prevention Clinical
Partnerships
Office of Performance, Accountability,
Resources Technology
Center for Quality Improvement Patient Safety
Office of Extramural Research, Education
Priority Populations
Center for Delivery, Organizations Markets
Center for Financing, Access Cost Trends
Office of Communications Knowledge Transfer
Center for Outcomes Evidence
6
CQuIPS
  • Patient safety research, education and
    training, development and dissemination of
    information
  • National Healthcare Quality and Disparities
    Reports
  • National report on quality
  • National report on disparities
  • Disease-specific reports
  • State snapshots

7
  • Making the case
  • Whats the data
  • Turning data into information
  • Learning from others
  • Developing a QI plan
  • Moving the agenda forward

8
CQuIPS
  • Consumer Assessment of Healthcare Providers and
    Systems (CAHPS)
  • Quality improvement
  • Conducting and supporting user-driven research
  • Disseminating reports and information
  • Patient Safety and Quality Improvement Act PL
    109-41

9
PSQIA PL 109-41
  • Purpose of Act
  • To provide for the improvement of patient safety
  • To reduce the incidence of events that adversely
    affect patient safety

10
Major Provisions of Act
  • Creates Patient Safety Organizations (PSOs)
  • Establishes Network of Patient Safety Databases
    (NPSD)
  • Mandates Comptroller General to study
    effectiveness of Act (by 2010)
  • Is a completely voluntary system

11
What is the Problem?
  • Providers fear that patient safety analyses can
    be used against them in court (malpractice) or in
    disciplinary proceedings
  • State laws offer inadequate protection (e.g.,
    large providers cannot share analyses system-wide
    without risk)
  • Patient safety improvement is hampered by the
    inability to aggregate data by analyzing large
    numbers of events, patterns of failures could be
    more rapidly identified

12
The Act Addresses These Issues
  • Authorizes creation of PSOs that enter into
    contracts with providers to assist them in
    analyzing threats to patient safety and
    correcting or preventing them
  • Requires PSOs to work with more than one provider
    so that PSOs can aggregate data across providers
    and with other PSOs
  • Provides Federal confidentiality protections for
    these analyses and significantly limits their use
    in criminal, civil, and administrative proceedings

13
Principal Implementation Strategies
  • Build on existing work
  • Sharp end infrastructure
  • Private sector resources
  • Previous conceptual work (JCAHO NQF)
  • Coordinate DHHS/Federal efforts
  • Use IT to maximum extent practical
  • Keep it simple

14
Two Basic Tracks
  • Development and operation of PSOs
  • Fostering an operational network of patient
    safety databases

15
Supporting Activities
  • Public listening sessions (just concluded)
  • Developing regulations to govern the operations
    of the PSO program
  • Compiling an inventory of operational patient
    safety reporting systems
  • Scope, operations, and output of reporting
    systems
  • Patient safety incident definitions (data element
    level)

16
Issues Requiring Rulemaking
  • AHRQ PSOs
  • Certification, operation, and revocation of
    certification
  • Office of Civil Rights Confidentiality
  • The Act necessitates new confidentiality
    standards as well as guidance on how and when to
    assess civil monetary penalties

17
PSO Program
  • PSO certification processing system
  • Reviewing accepting initial, subsequent PSO
    certifications
  • Certification statements
  • Optional narratives (under consideration)
  • Disclosures
  • Handling complaints revoking acceptance of
    certification
  • Technical assistance
  • Collecting, analyzing reports
  • Providing strategies to improve patient safety
  • Annual meeting

18
Issues Requiring Clarification
  • The Act establishes two novel concepts
  • Patient Safety Work Product
  • Patient Safety Evaluation System
  • To be protected, information must be considered
    patient safety work product and be in the
    patient safety evaluation system
  • Raises the issue of who where patient safety
    reporting, analysis, etc. are carried out

19
NPSD Objectives
  • To generate information relevant to preventing
    harm to patients from health care
    (aggregate/analyze incident data disseminate
    results)
  • To employ interoperable terms, definitions of
    patient safety incidents
  • To simplify task of reporting incidents
  • To provide benchmarking and trend reports
  • To share de-identified data for use in improving
    patient safety

20
Next Steps
  • Finish inventory of data elements, definitions
    encoding schemes used currently to
  • Inform development of common formats
  • Provide technical assistance to PSOs
  • Consider options for fostering development of
    network of patient safety databases
  • Plan for inclusion of patient safety information
    on performance, trends AHRQs NHQR/DR

21
Discussion
22
For Additional Information
  • http//www.ahrq.gov
  • William.Munier_at_ahrq.hhs.gov
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