The Elements of Health Care Quality and Current Improvement Efforts

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The Elements of Health Care Quality and Current
Improvement Efforts
Carolyn M. Clancy, MD Director Agency for
Healthcare Research and Quality Bipartisan
Congressional Health Policy Conference January
13, 2007
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Health Care Quality

• Varies A LOT NOT clearly related to spent
• Matters can be measured and improved
• Measurement science is evolving
• Structure, process and outcomes
• Broad recognition that patient experience is
  essential component
• Strong focus on public reporting is good
• Motivates providers to improve
• Not yet consumer friendly

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Current Landscape

• Numerous reports confirm substantial gap between
  best possible and actual care.
• Increasing demands from purchasers that providers
  demonstrate quality delivered.
• Public reporting of performance leads to
  improvements.
• Recognition of urgent need to align disparate
  monitoring initiatives.
• Initiatives that link payment with performance
  have proliferated in the private sector.

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Challenges and Enablers

• Quality assessment has been tightly linked with
  site of care or individual clinicians few
  integrated or episode-based metrics.
• Robust measures not yet developed for all
  physician specialties.
• Quality alliances collaboration between
  providers, purchasers, consumers and accreditors
  have produced uniform public reporting for
  hospitals (HQA) and physicians (AQA).
• HQA and AQA addressing gaps in existing measure
  sets, and need for measures that span care
  delivery.
• Efficient data capture remains an aspiration
  current electronic health records do not support.

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Public Views on Quality,Cost and P4P
Source Commonwealth Fund Survey of Public Views
of the U.S. Health Care System, 2006.
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Paired Reports
National Reports on Quality and Disparities

• NHQR
• Snapshot of quality of health care in America
• Quality
• Variation across states

• NHDR
• Snapshot of disparities in health care in America
• Quality Access
• Variation across populations

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Context for Current Quality Improvement Efforts

• Good News Quality is improving disparities are
  narrowing
• Bad News Progress is too slow
• What moves the ball
• Public Reporting
• Payment
• Common Measures
• (Health IT)
• (Consumer engagement)

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Disparities in Medicare Health Plans
Performance on four primary outcome
measures is lower for blacks than whites
80.2
72.2
72.2
71.6
62.9
60.2
57.2
53.4
Performance,
Hemoglobin A Control (Diabetes)
LDL-C Control (Diabetes)
Blood Pressure Control (Hypertension)
LDL-C Control (Coronary Event)
JAMA October 25, 2006
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Quality of Hospital Care for Heart Attack and
Heart Failure Poor Counties, Rich Counties
Source Gannett News Service, Rating Hospital
Heart Care, 2006.
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Getting to high quality health care
The most powerful contribution information
technology can make to improving health care
quality
Make the right thing to do the easy thing to do
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Growing HIT Evidence Base

• Health IT helps improve quality of care in large
  health care organizations that create their own
  systems and devote substantial resources to EHR,
  CPOE,e-prescribing, and other applications
• HIT has potential to enable dramatic
  transformation of health care safety,
  effectiveness and efficiency

AHRQ Southern California Evidence-Based Practice
Center- RAND Corporation, April, 2006
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AHRQ Research Improving Quality through HIT

• Over 125 projects and demonstrations to better
  understand how health IT can improve the safety,
  quality and efficiency of health care
• Projects in 43 states
• Special attention to best practices that can
  improve quality of care in rural, small
  community, safety net and community health center
  care settings

AHRQ HIT Investment 166 Million
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Booklet Helps Consumers Understand and Get
Quality Health Care

• Helps consumers identify high-quality health care
  and take a more active role in their own health
  care
• Explains clinical measures
• Track and improve the quality of care provided by
  doctors, hospitals, and others
• Explains consumer ratings
• Indicate how satisfied people are with their
  health care
• Lists Web sites and phone numbers for more
  resources

• Part of a series to help patients take a more
  active role in their health care

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All Health Care is Local.
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6 AQA Pilot Sites
Wisconsin Collaborative for Healthcare Quality
Minnesota Community Measurement
Indiana Health Information Exchange
Massachusetts Health Quality Partners
California Cooperative Healthcare
Reporting Initiative
Phoenix Regional Healthcare Value Measurement
Initiative
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Getting to Best Possible Care

• Moving the ball right now
• Public Reporting AND transparency
• Payment Reforms
• Common Measures for public and private sectors
• Enhanced support for local collaboratives
• Specific Policy Opportunities
• P4P absolute performance -- /or improvement?
• Rewarding the leading edge and bringing others
  along
• Support for unbiased consumer information and
  for effective use of HIT
• Insist on clear synthesis of results from public
  and private demonstrations

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Q A