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AHRQ Research Update: Improving Health Care for All Americans

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Title: AHRQ Research Update: Improving Health Care for All Americans


1
AHRQ Research Update Improving Health
Care for All Americans
  • Carolyn M. Clancy, MD Francis Chesley, MD
  • Agency for Healthcare Research and Quality
  • AcademyHealth Annual Research Meeting
  • Washington, DC June 8, 2008

2
More Americans are Unhappy With their Health Care
May 30, 2008
3
Opportunities for the Field
  • Using health IT to improve research
  • Building public/private partnerships that include
    representative stakeholders
  • Standardizing collection of race, ethnicity and
    language data, including priority populations and
    sub-groups
  • Insisting on clear synthesis of results from
    public and private demonstrations
  • Rewarding the leading edge and bringing others
    along

4
Improving Health Care for All
Americans
  • Knowledge Creation
  • Synthesis Dissemination
  • Implementation Use
  • How do We Move the Needle on Quality?

5
AHRQ Priorities
Patient Safety
  • Health IT
  • Patient SafetyOrganizations
  • New PatientSafety Grants

Effective HealthCare Program
AmbulatoryPatient Safety
  • Comparative Effectiveness Reviews
  • Comparative Effectiveness Research
  • Clear Findings for Multiple Audiences
  • Safety Quality Measures,Drug Management
    andPatient-Centered Care
  • Patient Safety ImprovementCorps

Medical ExpenditurePanel Surveys
Other Research Dissemination Activities
  • Visit-Level Information on Medical Expenditures
  • Annual Quality Disparities Reports
  • Quality Cost-Effectiveness, e.g.Prevention and
    PharmaceuticalOutcomes
  • U.S. Preventive ServicesTask Force
  • MRSA/HAIs

6
Medical Expenditure Panel Survey (MEPS)
  • Annual survey of 15,000 households
  • Provides national estimates of health care use,
    expenditures, insurance coverage, sources of
    payment, access to care and health care quality
  • Permits studies of
  • Distribution of expenditures and sources of
    payment
  • Role of demographics, family structure, insurance
  • Expenditures for specific conditions
  • Trends over time

www.meps.ahrq.gov
7
The Healthcare Cost and Utilization Project
Billing record created
Patient enters hospital
AHRQ standardizes data to create uniform HCUP
databases
Hospital sends billing data and any additional
data elements toData Organizations
States store data in varying formats
8
AHRQ Health Care
Innovations Exchange
Web-based Repository of Cutting-Edge Service
Innovations
  • National electronic learning hub for sharing
    health care service innovations, bringing
    innovators and adopters together
  • Searchable database featuring innovation
    successes and failures, expert commentaries,
    lessons learned, etc.,
  • Designed to help health care Agents of Change
    improve quality

www.innovations.ahrq.gov
9
2007 National Healthcare Quality and
Disparities Reports
10
New in the 2007 NHQR
  • Cancer Cancer treatment measures (2-breast
    cancer, 1-colon cancer) from National Cancer Data
    Base conducted by the American Cancer Society and
    American College of Surgeons.
  • HIV and AIDS HIV Testing measures from CDC
    National Survey on Family Growth
  • Nursing Home and Home Health
    Pain Management for Nursing Home Residents from
    CDC National Nursing Home Survey
  • Efficiency Chapter

11
New in the 2007 NHDR
  • Chapter 2 Patient Centeredness Health Literacy
  • Chapter 2 Patient Centeredness Workforce
    Diversity for Nurses
  • Chapter 4 Priority Populations Supplemental data
    for Asians and Hispanics from the California
    Health Interview Survey (CHIS)
  • Chapter 4 Priority Populations People with
    Special Healthcare Needs - Adults with
    disabilities

12
State Snapshots
  • Now includes state contextual factors such as
    each states rate of obesity,
    health insurance coverage, mental illness, and
    the number of specialist doctors
  • Updated tool tracks states progress toward
    reaching Healthy People 2010
  • Other highlights
  • State rankings for selected measures, focus on
    diabetes and Clinical Preventive Services

http//statesnapshots.ahrq.gov/snaps07/index.jsp
13
Coming Soon MEADERS
Medication Error and Adverse Drug Event Reporting
System (MEADERS)
  • Designed to help doctors in small practices
    quantify medication errors and ADEs
  • Web-based system for documenting and reporting in
    ambulatory settings
  • Information fed back to practices for QI purposes
  • Voluntary and confidential

Preliminary results from a field test will be
presented at the
AHRQ Annual Conference in September
14
H-CAHPS Data Added to Hospital
Compare
  • Hospital Compare update announced March 28
  • H-CAHPS data from 2,500 hospitals nation-wide
  • Easy to understand
  • Reflects tangible experiences of patients
  • Collaboration of AHRQ, Centers for Medicare
    Medicaid Services and Hospital Quality Alliance

15
AHRQ Statistical Briefs
Clostridium Difficile-Associated Disease in U.S.
Hospitals, 1993-2005
  • The number of hospital discharges with CDAD more
    than doubled from 2001 to 2005, a trend that was
    considerably steeper than the prior 8-year
    period, during which the number of cases
    increased by 74 percent

Statistical Brief 50 April 2008 Conducted in
collaboration with CDC
Anne Elixhauser, Ph.D. and
Michael Jhung, M.D., M.P.H.
16
AHRQ News Numbers
  • Nearly 4 in 10 Americans between 18 and 34 years
    of age had at least one chronic condition, as did
    9 of every 10 aged 65 and older.
  • About 77 percent of Americans aged 65 and older
    had two or more chronic conditions. Only 14
    percent of those 18 to 34 had two or more
    conditions.
  • Nine of every 10 dollars spent for medical care
    (excluding expenses for dental care and medical
    equipment and supplies) on adults in the United
    States was spent to treat persons with chronic
    conditions.

17
AHRQ Research Activities
  • Monthly compendium of AHRQ activities
  • Includes announcements of Agency products and
    projects
  • Summarizes research findings from studies
    supported by the agency
  • Free online and hard copy subscriptions

http//www.ahrq.gov/research
18
Effective Health Care Program
  • Evidence synthesis (EPC program)
  • Systematically reviewing, synthesizing, comparing
    existing evidence on treatment effectiveness
  • Identifying relevant knowledge gaps
  • Evidence generation (DEcIDE, CERTs)
  • Development of new scientific knowledge to
    address knowledge gaps.
  • Accelerate practical studies
  • Evidence communication/translation (Eisenberg
    Center)
  • Translate evidence into improvements
  • Communication of scientific information in plain
    language to policymakers, patients, and providers

19
New Priority Conditions for the Effective Health
Care Program
  • Arthritis and non-traumatic joint disorders
  • Cancer
  • Cardiovascular disease, including stroke and
    hypertension
  • Dementia, including Alzheimer Disease
  • Depression and other mental health disorders
  • Developmental delays, attention-deficit
    hyperactivity disorder and autism
  • Diabetes Mellitus
  • Functional limitations and disability
  • Infectious diseases including HIV/AIDS
  • Obesity
  • Peptic ulcer disease and dyspepsia
  • Pregnancy including pre-term birth
  • Pulmonary disease/Asthma
  • Substance abuse

20
CERTs Centers
Brigham and Womens Hospital Health IT
Childrens Hospital - Cincinnati Pediatric care
Duke University Medical Center Therapies for heart and blood vessel disorders
HMO Research Network Multiple population-based delivery systems
Houston Area CERT Consumer education and patient adherence
KP Ctr for Health Research, Portland Coordinating Center
Rutgers University Mental health therapeutics
University of Alabama - Birmingham Musculoskeletal disorders
University of Arizona C-Path Drug interactions/Womens health
University of Chicago (New 9/07) Clinical/economic issues in hospital settings
University of Illinois - Chicago Prescribing tools, including formularies
University of Iowa Elderly and aging
University of Pennsylvania Anti-infective use and resistance
Vanderbilt University Therapeutic issues in Medicaid and VA system
Weill Medical College - Cornell Therapeutic medical devices
21
Effective Health Care Program New CERTs Funding
Opportunity Announcement
  • Limited Competition just announced for four
    awards in FY08 to CERTs collaboratives
  • Jointly funded by AHRQ FDA for a total of 7M
  • Four topics areas (1 award in each)
  • Antipsychotics comparative effectiveness/safety
  • TNF-blockers safety
  • Observational methods in endpoint
    definition/validation and unmeasured confounders
  • Characterization of inpatient and acetaminophen
    drug usage

22
DEcIDE Research Network
Network of institutions and partner
organizations with access to de-identified data
of 50 million patients generates evidence and
analytic tools in practical, accelerated format
23
Effective Health Care Program New Solicitations
through DEcIDE Network
  • Computer-based Clinical Decision Support (CDS)
    Tools for Gene-based Tests Used in Breast Cancer
  • Developing clinical decision support (CDS) tools
    for gene-based tests that are used in the
    prevention and treatment of breast cancer
  • Multicenter Research Cooperatives for Clinical
    Comparative Effectiveness Studies
  • Creating multicenter research cooperatives to
    coordinate and conduct studies on clinical
    effectiveness and comparative effectiveness in
    selected priority health conditions (diabetes and
    cancer)
  • Pilot Studies For Evaluating the Safety and
    Effectiveness of Prescription Drugs, Biologics
    and Vaccines Using Medicare Part D
  • Conducting pilot studies which evaluate the
    safety and effectiveness of prescription drugs,
    biologics and vaccines using Medicare Part D data

Proposed information and not final information
24
Effective Health Care Program EPC Comparative
Effectiveness Reviews in Progress
Condition Topic
Diabetes Comparative Effectiveness, Safety, and Indications of Insulin Analogues in Premixed Formulations for Adults with Type 2 Diabetes
Heart and blood vessel conditions Comparative Effectiveness of Combinations of Lipid-Modifying Agents
Cancer Core Needle Breast Biopsy and Surgical Excision Biopsy for Diagnosing Breast Lesions
Cancer Comparative Effectiveness of Chemotherapy Agents in the Prevention of Primary Breast Cancer in Women
Heart and blood vessel conditions Effectiveness of Radiofrequency Catheter Ablation (RFA) for Atrial Fibrillation
Cancer Comparative Effectiveness and Safety of Radiotherapy Treatments for Head and Neck Cancer
Heart and blood vessel conditions Comparative Effectiveness of Medical Therapies for Stable Ischemic Heart Disease
Heart and blood vessel conditions Effectiveness and Off-label Use of Recombinant Factor VIIa
25
The Promise of Genomics Completed
Projects
  • DEcIDE report Infrastructure for Monitoring
    Utilization and Outcomes of Gene-based
    Applications An Assessment has identified a
    need for improvements in existing databases and
    HIT informed work of two advisory committees
    AHIC and SACGHS
  • EPC Reports
  • Genomic Testing in Ovarian Cancer (for EGAPP/CDC)
  • CYP450 testing in Depression
  • (w/EGAPP recommendation)
  • HNPCC Testing in Colorectal Patients (for
    EGAPP/CDC)
  • Horizon Scans on Cancer and non-Cancer Genetic
    Tests (for CMS)
  • BRCA Testing in Breast and Ovarian Cancers
    (CDC-funded w/USPSTF recommendation)
  • Outcomes of Gene Expression Profile tests in
    Breast Cancer (for EGAPP/CDC)
  • Collection and Use of Cancer Family History in
    Primary Care (CDC-funded)
  • Screening for Hereditary Hemochromatosis
    (w/USPSTF recommendation)

26
The Promise of Genomics Ongoing Activities
  • Randomized control trial to clarify the added
    value of genetic testing to improve warfarin
    dosing (AHRQ-funded grant)
  • DEcIDE projects
  • Case-control study to Assess Association of OTC
    Genes and Effectiveness of Metformin in Diabetes
    (joint NIH and AHRQ funding)
  • Clinical Decision Support Tools for Gene-based
    Tests in Breast Cancer (AHRQ funded
    soon-to-be-awarded)
  • EPC projects
  • HER2 Testing in Breast Cancer or Other Solid
    Tumors (AHRQ-funded)
  • Outcomes from Testing for Factor V Leiden and
    Prothrombin G20210A (for EGAPP/CDC)
  • Clinical Utility of Cancer Family History
    (CDC-funded)
  • Family History in Primary Care (NIH funded for
    State-of-Science conference)
  • Analytic Validity of Genetic and other Laboratory
    Tests (AHRQ funded to-be-awarded)

27
Health IT and Patient Safety
  • Long-term agency priority
  • Since 2004, AHRQ has supported more than 200
    projects and demonstrations to improve the
    safety, quality and efficiency of health care in
    virtually every state
  • Special attention to best practices that can
    improve quality of care in rural, small
    community, safety net and community health center
    care settings
  • New focus on ambulatory safety and quality

28
Health IT Accomplishments
  • CMS rule for e-prescribing standards adoption
    based on AHRQ collaboration
  • Final Health Information Security and Privacy
    Reports and Toolkits
  • NQF Health IT Expert Panel Report on data for
    national consensus measures
  • NRC Health IT Survey Compendium
  • Supply Chain Meeting of Medical Specialty
    Societies

29
Health IT Awards Solicitations
  • Clinical Decision Support Contracts awarded
  • CDS Consortium (BW) and GLIDES (Yale)
  • 5M total over two years three option years
  • Special issue of Health Affairs on Health IT
  • Publication March 2009
  • Cofunded by Markle Foundation and CHCF
  • ASQ II FOA Care of the Complex Patient
  • almost 100 applications (for 5-7 awards)
  • ACTION e-prescribing implementation solicitation

30
Health IT External Collaborations
  • NCVHS Quality Workgroup
  • AHRQ lead staff
  • Medical Home Hearings in May
  • AHIC CDS Ad Hoc Workgroup
  • Government Collaboratory Formation
  • CDS Recommendations in April
  • AHIC Quality Workgroup
  • Recommendations in April
  • AQA Data Sharing and Aggregation Workgroup
  • Stewardship RFI Summary Available

31
Hospital Associated Infections (HAI)
  • Awards to 5 ACTION Partners (AIR, Denver Health,
    HRET, Iowa, Yale)
  • Qualitative, exploratory studies
  • Title Reducing HAIs Improving patient safety
    through implementing multi-disciplinary
    interventions
  • Goal To identify factors associated with the
    implementation of training that can assist
    hospitals in successfully reducing, and
    sustaining the reduction of, infections
    associated with the process of care.

32
2008 Conference Report on MRSA
  • Report included 5 million for research and
    activities to reduce infections for Methicillin
    Resistant Staphylococcus aureus (MRSA) and
    related infections
  • Goal To create actionable new knowledge and
    tools that can be used by clinicians and health
    care organizations to diagnose, treat and
    demonstrate prevention of, and reduction in, MRSA
    infections in all pertinent settings

CDC contributes an additional 500k
33
25 T32 Training Programs
  • University of California, Los Angeles
  • University of Chicago
  • University of Michigan
  • University of Minnesota
  • University of North Carolina, Chapel Hill
  • University of Pennsylvania
  • University of Pittsburgh
  • University of Rochester
  • University of Texas
  • Vanderbilt University
  • University of Washington, Seattle
  • University of Wisconsin
  • Yale
  • Brown University
  • Case Western Reserve University
  • Childrens Hospital, Boston postdoc
  • Cornell Medical College
  • Johns Hopkins University Predoc
  • Johns Hopkins University Postdoc
  • Harvard Predoc
  • Indiana University/Purdue
  • New England Medical Center
  • Northwestern University
  • Stanford University
  • University of Alabama, Birmingham

The four bold entries are new programs
34
NRSA Institutional Training
Programs
Minnesota
Wisconsin
Washington
Rochester
3
U MI
Brown
Pitt, Penn
2
CWRU
Chicago
Yale
Cornell
2
IN
Northwestern
JHU (2)
UNC
Stanford
Vanderbilt
UCLA
UAB
U Texas HSC, Houston
The three programs are Harvard predoc,
Childrens Hospital, and NEMC
35
Training K Grants
  • Mentored Clinical Scientist (K08)
  • Mentored Research Scientist (K01)
  • Independent Scientist (K02)
  • Three to five years of support
  • Salary support up to 90,000 annually
  • Up to 25,000 per year for research development
    support

36
Improving Health Care for All
Americans
  • Knowledge Creation
  • Synthesis Dissemination
  • Implementation Use
  • How do We Move the Needle on Quality?

37
Evidence-Based Practice Centers
  • Created in 1997 promotes evidence-based practice
    and decision-making
  • Generate comparative effectiveness reviews on
    medications, devices and other interventions
  • User-driven, with public and private-sector
    partners
  • Blue Cross and Blue Shield Association,
    Technology Evaluation Center (TEC), Chicago, IL
  • Duke University, Durham, NC
  • ECRI, Plymouth Meeting, PA
  • Johns Hopkins University, Baltimore, MD
  • McMaster University, Hamilton, Ontario
  • Oregon Evidence-Based Practice Center
  • RTI International-University of North Carolina at
    Chapel Hill, NC
  • Southern California Evidence-based Practice
    Center-RAND, Santa Monica, CA
  • Tufts University-New England Medical Center,
    Boston, MA
  • University of Alberta
  • University of Connecticut
  • Minnesota Evidence-based Practice Center
  • University of Ottawa
  • Vanderbilt University

38
EPC Comparative Effectiveness Reviews Recently
Released
Condition Topic Joint Release w/ Annals of Internal Medicine E-Manuscript
Cancer Comparison of Therapies for Clinically Localized Prostate Cancer 2/5/2008
Muscle, bone, and joint conditions Comparative Effectiveness of Treatments To Prevent Fractures in Men and Women With Low Bone Density or Osteoporosis 12/17/2007
Heart and blood vessel conditions Renal Artery Stenosis - Update 11/19/2007 (Effective Health Care Web site only)
Muscle, bone, and joint conditions Comparative Effectiveness of Drug Therapy for Rheumatoid Arthritis and Psoriatic Arthritis in Adults 11/19/2007
Heart and blood vessel conditions Comparative Effectiveness of Angiotensin-Converting Enzyme Inhibitors (ACEIs) and Angiotensin II Receptor Antagonists (ARBs) for Treating Essential Hypertension 11/1/2007
Heart and blood vessel conditions Comparative Effectiveness of Percutaneous Coronary Interventions and Coronary Artery Bypass Grafting for Coronary Artery Disease 10/15/2007
Diabetes Comparative Effectiveness and Safety of Oral Diabetes Medications for Adults with Type 2 Diabetes 7/16/2007
39
Support for U.S. Preventive Services Task Force
  • Evidence-based Practice Centers support The Guide
    to Clinical Preventive Services Recommendations
    of the U.S. Preventive Services Task Force
  • Prepare systematic evidence reviews and evidence
    summaries for topics under consideration by Task
    Force

40
Seven New USPSTF Clinical Recommendations
  • Screening for High Blood Pressure
  • Screening for Carotid Artery Stenosis
  • Screening for Bacterial Vaginosis in Pregnancy
  • Screening for Illicit Drug Use
  • Screening for Chronic Obstructive Pulmonary
    Disease
  • Screening for Phenylketonuria
  • Screening for Congenital Hypothyroidism

41
AHRQ Evidence Translation/ Communication
(Eisenberg Center)
  • Translates knowledge about effective health care
    into clear, actionable summaries to assess
  • Treatments
  • Medications
  • Technologies
  • Develops information summaries for 3 key audience
    groups
  • Consumers
  • Health care providers
  • Policymakers

Oregon Health Science University
42
Effective Health Care Program Reviews to Date
  • 14 comparative effectiveness research reviews
    released to date, including
  • Therapies for Clinically Localized Prostate
    Cancer No therapy can be considered preferred
    due to limits in evidence and likely tradeoffs in
    effectiveness, necessity and adverse events,
    February 2008.
  • PCI vs. CABG Bypass surgery is more likely than
    balloon angioplasty (with or without a stent) to
    bring relief from angina in patients with
    mid-range coronary artery disease, October 2007

All reviews available at effectivehealthcare.ahrq
.gov
43
Coumadin/Warfarin Guide
  • Explains what patients should expect and watch
    out for while undergoing Coumadin/Warfarin
    therapy
  • Warfarin is the second most common drug after
    insulin implicated in emergency room visits for
    adverse drug events
  • The guide is intended to help patients who have
    been prescribed the blood thinner to use it
    safely

www.ahrq.gov/consumer/coumadin.htm
44
Real Men Wear Gowns
  • Campaign designed to raise awareness among
    middle-aged men about the importance of
    preventive medical testing
  • Men over 40 learn which preventive screening
    tests they need and when to get them
  • Incorporates family as a key motivating factor
    for men to take a more active role in preventive
    health

www.ahrq.gov/realmen
45
Consumer Financial Incentives Guide
  • Helps employers, private health plans, Federal
    Government, State Medicaid agencies achieve
    better value for services
  • Using financial incentives, health care
    purchasers hope to encourage patients to take
    actions that improve outcomes or reduce costs
  • Using incentives to promote better value in
    health care is one of the four cornerstones of
    HHS Value-Driven Care Initiative

http//www.ahrq.gov/qual/value/incentives.htm
46
New Book on
Evidence-Based Nursing
Patient Safety Quality An Evidence-Based
Handbook for Nurses
  • More than 90 experts, 51 peer-reviewed chapters
  • Intended for all nurses, especially those in
    universities and hospitals
  • Provides practice implications for nurses and
    sets forth a research agenda
  • Links with curriculum on patient safety quality
    improvement developed by UNC

www.ahrq.gov/qual/nurseshdbk
47
Impact Case Study Milken Institute
  • MEPS data on chronic disease used in report, An
    Unhealthy America The Economic Burden of Chronic
    Disease
  • Report used in briefings to National Governors
    Association, Congressional Budget Office and
    California State of the State Conference
  • Health care advisors from several 2008
    presidential campaigns also used report to
    establish how candidates health policy platforms
    would address chronic disease
  • (CFACT 08-06)

48
Value The Transformational Goal
High
Efficiency
Low
Low
High
Quality
49
An Update on theAHRQ Quality Indicators (QIs)
  • 5 new composite measures  PQI Mortality for
    Selected Conditions Mortality for Selected
    Procedures Patient Safety for Selected
    Indicators and Pediatric Patient Safety for
    Selected Indicators.
  • Validation work expert panels of
    multidisciplinary professionals reviewed and
    suggest changes to selected measures these
    incorporated
  • NQF Endorsement All 16 of Prevention Quality
    Indicators (PQIs) endorsed by NQF other QIs
    nearing end of NQF process
  • Public Reporting 12 states currently use QIs for
    public reporting.

50
12 States Use AHRQ QIs for Public Hospital
Reporting
Wisconsin (parts of state)
Iowa
Vermont
NewYork
Oregon
Ohio
Massachusetts
Kentucky
Utah
Colorado
Florida
Texas
51
Reducing Health Literacy Demands New AHRQ Tools
  • AHRQs Guide for Developing and Purchasing
    Accessible Health IT
  • Strategies to Improve Communication Between
    Pharmacy Staff and Patients
  • Is Our Pharmacy Meeting Patients Needs?
  • Automated Telephone Reminders
  • How to Create a Pill Card

www.ahrq.gov/qual/pillcard/pillcard.htm
52
Chartered Value Exchange Awards Presented
  • HHS Secretary Mike Leavitt has named 14 chartered
    Value Exchanges
  • Value Exchanges will join a national Learning
    Network sponsored by AHRQ

http//www.hhs.gov/valuedriven
53
Secretarys Value-Driven Health Care Principles
Guide Chartered Value Exchanges (CVEs)
  1. Health care is local national quality
    improvement will occur one community at a time
  2. Transparency accurate meaningful information on
    quality and cost is key to provider improvement
    and consumer engagement
  3. Collaboratives involving key stakeholder groups
    public and private payers, providers, plans and
    consumer organizations hold promise to foster
    requisite reforms

54
Improving Health Care for All
Americans
  • Knowledge Creation
  • Synthesis Dissemination
  • Implementation Use
  • How do We Move the Needle on Quality?

55
The 3 Ts Road Map to Transforming U.S. Health
Care
T indicates translation. T1, T2, and T3
represent the 3 major translational steps in the
proposed framework to transform the health care
system. The activities in each translational step
test the discoveries of prior research activities
in progressively broader settings to advance
discoveries originating in basic science research
through clinical research and eventually to
widespread implementation through transformation
of health care delivery. Double-headed arrows
represent the essential need for feedback loops
between and across the parts of the
transformation framework.
Source JAMA, May 21, 2008 D. Dougherty and
P.H. Conway, pp. 2319-2321. The 3Ts Roadmap to
Transform U.S. Health Care The How of
High-Quality Care.
56
Pronovost Checklists
  • The fundamental problem with the quality of
    American medicine is that weve failed to view
    delivery of health care as a science. Thats a
    mistake, a huge mistake.
  • Peter Pronovost, MD
  • December 10, 2007

57
Pronovost Study
  • Settings Volunteer MI hospital ICUs for adults
    (108 intention to treat)
  • Primary hypothesis Rate of CABSIs would be
    reduced during first 3 months of intervention v
    baseline
  • Multiple interventions (sequential and parallel)
  • Outcome measure Incidence-rate ratios for CABSIs

New Yorker, December 2007
  • Analytic approach Generalized linear latent and
    mixed model with robust variance estimation and
    random effects to account for clustering within
    hospitals and hospitals within regions, adjusted
    for hospital teaching status and number of beds

Pronovost et al., NEJM 355(26) Dec. 28, 2006
58
Hospital Survey on Patient
Safety Culture
  • New suite of tools helps hospitals, nursing homes
    and medical offices evaluate employee attitudes
    about patient safety
  • Hospitals available since 2004
  • Nursing Homes 2008
  • Medical Offices 2008
  • International 2009

http//www.ahrq.gov/qual/hospculture
59
Proposed Patient Safety Regulation
  • Encourages the formation of Patient Safety
    Organizations (PSOs) to improve the quality and
    safety of health care
  • AHRQ will administer rules for listing
    qualified PSOs
  • HHS Office for Civil Rights will be
    responsible for enforcing confidentiality

60
Proposed Patient Safety Regulation (contd)
  • Originally authorized under the Patient Safety
    and Quality Improvement Act of 2005
  • Voluntary for clinicians and health care
    organizations
  • Provide legal protection for collection,
    aggregation, and analysis of data on
    patient-safety events

61
Proposed Patient Safety Regulation (contd)
  • PSOs will provide feedback to clinicians and
    health care organizations on improving safety
  • Does not relieve clinicians or health care
    organizations from meeting reporting requirements
    under Federal, State, or Local laws
  • Notice of proposed rulemaking published in the
    February 12 Federal Register. Public comment
    period ended April 14th

62
PSO Common Formats
  • NPRM announced Common Formats to be published in
    July/August 2008- Version 0.1 Beta
  • 50 pilot test participants over 3 federal
    agencies- completed February and March 2008
  • Second Pilot test planned for May 2008- revised
    data elements and a paper reporting form
  • National Quality Forum (NQF) has Task Order with
    AHRQ to receive public/user feedback on Common
    Formats after the release (July/August)

63
Challenges for the Field
  • Developing partnerships between researchers and
    policy makers to address critical issues in
    health policy
  • The priority of cultural and political barriers
    adoption over technical challenges
  • The shift to a consumer-centric system
  • Ensuring the more informed actually means better
    informed
  • Enhancing public participation in research
  • Maintaining funding levels using public and
    private resources

64
2008 AHRQ Annual Conference
  • Promoting Quality Partnering for Change
  • September 7-10, 2008
    Bethesda North Marriott Convention
    Center Bethesda, MD
  • Sessions on topics including the following
  • AHRQs patient safety and health IT portfolios
  • Implementation of research findings into changes
    in practice and policy
  • Health Care Innovations

Mark Your Calendars!
65
Improving Health Care for All
Americans
  • Knowledge Creation
  • Synthesis Dissemination
  • Implementation Use
  • How do We Move the Needle on Quality?
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