Transcript QICM Grand Rounds: AHRQ Update

Improving Quality and Safety
Through Value-Driven Health Care
Carolyn M. Clancy, MD
Director
Agency for Healthcare Research and Quality
Medicare Advantage Quality Measurement &
Performance Assessment Training Conference
Baltimore, MD – April 8, 2007
Improving Quality and Safety
 Perceptions of the U.S.
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Health Care System & the
Quality Challenge
AHRQ Roles & Resources
Value-Driven Health Care
Turning Evidence Into Action
Q&A
The Quality Challenge
What Is Quality?
The Right
Care
For The
Right Person
At The
Right Time
A Quality Disconnect
Health care
costs up 6.7%
per year
Health care
quality up
2.3%
Public Perceptions of
U.S. Health Care
Are you generally satisfied or dissatisfied with…
Satisfied
95%
Dissatisfied
64%
35%
4%
Cost of Health Care
Quality of Health Care
Health Care for America Survey – AFLCIO – March 2008
In addition, 95%
of people with
insurance are
dissatisfied with
cost and 62% are
dissatisfied with
quality
Public Perceptions of
U.S. Health Care
Overall, what do you think about today’s health care system?
52%
Should Be
Completely Rebuilt
1%
4%
Fundamental
Changes needed
43%
Health Care for America Survey – AFLCIO – March 2008
Not Sure
Works Pretty Well
– Minor Changes
Physician Involvement in
Collaborative Efforts to Improve
Quality of Care
Percent indicating involvement in any collaborative efforts in past two years*
100
No, have not been involved
Yes, a LOCAL effort
Yes, a REGIONAL effort
Yes, a NATIONAL effort
67
Involved in at least one effort (32%)
50
23
8
0
* Multiple answers possible
The Commonwealth Fund National Survey of Physicians and Quality of Care, 2005
6
Physician Opinions on Effectiveness
of Collaborative Activities, by
Practice Size
Percent saying that involvement in collaborative efforts is
“very/somewhat” effective in improving quality of care
100
76
68
77
83
81
50
0
Total
1 Physician
2-9
10-49
50+
Physicians
Physicians
Physicians
The Commonwealth Fund National Survey of Physicians and Quality of Care, 2005
Coordination of Care
Improving Quality and Safety
 Perceptions of the U.S.
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Health Care System & the
Quality Challenge
AHRQ Roles & Resources
Value-Driven Health Care
Turning Evidence Into Action
Q&A
AHRQ’s Mission
Improve the quality, safety,
efficiency and effectiveness of
health care for all Americans
AHRQ Roles and Resources
Health IT Research
Funding
• Support advances that
improve patient
safety/quality of care
• Continue work in
hospital settings
• Step up use of health IT
to improve ambulatory
patient care
Develop Evidence Base
for Best Practices
Four key domains:
• Patient-centered care
• Medication management
• Integration of decision
support tools
• Enabling quality
measurement
Promote Collaboration
and Dissemination
• Support efforts of AHIC,
ONC, HRSA and CMS
• Build on public and
private partnerships
• Use web tools to share
knowledge and
expertise
Source: FY 2007 Budget Summary for HHS and BNA Health Care Policy Report 2-13-06
AHRQ FY 2008 Priorities
Patient Safety
 Health IT
 Patient Safety
Ambulatory
Patient Safety
Organizations
 New Patient
 Safety & Quality Measures, Safety Grants
Drug Management and
Patient-Centered Care
 Patient Safety Improvement
Corps
Medical Expenditure
Panel Surveys
Effective Health
Care Program
 Comparative
Effectiveness Reviews
 Comparative Effectiveness
Research
 Clear Findings for
Multiple Audiences
Other Research &
Dissemination Activities
 Visit-Level Information on  Quality & Cost-Effectiveness, e.g.
Medical Expenditures
 Annual Quality &
Disparities Reports
Prevention and Pharmaceutical
Outcomes
 U.S. Preventive Services
Task Force
 MRSA/HAIs
FY 2008 Funding
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$334.6 million
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FY 2008 Request – $329.6 million
FY 2007 Appropriation – $318.7 million
FY 2008 appropriation includes:
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$30 million for comparative effectiveness research
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$5 million for research and activities to reduce Methicillin Resistant
Staphylococcus aureus (MRSA) and related infections
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Double the $15 million designated in FY 2007
The first such federal grant to AHRQ for MRSA/HAIs
Congress also encouraged AHRQ to:
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Consider proposals to detect medical errors and preemptively
control injury via compact medical devices
Investigate the feasibility of an open-source, no-cost license
computer model capable of predicting the effects of health care
policy alternatives to improve quality and cost-effectiveness
Distributed Network Prototypes
for Population-Based Studies
 The aim is to develop a federated network prototype
that supports secure analyses of electronic
information across multiple organizations to study
risks, effects and outcomes of various medical
therapies
 The long-term goal is a coordinated partnership of
multiple research networks that provide information
that can be quickly queried and analyzed:
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Model 1: Colorado DEcIDE center with American Academy of
Family Practice will develop the “Distributed Ambulatory
Research Network” (DARTNet) using electronic health record
(EHR) data from eight organizations representing over 200
clinicians and over 350,000 patients
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Model 2: HMO Research Network (HMORN) DEcIDE will develop
the “Virtual Data Warehouse” to assess the effectiveness and
safety of different anti-hypertensive 5.5 to 6 million individuals
cared for by six health plans
Health IT: Where We’ve Been;
Where We’re Going
 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
AHRQ Health IT
Investment:
$216 Million
Ambulatory Safety and
Quality Program (ASQ)
 Purpose: Improve safety and quality of ambulatory
health care in the U.S. More than 60 grants in 3 areas:
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Enabling Quality Measurement through Health IT (EQM)
Improving Quality Through Clinician Use of Health IT (IQHIT)
Enabling Patient-Centered Care Through Health IT (PCC)
 Types of Health IT used in projects:
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Personal Health Records
Clinical/Medication Reminders
Clinical Decision Support
Telehealth
Human/Machine Interface
ASQ Example: Enabling Quality
Measurement through Health IT
 Medication Monitoring for
Vulnerable Populations via Health
IT – Johns Hopkins University,
Baltimore
– Demonstrates the ability of HIEs and
EHRs to provide quality and safety
measures for vulnerable populations
served by a community health center
– Type of Health IT: System integration,
quality of care decision support
Estimated Total Funding: $994,325
Project Start – September 21, 2007
Project End – August 31, 2009
AHRQ’s National Reports
on Quality and Disparities
2007 Reports: Some Good News,
Need for Improvement
 More than 93% of heart attack
patients received the recommended
hospital care in 2005, up from about
77 percent in 2000/2001
 The percent of heart attack patients
who were counseled to quit smoking
increased from about 43% in
2000/2001 to about 91% in 2005
 Measures of patient safety showed
an average annual improvement of
about 1%
New Efficiency Chapter
Disability Data Added
More on Health Literacy
Maryland: Overall Health Care
Performance vs. All States,
One-Year Performance Change
Average
Weak
Strong
Very
Weak
Very
Strong
Performance Meter
= Most Recent Year
= Baseline Year
2007 National Healthcare Quality Report, State Snapshots
Examples: MD Snapshot
Measure
% of heart failure patients who received
recommended hospital care, all payers
% of adult surgery patients who received
appropriate timing of antibiotics, all payers
HIV-infection deaths per 100,000
population
Performance
Better than
Average
Average
Lower than
Average
*National Healthcare Quality Report, State Snapshots, 2007
The Promise of Genomics:
Recent Activities
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AHRQ is funding a randomized control trial to clarify the added
value of genetic testing to improve warfarin dosing.
AHRQ and CDC are finalizing a DEcIDE project to review
databases focusing on utilization and outcomes of gene-based
tests and therapies
EPC Reports:
– Genomic testing in ovarian cancer
(completed)
– CYP450 testing in depression
(completed)
– HNPCC testing in colorectal
patients (completed)
– Horizon scan on cancer genetic
tests for CMS (completed)
– BRCA testing in breast and
ovarian cancers (w/USPSTF
recommendation)
– HER-2-Neu testing in breast
cancer (ongoing)
– Expression profile tests in breast
cancer (completed)
– Family history in breast, ovarian,
colorectal and prostate cancers
(completed)
– Screening for hemochromatosis
(w/USPSTF recommendation)
Improving Quality and Safety
 Perceptions of the U.S.




Health Care System & the
Quality Challenge
AHRQ Roles & Resources
Value-Driven Health Care
Turning Evidence Into Action
Q&A
Cornerstones of Value-Driven
Health Care
Quality Standards
Price Standards
Design systems to collect quality
of care information and define
what constitutes quality health care
Aggregate claims information to
enable cost comparisons between
specific doctors and hospitals
Interoperability
Incentives
Set common technical standards
for quick and secure
communication and data exchange
Reward those who provide and
purchase high-quality and
competitively priced health care
Getting to Value-Driven
Quality Health Care
"All health care is local, and
we need cooperative local
action just as we need
common national goals."
Michael O. Leavitt, Secretary
US Dept. of Health and Human Services
January 5, 2007
Chartered Value Exchanges
What Will This Take?
 Good measures and data
– Local data, but national
benchmarks
 Strong local coalitions
 Evidence-based reporting,
payment strategies
 Evidence, tools, strategies for improvement
 Collaboration, TA across sites
AHRQ Learning Network
for Value Initiative
 Encourage sharing of
 Identify interventions or
experiences and
tactics that yield the best
lessons learned
outcomes
 Identify and share
 Translate interventions
promising practices that
into adaptable change
improve health care
strategies
value
 Create a user-friendly,
 Identify gaps where
Web-based knowledge
innovation is needed
repository
 Provide face-to-face
 Goal: have all Community
and virtual opportunities
Leaders become or join
for peer-to-peer sharing
Chartered Value
of experience
Exchanges
Measurement
Data aggregation
Report Cards
Provider Incentives Consumer Incentives
Better Quality Information
(2006 AQA Pilot Project*)
Minnesota Community
Measurement
California
Cooperative
Healthcare
Reporting
Phoenix Regional
Initiative
Healthcare Value
Measurement Initiative
Wisconsin
Collaborative
for Healthcare
Quality
Indiana Health
Information Exchange
Massachusetts
Health Quality
Partners
*Supported by funding from CMS and AHRQ
HQA and AQA Collaborate
 National Quality Alliance Steering Committee
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Formed by two key health care quality alliances, the
AQA Alliance and the Hospital Quality Alliance
 Purpose: To better coordinate the promotion of
quality measurement, transparency and
improvement in care
 First Step: Expand pilot project sites to identify,
collect and report data on the quality of physician
performance across care settings, including
hospital and cost-of-care. Will work closely with
AHRQ and CMS
HCAHPS 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
Improving Quality and Safety
 Perceptions of the U.S. Health
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Care System & the Quality
Challenge
AHRQ Roles & Resources
Value-Driven Health Care
Turning Evidence Into Action
Q&A
New User’s Guide
to Patient Registries
Registries for Evaluating Patient Outcomes: A User’s Guide*
 The first government-supported
handbook for establishing,
managing and analyzing patient
registries
– Designed so patient registry data
can be used to evaluate the real-life
impact of health care treatments
– A milestone in growing efforts to
better understand what treatments
actually work best, and for whom
– http://effectivehealthcare.ahrq.gov,
print versions coming soon
EHC Research Report May 16, 2007
* Co-funded by AHRQ & CMS
Other Program Outputs:
Spreading the Word
Research
Reports
Consumer
Guides
Systematic
Reviews
AHRQ Health Care
Innovations Exchange
Web-based Repository of Cutting-Edge Service Innovations
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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
Transparency and Transformation
More effortless
information
sharing with
Health IT
More transparent
cost/quality
information
More
collaboration
for
improvement
More trust between purchasers, providers and consumers
Near-Term Frontier
 Focus on disparities reduction as core
component of quality improvements
 Combine administrative data with selected
clinical IT data elements (e.g., lab, pharmacy)
to enhance efficiency of data aggregation
 Build quality reporting functionality – and
decision support – into certified electronic
health records
 Engineer value-driven health care on a
national scale via regional/local public-private
collaboration
Improving Quality and Safety
 Perceptions of the U.S. Health




Care System & the Quality
Challenge
AHRQ Roles & Resources
Value-Driven Health Care
Turning Evidence Into Action
Q&A