Transcript Doing the Right Thing AND Doing Things Right Carolyn M. Clancy, MD

Health System Reform: Doing the
Right Thing AND Doing Things Right
Carolyn M. Clancy, MD
Director
Agency for Healthcare Research and Quality
Alliance for Health Care Reform
Washington, DC – March 27, 2009
Treating Cardiac Patients
“In the current, long-overdue
debate about health care, the
focus is almost entirely on health
insurance. And there is no question
that the country would be better off
if everyone were covered. But the
gaps in insurance aren’t the only
problem with the medical system.
They are not even the biggest
problem.”
New York Times
March 7, 2007
The Importance of Reforming
Health Care Delivery
 Making Reform of the
Health Care Delivery
System a Part of
Health Care Reform
 Success Stories
 21st Century Health
Care
AHRQ’s Mission
Improve the quality, safety,
efficiency and effectiveness of
health care for all Americans
AHRQ 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
Key Challenge
 We’re not going to get to high-quality
high-value health care until we put a lot
more focus on doing things right
– Comparative effectiveness research is
about doing the right thing
– System reform is about doing things right
Pronovost Study
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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
CLBSI-Reduction Program:
10 State Pilot
10 States
Experts will help
hospital ICUs in
these states:
• California
• Colorado
• Florida
• Massachusetts
• Nebraska
• North Carolina
• Ohio
• Pennsylvania
• Texas
• Washington
Builds on the Keystone Project
AHRQ Health IT
Research Funding
 Long-term agency priority
– More than 200 projects
and demonstrations to
improve the safety,
quality and efficiency of
health care in virtually
every state
– Focus on the adoption
of health IT
– Projects in 43 states
AHRQ Health IT
Investment: $260
Million
AHRQ-Sponsored Interactive
Preventive Health Record (IPHR)
Promoting Patient-Centered Care
 Virginia Commonwealth University IPHR
called My Preventive Health Care designed to
increase the delivery of health care services
 Goals include determining whether the IPHR
increases delivery and patients use it, and
whether it increases shared decision making
and improves communication
 Involves seven primary care practices in the
Virginia Ambulatory Care Outcomes Network
(ACORN)
Project End – August 31, 2010
Communication is a
Core Component of HROs
Evidence-Based Team Training and Implementation
TeamSTEPPS Toolkit
Team Strategies & Tools to Enhance
Performance & Patient Safety
– Improves communication &
teamwork skills among health
care professionals
– Collaboration between AHRQ
and the Department of
Defense’s military health system
– Adopted in the U.S. and
internationally, in places including
Singapore and Southern Australia
AHRQ/DoD Initiatives
 Activities began in 2002
 AHRQ issued PSO Task Order
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Contract to American Institutes of
Research (AIR)
Expert Panel
Comprehensive Literature Review
Case Study Analysis
Journals/Articles
Presentations
Clinical Measures of Teamness
(RAND evaluation contract Mod)
 Medical Team Training Curriculum
TeamSTEPPS
 Edited Handbook
EvidenceBased
Methods
Principles and
Guidelines
Tools for
Training and
Measurement
Collaboration Products
Teamwork &
Simulation
Relevant Evidence
Teamwork in
Healthcare
Teamwork in
Professional
Education
National Implementation Team
Minnesota -TRC
Delmarva
AIR
Lumetra
Carilion TRC
Creighton TRC
Duke TRC
Booz | Allen | Hamilton
Trained more than 1,000 Master Trainers who have trained 8,000 trainees
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
Co-sponsored by RWJF
www.ahrq.gov/qual/nurseshdbk
Re-Engineered Hospital
Discharge Program (RED)
 AHRQ-funded research
program at Boston University
Medical Center, Department
of Family Medicine
– RED patients had 30 percent
fewer subsequent emergency
visits and readmissions
 RCT-tested, designed to
educate patients about their
post-hospital care plans
 Ongoing research is testing
the automation of discharge
principles in RED
More than 1,400 hospitals have signed up to date
Delivery of Health Care
is a Team Sport
 Having a common
understanding and a
common strategy for
addressing the issues
 Collecting enough data
to monitor progress
 Adapting based on the
specific circumstances
involved
21st Century Health Care
Improving quality by promoting a culture of safety
through Value-Driven Health Care
Information-rich, patientfocused enterprises
Evidence is
continually refined
as a by-product of
care delivery
21st Century
Health Care
Information and
evidence transform
interactions from
reactive to
proactive (benefits
and harms)
Actionable information available – to
clinicians AND patients – “just in time”
Your questions?