Transcript Document 7408596

Agency for Healthcare Research and Quality
Advancing Excellence in Health Care • www.ahrq.gov
Tracking the Nation’s Health Care:
The National Healthcare Quality and
Disparities Reports
Edward Kelley
Ernest Moy
Center for Quality Improvement and Patient
Safety
Advancing
Excellence in
Health Care
Reports Mandates
Mandated by Congress in
the Healthcare
Research and Quality Act
(PL. 106-129)
 “Beginning in fiscal year 2003, the
Secretary, acting through the
Director, shall submit to Congress
an annual report on national trends
in the quality of health care
provided to the American people.”
 To track “prevailing disparities in
health care delivery as it relates to
racial factors and socioeconomic
factors in priority populations”
Advancing
Excellence in
Health Care
Why are the reports important?
 New tools for monitoring
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health care delivery
Summarize information
Makes clear where
improvement is most
needed
Provide consensus on
what is important to
measure
Facilitates measurement
alignment
Advancing
Excellence in
Health Care
How the NHDR and NHQR
are Related
NHQR
Snapshot of quality of
health care in America
Quality
Safety, effectiveness,
timeliness, patient
centeredness
Variation across states
NHDR
Snapshot of disparities in
health care in America
Quality + Access
Equity
Variation across
populations
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Health Care
How the Reports Fit into AHRQ’s
Focus on Implementation
Purpose of the Reports:
 To promote awareness of
the status of health care
quality and disparities in
America; and
Quality?
 To lead to action and
support AHRQ’s overall
mission “to improve the
quality… of health care
for all Americans.”
Advancing
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Health Care
Who Helped Design the NHQR?
 Public and private call for
measures
 Measure set culled with
HHS agencies
 Released for public
comment, provider
associations, industry gave
feedback Final proposed
measure set approved by
HHS partners
ASPE, CDC, HRSA,
CMS, NCHS,
SAMHSA, NIH, Data
Council, HIS, FDA
AMA, AHA, JCAHO,
Midwest Business Group on
Health, NAHDO, NASHP,
IOM, general public
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Health Care
Conceptual Framework
Advancing
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Health Care
Priority Areas: What Conditions are
Included?
 Defined by national experts brought together by IOM
(Bill Roper, co-chair)
 Aligned with HHS existing priorities—HP2010,
Secretary’s prevention agenda, IOM priority areas
 Includes: cancer*, chronic kidney disease, diabetes*,
heart disease, HIV/AIDS, maternal and child health,
mental illness-depression, respiratory illness (e.g.,
asthma, flu), nursing home and home health, patient
safety, timeliness, patient centeredness, resource
consumption
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Health Care
Who Has Helped Design
the NHDR?
 AHRQ-led effort starting in 2001
 IOM Committee on Guidance for Designing a NHDR
 DHHS
– Interagency Workgroup for the NHDR: ACF, AoA, ASH, ASL,
ASPA, ASPE, CDC, CMS, FDA, HRSA, IHS, NCHS, NIH,
OCR, OMH, SAMHSA
– Data Council
 Extensive input from other organizations & stakeholders
– Congressional staff, Asian and Pacific Islander American
Health Forum, American Association of Health Plans,
Association of State and Territorial Health Officials, National
Rural Health Association, NMA, AAFP, AMA, ANA, AAHP
Advancing
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NHDR Conceptual Framework
Access to Care
Entry
Barriers
Structural
Barriers
Cultural
Barriers
Use
Quality of Care
Costs
Effectiveness
Safety
Timeliness
Patient
Centeredness
Staying Healthy
Getting Better
Getting Better
Living with Illness or Disability
Living with Illness or Disability
Coping with the End of Life
Coping with the End of Life
Health Status / Health Care Need
Disparities
Staying Healthy
Advancing
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Health Care
What is in the NHDR?
 For the first time, the NHDR:
– Tracks disparities at the national level
– Reports on disparities in terms understandable by
patients and providers
– Gives policymakers, researchers and providers
information to reduce disparities
 Report chapters
– Quality of Health Care
– Access and Receipt of Health Care
– Priority Populations
Advancing
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Measure Selection Process
 Identify pool of candidate
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measures
Map candidate measures into
conceptual framework
Evaluate and vet candidate
measures
Identify draft measure set
Analysis of draft measure set
Finalize final 2003 measure set
Review and vet 2003 measure
set
Finalize 2004 measure set
Call for measures
600-700 NHQR/NHDR
measures
2003 reports
~150 NHQR measures
~ 240 NHDR measures
2004 reports
178 NHQR measures
238 NHDR measures
Measure Topics
Advancing
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Quality of Health Care
 Effectiveness
– Cancer, Diabetes,
ESRD, Heart Disease,
HIV/AIDS, Maternal and
Child Health, Mental
Disease, Respiratory
Disease, Nursing Home
and Home Health Care
 Safety
 Timeliness
 Patient centeredness
Access to Health Care
 Getting into the system
– Insurance, Usual
Source of Care,
Perceptions of Need
 Getting care within the
system
 Perceptions of care
– Patient-provider
communication,
relationship
 Health care use
Advancing
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AHRQ Priority Populations
Women
Children
Elderly
Racial and ethnic minorities
Low-income
Residents of rural areas
Persons with special health care needs
– Disabled
– Chronic care
– End of life
Databases
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 Surveys collected from samples of civilian,
noninstitutionalized populations:
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AHRQ, Medical Expenditure Panel Survey (MEPS), 1998-2000
California Health Interview Survey (CHIS), 2001
CDC-NCHS, National Health and Nutrition Examination Survey (NHANES), 1999-2000
CDC-NCHS, National Health Interview Survey (NHIS), 1998 and 2000
CDC-NCHS/National Immunization Program, National Immunization Survey (NIS), 2001
CMS, Medicare Current Beneficiary Survey (MCBS), 1999
The Commonwealth Fund, Health Care Quality Survey, 2001
NCHS, National Health and Nutrition Examination Survey (NHANES), 1999-2000
NCHS, National Health Interview Survey (NHIS), 1998 and 2000
NCHS, National Immunization Survey (NIS), 2001
SAMHSA, National Household Survey of Drug Abuse (NHSDA), 2000.
 Data collected from samples of health care facilities:
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CDC-NCHS, National Ambulatory Medical Care Survey (NAMCS), 1999-2000
CDC-NCHS, National Home and Hospice Care Survey (NHHCS), 2000
CDC-NCHS, National Hospital Ambulatory Medical Care Survey-Outpatient Department (NHAMCS-OPD), 1999-2000
CDC-NCHS, National Hospital Ambulatory Medical Care Survey-Emergency Department (NHAMCS-ED), 1999-2000
CDC-NCHS, National Hospital Discharge Survey (NHDS), 1998-2000
CDC-NCHS National Nursing Home Survey (NNHS), 1999
CMS, End-Stage Renal Disease Clinical Performance Measurement Program, 2001
CMS, Nursing Home Resident Profile Table, 2001
NCHS, National Ambulatory Medical Care Survey (NAMCS), 1999-2000
NCHS, National Home and Hospice Care Survey (NHHCS), 2000
NCHS, National Hospital Ambulatory Medical Care Survey-Outpatient Department (NHAMCS-OPD), 1999-2000
NCHS, National Hospital Ambulatory Medical Care Survey-Emergency Department (NHAMCS-ED), 1999-2000
NCHS, National Hospital Discharge Survey (NHDS), 1998-2000
NCHS’s National Nursing Home Survey (NNHS), 1999
NIH, United States Renal Data System (USRDS), 2000
SAMHSA, Client/Patient Survey Sample (CPSS), 1997.
CMS, Quality Indicators program, 1998-1999.
 Data extracted from administrative data systems of
health care organizations:
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AHRQ, Healthcare Cost and Utilization Project State Inpatient Databases 16- State database (HCUP SID), 2000
Medicare claim data from CMS
HIV Research Network data (HIVRN), 2000.
 Data from surveillance and vital statistics systems:
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CDC-National Center for HIV, STD, and TB Prevention, HIV/AIDS Surveillance System, 2000
CDC-National Center for HIV, STD, and TB Prevention, TB Surveillance System, 1998-1999
Advancing
Excellence in
Health Care
Agency for Healthcare Research and Quality
Advancing Excellence in Health Care • www.ahrq.gov
NHQR/NHDR:
Key Findings and Next Steps
Ernest Moy
Edward Kelley
Center for Quality Improvement and
Patient Safety
Key Findings
Advancing
Excellence in
Health Care
 High quality health care
is not universal.
 Disparities in health
care are pervasive.
– Preventive care
– Preventive care
– Chronic disease
– Chronic disease
management
management
– Access to care
 There is more to learn.
 There is more to learn.
 Greater improvement is
 Greater improvement is
possible.
possible.
Advancing
Excellence in
Health Care
High quality
health care is
not universal.
Key Report Findings
Disparities in
health care are
pervasive.
Advancing
Excellence in
Health Care
There is more to learn.
NHQR Gaps
 Limited measures
NHDR Gaps
 Limited data
– HIV/AIDS
– Native Hawaiians
– Mental Health
– American Indians
– Timeliness
– Asians
– Patient Centeredness
– Children
– End of life care
– Rural residents
– Special care needs
 Limited understanding
Trends
Best practices
How to integrate quality and disparities activities
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Greater improvement is
possible.
 Of quality measures with trend data, a third
show improvement, two-thirds show no
change or deterioration.
 Blacks and Hispanics do worse than whites
on half of quality measures.
 Hispanics and Asians do worse than whites
on two-thirds of access measures.
 Poor people do worse on two-thirds of quality
and access measures.
Next Steps
Advancing
Excellence in
Health Care
 Begin to fill gaps
– Measurement
– Data
– Information
 Begin to refine report products
– Reports
– Spin-off products
Advancing
Excellence in
Health Care
Filling Measurement Gaps
 Child Health: MEPS adds child preventive
services module in 2001
 Patient Safety
– Add analyses of Medicare Patient Safety
Monitoring System this year
– HCUP develops special disparities analytic file
that allows national estimates by race/ethnicity
 Timeliness: Add measures of clinical
timeliness
 Cultural Competency/Language: MEPS adds
questions to Access to Care module in 2002
Advancing
Excellence in
Health Care
Filling Data Gaps
 Asians: MEPS oversamples Asians in 2002
 AI/ANs: IHS supplements national analyses
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with IHS data
Low income: HRSA supplements national
analyses with CHC data
Elderly: More MCBS analyses
Rural: Adopt new metro, micro, non-core
categories
Special health care needs: Add analyses of
Survey of Children with Special Health Care
Needs
Advancing
Excellence in
Health Care
Filling Information Gaps
 New analyses
– Trends
– Regional analyses
– More stratified/multivariate analyses
– More summary measures
 Review of best practices
National Reports Products
Advancing
Excellence in
Health Care
NHQR/DR-net
QI Clearinghouse
Data
Products
Workbooks
qualitytools.gov
Information
packs
General
Awareness
NHQR
NHDR
Document
Focus
Areas
Webcasts
Knowledge
Packs
Patient
Guides
Research
Reports
Working papers Articles
Supplements
Advancing
Excellence in
Health Care
Report Diffusion Strategies,
Tactics, and Actions
Knowledge
Strategies
Tactics
Awareness
-Media Outreach
-Direct promotion
-General conferences and briefings
National press*
Flyers
Web-Cast
Summit
Persuasion
-Detailed information
-Specific conferences on QM&I
-Data and tools
qualitytools.gov
Town Hall Meetings
Workbooks
Decision
-Customized information
-Targeted conferences on QI programs
NHQR/DR-net
QI Successes
Implementation
-Support high-leverage intermediaries
Targeted TA
Confirmation
-Evaluation of QI programs
QI Clearinghouse
*Italicized actions are on-hold or in development
Actions
Improvement
Advancing
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Health Care
Refining the Report Products
 Chartbook
– Shorter
– Less text, more graphics
– Focus on a smaller number of “highlight”
measures
– Push more detail to Appendices
 Spin-off Products
– Actionable
– Targeted audiences
– Specific strategies, tactics, and actions
Advancing
Excellence in
Health Care
Diabetes Resource Guide
for State Leaders
Compare State data with national benchmarks, identify gaps in State data, and develop a
complete inventory of the data systems available at the State and local levels.
Percent of adults Your state National
Best-in-class
Healthy People
who received
(%)
Average (%)* average (%)*
2010 goal (%)*
HbA1c testing
61
82
50
Retinal eye
67
81
75
examination
Foot examination
65
82
75
Flu vaccination
37
58
n/a
*Review Appendix D for definitions of these terms. The figures are from Figure D1,
page 130.
Advancing
Excellence in
Health Care
ULP Web Conferences
Making Quality Count: Tools, Strategies, and Resources
A Series of Two Free Web-assisted Audio Conferences for State, Local,
and Health System Policymakers.
Tuesday, February 10 and Wednesday, February 18, 2004
2:00–3:30 p.m., EST
Advancing
Excellence in
Health Care
Peer-reviewed Literature
NHQR-DR
Medical Care Supplement
Fall 2004
Prevention Health Care Quality in
America:
Findings from the first National
Healthcare Quality and Disparities
Reports
Advancing
Excellence in
Health Care
http://www.innovations.ahrq.gov/qu
alitytools/
Advancing
Excellence in
Health Care
Web-based data tools
NHQR/DR-net
Quality Improvement
Clearinghouse
How you can help
Advancing
Excellence in
Health Care
 Review first Reports
 Review
http://www.innovations.ahrq.gov/qualitytools/
 Provide advice about
– Adding and refining measures
– Accessibility and usability of reports and tools
 Tell us about your experiences
– Measuring quality and disparities
– Improving quality
– Reducing disparities
Advancing
Excellence in
Health Care
For Further Information
AHRQ’s web site for the NHQR and NHDR:
http://www.innovations.ahrq.gov/qualitytools/
Contact information:
Dr. Ed Kelley, Director
National Healthcare Quality Report
([email protected])
Dr. Ernie Moy, Senior Service Fellow
National Healthcare Disparities Report
([email protected])
Dr. Dan Stryer, Director
Center for Quality Improvement and Patient Safety
([email protected])