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					Solutions for Prevention and
   Quality in Health Care
           Carolyn M. Clancy, MD
                  Director
 Agency for Healthcare Research and Quality

 SHSMD Conference: “Capitol Connections”
           October 6, 2007
         Capitol Connections

 Researchers to
  clinicians
 Communities to
  each other
 Providers to each
  other
 Providers to
  patients
     Care Connectors

                 Value
                 Health IT
                 Patient Education
                 Better Quality
                  Information



The goal: quality care delivered
  to every patient, every time
  The Challenge of
‘Patient-Centric’ Care
             What is Quality?

IOM defines quality
 as care that is:

   Safe
   Timely
   Effective
   Efficient
   Equitable
   Patient-Centered
    AHRQ’s Mission

  Improve the quality, safety,
efficiency and effectiveness of
 health care for all Americans
                AHRQ Roles and Resources



  Health IT Research         Develop Evidence Base       Promote Collaboration
       Funding                  for Best Practices         and Dissemination
• Support advances that      Four key domains:           • Support efforts of AHIC,
  improve patient            • Patient-centered care       ONC, HRSA and CMS
  safety/quality of care     • Medication management     • Build on public and
• Continue work in           • Integration of decision     private partnerships
  hospital settings            support tools             • Use web tools to share
• Step up use of health IT   • Enabling quality            knowledge and
  to improve ambulatory        measurement                 expertise
  patient care
            Context for Current Quality
               Improvement Efforts

 Good News: Quality is
  improving; disparities are
  narrowing
 Bad News: Progress is
  S-L-O-W

Better News:
    – Substantial opportunity
       for improvement
    – Good momentum
       toward improvement
                 Connecting the Dots


“All health care is local, and
we need cooperative local
action just as we need
common national goals.”
             Michael O. Leavitt, Secretary
Department of Health and Human Services
                         January 5, 2007
            Cornerstones of Value-Driven
                    Health Care



    Quality Standards                       Price Standards
 Design systems to collect quality      Aggregate claims information to
  of care information and define       enable cost comparisons between
what constitutes quality health care     specific doctors and hospitals




          Incentives                        Interoperabiliity
 Reward those who provide and           Set common technical standards
   purchase high-quality and                  for quick and secure
 competitively priced health care      communication and data exchange
              Value-Driven Health Care:
                   Core Principles

 Health care is a local service
 Broad access to information
  will improve value by:
   – stimulating provider
       improvement
   – engaging consumers in
       provider selection,
       treatment choices
   – enabling purchasers to align consumer,
       provider incentives
 Nationwide learning network will foster market-
  based health care reform
              The Role for Communities

 Regional/local public-private collaboration is essential to
  the success of the Value-Driven Health Care Initiative
 HHS is building a system of Community Leaders and Value
  Exchanges that recognize local organizations which are
  engaged in the Value-Driven Health Care Initiative

    As of October 5, 2007

          795                    60                 94
      Employers &              State and     Organizations have
     providers have           government     applied to become
          signed             entities have      Community
      statements of         signed pledges   Leaders (88 have
         support                              been confirmed)
                   Community Leaders

Multi-participant organizations working
to achieve the four cornerstones of
value-driven health care
Examples are:
    –   Puget Sound Health Alliance
    –   Greater Detroit Area Health
        Council
    –   Health Action Council of
        Northeastern Ohio
    –   Center for Health Transformation
                                           Downtown USA
    –   Memphis Business Group on              Alejandra Vernon
        Health


          HHS is accepting requests for Community Leader
          Recognition valuedriven@hhs.gov
          Chartered Value Exchanges

 Community Leaders that have
  taken clear action to advance the
  four cornerstones of Value-Driven
  Health Care
 Will be chartered by HHS to carry
  out provider performance and
  quality outcomes
 Some advanced collaboratives
  may qualify to pool data with
  Medicare data for broad-based
  measurement of provider
  performance and quality outcomes
                 National Collaborative for
                       Consistency

A uniform approach to quality measurement reporting

 Broad-based group of health care organizations
   and health quality experts are working on a
   national framework for implementing quality and
   cost measures*
    –    The project will combine data from national health
         plans to provide a broader picture of physicians’ care
    –    Medicare data will be used to develop a snapshot of
         cost and quality
    –    All of the data will used to identify racial and ethnic
         disparities and to work on eliminating them



   * The Robert Wood Johnson Foundation is providing nearly $16 million for the initiative
            Value-Driven Health Care will
                  Improve Quality
 Value-Driven Health Care promotes a “culture of
   safety” that improves quality by:

     Sharing cost and quality improvement goals across a critical
       mass of stakeholders
           Physicians
           Patients
           Health providers
           Purchasers

     Stimulating improvements by doctors and hospitals through
       broad access to information

     Identifying, disseminating and adopting best practices
       through learning networks
  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
                Growing HIT Evidence Base

                                   Health IT helps improve
                                    quality of care in large health
        Costs and                   care organizations that create
        Benefits of                 their own systems and devote
          Health                    substantial resources to EHR,
       Information                  CPOE, e-prescribing, and
       Technology                   other applications
                                   Health IT has the potential
                                    to enable dramatic
                                    transformation of health care
                                    safety, effectiveness and
AHRQ Southern California
Evidence-Based Practice Center-     efficiency
RAND Corporation, April 2006
                 AHRQ Health IT
              Implementation Grants

 Health Improvement Collaborative in
  Cherokee County, OK
  Goal: Implement an electronic health information
  system among 7 agencies; implement a Web-
  based 24/7 information and referral service; and
  implement a community-wide, science-based
  prevention strategy supported by community
  based health IT data systems.
       Multiple outcomes: Improve patient safety,
         treat multiple problems in coordinated
         manner, build relationships with providers,
         encourage and track referrals.
       Project completion date: September
         2008
                  AHRQ Health IT
               Implementation Grants

 Integris Tele-woundcare Network
   –   Applicant: Integris Health Inc., Oklahoma City, OK.
   –   Goal: Demonstrate the clinical and cost-effectiveness of
       using telehealth technology to reduce days to heal for
       chronic wounds.
         Use health IT to improve access to knowledgeable
           caregivers, point of care processes, and dissemination
           of best practice information.
         Incorporate a combination of broadband, analog, and
           Web-based applications to serve patients in a variety of
           settings, including clinics, homes and long-term care
           facilities.
         Projection completion date: September 2007
            Helping 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
         Patient Safety for Consumers

AHRQ Web site devoted to
consumer information and
resources. Includes:

 Helpful links
 Fact sheets
 How to be an active health care
  consumer
 Pocket guides
 Checklists on preventive care

      www.ahrq.gov/consumer
         Patient Involvement Campaign




 AHRQ’s campaign with the Ad Council uses a series of
  TV, radio and print public service announcements
 Web site features a “Question Builder” for patients to
  enhance their medical appointments
   – www.ahrq.gov/questionsaretheanwser
           Better Quality Information
              (AQA Pilot Project*)

 Designed to increase the transparency of health
  care quality information to help consumers make
  informed choices about their health care
 First national effort to combine public and private
  information to measure and report on physician
  practice
 Currently 80 standard performance measures
  being incorporated nationwide
 Similar efforts under way by major insurers,
  including Blue Cross Blue Shield, Humana,
  Aetna, UnitedHealthcare, and CIGNA.



                     *Supported by funding from CMS and AHRQ
                        BQI: Six Selected Sites
                 Minnesota Community   Wisconsin
                 Measurement           Collaborative    Indiana Health
                                       for Healthcare   Information Exchange
                                       Quality




                                                           Massachusetts
California                                                 Health Quality
Cooperative                                                Partners
Healthcare
Reporting
            Phoenix Regional
Initiative
            Healthcare Value
            Measurement Initiative
                    Hospital Quality Alliance

 HQA: Public-private collaboration
  to measure and publicly report
  care in U.S. hospitals
 20 measures reported on Hospital
  Compare Web site include 10
  “starter measures” and additional
  measures for voluntary reporting,
  with more measures to come
 Ultimate goal: Improve the quality of care in all U.S.
  hospitals by having them report to this set of measures,
  which would be accepted by all purchasers, oversight and
  accrediting entities, payers, and providers

             Supported by AHRQ, NQF, Joint Commission, AMA, American Nurses
              Association, National Association of Children’s Hospitals and Related
       Institutions, Consumer-Purchaser Disclosure Project, AARP, AFL-CIO, and
                                                       U.S. Chamber of Commerce
A View Toward the Future

           Health care must satisfy the “IOM 6”
            criteria
           Organizations that pay for health
            care must receive value for their
            investment
           Improvement must be evidence-
            based and enabled by technology
           All Americans must benefit from
            quality improvement
           Improvement must be executed at
            the local level
Your questions?

				
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