Methods for Quality Improvement Research: AHRQ Introduction
Denise Dougherty, Ph.D. Office of Extramural Research, Education, and Priority Populations June 2004
AHRQ’s Mission Statement
To improve the quality and safety, efficiency and effectiveness, of health care for all
Americans
Selected Quality Challenges in U.S. Health Care
Cancer – rate of women diagnosed at advanced stages has
not declined over last several years, while other cancer rates have Diabetes –
– – – – –
1/5 of patients got all 5 recommended tests in 2000 No eye or foot exam for 1/3 of patients Only 25% of people with high blood pressure have it under control < 50% of acute heart attack patients are advised to quit smoking in the hospital 69% of heart attack patients get beta blockers on admission
Heart disease –
Quality Challenges (2)
HIV-AIDS – AIDS incidence increased in ’02 Mental health – 80% of adult patients diagnosed with
depression do not have optimal levels of contact with a health care provider Respiratory disease – black children are nearly twice as likely to be admitted to a hospital for asthma as white children Children are nearly twice as likely as adults to get an antibiotic for a common cold Patient safety – HP2010 targets for hospital-acquired infections are not being met Source: National Healthcare Quality Report, 2003.
4 Interacting Levels for Changing the System
Public Policy Health systems and plans Clinical microsystems Patient
Sources: Berwick; Shortell
AHRQ funding announcements Improvement/Implementation research
REACHES (forthcoming) Partnerships for Quality
THQIT RFAs (2004) PBRNS and TRIP PA (2004) TRIP 2 RFAs and 2 PAs Innovations in Organization and Financing to Improve Cost, Quality, Access PA
RFA (2002) Health Disparities Collaboratives Evaluation (RFA—Chin and Guadagnoli) Quality Improvement RFA (1998) Translational research in diabetes PA (jointly with NIH and CDC)
Other Agencies’ Improvement/Implementation Announcements (Selected)
NIMH
– STATE IMPLEMENTATION OF EVIDENCE-BASED PRACTICES (RFA 2002—NIMH AND SAMHSA) – DISSEMINATION AND IMPLEMENTATION RESEARCH IN MENTAL HEALTH (PA 2001-NIMH) – EFFECTIVENESS, PRACTICE, AND IMPLEMENTATION IN CMHS’ CHILDREN’S SERVICE SITES (PA 2003 – NIMH) – IMPLEMENTATION OF INTERVENTION STRATEGIES FOR CHILDREN WITH DISRUPTIVE BEHAVIORS (RFA 2000-NIMH)
Other Selected (2)
OTHER NIH:
– COMMUNITY IMPLEMENTATION OF HIV
PREVENTION INTERVENTIONS
(RFA 2001--NIMH, NIDA, NINR)
– INTERVENTIONS TO IMPROVE
HYPERTENSION CONTROL RATES IN AFRICAN AMERICANS
(RFA 2004—NHLBI)
NIH Implementation/Improvement Awards
– NHLBI Guideline Implementation RCTs (Diette, Cloutier, Cabana, Crabtree) – Improving Use of ADHD guidelines (Bickman, NIMH grant) – Quality Improvement School Mental Health
Services (Kataoka-Endo, NIMH K award) – Quality improvement for Depression (Rubinstein, NIMH award)
NIH Awards (2)
Pathways to overcoming disparities in
depression – (Wells, NIMH award) Improving Diabetes by Primary Care Translation (IMPACT) – (Peterson, DK project) Improving Palliative Care for Patients with Cancer – (Ahles, CA project)
Selected publications from AHRQsupported QI/TRIP research
Glasgow, R.E., Bull, S.S. (2001). "Making a difference with
interactive technology: considerations in using and evaluating computerized aids for diabetes self-management education." Diabetes Spectrum, Vol. 14, pp. 99-106
Scribano, P.V., Lerer, T., Kennedy, D., Cloutier, M.M. (2001). "Provider adherence to a clinical practice guideline for acute
asthma in a pediatric emergency department." Academic Emergency Medicine, Vol. 8, pp. 1147-1152
Margolis P, et al., Practice based education to improve delivery systems for prevention in primary care: randomised trial. BMJ. 2004 Feb 14;328(7436):388. Epub 2004 Feb 06.
Selected publications (continued)
Shafer MA, et al., Effect of a clinical practice improvement
intervention on Chlamydial screening among adolescent girls. JAMA. 2002 Dec 11;288(22):2846-52. Casebeer, et al., Designing tailored Web-based instruction to improve practicing physicians' preventive practices. J Med Internet Res. 2003 Jul-Sep;5(3):e20.
Upcoming PAs—What Will AHRQ Be Looking for?
Interventions Reach and generalizability Beyond direct attempts in single settings to ―change provider behavior‖ Sample questions: – Interventions that demonstrate the forces and
processes that will support adoption of promising innovations and system changes and development of routines that sustain improvements? – Which interventions work best when they are bundled with other practices to create systemic change? Solid research designs
–
Difficult to do; we are working on it
Suggestions/Caveats
Suggestion: work with colleagues who understand organizational behavior and
systems
Caveat: Appropriate single-setting research on limited innovative interventions may still be necessary and appropriate. Make the case!
For more information about AHRQ funding
Debbie Rothstein, Ph.D.
– Senior Advisor, Extramural Research – Office of Extramural Research, Education, and
Priority Populations (OEREP) – drothste@ahrq.gov
Francis Chesley, MD
– Director, OEREP – fchesley@ahrq.gov
http://www.ahrq.gov/fund/