AHRQ Research Update: Improving Health Care for All Americans

1
AHRQ Research Update Improving Health
Care for All Americans

• Carolyn M. Clancy, MD Francis Chesley, MD
• Agency for Healthcare Research and Quality
• AcademyHealth Annual Research Meeting
• Washington, DC June 8, 2008

2
More Americans are Unhappy With their Health Care
May 30, 2008
3
Opportunities for the Field

• Using health IT to improve research
• Building public/private partnerships that include
  representative stakeholders
• Standardizing collection of race, ethnicity and
  language data, including priority populations and
  sub-groups
• Insisting on clear synthesis of results from
  public and private demonstrations
• Rewarding the leading edge and bringing others
  along

4
Improving Health Care for All
Americans

• Knowledge Creation
• Synthesis Dissemination
• Implementation Use
• How do We Move the Needle on Quality?

5
AHRQ Priorities
Patient Safety

• Health IT
• Patient SafetyOrganizations
• New PatientSafety Grants

Effective HealthCare Program
AmbulatoryPatient Safety

• Comparative Effectiveness Reviews
• Comparative Effectiveness Research
• Clear Findings for Multiple Audiences

• Safety Quality Measures,Drug Management
  andPatient-Centered Care
• Patient Safety ImprovementCorps

Medical ExpenditurePanel Surveys
Other Research Dissemination Activities

• Visit-Level Information on Medical Expenditures
• Annual Quality Disparities Reports

• Quality Cost-Effectiveness, e.g.Prevention and
  PharmaceuticalOutcomes
• U.S. Preventive ServicesTask Force
• MRSA/HAIs

6
Medical Expenditure Panel Survey (MEPS)

• Annual survey of 15,000 households
• Provides national estimates of health care use,
  expenditures, insurance coverage, sources of
  payment, access to care and health care quality
• Permits studies of
• Distribution of expenditures and sources of
  payment
• Role of demographics, family structure, insurance
• Expenditures for specific conditions
• Trends over time

www.meps.ahrq.gov
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The Healthcare Cost and Utilization Project
Billing record created
Patient enters hospital
AHRQ standardizes data to create uniform HCUP
databases
Hospital sends billing data and any additional
data elements toData Organizations
States store data in varying formats
8
AHRQ Health Care
Innovations Exchange
Web-based Repository of Cutting-Edge Service
Innovations

• 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
9
2007 National Healthcare Quality and
Disparities Reports
10
New in the 2007 NHQR

• Cancer Cancer treatment measures (2-breast
  cancer, 1-colon cancer) from National Cancer Data
  Base conducted by the American Cancer Society and
  American College of Surgeons.
• HIV and AIDS HIV Testing measures from CDC
  National Survey on Family Growth
• Nursing Home and Home Health
  Pain Management for Nursing Home Residents from
  CDC National Nursing Home Survey
• Efficiency Chapter

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New in the 2007 NHDR

• Chapter 2 Patient Centeredness Health Literacy
• Chapter 2 Patient Centeredness Workforce
  Diversity for Nurses
• Chapter 4 Priority Populations Supplemental data
  for Asians and Hispanics from the California
  Health Interview Survey (CHIS)
• Chapter 4 Priority Populations People with
  Special Healthcare Needs - Adults with
  disabilities

12
State Snapshots

• Now includes state contextual factors such as
  each states rate of obesity,
  health insurance coverage, mental illness, and
  the number of specialist doctors
• Updated tool tracks states progress toward
  reaching Healthy People 2010
• Other highlights
• State rankings for selected measures, focus on
  diabetes and Clinical Preventive Services

http//statesnapshots.ahrq.gov/snaps07/index.jsp
13
Coming Soon MEADERS
Medication Error and Adverse Drug Event Reporting
System (MEADERS)

• Designed to help doctors in small practices
  quantify medication errors and ADEs
• Web-based system for documenting and reporting in
  ambulatory settings
• Information fed back to practices for QI purposes
• Voluntary and confidential

Preliminary results from a field test will be
presented at the
AHRQ Annual Conference in September
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H-CAHPS 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

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AHRQ Statistical Briefs
Clostridium Difficile-Associated Disease in U.S.
Hospitals, 1993-2005

• The number of hospital discharges with CDAD more
  than doubled from 2001 to 2005, a trend that was
  considerably steeper than the prior 8-year
  period, during which the number of cases
  increased by 74 percent

Statistical Brief 50 April 2008 Conducted in
collaboration with CDC
Anne Elixhauser, Ph.D. and
Michael Jhung, M.D., M.P.H.
16
AHRQ News Numbers

• Nearly 4 in 10 Americans between 18 and 34 years
  of age had at least one chronic condition, as did
  9 of every 10 aged 65 and older.
• About 77 percent of Americans aged 65 and older
  had two or more chronic conditions. Only 14
  percent of those 18 to 34 had two or more
  conditions.
• Nine of every 10 dollars spent for medical care
  (excluding expenses for dental care and medical
  equipment and supplies) on adults in the United
  States was spent to treat persons with chronic
  conditions.

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AHRQ Research Activities

• Monthly compendium of AHRQ activities
• Includes announcements of Agency products and
  projects
• Summarizes research findings from studies
  supported by the agency
• Free online and hard copy subscriptions

http//www.ahrq.gov/research
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Effective Health Care Program

• Evidence synthesis (EPC program)
• Systematically reviewing, synthesizing, comparing
  existing evidence on treatment effectiveness
• Identifying relevant knowledge gaps
• Evidence generation (DEcIDE, CERTs)
• Development of new scientific knowledge to
  address knowledge gaps.
• Accelerate practical studies
• Evidence communication/translation (Eisenberg
  Center)
• Translate evidence into improvements
• Communication of scientific information in plain
  language to policymakers, patients, and providers

19
New Priority Conditions for the Effective Health
Care Program

• Arthritis and non-traumatic joint disorders
• Cancer
• Cardiovascular disease, including stroke and
  hypertension
• Dementia, including Alzheimer Disease
• Depression and other mental health disorders
• Developmental delays, attention-deficit
  hyperactivity disorder and autism
• Diabetes Mellitus

• Functional limitations and disability
• Infectious diseases including HIV/AIDS
• Obesity
• Peptic ulcer disease and dyspepsia
• Pregnancy including pre-term birth
• Pulmonary disease/Asthma
• Substance abuse

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CERTs Centers
Brigham and Womens Hospital Health IT
Childrens Hospital - Cincinnati Pediatric care
Duke University Medical Center Therapies for heart and blood vessel disorders
HMO Research Network Multiple population-based delivery systems
Houston Area CERT Consumer education and patient adherence
KP Ctr for Health Research, Portland Coordinating Center
Rutgers University Mental health therapeutics
University of Alabama - Birmingham Musculoskeletal disorders
University of Arizona C-Path Drug interactions/Womens health
University of Chicago (New 9/07) Clinical/economic issues in hospital settings
University of Illinois - Chicago Prescribing tools, including formularies
University of Iowa Elderly and aging
University of Pennsylvania Anti-infective use and resistance
Vanderbilt University Therapeutic issues in Medicaid and VA system
Weill Medical College - Cornell Therapeutic medical devices
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Effective Health Care Program New CERTs Funding
Opportunity Announcement

• Limited Competition just announced for four
  awards in FY08 to CERTs collaboratives
• Jointly funded by AHRQ FDA for a total of 7M
• Four topics areas (1 award in each)
• Antipsychotics comparative effectiveness/safety
• TNF-blockers safety
• Observational methods in endpoint
  definition/validation and unmeasured confounders
• Characterization of inpatient and acetaminophen
  drug usage

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DEcIDE Research Network
Network of institutions and partner
organizations with access to de-identified data
of 50 million patients generates evidence and
analytic tools in practical, accelerated format
23
Effective Health Care Program New Solicitations
through DEcIDE Network

• Computer-based Clinical Decision Support (CDS)
  Tools for Gene-based Tests Used in Breast Cancer
• Developing clinical decision support (CDS) tools
  for gene-based tests that are used in the
  prevention and treatment of breast cancer
• Multicenter Research Cooperatives for Clinical
  Comparative Effectiveness Studies
• Creating multicenter research cooperatives to
  coordinate and conduct studies on clinical
  effectiveness and comparative effectiveness in
  selected priority health conditions (diabetes and
  cancer)
• Pilot Studies For Evaluating the Safety and
  Effectiveness of Prescription Drugs, Biologics
  and Vaccines Using Medicare Part D
• Conducting pilot studies which evaluate the
  safety and effectiveness of prescription drugs,
  biologics and vaccines using Medicare Part D data

Proposed information and not final information
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Effective Health Care Program EPC Comparative
Effectiveness Reviews in Progress
Condition Topic
Diabetes Comparative Effectiveness, Safety, and Indications of Insulin Analogues in Premixed Formulations for Adults with Type 2 Diabetes
Heart and blood vessel conditions Comparative Effectiveness of Combinations of Lipid-Modifying Agents
Cancer Core Needle Breast Biopsy and Surgical Excision Biopsy for Diagnosing Breast Lesions
Cancer Comparative Effectiveness of Chemotherapy Agents in the Prevention of Primary Breast Cancer in Women
Heart and blood vessel conditions Effectiveness of Radiofrequency Catheter Ablation (RFA) for Atrial Fibrillation
Cancer Comparative Effectiveness and Safety of Radiotherapy Treatments for Head and Neck Cancer
Heart and blood vessel conditions Comparative Effectiveness of Medical Therapies for Stable Ischemic Heart Disease
Heart and blood vessel conditions Effectiveness and Off-label Use of Recombinant Factor VIIa
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The Promise of Genomics Completed
Projects

• DEcIDE report Infrastructure for Monitoring
  Utilization and Outcomes of Gene-based
  Applications An Assessment has identified a
  need for improvements in existing databases and
  HIT informed work of two advisory committees
  AHIC and SACGHS
• EPC Reports

• Genomic Testing in Ovarian Cancer (for EGAPP/CDC)
• CYP450 testing in Depression
• (w/EGAPP recommendation)
• HNPCC Testing in Colorectal Patients (for
  EGAPP/CDC)
• Horizon Scans on Cancer and non-Cancer Genetic
  Tests (for CMS)
• BRCA Testing in Breast and Ovarian Cancers
  (CDC-funded w/USPSTF recommendation)

• Outcomes of Gene Expression Profile tests in
  Breast Cancer (for EGAPP/CDC)
• Collection and Use of Cancer Family History in
  Primary Care (CDC-funded)
• Screening for Hereditary Hemochromatosis
  (w/USPSTF recommendation)

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The Promise of Genomics Ongoing Activities

• Randomized control trial to clarify the added
  value of genetic testing to improve warfarin
  dosing (AHRQ-funded grant)
• DEcIDE projects
• Case-control study to Assess Association of OTC
  Genes and Effectiveness of Metformin in Diabetes
  (joint NIH and AHRQ funding)
• Clinical Decision Support Tools for Gene-based
  Tests in Breast Cancer (AHRQ funded
  soon-to-be-awarded)

• EPC projects
• HER2 Testing in Breast Cancer or Other Solid
  Tumors (AHRQ-funded)
• Outcomes from Testing for Factor V Leiden and
  Prothrombin G20210A (for EGAPP/CDC)
• Clinical Utility of Cancer Family History
  (CDC-funded)
• Family History in Primary Care (NIH funded for
  State-of-Science conference)
• Analytic Validity of Genetic and other Laboratory
  Tests (AHRQ funded to-be-awarded)

27
Health IT and Patient Safety

• 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

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Health IT Accomplishments

• CMS rule for e-prescribing standards adoption
  based on AHRQ collaboration
• Final Health Information Security and Privacy
  Reports and Toolkits
• NQF Health IT Expert Panel Report on data for
  national consensus measures
• NRC Health IT Survey Compendium
• Supply Chain Meeting of Medical Specialty
  Societies

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Health IT Awards Solicitations

• Clinical Decision Support Contracts awarded
• CDS Consortium (BW) and GLIDES (Yale)
• 5M total over two years three option years
• Special issue of Health Affairs on Health IT
• Publication March 2009
• Cofunded by Markle Foundation and CHCF
• ASQ II FOA Care of the Complex Patient
• almost 100 applications (for 5-7 awards)
• ACTION e-prescribing implementation solicitation

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Health IT External Collaborations

• NCVHS Quality Workgroup
• AHRQ lead staff
• Medical Home Hearings in May
• AHIC CDS Ad Hoc Workgroup
• Government Collaboratory Formation
• CDS Recommendations in April
• AHIC Quality Workgroup
• Recommendations in April
• AQA Data Sharing and Aggregation Workgroup
• Stewardship RFI Summary Available

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Hospital Associated Infections (HAI)

• Awards to 5 ACTION Partners (AIR, Denver Health,
  HRET, Iowa, Yale)
• Qualitative, exploratory studies
• Title Reducing HAIs Improving patient safety
  through implementing multi-disciplinary
  interventions
• Goal To identify factors associated with the
  implementation of training that can assist
  hospitals in successfully reducing, and
  sustaining the reduction of, infections
  associated with the process of care.

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2008 Conference Report on MRSA

• Report included 5 million for research and
  activities to reduce infections for Methicillin
  Resistant Staphylococcus aureus (MRSA) and
  related infections
• Goal To create actionable new knowledge and
  tools that can be used by clinicians and health
  care organizations to diagnose, treat and
  demonstrate prevention of, and reduction in, MRSA
  infections in all pertinent settings

CDC contributes an additional 500k
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25 T32 Training Programs

• University of California, Los Angeles
• University of Chicago
• University of Michigan
• University of Minnesota
• University of North Carolina, Chapel Hill
• University of Pennsylvania
• University of Pittsburgh
• University of Rochester
• University of Texas
• Vanderbilt University
• University of Washington, Seattle
• University of Wisconsin
• Yale

• Brown University
• Case Western Reserve University
• Childrens Hospital, Boston postdoc
• Cornell Medical College
• Johns Hopkins University Predoc
• Johns Hopkins University Postdoc
• Harvard Predoc
• Indiana University/Purdue
• New England Medical Center
• Northwestern University
• Stanford University
• University of Alabama, Birmingham

The four bold entries are new programs
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NRSA Institutional Training
Programs
Minnesota
Wisconsin
Washington
Rochester
3
U MI
Brown
Pitt, Penn
2
CWRU
Chicago
Yale
Cornell
2
IN
Northwestern
JHU (2)
UNC
Stanford
Vanderbilt
UCLA
UAB
U Texas HSC, Houston
The three programs are Harvard predoc,
Childrens Hospital, and NEMC
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Training K Grants

• Mentored Clinical Scientist (K08)
• Mentored Research Scientist (K01)
• Independent Scientist (K02)

• Three to five years of support
• Salary support up to 90,000 annually
• Up to 25,000 per year for research development
  support

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Improving Health Care for All
Americans

• Knowledge Creation
• Synthesis Dissemination
• Implementation Use
• How do We Move the Needle on Quality?

37
Evidence-Based Practice Centers

• Created in 1997 promotes evidence-based practice
  and decision-making
• Generate comparative effectiveness reviews on
  medications, devices and other interventions
• User-driven, with public and private-sector
  partners

• Blue Cross and Blue Shield Association,
  Technology Evaluation Center (TEC), Chicago, IL
• Duke University, Durham, NC
• ECRI, Plymouth Meeting, PA
• Johns Hopkins University, Baltimore, MD
• McMaster University, Hamilton, Ontario
• Oregon Evidence-Based Practice Center
• RTI International-University of North Carolina at
  Chapel Hill, NC
• Southern California Evidence-based Practice
  Center-RAND, Santa Monica, CA
• Tufts University-New England Medical Center,
  Boston, MA
• University of Alberta
• University of Connecticut
• Minnesota Evidence-based Practice Center
• University of Ottawa
• Vanderbilt University

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EPC Comparative Effectiveness Reviews Recently
Released
Condition Topic Joint Release w/ Annals of Internal Medicine E-Manuscript
Cancer Comparison of Therapies for Clinically Localized Prostate Cancer 2/5/2008
Muscle, bone, and joint conditions Comparative Effectiveness of Treatments To Prevent Fractures in Men and Women With Low Bone Density or Osteoporosis 12/17/2007
Heart and blood vessel conditions Renal Artery Stenosis - Update 11/19/2007 (Effective Health Care Web site only)
Muscle, bone, and joint conditions Comparative Effectiveness of Drug Therapy for Rheumatoid Arthritis and Psoriatic Arthritis in Adults 11/19/2007
Heart and blood vessel conditions Comparative Effectiveness of Angiotensin-Converting Enzyme Inhibitors (ACEIs) and Angiotensin II Receptor Antagonists (ARBs) for Treating Essential Hypertension 11/1/2007
Heart and blood vessel conditions Comparative Effectiveness of Percutaneous Coronary Interventions and Coronary Artery Bypass Grafting for Coronary Artery Disease 10/15/2007
Diabetes Comparative Effectiveness and Safety of Oral Diabetes Medications for Adults with Type 2 Diabetes 7/16/2007
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Support for U.S. Preventive Services Task Force

• Evidence-based Practice Centers support The Guide
  to Clinical Preventive Services Recommendations
  of the U.S. Preventive Services Task Force
• Prepare systematic evidence reviews and evidence
  summaries for topics under consideration by Task
  Force

40
Seven New USPSTF Clinical Recommendations

• Screening for High Blood Pressure
• Screening for Carotid Artery Stenosis
• Screening for Bacterial Vaginosis in Pregnancy
• Screening for Illicit Drug Use
• Screening for Chronic Obstructive Pulmonary
  Disease
• Screening for Phenylketonuria
• Screening for Congenital Hypothyroidism

41
AHRQ Evidence Translation/ Communication
(Eisenberg Center)

• Translates knowledge about effective health care
  into clear, actionable summaries to assess
• Treatments
• Medications
• Technologies
• Develops information summaries for 3 key audience
  groups
• Consumers
• Health care providers
• Policymakers

Oregon Health Science University
42
Effective Health Care Program Reviews to Date

• 14 comparative effectiveness research reviews
  released to date, including
• Therapies for Clinically Localized Prostate
  Cancer No therapy can be considered preferred
  due to limits in evidence and likely tradeoffs in
  effectiveness, necessity and adverse events,
  February 2008.
• PCI vs. CABG Bypass surgery is more likely than
  balloon angioplasty (with or without a stent) to
  bring relief from angina in patients with
  mid-range coronary artery disease, October 2007

All reviews available at effectivehealthcare.ahrq
.gov
43
Coumadin/Warfarin Guide

• Explains what patients should expect and watch
  out for while undergoing Coumadin/Warfarin
  therapy
• Warfarin is the second most common drug after
  insulin implicated in emergency room visits for
  adverse drug events
• The guide is intended to help patients who have
  been prescribed the blood thinner to use it
  safely

www.ahrq.gov/consumer/coumadin.htm
44
Real Men Wear Gowns

• Campaign designed to raise awareness among
  middle-aged men about the importance of
  preventive medical testing
• Men over 40 learn which preventive screening
  tests they need and when to get them
• Incorporates family as a key motivating factor
  for men to take a more active role in preventive
  health

www.ahrq.gov/realmen
45
Consumer Financial Incentives Guide

• Helps employers, private health plans, Federal
  Government, State Medicaid agencies achieve
  better value for services
• Using financial incentives, health care
  purchasers hope to encourage patients to take
  actions that improve outcomes or reduce costs
• Using incentives to promote better value in
  health care is one of the four cornerstones of
  HHS Value-Driven Care Initiative

http//www.ahrq.gov/qual/value/incentives.htm
46
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

www.ahrq.gov/qual/nurseshdbk
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Impact Case Study Milken Institute

• MEPS data on chronic disease used in report, An
  Unhealthy America The Economic Burden of Chronic
  Disease
• Report used in briefings to National Governors
  Association, Congressional Budget Office and
  California State of the State Conference

• Health care advisors from several 2008
  presidential campaigns also used report to
  establish how candidates health policy platforms
  would address chronic disease

• (CFACT 08-06)

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Value The Transformational Goal
High
Efficiency
Low
Low
High
Quality
49
An Update on theAHRQ Quality Indicators (QIs)

• 5 new composite measures  PQI Mortality for
  Selected Conditions Mortality for Selected
  Procedures Patient Safety for Selected
  Indicators and Pediatric Patient Safety for
  Selected Indicators.
• Validation work expert panels of
  multidisciplinary professionals reviewed and
  suggest changes to selected measures these
  incorporated
• NQF Endorsement All 16 of Prevention Quality
  Indicators (PQIs) endorsed by NQF other QIs
  nearing end of NQF process
• Public Reporting 12 states currently use QIs for
  public reporting.

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12 States Use AHRQ QIs for Public Hospital
Reporting
Wisconsin (parts of state)
Iowa
Vermont
NewYork
Oregon
Ohio
Massachusetts
Kentucky
Utah
Colorado
Florida
Texas
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Reducing Health Literacy Demands New AHRQ Tools

• AHRQs Guide for Developing and Purchasing
  Accessible Health IT
• Strategies to Improve Communication Between
  Pharmacy Staff and Patients
• Is Our Pharmacy Meeting Patients Needs?
• Automated Telephone Reminders
• How to Create a Pill Card

www.ahrq.gov/qual/pillcard/pillcard.htm
52
Chartered Value Exchange Awards Presented

• HHS Secretary Mike Leavitt has named 14 chartered
  Value Exchanges
• Value Exchanges will join a national Learning
  Network sponsored by AHRQ

http//www.hhs.gov/valuedriven
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Secretarys Value-Driven Health Care Principles
Guide Chartered Value Exchanges (CVEs)

1. Health care is local national quality
   improvement will occur one community at a time
2. Transparency accurate meaningful information on
   quality and cost is key to provider improvement
   and consumer engagement
3. Collaboratives involving key stakeholder groups
   public and private payers, providers, plans and
   consumer organizations hold promise to foster
   requisite reforms

54
Improving Health Care for All
Americans

• Knowledge Creation
• Synthesis Dissemination
• Implementation Use
• How do We Move the Needle on Quality?

55
The 3 Ts Road Map to Transforming U.S. Health
Care
T indicates translation. T1, T2, and T3
represent the 3 major translational steps in the
proposed framework to transform the health care
system. The activities in each translational step
test the discoveries of prior research activities
in progressively broader settings to advance
discoveries originating in basic science research
through clinical research and eventually to
widespread implementation through transformation
of health care delivery. Double-headed arrows
represent the essential need for feedback loops
between and across the parts of the
transformation framework.
Source JAMA, May 21, 2008 D. Dougherty and
P.H. Conway, pp. 2319-2321. The 3Ts Roadmap to
Transform U.S. Health Care The How of
High-Quality Care.
56
Pronovost Checklists

• The fundamental problem with the quality of
  American medicine is that weve failed to view
  delivery of health care as a science. Thats a
  mistake, a huge mistake.
• Peter Pronovost, MD
• December 10, 2007

57
Pronovost Study

• 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
58
Hospital Survey on Patient
Safety Culture

• New suite of tools helps hospitals, nursing homes
  and medical offices evaluate employee attitudes
  about patient safety
• Hospitals available since 2004
• Nursing Homes 2008
• Medical Offices 2008
• International 2009

http//www.ahrq.gov/qual/hospculture
59
Proposed Patient Safety Regulation

• Encourages the formation of Patient Safety
  Organizations (PSOs) to improve the quality and
  safety of health care
• AHRQ will administer rules for listing
  qualified PSOs
• HHS Office for Civil Rights will be
  responsible for enforcing confidentiality

60
Proposed Patient Safety Regulation (contd)

• Originally authorized under the Patient Safety
  and Quality Improvement Act of 2005
• Voluntary for clinicians and health care
  organizations
• Provide legal protection for collection,
  aggregation, and analysis of data on
  patient-safety events

61
Proposed Patient Safety Regulation (contd)

• PSOs will provide feedback to clinicians and
  health care organizations on improving safety
• Does not relieve clinicians or health care
  organizations from meeting reporting requirements
  under Federal, State, or Local laws
• Notice of proposed rulemaking published in the
  February 12 Federal Register. Public comment
  period ended April 14th

62
PSO Common Formats

• NPRM announced Common Formats to be published in
  July/August 2008- Version 0.1 Beta
• 50 pilot test participants over 3 federal
  agencies- completed February and March 2008
• Second Pilot test planned for May 2008- revised
  data elements and a paper reporting form
• National Quality Forum (NQF) has Task Order with
  AHRQ to receive public/user feedback on Common
  Formats after the release (July/August)

63
Challenges for the Field

• Developing partnerships between researchers and
  policy makers to address critical issues in
  health policy
• The priority of cultural and political barriers
  adoption over technical challenges
• The shift to a consumer-centric system
• Ensuring the more informed actually means better
  informed
• Enhancing public participation in research
• Maintaining funding levels using public and
  private resources

64
2008 AHRQ Annual Conference

• Promoting Quality Partnering for Change
• September 7-10, 2008
  Bethesda North Marriott Convention
  Center Bethesda, MD

• Sessions on topics including the following
• AHRQs patient safety and health IT portfolios
• Implementation of research findings into changes
  in practice and policy
• Health Care Innovations

Mark Your Calendars!
65
Improving Health Care for All
Americans

• Knowledge Creation
• Synthesis Dissemination
• Implementation Use
• How do We Move the Needle on Quality?