Health System Reform: Doing the Right Thing AND Doing Things Right

1. 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

2. 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

3. 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

4. AHRQ’s Mission Improve the quality, safety, efficiency and effectiveness of health care for all Americans

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 Other Research & Dissemination Activities Medical ExpenditurePanel Surveys • 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. 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

7. 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

8. 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

9. AHRQ Health IT Investment: $260 Million 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

10. 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

11. 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

12. AHRQ/DoD Initiatives • Activities began in 2002 • AHRQ issued PSO Task Order 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

13. Collaboration Products Teamwork & Simulation Relevant Evidence Teamwork in Healthcare Teamwork in Professional Education

14. 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

15. Co-sponsored by RWJF 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

16. 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

17. 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

18. 21st Century Health Care Improving quality by promoting a culture of safety through Value-Driven Health Care Information-rich, patient-focused enterprises Information and evidence transform interactions from reactive to proactive (benefits and harms) Evidence is continually refined as a by-product of care delivery 21st Century Health Care Actionable information available – to clinicians AND patients – “just in time”

19. Your questions?