Director’s Update

1. Director’s Update Carolyn Clancy, MD National Advisory Council April 13, 2012

2. New Members • Jane Durney Crowley, Executive Vice President and Chief Administrative Officer, Catholic Health Partners • Michael P. Johnson, P.T., Ph.D., O.C.S.,  Division Director & ChiefClinicalOfficer, Home Health Practice, Bayada Home Health Care • Newell E. McElwee, III, Pharm.D., M.S.P.H., ExecutiveDirector, U.S. OutcomesResearch, Merck Global Affairs • Henry H. Ng, M.D., M.P.H., F.A.A.P., F.A.C.P., Internist-Pediatrician MetroHealth Medical Center and Assistant Professor, Case Western School of Medicine • David Fredrick Penson, M.D., M.P.H., Director, Center for Surgical Quality and Outcomes Research, Vanderbilt University Medical Center Professor of Urologic Surgery, Vanderbilt University • Harry Paul Selker, M.D., M.S.P.H, Dean, Tufts Clinical and Translational Science Institute, Tufts University; Executive Director, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center Re-appointed: • Bruce Siegel, M.D., M.P.H., ChiefExecutiveOfficer, National Association of Public Hospitals and Health Systems

3. Member Updates New Roles: • Andrea H. McGuire, M.D., M.B.A., President and Chief Operating Officer– Meridian Health Plan • Welton O’Neal, Pharm.D., VP, Medical Affairs – CryerHealth, LLC Awards: • Helen Darling – recipient of a 2012 National Committee for Quality Assurance Health Quality Award for her sustained leadership promoting health care quality as an issue of commercial competitiveness

4. Overview • The Big Picture • FY 2012 • FY 2013 Budget Request • Recent Accomplishments • In the News • Impact Case Studies • AHRQ Program Updates • Today’s Agenda

5. FY AHRQ 2012 Budget • $369 M – $3 M less than FY 2011 • Plus: • $12 M in Prevention and Public Health Funds • $24 M from Patient-Centered Outcomes Research Trust Fund • Total AHRQ Funding in FY 2012 – $405 M

6. FY 2012 Budget Details • $16.6 M for Patient-Centered Outcomes Research (+$24 M from the PCORTF) • $15.9 M for Prevention/Care Management (+$12 M from the Prevention and Public Health Fund) • $3.7 M for Value Research • $25.6 M for Health IT • $65.6 M for Patient Safety ($34 M HAI) • $108.4 M for Crosscutting ($15.9 M in NEW grants)

7. FY AHRQ 2013 Budget Request • $334.4 M – $34.7 M less than FY 2012 • Plus: • $12 M in Prevention and Public Health Funds • $62.4 M from Patient-Centered Outcomes Research Trust Fund • Total AHRQ Funding in FY13 – $408.8 M

8. FY 2013 Request Details • $10.0 M for Patient-Centered Outcomes Research (+$62.4 M from the PCORTF) • $15.9 M for Prevention/Care Management (+$12 M from the Prevention and Public Health Fund) • $3.6 M for Value Research • $25.6 M for Health IT • $62.6 M for Patient Safety ($34 M HAI) • $88.9 M for Crosscutting ($2.7 M in NEW grants) http://www.ahrq.gov/about/cj2013/cjweb13over.htm

9. AHRQ Move • GSA awarded a 15-year lease to the owners of the Parklawn Building • The entire building will be completely renovated which will create a new, modern, and efficient facility • Only concrete and steel infrastructure will remain • HHS employees will be located in the A and B wings and the A-B head house • Four OPDIVs will move into this space: • AHRQ • HRSA • IHS • SAMHSA • Components of the Program Support Center (PSC)

10. Old Parklawn Building

11. New Parklawn Building

12. Overview • The Big Picture • FY 2012 • FY 2013 Budget Request • Recent Accomplishments • In the News • Impact Case Studies • AHRQ Program Updates • Today’s Agenda

13. AHCPR-Funded Chronic Disease Self-Management Program

14. E-Prescribing Safe and Efficient,But Barriers Remain • Interviews with physician practices, community pharmacies, and mail-order pharmacies reveal: • E-prescribing generally regarded as important tool to improve patient safety and save time • Physicians and pharmacies both face barriers in realizing e-prescribing’s full potential Grossman JM, Cross DA, Boukus ER, et al. Transmitting and processing electronic prescriptions: Experiences of physician practices and pharmacies. J Am Med Inform Assoc doi: 10.1136/amiajnl-2011-000515

15. AHRQ, Hispanic Groups Promote Use of Spanish-Language Resources • AHRQ launches Tomalasriendas (Take the Reins) campaign to encourage Hispanics to take control of their own health and explore treatment options • Campaign partners include: • National Hispanic Medical Association • Latino Student Medical Association • National Association of Hispanic Elderly • National Latina Health Network • Telemundo www.facebook.com/AHRQehc.espanol www.ahrq.gov/consumer/espanoix.htm

16. Consumers Choose High-Value Providers When Given Good Data • AHRQ-funded study in March 2012 issue of Health Affairs: • When asked to choose a provider based only on cost, consumers choose the more expensive option, equating cost with quality • When cost and quality data are combined, consumers more easily identify providers who deliver high-quality care at a lower cost • Study explored ways to present cost and quality information, such as symbols, specific figures, and labels • Implications for the design of public report cards Hibbard JH, Greene J, Sofaer S, et al. An experiment shows that a well-designed report on costs and quality can help consumers choose high-value health care. Health Aff 2012 31:560-568.

17. Saint Louis University School of Medicine • AHRQ’s Health Literacy Universal Precautions Toolkit • Incorporated into curriculum on clear communication techniques • More than 1,200 students from seven professions took part in literacy seminars • Toolkit used during clinical rotations in outreach educational activities

18. AHRQ’s Nursing Home Survey on Patient Safety Culture and TeamSTEPPS™ Safety culture survey administered in 62 nursing homes before TeamSTEPPS training; results inform best strategies to improve care QIO offered TeamSTEPPS training to every nursing home through State’s biennial regional meetings Training reached 118 administrators in 62 nursing homes Results showed improved communication and teamwork skills Alliant/GFMC, the Medicare Quality Improvement Organization for Georgia

19. Primary Health Care Centers (GA) • AHRQ’s Staying Active and Healthy with Blood Thinners • Used in educational program to help patients manage their anticoagulation therapy and overall health • Program helped boost number of patients coming in for regular blood tests from 56% to 81% • Centers received patient safety awards for efforts in improving health and care of patients using anticoagulants

20. Alliant/GFMC, the Medicare Quality Improvement Organization for Georgia • AHRQ’s Staying Active and Healthy with Blood Thinners • Used as part of educational program to help Medicare patients manage anticoagulant therapy and overall health • DVD and brochure provided to 1,400 Medicare Part D beneficiaries who filled warfarin prescriptions in Q1, 2009 • 14.5% reduction in warfarin prescriptions filled with another Rx that can cause adverse drug interaction

21. St. Barnabas Rehabilitation and Continuing Care (NY) • On-Time Quality Improvement in Long-Term Care (On-Time) Program • Residents with new pressure ulcers decreased by 56% • Improved integration of clinical information between certified nursing assistants (CNAs) and dietary staff, social workers, nursing staff • CNAs advocate better for residents after On-Time implementation

22. Schuyler Ridge Nursing Home (NY) • On-Time Quality Improvement in Long-Term Care (On-Time) Program • Residents with new pressure ulcers dropped from 6.5% before program to 2% after • Implementation improved documentation completion to nearly 100% • Reports helped identify 2 to 3 new high-risk patients each week • Reports integrated into facility’s information system for increased accuracy, efficiency

23. StayWell Health Management (MN) • AHRQ’s Effective Health Care (EHC) Program Guides • Incorporated guides for consumers into pool of organization’s resources • StayWell health coaches help make consumers aware of program guides • Company learned about AHRQ guides while participating in EHC Tools for Business Project

24. Overview • The Big Picture • FY 2012 • FY 2013 Budget Request • Recent Accomplishments • In the News • Impact Case Studies • AHRQ Program Updates • Today’s Agenda

25. AHRQ Nursing News • Beth Collins Sharp, Ph.D., R.N. Named AHRQ’s Senior Advisor for Nursing • New Effective Health Care Nursing Working Group comprising leading nursing organizations • Explore ways that the nursing community can play a role • Explore the needs of the nursing community • Embrace innovation and collaboration driven by the needs of the nursing community • Sustain a new dialogue between nursing organizations and AHRQ with a goal of greater dissemination and implementation of Effective Health Care Program research and tools

26. March AHRQ-Sponsored Health AffairsArticles on Public Reporting • An Experiment Shows That A Well-Designed Report On Costs And Quality Can Help Consumers Choose High-Value Health Care (J. Hibbard, J. Greene, S. Sofaer, K. Firminger, J. Hirsh) • Multistakeholder Regional Collaboratives Have Been Key Drivers Of Public Reporting, But Now Face Challenges (G. Young) • How Report Cards On Physicians, Physician Groups, And Hospitals Can Have Greater Impact On Consumer Choices (A. Sinaiko, D. Eastman, M. Rosenthal) • A Five-Point Checklist To Help Performance Reports Incentivize Improvement And Effectively Guide Patients (M. Friedberg, C. Damberg) • Advancing Public Reporting Through A New ‘Aggregator’ To Standardize Data Collection On Providers’ Cost And Quality (H. Luft)

27. Commonwealth of Kentucky Office of Health Policy Introducing 6th Web SiteBased on MONAHRQ: Arkansas • Utah Department of Health • Maine Health Data Organization • Hawaii Health Information Corporation • Nevada Division of Health Care Financing and Policy • Arkansas Department of Health

28. New Toolkit Supports Efforts To Improve Quality and Safety • Guides hospitals in using the AHRQ Inpatient and Patient Safety Quality Indicators™ to improve care • Explains the quality improvement process and offers tools • “Introduction and Roadmap” helps various users identify the best resources for their needs • Available at www.ahrq.gov/qual/qitoolkit

29. New FindingsHealth IT Effects on Hospital Costs, Outcomes, and Patient Safety • Findings: • While EMRs do not reduce rate of patient safety events – once an event occurs, they DO reduce: • Death by 34% • Readmissions by 39% • Spending by 16% • Conclusion: • EMRs contain costs by better coordinating care to rescue patients from medical errors once they occur. Encinosa WE, Bae, J. Health information technology and its effects on hospital costs, outcomes, and patient safety. Inquiry. 2011-2012 Winter;48(4):288-303.

30. New ACTION ProjectReducing Readmissions for Medicaid Patients • Background: • Readmission rates are 50% - 90% higher for Medicaid patients • Medicaid patients are more concentrated in safety-net hospitals • New ACTION project will: • Create strategies/tools to address uniquechallenges of Medicaid patients • Test feasibility of strategies/tools at selected safety-net hospitals • In multiple States, collaborating with State Medicaid agencies • Refine strategies and tools based on test results

31. Research Efforts Tied to Implementation of the Affordable Care Act • Determination of the amount of the small employer health insurance tax credit • Evaluations of the health insurance status of young adults and their health care use and costs, ages 22-25 • Estimates of the tax subsidy for employer sponsored insurance (ESI) • Analysis of trends in the health insurance status of high-risk individuals and their health care use and costs • Inform allocation of Federal Medical Assistance Percentages (FMAP) matching funds for State Medicaid programs • Analysis of Modified Adjusted Gross Income (MAGI) to estimate future premium subsidies based on income eligibility

33. MEPS-Based Simulations • MEPS widely used inside and outside government in models to simulate ACA effects • Some ways we support these efforts: • Detailed reconciliation of MEPS with the National Health Expenditure Accounts (CMS) • Tax simulations

34. Recently Released Summary Products • Materials for Clinicians and Patients • Analgesics for Osteoarthritis • Self-Measured Blood Pressure Monitoring • Non-Pharmacological Therapies for Treatment-Resistant Depression

35. Consumer and Clinician Products Coming Soon • Preventing Fractures in People with Low Bone Density • Treating Urinary Incontinence • Therapies for Chronic Pelvic Pain • Mechanical Thrombectomy for Acute Cardiac Syndrome Healthy Bones: A Decision Aid for Women After Menopause

36. ADHD Medications and Risk of Serious Cardiovascular Events in Adults • AHRQ and FDA study of 440,000 adults aged 25-64 years, including over 150,000 adults treated with medications for ADHD • Assessed myocardial infarction, stroke, and sudden cardiac death • Use of ADHD medications was not associated with an increased risk of serious cardiovascular events • The result is consistent with the research team’s early publication in NEJM, which found no evidence of cardiovacular risk of ADHD drugs among children and young adults • New study from Effective Health Care Program’s DEcIDE Network in JAMA Habel LA, et al. ADHD medications and risk of serious cardiovascular events in young and middle-aged adults. JAMA. 2011 Dec 28;306(24):2673-83. Epub 2011 Dec 12.

37. Patients With Diabetes Who Undergo Bariatric Surgery Do Not Have Lower Health Care Costs • Six years following bariatric surgery, individuals with type 2 diabetes did not have lower health care costs than they had before surgery • These patients did have fewer primary care visits in the years following surgery • The findings were based on health insurance data of 7,806 patients with type 2 diabetes who underwent bariatric surgery using data from 7 Blue Cross Blue Shield Plans • New study from Effective Health Care Program’s DEcIDE Network published in Medical Care Bleich SN, Chang HY, Lau B, Steele K, Clark JM, Richards T, Weiner JP, Wu AW, Segal JB. Impact of bariatric surgery on health care utilization and costs among patients with diabetes. Med Care. 2012 Jan;50(1):58-65.

38. Comparative Effectiveness of Oral Antidiabetic Drugs on Kidney Function • Evaluated oral antidiabetic drugs & renal outcomes by using a national VHA database of 93,577 diabetic patients • Compared with patients using the metformin, patients using sulfonylureas had an increased risk of a decline in kidney function, end-stage renal disease, or death • Because of these new findings, the current recommendation to limit the use of metformin alone in patients with mild to moderate kidney disease should be re-examined • New study from Effective Health Care Program’s DEcIDE Network published in Nature’s Kidney International Hung AM, Roumie CL, Greevy RA, Liu X, Grijalva CG, Murff HJ, Ikizler TA, Griffin MR. Comparative effectiveness of incident oral antidiabetic drugs on kidney function. Kidney Int. 2012 Apr;81(7):698-706.

39. 4th Methods Symposium: From Efficacy to Effectiveness • Fourth symposium on original research methods for comparative effectiveness research (CER) and patient-centered outcomes research (PCOR) • June 12 and 13, 2012 at the AHRQ Conference Center and Webcast over internet • Theme is “From Efficacy to Effectiveness” • The proceedings will be published as a special journal supplement in 2013 • Registration at http://effectivehealthcare.ahrq.gov/

40. Collaborations in HHS Health Data Initiative (HDI) • HDI Helps: • Consumers take control of their health and health care • Employers promote health and wellness • Care providers deliver better care • Local leaders make better-informed decisions • HDI Initiatives: • Publish new HHS data for public access • Make existing HHS data much more accessible • Publicize HHS data to innovators • AHRQ Data Resources to be featured at forthcoming Health Data Initiative Forum

41. New PCMH Resources and Activities • Evidence and Evaluation White Papers and Briefs • Early Evidence on Patient-Centered Medical Home • Improving Evaluations of the Medical Home • Care Coordination White Papers and Briefs • Coordinating Care in the Medical Neighborhood: Critical Components and Available Mechanisms • Ensuring that Patient Centered Medical Homes Effectively Serve Patients with Complex Needs • Primary Care Practice Facilitation • Developing and Running a Practice Facilitation Program for Primary Care Transformation: A How-To Guide • Learning Community for organizations interested in primary care practice facilitation services www.pcmh.ahrq.gov

42. Improving Care Coordination in Primary Care: Measure Development • Measures of care coordination processes can be used to generate evidence; evaluate current practices; design, implement, and assess improvement activities; and support payment initiatives • Two new reports from AHRQ address key issues in measuring care coordination in primary care: accountability and data sources • Care Coordination Accountability Measures for Primary Care Practice (available now) • Prospects for Care Coordination Measurement Using Electronic Data Sources (coming soon)

43. Update From the U.S. Preventive Services Task Force • First draft Research Plans posted for public comment • Screening for Peripheral Arterial Disease December 15, 2011–January 12, 2012 • Genetic Risk Assessment and BRCA Mutation Testing for Breast and Ovarian Cancer SusceptibilityFebruary 28–March 27, 2012 • Final Recommendation on Screening for Cervical Cancer released March 15 • Change from draft RS posted for public comment due to new evidence • The USPSTF recommends screening for cervical cancer in women ages 21 to 65 years with cytology (Pap smear) every 3 years OR, for women ages 30 to 65 years who want to lengthen the screening interval, screening with a combination of cytology and human papillomavirus (HPV) testing every 5 years • Coordinated release with the American Cancer Society & other groups

44. USPSTF Welcomed Four New Members • Linda Ciofu Baumann, Ph.D., R.N.Professor Emerita, School of NursingAffiliate Faculty, School of Medicine and Public HealthUniversity of Wisconsin, Madison, WI • Mark Ebell, M.D., M.S.Associate Professor, Epidemiology and Biostatistics The University of Georgia, Athens, GA • Jessica Herzstein, M.D., M.P.H.Global Medical DirectorAir Products, Allentown, PA • Douglas K. Owens, M.D., M.S.Associate Director, Center for Health Care Evaluation, VA Palo Alto Health Care SystemDirector, Center for Health Policy, Freeman Spogli Institute for International StudiesStanford University, Stanford, CA Nominations for 2013 close May 15 Submit Online!

45. Health Information in the Home – Human Factors Assessment • Case study of four families’ health information management tasks • Highlights: • 69 unique health information management tasks • Nine different locations • 22 different information storage artifacts (e.g., calendars, notebooks, cupboards) • Finding: Foundational consumer health IT design elements must be balanced with individual needs Zayas-Cabán T. Health information management in the home: A human factors assessment. Work. 2012 Jan 1;41(3):315-28.

46. Health IT Videos • Dr. Kate Lapane, Brown-Virginia Commonwealth University • Video highlights innovative approach to generate EHR-enabled culturally informed multi-media medication guidance in Spanish and English for older adults • First in a series of inspirational videos featuring AHRQ Health IT grantees • Next in the series: Dr. Lynne Nemeth, Medical University of South Carolina • Videos are available at http://healthit.ahrq.gov/HITFeaturedProjects

47. AHRQ Health IT Research Funding • AHRQ and the National Science Foundation: Advancing Health Services Through System Modeling Research • External interest in AHRQ Health IT FOAs: • Understanding User Need and Context to Inform Consumer Health Information Technology Design • Understanding Clinical Information Needs and Health Care Decision Making Processes in the Context of Health Information Technology

48. Health IT Research Published in JAMIA • The effectiveness of integrated health information technologies across the phases of medication management: a systematic review of randomized controlled trials (Grossman JM, Cross DA, Boukus ER, Cohen GR. Transmitting and processing electronic prescriptions: experiences of physician practices and pharmacies. J Am Med Inform Assoc. 2011 Nov 18. [Epub ahead of print] PubMed PMID: 22101907) • Transmitting and processing electronic prescriptions: experiences of physician practices and pharmacies (McKibbon KA, Lokker C, Handler SM, Dolovich LR, Holbrook AM, O'Reilly D, Tamblyn R, Hemens BJ, Basu R, Troyan S, Roshanov PS. The effectiveness of integrated health information technologies across the phases of medication management: a systematic review of randomized controlled trials. J Am Med Inform Assoc. 2012 Jan-Feb;19(1):22-30. Epub 2011 Aug 18. Review. PubMed PMID: 21852412; PubMed Central PMCID: PMC3240758)

49. Patient Safety Organizations and the Affordable Care Act • Section 399KK: Secretary shall make available a program for hospitals with high readmission rates to work with PSOs • AHRQ and CMS have undertaken some planning in order to execute this part of ACA • AHRQ PSO Web site enhancement launched March 6th to provide resources for PSOs to work with those hospitals

50. PSOs and Common Formats • PSO Annual Meeting and Software Developers Meeting • 166 registrants (as of March 19, 2012) • 11 PSO presentations • Hospital Common Formats v 1.2 published April 2012 • Incorporates new modules for VTE and Device with Health IT