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Return to tutorials Measuring Health Care Quality Carolyn M. Clancy, MD Director U.S. Agency for Healthcare Research and Quality forKaiserEDU.org May 2008.

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Presentation on theme: "Return to tutorials Measuring Health Care Quality Carolyn M. Clancy, MD Director U.S. Agency for Healthcare Research and Quality forKaiserEDU.org May 2008."— Presentation transcript:

1 Return to tutorials Measuring Health Care Quality Carolyn M. Clancy, MD Director U.S. Agency for Healthcare Research and Quality forKaiserEDU.org May 2008 Figure 1

2 Return to tutorials Health Care Quality Varies A LOT; NOT clearly related to $$ spent Varies A LOT; NOT clearly related to $$ spent Matters – can be measured and improved Matters – can be measured and improved Measurement science is evolving: Measurement science is evolving: – Structure, process and outcomes – Broad recognition that patient experience is essential component Strong focus on public reporting Strong focus on public reporting – Motivates providers to improve – Not yet ‘consumer friendly’ Figure 5

3 Return to tutorials 70 Million Americans Benefit from Quality Measurement 96% of heart attack victims were prescribed beta-blocker treatment in 2005, up from 62% in 1996* 96% of heart attack victims were prescribed beta-blocker treatment in 2005, up from 62% in 1996* 77.7% of children enrolled in private health plans received all recommended immunizations, up 5% from 72.5% in 2004* 77.7% of children enrolled in private health plans received all recommended immunizations, up 5% from 72.5% in 2004* Evidence-based guidelines from the American College of Cardiology and the American Heart Association have reduced mortality among patients who have had a heart attack Evidence-based guidelines from the American College of Cardiology and the American Heart Association have reduced mortality among patients who have had a heart attack * National Committee for Quality Assurance Figure 6

4 Return to tutorials AHRQ’s National Reports on Quality and Disparities New editions available New editions available – New efficiency chapter – Disability data added – More on health literacy Figure 7

5 Return to tutorials 2007 National Reports: Some Good News, Need for Improvement The rate of improvement in quality between 1994 and 2005 was 2.3%, down from 3.1% from 1994-2004 The rate of improvement in quality between 1994 and 2005 was 2.3%, down from 3.1% from 1994-2004 More than 60% of the disparities in quality of care have stayed the same or worsened for Blacks, Asians and the poor, and approximately 56% of disparities have not improved for Hispanics More than 60% of the disparities in quality of care have stayed the same or worsened for Blacks, Asians and the poor, and approximately 56% of disparities have not improved for Hispanics For Blacks, Asians, Hispanics and poor populations, about half of the core measures of quality used to track access to care are improving For Blacks, Asians, Hispanics and poor populations, about half of the core measures of quality used to track access to care are improving Figure 8

6 Return to tutorials Uninsurance is a Major Barrier to Reducing Disparities Uninsured individuals do worse than privately insured individuals on almost 90% of quality measures Uninsured individuals do worse than privately insured individuals on almost 90% of quality measures Uninsured individuals do worse than privately insured individuals on all access measures Uninsured individuals do worse than privately insured individuals on all access measures 0 25% 50% 75% 100% Quality(9CRM) Access(6CRM) 1BetterSame Worse 2007 National Healthcare Disparities Report, AHRQ Figure 9

7 Return to tutorials Overall Scope Patients receive the proper diagnosis and treatment only about 55% of the time* Patients receive the proper diagnosis and treatment only about 55% of the time* Overall, disparities in health care quality and access are not getting smaller ** Overall, disparities in health care quality and access are not getting smaller ** Total health care expenditures in 2006 totaled $2.1 trillion (16% of GDP) and are projected to reach $4.1 trillion (19.6% of GDP) by 2016*** Total health care expenditures in 2006 totaled $2.1 trillion (16% of GDP) and are projected to reach $4.1 trillion (19.6% of GDP) by 2016*** * McGlynn E, Asch S, et al. The Quality of Health Care Delivered to Adults in the United States N Engl J Med 2003;348:2635-45. ** AHRQ 2007 National Healthcare Disparities Report *** National Health Expenditure Accounts Figure 10

8 Return to tutorialsWhat? Figure 11

9 Return to tutorialsWhy? The “why” is a systems challenge: The “why” is a systems challenge: – The U.S. has extremely talented and qualified health care professionals who have not been trained to work in teams – The delivery system is fragmented, so information doesn’t follow patients as they move from hospitals to other sites of care – Payment is quality neutral Light Figure Fragment Craig A. Kraft Washington, DC Figure 12

10 Return to tutorials There Are Major Opportunities for Improvement: Examples Uptake of health information technology, while still relatively slow, is gaining traction Uptake of health information technology, while still relatively slow, is gaining traction Growing focus on comparative effectiveness research Growing focus on comparative effectiveness research HHS Secretary Michael Leavitt’s Value-Driven Health Care Initiative HHS Secretary Michael Leavitt’s Value-Driven Health Care Initiative – Chartered Value Exchanges – National Learning Network Downtown USA Alejandra Vernon Figure 13

11 Return to tutorials Emerging Methods in Comparative Effectiveness & Safety A series of 23 articles by AHRQ researchers on new approaches in comparative effectiveness methods are compiled in a special October edition of Medical Care A series of 23 articles by AHRQ researchers on new approaches in comparative effectiveness methods are compiled in a special October edition of Medical Care A valuable new resource for scientists committed to advancing the comparative effectiveness and safety research A valuable new resource for scientists committed to advancing the comparative effectiveness and safety research The Resource Center in Oregon led the development process, helped draft the document and manage work groups, and handled public comment The Resource Center in Oregon led the development process, helped draft the document and manage work groups, and handled public comment Source: http://effectivehealthcare.ahrq.gov/reports/med-care-report.cfm http://effectivehealthcare.ahrq.gov/reports/med-care-report.cfm Figure 14

12 Return to tutorials Percent who say… Role Of IT In Reducing Medical Errors The coordination among the different health professionals that they see is a problem They had to wait or come back for another appointment because the provider did not have all their medical information They have seen a health care professional and noticed that they did not have all of their medical information Have you or a family member ever created your own set of medical records to ensure that you and all of your health care providers have all of your medical information? Don’t know No Yes Source: Kaiser Family Foundation / Agency for Healthcare Research and Quality / Harvard School of Public Health National Survey on Consumers’ Experiences with Patient Safety and Quality Information, November 2004 (Conducted July 7 – September 5, 2005). 32% 67% 1% Figure 16

13 Return to tutorials Personal Experience Have you been personally involved in a situation where a preventable medical error was made in your own medical care or that of a family member? Yes Don’t Know No Source: Kaiser Family Foundation / Agency for Healthcare Research and Quality / Harvard School of Public Health National Survey on Consumers’ Experiences with Patient Safety and Quality Information, November 2004 (Conducted July 7 – September 5, 2005). Did the error have serious health consequences, minor health consequences, or no health consequences at all? Minor health consequences No health consequences Serious health consequences 65% 1% 21% 10% 3% 34% Figure 17

14 Return to tutorials Guidelines & Measures More emphasis needs to be placed on what’s most important We measure what we can Identifying what counts and determining how it can be measured Rather Than Figure 18

15 Return to tutorials Guidelines Measures Incentives “You can get 60% of the improvement from 15% of the change” Don Berwick Where should the busy primary care practice begin? Where should the busy primary care practice begin? Where should policy makers target their incentives? Where should policy makers target their incentives? To changes that: Produce the greatest benefit Produce the greatest benefit Address the biggest quality gap Address the biggest quality gap Can be implemented most easily, cheaply and safely Can be implemented most easily, cheaply and safely Figure 19

16 Return to tutorials Reconciling Guidelines and Quality Measures Developing guidelines that address a wide range of needs… Low-Risk Patients Higher Risk Patients Figure 20

17 Return to tutorials Challenges in Addressing Multiple Conditions Interactions between illnesses Interactions between treatments Tension between therapeutic goals Multiple providers Multiple medications Figure 21

18 Return to tutorials Setting Priorities for Patients with Multiple Conditions Address the need for clinicians to set priorities, weighing the benefits and burdens of increasingly complex medical regiments Address the need for clinicians to set priorities, weighing the benefits and burdens of increasingly complex medical regiments Make sure guidelines keep up with unique issue of treating older and more frail patients Make sure guidelines keep up with unique issue of treating older and more frail patients Figure 22

19 Return to tutorials “Patient-Centered” Guidelines If care is to be patient centered, guidelines need to reflect this goal If care is to be patient centered, guidelines need to reflect this goal – Quality measures must accommodate differences in: Patient values Patient values Patient preferences Patient preferences Figure 23

20 Return to tutorials What Level of Collaboration Is Practical? Guidelines may need to reflect local values, disease burdens, priorities and resources Guidelines may need to reflect local values, disease burdens, priorities and resources BUT WE NEED TO SHARE… Information on how to develop clear and practical guidelines Information on how to develop clear and practical guidelines Evidence on barriers and facilitators to implementing guidelines Evidence on barriers and facilitators to implementing guidelines Evidence about integration of guidelines in electronic health records Evidence about integration of guidelines in electronic health records Globalize the evidence, localize the decision-making Figure 24

21 Return to tutorials The Goal Historically, the focus has been on structure Historically, the focus has been on structure In recent years, there has been more interest in process – the right care In recent years, there has been more interest in process – the right care Tomorrow’s goal? Outcomes and end results Tomorrow’s goal? Outcomes and end results Figure 25

22 Return to tutorials The Information Exists Figure 26 Information on topics including guidelines, measures, incentives and outcomes are available for a wide range of uses. Included is information about: Information on topics including guidelines, measures, incentives and outcomes are available for a wide range of uses. Included is information about: – Hospitals: – Nursing Homes: – Health Plans: – Various Health Care Organizations: Hospital Compare Nursing Home Compare National Committee for Quality Assurance Quality Check ®

23 Return to tutorials CBO Report on Comparative Effectiveness Discusses several mechanisms for organizing and funding additional comparative effectiveness research efforts Discusses several mechanisms for organizing and funding additional comparative effectiveness research efforts Reviews the different types of research that could be pursued and the likely benefits and costs Reviews the different types of research that could be pursued and the likely benefits and costs Considers the potential effects that such research could have on health care spending Considers the potential effects that such research could have on health care spending Congressional Budget Office Report: Figure 27

24 Return to tutorials Reasons for Optimism Multiple stakeholders are working together Multiple stakeholders are working together – AQA & HQA established the Quality Alliance Steering Committee to promote quality measurement, transparency and improvement in care There is clear recognition that there should be one set of measures There is clear recognition that there should be one set of measures – A move is underfoot toward real standardization across agencies and organizations A shared sense of urgency exists on improving patient outcomes, workforce productivity and costs A shared sense of urgency exists on improving patient outcomes, workforce productivity and costs – The National Quality Forum is bringing stakeholders together to establish priorities for moving forward Figure 28

25 Return to tutorials Future Opportunities The primary opportunity involves patients The primary opportunity involves patients – We will not improve chronic illness care without active, informed patients – Patients as shoppers – Women are key Figure 29

26 Return to tutorials This is not a Political Issue, It’s a Practical Issue Quality and access are linked Quality and access are linked Quality will be a major theme of multiple reform proposals Quality will be a major theme of multiple reform proposals Quality is central to getting better value for what we’re spending on health care Quality is central to getting better value for what we’re spending on health care Figure 30

27 Return to tutorials 21 st Century Health Care Improving quality by promoting a culture of safety through Value-Driven Health Care 21 st Century 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 Actionable information available – to clinicians AND patients – “in real time” Figure 31

28 Return to tutorials Measuring Health Care Quality http://www.ahrq.gov AHRQ Mission To improve the quality, safety, efficiency, and effectiveness of health care for all Americans AHRQ Vision As a result of AHRQ's efforts, American health care will provide services of the highest quality, with the best possible outcomes, at the lowest cost Figure 32

29 Return to tutorialsResources To learn more about health care quality, visit these websites: Agency for Heathcare Research and Quality, http://www.ahrq.gov/ Agency for Heathcare Research and Quality, http://www.ahrq.gov/ http://www.ahrq.gov/ Quality of Care, Reference Library, KaiserEDU.org Quality of Care, Reference Library, KaiserEDU.org http://www.kaiseredu.org/topics_reflib.asp?id=139&parentid=70&rID=1 The Commonwealth Fund, http://www.commonwealthfund.org/topics/topics_list.htm?attrib_id=15312 The Commonwealth Fund, http://www.commonwealthfund.org/topics/topics_list.htm?attrib_id=15312 http://www.commonwealthfund.org/topics/topics_list.htm?attrib_id=15312 Institute for Healthcare Improvement, http://www.ihi.org/ihi Institute for Healthcare Improvement, http://www.ihi.org/ihi http://www.ihi.org/ihi National Committee on Quality Assurance, http://www.ncqa.org/ National Committee on Quality Assurance, http://www.ncqa.org/ http://www.ncqa.org/ Robert Wood Johnson Foundation, http://www.rwjf.org/pr/topic.jsp?topicid=1053 Robert Wood Johnson Foundation, http://www.rwjf.org/pr/topic.jsp?topicid=1053 http://www.rwjf.org/pr/topic.jsp?topicid=1053 Figure 33


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