AHRQ: Quality Initiatives Put Research into Action


November / December 2005


Quality Initiatives Put Research into Action

We are soon approaching the sixth anniversary of the landmark Institute of Medicine report, To Err Is Human, and I am very pleased to report that the healthcare system is making progress toward ensuring that it provides the safest, highest quality healthcare possible.

An important element in this progress has been the development and dissemination of evidence-based information on improving the quality and safety of healthcare. To that end, Patient Safety and Quality Healthcareand its readers play a critical role in advancing and adopting evidence-based best practices that can make a difference in the care patients receive.

The mission of the Agency for Healthcare Research and Quality (AHRQ) is “to improve the quality, safety, efficiency and effectiveness of healthcare for all Americans.” As a research agency, we support studies, systematic reviews, and evaluations that help build the foundation of evidence for healthcare. However, our mission goes beyond just conducting, supporting, and disseminating health services research. The core of our mission is helping the healthcare system translate research into improved practice and policy.

Research is not an end in itself, but rather a vehicle to improve healthcare and health. We achieve our goals by working with our public- and private-sector partners to translate the research we support and conduct into knowledge and information that can be used immediately to improve healthcare for all Americans.

Health Information Technology
This commentary features quality-related initiatives that are currently underway at AHRQ, including promoting the use of health information technology to improve quality and safety, providing the tools to assess healthcare quality, and providing training to foster quality improvement in local communities.

AHRQ is a leading edge in the President’s vision of a healthcare system that harnesses the power of health information technology to improve the quality of healthcare. AHRQ has invested more than $166 million in an initiative to promote the use of health IT, with a special focus on rural hospitals and communities. AHRQ has funded grants and contracts that will enable providers to improve patient safety and reduce medication errors by eliminating handwritten prescriptions, help ensure that important information follows patients as they move among healthcare settings, and reduce duplicative and unnecessary testing.

As part of this investment, AHRQ has awarded multi-year contracts totaling nearly $30 million to Colorado, Delaware, Indiana, Rhode Island, Tennessee, and Utah to help develop statewide networks that are secure, ensure privacy, and make information more accessible. Participants in the networks include major purchasers of healthcare, public and private payers, hospitals, ambulatory care facilities, home healthcare providers, and long-term care providers.

In addition, AHRQ has created the AHRQ National Resource Center for Health Information Technology (http://healthit.ahrq.gov) as a focus for technical assistance, information sharing, and collaboration, including a repository for best practices and a means for disseminating health IT tools. The National Resource Center also will provide a special portal for the nation’s community health centers. In addition, this Web site will help providers involved in the Medicare initiative and within the Indian Health Service to expand the use of health IT in physician offices.

As we all know, health IT is not the sole answer to the quality and safety problems facing the American healthcare system. It is a means to an end.

Patient Safety
Since 2001, AHRQ has been the leading funder of patient safety research, and I am proud that we are beginning to see results from the $165 million patient safety research program that we began in 2001.

AHRQ also has launched the Patient Safety Network, which can be found at http://www.psnet.ahrq.gov. PSNet is a national Web-based resource featuring the latest news and essential resources on patient safety. Included in the Patient Safety Network is AHRQ’s Web M&M site (http://www.webmm.ahrq.gov/), an anonymous forum where clinicians post new cases of medical errors for discussion. The site also includes expert commentaries on how to think through such cases, identifying problem areas and potential solutions.

A new AHRQ-sponsored quality improvement effort that should be of great interest to the readers of this journal is AHRQ’s Hospital Survey on Patient Safety Culture, which we released last year in partnership with Premier, Inc., the Department of Defense (DoD), and the American Hospital Association. The survey can be used to evaluate employees’ attitudes about patient safety in their facilities or within specific units. It addresses a critical aspect of patient safety improvement: measuring organizational conditions that can lead to adverse events and patient harm. The survey, which is being used in DoD’s medical facilities, is available at www.ahrq.gov/qual/hospculture. Premier and AHA are encouraging their members to adopt AHRQ’s patient safety culture survey if they are not already using one as part of their safety improvement efforts.

Software Tools
AHRQ also has developed a series of software tools that can help hospitals gauge the quality of care they provide. AHRQ’s Prevention Quality Indicators allow hospitals to detect potentially avoidable hospital admissions for illnesses that can be effectively treated with high-quality, community-based primary care. Another tool in the series, the Inpatient Quality Indicators, consists of 29 measures that can be used to help hospitals identify potential problem areas and provide a proxy measure of hospital quality of care. The Patient Safety Indicators can help hospitals enhance their patient safety performance by quickly detecting potential medical errors in patients who have undergone medical or surgical care. Hospitals can then investigate to determine whether the problems detected were caused by potentially preventable medical errors or have some other explanation.

AHRQ has developed H-CAHPS, a survey tool that can be used by hospitals, employers, states, and others to assess the perceptions of hospital patients about the quality of the care they receive. This information is designed to help patients, their employers, and other purchasers make informed decisions and give hospitals feedback that they can use to improve care. CMS, in partnership with the nation’s major hospital trade groups, is using H-CAHPS as part of its collaborative Hospital Quality Alliance to develop comparative information about hospitals.

In the future, AHRQ will build on our successful Consumer Assessment of Health Plans Survey to create other surveys, including Ambulatory CAHPS, In-Center Hemodialysis CAHPS, and Nursing Home CAHPS. AHRQ also is now working in partnership with the Department of Veterans Affairs to train the third class of state and hospital teams participating in the Patient Safety Improvement Corps. The program was created because states expressed a need for capacity in areas such as conducting effective investigations of reports of medical errors and developing interventions and changes in standard clinical practice. When trained, the teams return to their local communities armed with the knowledge to improve patient safety.

Quality and Disparities Reports
Finally, AHRQ is poised to release the third annual edition of the National Healthcare Quality Report and its companion, the National Healthcare Disparities Report. These reports provide data on the quality of healthcare and disparities in the use of healthcare services associated with patient characteristics, including race, ethnicity, income, education, and area of residence. These reports are rapidly becoming an important part of the nation’s tracking system for healthcare quality and disparities. They also have been a catalyst to the science of quality measure development and collection. The reports are available on AHRQ’s QualityTools Web site at http://www.qualitytools.ahrq.gov/.

I hope this commentary has provided a glimpse into the quality improvement initiatives and activities supported by AHRQ. For ongoing information on these activities, I urge readers to go to AHRQ’s Web site and sign up for our electronic newsletter (www.ahrq.gov/news/ahrqlist.htm) and our patient safety newsletter (www.ahrq.gov/qual/ptsflist.htm). These newsletters provide updates on safety initiatives and other important news from AHRQ.

AHRQ’s bottom line is that we will make doing the right thing the easy thing to do for the healthcare system. We look forward to working with the readers of Patient Safety and Quality Healthcare to achieve that goal.

Carolyn M. Clancy (cclancy@ahrq.gov) is director of the Agency for Healthcare Research and Quality.