Quality Clancy Download

7/31/2019 Quality Clancy Download

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Measuring Health Care Quality

Carolyn M. Clancy, MDDirector

U.S. Agency for Healthcare Research and Quality

for

KaiserEDU.org

May 2008

Figure 1
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Health Care Quality

Varies A LOT; NOT clearly related to $$ spent

Matters can be measured and improved

Measurement science is evolving:

Structure, process and outcomes

Broad recognition that patient experience isessential component

Strong focus on public reporting Motivates providers to improve

Not yet consumer friendly

Figure 5


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70 Million Americans Benefitfrom Quality Measurement

96% of heart attack victims wereprescribed beta-blocker treatment in2005, up from 62% in 1996*

77.7% of children enrolled in privatehealth plans received allrecommended immunizations, up5% from 72.5% in 2004*

Evidence-based guidelines fromthe American College of Cardiologyand the American Heart Associationhave reduced mortality amongpatients who have had a heartattack

*National Committee for Quality Assurance

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AHRQs National Reportson Quality and Disparities

New editions available

New efficiency chapter

Disability data added

More on health literacy

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2007 National Reports: Some GoodNews, Need for Improvement

The rate of improvement in qualitybetween 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 orworsened for Blacks, Asians and thepoor, and approximately 56% ofdisparities have not improved forHispanics

For Blacks, Asians, Hispanics and poorpopulations, about half of the coremeasures of quality used to track accessto care are improving

Figure 8


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Uninsurance is a Major Barrier toReducing Disparities

Uninsured individualsdo worse than privatelyinsured individuals onalmost 90% of qualitymeasures

Uninsured individualsdo worse than privatelyinsured individuals onall access measures

0

25%

50%

75%

100%

1

Better

Same

Worse

2007 National Healthcare Disparities Report, AHRQ

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Overall Scope

Patients receive the proper diagnosis andtreatment only about 55% of the time*

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 toreach $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 StatesN Engl J Med 2003;348:2635-45.

** AHRQ 2007 National Healthcare Disparities Report

*** National Health Expenditure Accounts

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What?

Figure 11



Why?

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 doesnt 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



There Are Major Opportunitiesfor Improvement: Examples

Uptake of health informationtechnology, while still relativelyslow, is gaining traction

Growing focus on comparative

effectiveness research

HHS Secretary MichaelLeavitts Value-Driven HealthCare Initiative

Chartered Value Exchanges National Learning Network

Downtown USAAlejandra Vernon

Figure 13



Emerging Methods inComparative Effectiveness & Safety

A series of 23 articles by AHRQresearchers on new approachesin comparative effectivenessmethods are compiled in a specialOctober edition ofMedical Care

A valuable new resource forscientists committed to advancingthe comparative effectiveness andsafety research

The Resource Center in Oregon

led the development process,helped draft the document andmanage work groups, andhandled public comment

Source:http://effectivehealthcare.ahrq.gov/reports/med-care-report.cfm

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Percent who say

Role Of IT In ReducingMedical Errors

The coordination among thedifferent health professionals

that they see is a problem

32%

69%

48%

They had to wait or come backfor another appointment

because the provider did nothave all their medical

information

They have seen a health careprofessional and noticed that

they did not have all of theirmedical information

Have you or a family member evercreated your own set of medicalrecords to ensure that you and allof your health care providers haveall of your medical information?

Dont

knowNo

Yes

Source: Kaiser Family Foundation / Agency for Healthcare Research and Quality / Harvard School of Public Health National Surveyon Consumers Experiences with Patient Safety and Quality Information, November 2004 (Conducted July 7 September 5, 2005).

32%

67%

1%

Figure 16

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Personal Experience

Have you been personally involvedin a situation where a preventablemedical error was made in your ownmedical care or that of a familymember?

Yes

Dont

Know

No

Source: Kaiser Family Foundation / Agency for Healthcare Research and Quality / Harvard School of Public Health National Surveyon Consumers Experiences with Patient Safety and Quality Information, November 2004 (Conducted July 7 September 5, 2005).

Did the error have serious healthconsequences, minor healthconsequences, or no healthconsequences at all?

Minor healthconsequences

No health

consequences

Serious healthconsequences

65%

1%

21%

10%

3%

34%

Figure 17

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Guidelines & Measures

More emphasis needs to be placedon whats most important

We measurewhat we can

Identifying whatcounts and

determining howit can be measured

Rather Than

Figure 18

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Guidelines MeasuresIncentives

You can get 60% of the improvement from 15% of thechange

Don Berwick

Where should the busy primary care practice begin?

Where should policy makers target their incentives?

To changes that:

Produce the greatest benefit

Address the biggest quality gap

Can be implemented most easily, cheaply and safely

Figure 19

Fig re 20



Reconciling Guidelinesand Quality Measures

Developing guidelines that address a wide range of needs

Low-Risk Patients

Higher Risk Patients

Figure 20

Figure 21



Challenges in AddressingMultiple Conditions

Interactionsbetween illnesses

Interactions betweentreatments

Tension betweentherapeutic goals

Multiple providers

Multiplemedications

Figure 21

Figure 22



Setting Priorities for Patientswith Multiple Conditions

Address the need for clinicians to setpriorities, weighing the benefits and burdensof increasingly complex medical regiments

Make sure guidelines keep up with uniqueissue of treating older and more frail patients

Figure 22

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Patient-Centered Guidelines

If care is to be patientcentered, guidelinesneed to reflect this goal

Quality measuresmust accommodatedifferences in:

Patient values Patient preferences

Figure 23

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What Level of CollaborationIs Practical?

Guidelines may need to reflect local values, diseaseburdens, priorities and resources

BUT WE NEED TO SHARE

Information on how to develop clear and practicalguidelines

Evidence on barriers and facilitators to implementingguidelines

Evidence about integration of guidelines in electronichealth records

Globalize the evidence, localize the decision-making

Figure 24

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The Goal

Historically, the focushas been on structure

In recent years, therehas been more interestin process the rightcare

Tomorrows goal?Outcomes and endresults

Figure 25

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The Information Exists

Figure 26

Information on topics including guidelines,measures, incentives and outcomes are availablefor a wide range of uses. Included is informationabout:

Hospitals: Nursing Homes:

Health Plans:

Various Health Care Organizations:

Hospital CompareNursing Home Compare

National Committee for Quality Assurance

Quality Check

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CBO Report onComparative Effectiveness

Discusses severalmechanisms for organizingand funding additionalcomparative effectivenessresearch efforts

Reviews the different types ofresearch that could bepursued and the likelybenefits and costs

Considers the potentialeffects that such researchcould have on health carespending

Congressional Budget OfficeReport:

Figure 27

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Reasons for Optimism

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 shouldbe 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, workforceproductivity and costs The National Quality Forum is bringing stakeholders

together to establish priorities for moving forward

Figure 28

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Future Opportunities

The primary opportunityinvolves patients

We will not improve

chronic illness carewithout active, informedpatients

Patients as shoppers

Women are key

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This is not a Political Issue,Its a Practical Issue

Quality and accessare linked

Quality will be a major

theme of multiplereform proposals

Quality is central togetting better value forwhat were spendingon health care

Figure 30

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21st Century Health Care

Improving quality by promoting a culture of safetythrough Value-Driven Health Care

21st CenturyHealth Care

Information-rich, patient-focused enterprises

Information andevidence transform

interactions fromreactive to

proactive (benefitsand harms)

Evidence iscontinually refinedas a by-product of

care delivery

Actionable information available to

clinicians AND patientsin real time

gu e 3

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Measuring Health Care Quality

http://www.ahrq.gov

AHRQ Mission

To improve the quality, safety,efficiency, and effectiveness ofhealth care for all Americans

AHRQ Vision

As a result of AHRQ's efforts,American health care will provideservices of the highest quality, withthe best possible outcomes, at the

lowest cost

g

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Resources

To learn more about health care quality, visit these websites:

Agency for Heathcare Research and Quality,http://www.ahrq.gov/

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

Institute for Healthcare Improvement,http://www.ihi.org/ihi

National Committee on Quality Assurance,http://www.ncqa.org/

Robert Wood Johnson Foundation,http://www.rwjf.org/pr/topic.jsp?topicid=1053

g
http://www.ahrq.gov/http://www.kaiseredu.org/topics_reflib.asp?id=139&parentid=70&rID=1http://www.commonwealthfund.org/topics/topics_list.htm?attrib_id=15312http://www.ihi.org/ihihttp://www.ncqa.org/http://www.rwjf.org/pr/topic.jsp?topicid=1053http://www.rwjf.org/pr/topic.jsp?topicid=1053http://www.ncqa.org/http://www.ihi.org/ihihttp://www.commonwealthfund.org/topics/topics_list.htm?attrib_id=15312http://www.kaiseredu.org/topics_reflib.asp?id=139&parentid=70&rID=1http://www.ahrq.gov/

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