Agency for Healthcare Research and Quality Advancing Excellence

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Agency for Healthcare Research and Quality Advancing Excellence in Health Care • www. ahrq.

Agency for Healthcare Research and Quality Advancing Excellence in Health Care • www. ahrq. gov Tracking the Nation’s Health Care: The National Healthcare Quality and Disparities Reports Edward Kelley Ernest Moy Center for Quality Improvement and Patient Safety

Advancing Excellence in Health Care Reports Mandated by Congress in the Healthcare Research and

Advancing Excellence in Health Care Reports Mandated by Congress in the Healthcare Research and Quality Act (PL. 106 -129) n “Beginning in fiscal year 2003, the Secretary, acting through the Director, shall submit to Congress an annual report on national trends in the quality of health care provided to the American people. ” n To track “prevailing disparities in health care delivery as it relates to racial factors and socioeconomic factors in priority populations”

Advancing Excellence in Health Care Why are the reports important? n New tools for

Advancing Excellence in Health Care Why are the reports important? n New tools for monitoring health care delivery n Summarize information n Makes clear where improvement is most needed n Provide consensus on what is important to measure n Facilitates measurement alignment

Advancing Excellence in Health Care How the NHDR and NHQR are Related NHQR Snapshot

Advancing Excellence in Health Care How the NHDR and NHQR are Related NHQR Snapshot of quality of health care in America Quality Safety, effectiveness, timeliness, patient centeredness Variation across states NHDR Snapshot of disparities in health care in America Quality + Access Equity Variation across populations

Advancing Excellence in Health Care How the Reports Fit into AHRQ’s Focus on Implementation

Advancing Excellence in Health Care How the Reports Fit into AHRQ’s Focus on Implementation Purpose of the Reports: n To promote awareness of the status of health care quality and disparities in America; and Quality? n To lead to action and support AHRQ’s overall mission “to improve the quality… of health care for all Americans. ”

Advancing Excellence in Health Care Who Helped Design the NHQR? n Public and private

Advancing Excellence in Health Care Who Helped Design the NHQR? n Public and private call for measures n Measure set culled with HHS agencies n Released for public comment, provider associations, industry gave feedback Final proposed measure set approved by HHS partners ASPE, CDC, HRSA, CMS, NCHS, SAMHSA, NIH, Data Council, HIS, FDA AMA, AHA, JCAHO, Midwest Business Group on Health, NAHDO, NASHP, IOM, general public

Advancing Excellence in Health Care Conceptual Framework

Advancing Excellence in Health Care Conceptual Framework

Advancing Excellence in Health Care Priority Areas: What Conditions are Included? n Defined by

Advancing Excellence in Health Care Priority Areas: What Conditions are Included? n Defined by national experts brought together by IOM (Bill Roper, co-chair) n Aligned with HHS existing priorities—HP 2010, Secretary’s prevention agenda, IOM priority areas n Includes: cancer*, chronic kidney disease, diabetes*, heart disease, HIV/AIDS, maternal and child health, mental illness-depression, respiratory illness (e. g. , asthma, flu), nursing home and home health, patient safety, timeliness, patient centeredness, resource consumption

Advancing Excellence in Health Care n n n Who Has Helped Design the NHDR?

Advancing Excellence in Health Care n n n Who Has Helped Design the NHDR? AHRQ-led effort starting in 2001 IOM Committee on Guidance for Designing a NHDR DHHS – Interagency Workgroup for the NHDR: ACF, Ao. A, ASH, ASL, ASPA, ASPE, CDC, CMS, FDA, HRSA, IHS, NCHS, NIH, OCR, OMH, SAMHSA – Data Council n Extensive input from other organizations & stakeholders – Congressional staff, Asian and Pacific Islander American Health Forum, American Association of Health Plans, Association of State and Territorial Health Officials, National Rural Health Association, NMA, AAFP, AMA, ANA, AAHP

Advancing Excellence in Health Care NHDR Conceptual Framework Access to Care Entry Barriers Structural

Advancing Excellence in Health Care NHDR Conceptual Framework Access to Care Entry Barriers Structural Cultural Barriers Use Quality of Care Costs Effectiveness Safety Timeliness Patient Centeredness Staying Healthy Getting Better Living with Illness or Disability Coping with the End of Life Health Status / Health Care Need Disparities Staying Healthy

Advancing Excellence in Health Care What is in the NHDR? n For the first

Advancing Excellence in Health Care What is in the NHDR? n For the first time, the NHDR: – Tracks disparities at the national level – Reports on disparities in terms understandable by patients and providers – Gives policymakers, researchers and providers information to reduce disparities n Report chapters – Quality of Health Care – Access and Receipt of Health Care – Priority Populations

Advancing Excellence in Health Care Measure Selection Process n Identify pool of candidate measures

Advancing Excellence in Health Care Measure Selection Process n Identify pool of candidate measures n Map candidate measures into conceptual framework n Evaluate and vet candidate measures n Identify draft measure set n Analysis of draft measure set n Finalize final 2003 measure set n Review and vet 2003 measure set n Finalize 2004 measure set Call for measures 600 -700 NHQR/NHDR measures 2003 reports ~150 NHQR measures ~ 240 NHDR measures 2004 reports 178 NHQR measures 238 NHDR measures

Advancing Excellence in Health Care Measure Topics Quality of Health Care n Effectiveness –

Advancing Excellence in Health Care Measure Topics Quality of Health Care n Effectiveness – Cancer, Diabetes, ESRD, Heart Disease, HIV/AIDS, Maternal and Child Health, Mental Disease, Respiratory Disease, Nursing Home and Home Health Care n n n Safety Timeliness Patient centeredness Access to Health Care n Getting into the system – Insurance, Usual Source of Care, Perceptions of Need n Getting care within the system n Perceptions of care – Patient-provider communication, relationship n Health care use

AHRQ Priority Populations Advancing Excellence in Health Care n n n n Women Children

AHRQ Priority Populations Advancing Excellence in Health Care n n n n Women Children Elderly Racial and ethnic minorities Low-income Residents of rural areas Persons with special health care needs – – – Disabled Chronic care End of life

Databases Advancing Excellence in Health Care n Surveys collected from samples of civilian, noninstitutionalized

Databases Advancing Excellence in Health Care n Surveys collected from samples of civilian, noninstitutionalized populations: – – – AHRQ, Medical Expenditure Panel Survey (MEPS), 1998 -2000 California Health Interview Survey (CHIS), 2001 CDC-NCHS, National Health and Nutrition Examination Survey (NHANES), 1999 -2000 CDC-NCHS, National Health Interview Survey (NHIS), 1998 and 2000 CDC-NCHS/National Immunization Program, National Immunization Survey (NIS), 2001 CMS, Medicare Current Beneficiary Survey (MCBS), 1999 The Commonwealth Fund, Health Care Quality Survey, 2001 NCHS, National Health and Nutrition Examination Survey (NHANES), 1999 -2000 NCHS, National Health Interview Survey (NHIS), 1998 and 2000 NCHS, National Immunization Survey (NIS), 2001 SAMHSA, National Household Survey of Drug Abuse (NHSDA), 2000. n Data collected from samples of health care facilities: – – – – – CDC-NCHS, National Ambulatory Medical Care Survey (NAMCS), 1999 -2000 CDC-NCHS, National Home and Hospice Care Survey (NHHCS), 2000 CDC-NCHS, National Hospital Ambulatory Medical Care Survey-Outpatient Department (NHAMCS-OPD), 1999 -2000 CDC-NCHS, National Hospital Ambulatory Medical Care Survey-Emergency Department (NHAMCS-ED), 1999 -2000 CDC-NCHS, National Hospital Discharge Survey (NHDS), 1998 -2000 CDC-NCHS National Nursing Home Survey (NNHS), 1999 CMS, End-Stage Renal Disease Clinical Performance Measurement Program, 2001 CMS, Nursing Home Resident Profile Table, 2001 NCHS, National Ambulatory Medical Care Survey (NAMCS), 1999 -2000 NCHS, National Home and Hospice Care Survey (NHHCS), 2000 NCHS, National Hospital Ambulatory Medical Care Survey-Outpatient Department (NHAMCS-OPD), 1999 -2000 NCHS, National Hospital Ambulatory Medical Care Survey-Emergency Department (NHAMCS-ED), 1999 -2000 NCHS, National Hospital Discharge Survey (NHDS), 1998 -2000 NCHS’s National Nursing Home Survey (NNHS), 1999 NIH, United States Renal Data System (USRDS), 2000 SAMHSA, Client/Patient Survey Sample (CPSS), 1997. CMS, Quality Indicators program, 1998 -1999. n Data extracted from administrative data systems of health care organizations: – – – AHRQ, Healthcare Cost and Utilization Project State Inpatient Databases 16 - State database (HCUP SID), 2000 Medicare claim data from CMS HIV Research Network data (HIVRN), 2000. n Data from surveillance and vital statistics systems: – – CDC-National Center for HIV, STD, and TB Prevention, HIV/AIDS Surveillance System, 2000 CDC-National Center for HIV, STD, and TB Prevention, TB Surveillance System, 1998 -1999

Advancing Excellence in Health Care

Advancing Excellence in Health Care

Agency for Healthcare Research and Quality Advancing Excellence in Health Care • www. ahrq.

Agency for Healthcare Research and Quality Advancing Excellence in Health Care • www. ahrq. gov NHQR/NHDR: Key Findings and Next Steps Ernest Moy Edward Kelley Center for Quality Improvement and Patient Safety

Key Findings Advancing Excellence in Health Care n High quality health care is not

Key Findings Advancing Excellence in Health Care n High quality health care is not universal. – Preventive care – Chronic disease management n There is more to learn. n Greater improvement is possible. n Disparities in health care pervasive. – Preventive care – Chronic disease management – Access to care n There is more to learn. n Greater improvement is possible.

Advancing Excellence in Health Care High quality health care is not universal. Key Report

Advancing Excellence in Health Care High quality health care is not universal. Key Report Findings Disparities in health care pervasive.

There is more to learn. Advancing Excellence in Health Care NHQR Gaps n Limited

There is more to learn. Advancing Excellence in Health Care NHQR Gaps n Limited measures – – – HIV/AIDS Mental Health Timeliness Patient Centeredness End of life care NHDR Gaps n Limited data – – – Native Hawaiians American Indians Asians Children Rural residents Special care needs n Limited understanding Trends Best practices How to integrate quality and disparities activities

Advancing Excellence in Health Care Greater improvement is possible. n Of quality measures with

Advancing Excellence in Health Care Greater improvement is possible. n Of quality measures with trend data, a third show improvement, two-thirds show no change or deterioration. n Blacks and Hispanics do worse than whites on half of quality measures. n Hispanics and Asians do worse than whites on two-thirds of access measures. n Poor people do worse on two-thirds of quality and access measures.

Next Steps Advancing Excellence in Health Care n Begin to fill gaps – Measurement

Next Steps Advancing Excellence in Health Care n Begin to fill gaps – Measurement – Data – Information n Begin to refine report products – Reports – Spin-off products

Advancing Excellence in Health Care Filling Measurement Gaps n Child Health: MEPS adds child

Advancing Excellence in Health Care Filling Measurement Gaps n Child Health: MEPS adds child preventive services module in 2001 n Patient Safety – Add analyses of Medicare Patient Safety Monitoring System this year – HCUP develops special disparities analytic file that allows national estimates by race/ethnicity n Timeliness: Add measures of clinical timeliness n Cultural Competency/Language: MEPS adds questions to Access to Care module in 2002

Advancing Excellence in Health Care Filling Data Gaps n Asians: MEPS oversamples Asians in

Advancing Excellence in Health Care Filling Data Gaps n Asians: MEPS oversamples Asians in 2002 n AI/ANs: IHS supplements national analyses with IHS data n Low income: HRSA supplements national analyses with CHC data n Elderly: More MCBS analyses n Rural: Adopt new metro, micro, non-core categories n Special health care needs: Add analyses of Survey of Children with Special Health Care Needs

Filling Information Gaps Advancing Excellence in Health Care n New analyses – – Trends

Filling Information Gaps Advancing Excellence in Health Care n New analyses – – Trends Regional analyses More stratified/multivariate analyses More summary measures n Review of best practices

National Reports Products Advancing Excellence in Health Care NHQR/DR-net QI Clearinghouse Data Products Workbooks

National Reports Products Advancing Excellence in Health Care NHQR/DR-net QI Clearinghouse Data Products Workbooks qualitytools. gov Information packs General Awareness NHQR NHDR Document Focus Areas Webcasts Knowledge Packs Patient Guides Research Reports Working papers Articles Supplements

Advancing Excellence in Health Care Report Diffusion Strategies, Tactics, and Actions Knowledge Improvement

Advancing Excellence in Health Care Report Diffusion Strategies, Tactics, and Actions Knowledge Improvement

Refining the Report Products Advancing Excellence in Health Care n Chartbook – Shorter –

Refining the Report Products Advancing Excellence in Health Care n Chartbook – Shorter – Less text, more graphics – Focus on a smaller number of “highlight” measures – Push more detail to Appendices n Spin-off Products – – – Actionable Targeted audiences Specific strategies, tactics, and actions

Advancing Excellence in Health Care Diabetes Resource Guide for State Leaders Compare State data

Advancing Excellence in Health Care Diabetes Resource Guide for State Leaders Compare State data with national benchmarks, identify gaps in State data, and develop a complete inventory of the data systems available at the State and local levels.

Advancing Excellence in Health Care ULP Web Conferences Making Quality Count: Tools, Strategies, and

Advancing Excellence in Health Care ULP Web Conferences Making Quality Count: Tools, Strategies, and Resources A Series of Two Free Web-assisted Audio Conferences for State, Local, and Health System Policymakers. Tuesday, February 10 and Wednesday, February 18, 2004 2: 00– 3: 30 p. m. , EST

Advancing Excellence in Health Care Peer-reviewed Literature NHQR-DR Medical Care Supplement Fall 2004 Prevention

Advancing Excellence in Health Care Peer-reviewed Literature NHQR-DR Medical Care Supplement Fall 2004 Prevention Health Care Quality in America: Findings from the first National Healthcare Quality and Disparities Reports

Advancing Excellence in Health Care http: //www. innovations. ahrq. gov/qu alitytools/

Advancing Excellence in Health Care http: //www. innovations. ahrq. gov/qu alitytools/

Advancing Excellence in Health Care Web-based data tools NHQR/DR-net Quality Improvement Clearinghouse

Advancing Excellence in Health Care Web-based data tools NHQR/DR-net Quality Improvement Clearinghouse

Advancing Excellence in Health Care How you can help n Review first Reports n

Advancing Excellence in Health Care How you can help n Review first Reports n Review http: //www. innovations. ahrq. gov/qualitytools/ n Provide advice about – Adding and refining measures – Accessibility and usability of reports and tools n Tell us about your experiences – Measuring quality and disparities – Improving quality – Reducing disparities

Advancing Excellence in Health Care For Further Information AHRQ’s web site for the NHQR

Advancing Excellence in Health Care For Further Information AHRQ’s web site for the NHQR and NHDR: http: //www. innovations. ahrq. gov/qualitytools/ Contact information: Dr. Ed Kelley, Director National Healthcare Quality Report (ekelley@ahrq. gov) Dr. Ernie Moy, Senior Service Fellow National Healthcare Disparities Report (emoy@ahrq. gov) Dr. Dan Stryer, Director Center for Quality Improvement and Patient Safety (dstryer@ahrq. gov)