Help AHRQ Shape New Tools for Shared Decisionmaking

The Agency for Healthcare Research and Quality (AHRQ) invites clinicians and other health care providers to participate in an online survey about their needs and preferences for tools to educate and engage patients in discussions about their treatment options. The results will inform the development of new tools and a workshop that will help clinicians use comparative effectiveness research findings in shared decisionmaking with patients and caregivers.

Your survey participation will help ensure that AHRQ provides resources that bring the most value to patients, caregivers, and health care professionals. To access the survey, go to: https://www.surveymonkey.com/s/AHRQ-EHC

The survey will be available until July 15, 2013 so act now to share your thoughts!

Upcoming Funding from AHRQ

The Agency for Healthcare Research and Quality (AHRQ) intends to publish a Funding Opportunity Announcement (FOA) to broadly solicit applications for research centers to participate in the “Developing Evidence to Inform Decisions about Effectiveness” (DEcIDE) Network, a component of AHRQ's Effective Health Care Program (see http://effectivehealthcare.ahrq.gov/). AHRQ plans to continue the collaborative research network that it established in 2005 with a specific focus on comparative effectiveness and patient-centered outcomes research (CER/PCOR) and methodologies that are designed to support evidence-base decision-making in patient communities served by (1) Medicare; or (2) State Medicaid and/or Children’s Health Insurance (CHIP) programs. Overall FOA objectives are to conduct original research and appropriately disseminate the results to stakeholders.

The primary purposes of each DEcIDE Center will be to:

1. Conduct a well-controlled, protocol-directed investigation on a specific CER/PCOR problem that stakeholders have identified or endorsed as critically important to informing decisions about the outcomes or effectiveness of healthcare interventions for Medicare, State Medicaid, or CHIP patients; and
2. Analyze decision processes and study practical approaches for improving patient outcomes through the effective dissemination of the DEcIDE Center’s primary research findings to Medicare, State Medicaid, or CHIP stakeholders.

This Notice is being provided to allow potential applicants sufficient time to develop meaningful collaborations and responsive projects. The Funding Opportunity Announcement (FOA) is expected to be published in late winter 2013 with an expected receipt date in spring 2013.

Funding Opportunity on Patient-Centered Outcomes Research

The Agency for Healthcare Research and Quality (AHRQ) is seeking applications for the new Patient-Centered Outcomes Research (PCOR) Pathway to Independence Award program. The primary purpose of this program is to increase and maintain a strong cohort of new and talented AHRQ-supported independent investigators trained in comparative effectiveness methods to conduct patient care outcomes research. The program is designed to facilitate a timely transition from a junior non-tenure track faculty or a postdoctoral research position (or their equivalents) to a stable independent research career. It targets investigators early in their careers to support their development in new sophisticated methodological comparative effectiveness research skills, interdisciplinary perspectives, and capabilities in PCOR.

The deadline to submit an application is December 17.

Click here for more information.

INQRI FallTIPS Study Profiled by AHRQ

We're thrilled to announce that FallTIPS, an INQRI team's fall prevention tool kit, is being featured on AHRQ's Healthcare Innovations Exchange.  Led by Patricia Dykes and Blackford Middleton, the team created a tool designed to prevent patient falls by translating an individual patient's fall risk assessment into a decision support intervention that communicates fall risk status, and creates a tailored plan that is accessible to care team members (including patients and family members).

The profile on the Innovations Exchange features a recap of the intervention, how it was designed and offers suggestions for ways other sites can adopt and sustain the innovation.

Click here to access the profile.

Video Advice Columns from AHRQ Director

The Agency for Healthcare Research and Quality (AHRQ) has a wonderful new resource available online: a series of videos featuring Director Carolyn M. Clancy, M.D. which provides advice to patients.  Topics include questions to ask of doctors, tips for safe medication practices and how to avoid medical errors.

Check out the series on the AHRQ website.

AHRQ National Teleconference on Transitions in Care - Feb 24 - 3:00-4:30pm EST

Managing Patient Care Transitions: How Health IT Can Reduce Unnecessary Rehospitalization

This free 90-minute teleconference will explore the latest research on leveraging health IT to reduce rehospitalizations and the potential impact of health IT systems to improve transitions in care and quality of care.

Date: February 24, 2010
Time: 3:00 – 4:30 p.m., EST

Sponsored by the Agency for Healthcare Research and Quality’s (AHRQ’s) National Resource Center for Health IT

Presenters:

Stephen Jencks, M.D., M.P.H., is an independent consultant in health care safety and quality and Senior Fellow at the Institute for Healthcare Improvement. Dr. Jencks served as the Chief Scientist in the Office of Research, Senior Clinical Advisor and Director of the Quality Improvement Organization program in the Office of Clinical Standards and Quality at the Federal Centers for Medicare & Medicaid Services.

Brian Jack, M.D., is Associate Professor and Vice Chair for Academic Affairs in the Department of Family Medicine at Boston University School of Medicine, Boston Medical Center. Dr. Jack currently serves as principle investigator for grants from the Health Resources and Services Administration, Centers for Disease Control and Prevention and AHRQ. His work relating to improving patient safety at hospital discharge (Project RED) has earned him awards from AHRQ and the Society of Family Medicine.

Terry Field, D.Sc., is an Associate Professor at the University of Massachusetts Medical School and the Associate Director of the Meyers Primary Care Institute. Dr. Field has participated in grant review panels for agencies such as the National Cancer Institute and the Agency for Healthcare Research and Quality. She is also a member of the Steering Committee for the National Cancer Institute-funded Cancer Research Network and co-leads the network's Scientific and Data Resources Core.

Dr. Jencks will provide an overview of the current state and challenges IT systems face in managing transitions in care, followed by Dr. Jack who will share his research findings on how evidence-based health IT tools can enable systems integration across care settings and issues surrounding patient support and education. He will focus on the role of health IT in improving quality of care and supporting patients transitioning from the hospital to the ambulatory settings. Dr. Field will speak to the role of health IT in supporting transitions in care in integrated delivery systems and other clinical settings. She will discuss her work in skilled nursing facilities for transitioning complex elderly patients to home care. Finally, Dr. Jencks will conclude the presentation by discussing health IT implementation issues at an institutional level and how the research findings presented by the Drs. Jack and Field affect these implementation efforts.

To register for the teleconference, please visit https://ahrq.peachnewmedia.com/store/seminar/seminar.php?seminar=3389 and select "Register."

Healthcare 411: Audio Podcast from AHRQ

Check out the newest edition of Healthcare 411...

This session features the first in a three part series on Clinical Decision Support.

Click here to stream the audio from your desktop.

Click here to read the transcript.

Click here to download the audio as an MP3.

AHRQ Innovations Exchange - Long Term Care

Check out today's edition of the AHRQ Innovations Exchange, highlighting issues in long term care.

A few highlights:

• Interdisciplinary Team Identifies and Addresses Risk Factors For Falls Among Nursing Home Residents, Leading to Fewer Falls and Less Use of Restraints
• Nurse-Led Program Increases Provision of Cessation Counseling to Inpatients Who Smoke
• Nursing Home Learning Collaborative Improves Quality of Care, Reduces Staff Turnover

INQRI's Connection to Long Term Care

Although much of our work is focused on acute care settings, in the last couple of years, INQRI has expanded to other health care settings. To that end, we are very interested in the issues surrounding long term care.

"The Res-Care-AL Intervention Study" is a randomized controlled trial to test a restorative care intervention for assisted living (AL). The project incorporates patient centered outcomes (falls); nursing centered outcomes (restorative care services); and system-centered outcomes (staff turnover) as designated by the National Quality Forum. The primary aim of this study is to maintain or improve the residents' physical activity, physical status, function, and length of stay in the facility. The secondary aim related to residents focuses on mood, life satisfaction, resilience, self-efficacy and outcome expectations, social-support for exercise, and person-environment fit. This team is co-led by Barbara Resnick, PhD, CRNP, a nurse researcher, and Sheryl Zimmerman, PhD, MSW, a social worker.

Click here to check out an update on the project.

As previously mentioned in this blog, our program director, Mary Naylor is the Marian S. Ware Professor in Gerontology at the University of Pennsylvania. She is passionate about ensuring that top quality care is delivered across settings. Click here to learn about Dr. Naylor's transitional care model.

Children's View on Quality Should be Considered

Early in his term President Barack Obama signed into law the Children’s Health Insurance Program Reauthorization Act (CHIPRA). CHIPRA promised a “new day for children’s health care quality” and launched a new coordinated effort from the Agency for Healthcare Research and Quality (AHRQ) and the Centers for Medicare & Medicaid Services (CMS) to implement its quality provisions.

Today, AHRQ’s National Advisory Council for Healthcare Research and CMS’s Quality Subcommittee on Quality Measures for Children’s Healthcare in Medicaid and Children’s Health Insurance Programs (CHIP) are holding a two-day meeting (July 22-23) on healthcare quality and research on issues related to pediatric care. This inaugural meeting is an exciting step forward in the implementation of CHIPRA and pediatric quality measures, an issue that two INQRI grantees have researched extensively.

Nearly half of the 7.6 million children hospitalized every year in the United States are over age 6, yet no one ever systematically asks these children about their hospital experiences or the quality of care they have received. Instead they turn to their parents to answer for them.

Columbus Children’s Hospital researchers Nancy Ryan-Wenger and William Gardner say too often children are the “silent consumers of care.” Their INQRI research of hospitalized children has shown that seeking answers from parents is not an accurate measure of children’s perceptions of their care. In fact, children prioritize an entirely different set of factors when rating their hospital experience. The graph below shows that while only about 10% of parents view “check on me often” as an important factor in the care of their children, children see this as a very important measure of their care. And, the list goes on from there.

Through their research, Ryan-Wenger and Gardner are hoping to improve the reliability of tools to measure children’s health care, an effort that has great implications for changing nursing practice and improving care. Why are children’s perceptions important? Early experiences with medical care can greatly impact future decision-making about seeking care. It can even influence future career decisions in a time when bringing new nurses and doctors into the system is essential and becoming increasingly important to the success of American healthcare.

Ryan-Wenger and Gardner recommend both adding a “quality of care from the hospitalized children’s perspective” component to existing nursing sensitive indicators and working to develop and implement a standard, reliable measure of a “children’s hospital experience scale.” They provide a sample concept, reproduced below.

As AHRQ and CMS meet with stakeholder groups this week on pediatric healthcare quality measures, they must acknowledge the difference between parents’ and children’s views of care and take that into account. There are ubiquitous surveys seeking patient views on hospital care but there are no surveys that ask children to answer directly. Ryan-Wenger and Gardner say this has to change because children’s opinions matter.

For more on Ryan-Wenger and Gardner’s study, please click here.

State Reports Reveal Wide Variation in Health Care Quality

The U.S. Department of Health and Human Services' (HHS) Agency for Healthcare Research and Quality (AHRQ) has released its annual set of reports detailing state-by-state health care quality, finding that there are "mixed reviews" for the quality of care being provided, with no states performing exceptionally well or very poorly on all quality measures, the Pittsburgh Post-Gazette reports. Created from state-level data that was originally used to draft the 2008 National Healthcare Quality Report released by HHS in May, these state snapshots draw from more than 30 sources, including government surveys, health care facilities and health care organizations. The reports summarize care quality in three dimensions: type of care, care setting and clinical area, such as cancer, diabetes, heart disease, maternal and child health and respiratory disease. The snapshots allow users to compare the care quality provided in states in the same region as well as compare state performance against the national average. For the first time, the 2008 reports include a section examining asthma rates—including data on potentially preventable hospitalizations—as well as an expanded focus on care disparities that includes new information on diabetes prevalence. Noting that there remains much room for improvement, the Wall Street Journal's Health Blog reports that Wisconsin, Minnesota and Massachusetts scored highest in the nation for all measures in overall health care. For Massachusetts, specifically, the strongest measures included the proportion of hospital patients with heart attacks who received a beta blocker within 24 hours of admission and the percentage of women older than age 40 who receive mammograms, among other measures. However, Massachusetts' weakest measure was for selected infections because of medical care per 1,000 medical and surgical discharges, with the state performing below the national average. Meanwhile, HHS also recently released its own series of state-specific reports on the health care status quo, which highlighted "the urgent need for health reform across the nation." The reports include information on care cost and quality and show that, while the cost of health care is rising, the quality of care is decreasing. Specifically, the reports examine metrics such as the percent increase in family premiums since 2000; the "hidden tax" that insured individuals and families pay to subsidize care for the uninsured; the overall quality ratings for health care in each state; and the impact of failing to adequately invest in preventive health measures. Noting that the reports provide a "clear demonstration that there are problems with health care in every state," HHS secretary Kathleen Sebelius added that "we cannot wait to pass reform that protects what works about health care and fixes what's broken." (Twedt, Pittsburgh Post-Gazette, 6/27/09; Wall Street Journal Health Blog, 6/26/09; HHS release, 6/26/09; AHRQ release, 6/26/09; AHRQ Web site).


Copyright 2009 The Robert Wood Johnson Foundation http://www.rwjf.org The Robert Wood Johnson Foundation, based in Princeton, N.J., is the nation's largest philanthropy devoted exclusively to health and health care.

HRET Receives Funding to Help Hospitals Implement AHRQ Quality, Safety Tools

The U.S. Department of Health and Human Services' Agency for Healthcare Research and Quality (AHRQ) has awarded the Health Research & Educational Trust (HRET) a $1.8-million contract to assist hospitals as they implement the agency's quality and safety resources, AHA News Now reports. Slated to begin June 1, the 20-month project will require HRET to develop innovative methods to encourage hospitals, health systems and policy-makers to more broadly adopt AHRQ's various toolkits and educational resources. According to a release, HRET will collaborate with American Hospital Association affiliates, state hospital associations, quality improvement organizations and an advisory panel of experts to provide free assistance to participants (AHA News Now, 5/28/09; HRET release, 5/28/09).

http://www.rwjf.org/qualityequality/digest.jsp?id=10909

Updates from AHRQ

AHRQ Report Highlights Health Care Quality, Access Disparities Gap

A new report published by the Agency for Healthcare Research and Quality (AHRQ) finds that health care disparities across at least 60 percent of quality measures stayed the same or worsened between 2000 to 2001 and 2005 to 2006, AHA News Now reports. The National Healthcare Disparities Report takes into account 220 quality measures pertaining to effectiveness, patient safety, timeliness and patient centeredness, focusing on 45 core measures. Outlining three overarching conclusions, the report suggests that disparities persist in health care quality and access, that the magnitude and pattern of disparities vary within subpopulations, and that some disparities exist across multiple priority populations. However, the group also reports a reduction in some disparities. For example, the rate of deaths per 1,000 discharges with complications potentially resulting from care for African-American patients declined between 2000 and 2005, and the gap between African-American and white patients on that measure decreased to the point that African Americans have better outcomes than whites. Meanwhile, saying that patient experience is an important indicator of health care quality but noting that many minorities report poor provider-patient communication, the report suggests that addressing disparities will "require special attention to cultural attitudes and perceptions that affect health behaviors and patterns of health care access and utilization." (AHA News Now, 5/6/09; AHRQ report; HHS release, 5/6/09)

http://www.rwjf.org/qualityequality/digest.jsp?id=10615


Patients Receiving Only 59 Percent of Recommended Care, AHRQ Finds

The sixth annual National Healthcare Quality Report from the Agency for Healthcare Research and Quality (AHRQ) finds that the quality of care provided by the U.S. health care system continues to improve at a slow pace, but many Americans still do not receive recommended care, AHA News Now reports. The congressionally-mandated analysis tracks trends in health system performance on 45 core measures of the effectiveness, safety, timeliness and patient focus of care. According to the report, the median annual rate of change for all quality measures was 1.4 percent, while the median level of receipt of needed care was 59 percent across the core measures. Measuring improvement across prevention, acute care and chronic care management categories, the AHRQ found that acute treatment measures showed the strongest rate of quality improvement, with 66 percent exhibiting some gains. However, the report indicates that patient safety measures worsened by nearly 1 percent per year during the past six years. Meanwhile, quality improvements continued to be spread unevenly across health care settings. For instance, care delivered in hospitals improved at an annual rate of change of nearly 3 percent, while care provided in ambulatory care settings improved at a rate that only slightly exceeded 1 percent. Commenting on the report's findings, U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius urged providers to work harder at reducing health care-associated infections and announced the availability of $50 million in federal stimulus grants to help facilities meet this challenge. Specifically, HHS will allocate $40 million to create or expand state infection and surveillance programs and $10 million to improve processes and increase ambulatory surgical center inspections. Noting that the report demonstrates why the country "can't wait to enact comprehensive health reform," Sebelius, who was speaking at the United Nurses of America's National Nurses Congress, added, "the status quo is unsustainable." (AHA News Now, 5/6/09; AHRQ report, March 2009; AHRQ release, 5/6/09; Goedert, Health Data Management, 5/6/09)

http://www.rwjf.org/qualityequality/digest.jsp?id=10614