William B. Munier, MD Director, Center for Quality Improvement and Patient Safety Agency for Healthcare Research and Quality National Advisory Council 22 July 2011 AHRQ Collaboration to Support the Partnership for Patients

2 AHRQ: A Highly Collaborative Agency AHRQ’s mission entails collaboration in developing our own research and implementation projects, and integrating and expanding on work done by others, e.g., NIH, CDC, FDA, and private-sector organizations AHRQ’s mission entails collaboration in developing our own research and implementation projects, and integrating and expanding on work done by others, e.g., NIH, CDC, FDA, and private-sector organizations AHRQ is compact, and it potentiates its effectiveness by collaborating with agencies that can promote its findings, e.g., CMS through payment policy AHRQ is compact, and it potentiates its effectiveness by collaborating with agencies that can promote its findings, e.g., CMS through payment policy The quality of output is usually higher as a result of collaboration with others The quality of output is usually higher as a result of collaboration with others

3 Examples of AHRQ Collaboration in Patient Safety CAHPSFederal partners, purchasers, patients, stakeholders and gatekeepers CAHPSFederal partners, purchasers, patients, stakeholders and gatekeepers HAIsHHS steering committee (members include CDC, CMS, NIH, others), private-sector organizations HAIsHHS steering committee (members include CDC, CMS, NIH, others), private-sector organizations NHQR/DRFederal interagency workgroup NHQR/DRFederal interagency workgroup TeamSTEPPSAHRQ and DoD TeamSTEPPSAHRQ and DoD PSOs PSOs Partnership for Patients Partnership for Patients today’s primary examples }

PSOs and Common Formats

5 Patient Safety Act Patient Safety and Quality Improvement Act of 2005 contains a provision authorizing the Secretary of HHS to promulgate common definitions and reporting formats (Common Formats) to support uniform reporting of quality and safety performance Patient Safety and Quality Improvement Act of 2005 contains a provision authorizing the Secretary of HHS to promulgate common definitions and reporting formats (Common Formats) to support uniform reporting of quality and safety performance Such Common Formats allow PSOs (and other interested parties) to collect information on quality and safety that is “interoperable” and can be aggregated locally, regionally, and nationally for accelerated learning Such Common Formats allow PSOs (and other interested parties) to collect information on quality and safety that is “interoperable” and can be aggregated locally, regionally, and nationally for accelerated learning

6 Common Formats AHRQ created a “Patient Safety Work Group” comprising all relevant agencies in HHS, plus DoD and VA, to contribute to the development of Common Formats AHRQ created a “Patient Safety Work Group” comprising all relevant agencies in HHS, plus DoD and VA, to contribute to the development of Common Formats The National Quality Forum was retained to solicit public comment and to provide expert opinion on that comment and on the Formats themselves The National Quality Forum was retained to solicit public comment and to provide expert opinion on that comment and on the Formats themselves Collaborative information is advisory to AHRQ, which publishes availability of the Formats in the Federal Register Collaborative information is advisory to AHRQ, which publishes availability of the Formats in the Federal Register

7 Common Formats There is no “final” version of the Formats, which are clinical instruments; AHRQ publishes iterative versions which are updated periodically There is no “final” version of the Formats, which are clinical instruments; AHRQ publishes iterative versions which are updated periodically This process allows nimble accommodation of: 1) changes in science, and 2) suggestions from users, and others, that improve the Formats This process allows nimble accommodation of: 1) changes in science, and 2) suggestions from users, and others, that improve the Formats Everyone has the opportunity to contribute to the evolution/improvement of the Formats Everyone has the opportunity to contribute to the evolution/improvement of the Formats This collaborative process has itself been subject to public comment and is approved by OMB This collaborative process has itself been subject to public comment and is approved by OMB

Partnership for Patients

9 Patient Safety Advocate Sorrel King

10 Working Draft - Last Modified 9/8/2015 5:41:29 PM The Affordable Care Act Improves Health Care Quality  The Affordable Care Act is best known for fixing broken health insurance laws and helping to cover millions of previously uninsured Americans.  What many people don’t know is all of the ways the new law is also reducing costs while improving the experience of being a patient, being a caregiver, and being a health care provider.  The Partnership for Patients: Better Care, Lower Costs is one example of how the President is using provisions of the Affordable Care Act to make health care in America safer, more efficient, and less costly.

11 Working Draft - Last Modified 9/8/2015 5:41:29 PM Adverse Events in Healthcare are Not Rare On any given day, about 5% of inpatients are affected by a hospital-acquired infection. Among chronically ill adults, 22 percent report a “serious error” in their care. According to the HHS OIG, nearly 30% of Medicare inpatients are harmed in the course of their care, directly costing the federal government over $4.4 billion each year. Despite pockets of success -- we still see massive variation in the quality and safety of care.

12 Working Draft - Last Modified 9/8/2015 5:41:29 PM Secretary Sebelius has launched a new nationwide public-private partnership to tackle all forms of harm to patients. Our goals are: 1. Keep patients from getting injured or sicker. By the end of 2013, preventable hospital-acquired conditions would decrease by 40% compared to  Achieving this goal would mean approximately 1.8 million fewer injuries to patients with more than 60,000 lives saved over the next three years. 2. Help patients heal without complication. By the end of 2013, preventable complications during a transition from one care setting to another would be decreased so that all hospital readmissions would be reduced by 20% compared to  Achieving this goal would mean more than 1.6 million patients would recover from illness without suffering a preventable complication requiring re- hospitalization within 30 days of discharge. Potential to save up to $35 billion dollars over three years.

13 AHRQ-Funded Project: Virtual Discharge Advocate Using Innovative Communication Technology to Improve Health of Young African-American Women Using Innovative Communication Technology to Improve Health of Young African-American Women – Part of the Project RED Initiative to reduce re-hospitalizations – Boston University project using a “virtual nurse” during the discharge process – Simulates face-to-face interaction between a patient and nurse, based on individual patient’s medical data Project RED Avatar “Louise”

14 P for P Organization Leadership Communications Policy/Regs Field/TAScience Data and Measurement Operations

15 P for P Organization Leadership Communications Policy/Regs Field/TAScience Data and Measurement Operations AHRQ represented in yellow activities

16 Leadership The Partnership for Patients is co-led by: The Partnership for Patients is co-led by: – Don Berwick, Administrator, CMS – Carolyn Clancy, Director, AHRQ AHRQ (Bill Munier) chairs two work groups: AHRQ (Bill Munier) chairs two work groups: – Science – Data and Measurement AHRQ (Howard Holland) leads consumer engagement within Field/TA AHRQ (Howard Holland) leads consumer engagement within Field/TA Other AHRQ personnel (Fraser, Eldridge, Jiang, Prasad, Battles) contribute a significant percentage of time, plus others as needed Other AHRQ personnel (Fraser, Eldridge, Jiang, Prasad, Battles) contribute a significant percentage of time, plus others as needed

17 Science Science work group comprises AHRQ, CDC, CMS, FDA, as well as the DoD and VA Science work group comprises AHRQ, CDC, CMS, FDA, as well as the DoD and VA Three months of research last fall revealed: Three months of research last fall revealed: – There are no agreed-upon ways of measuring hospital-acquired conditions (HACs) – There is no way to know precisely how many HACs are occurring now or have in the past – Studies exist that provide information on estimated incidence and effective prevention methods

18 Science Science work group has developed: Science work group has developed: 1. Estimates for each type of HAC Incidence – national Incidence – national Preventability Preventability 2. Recommended goals for P for P, based on 1 3. Evidence-based intervention tools 4. Bibliography to support 1-3 above Science work group will “refresh” science base of P for P every six months Science work group will “refresh” science base of P for P every six months

19 Data and Measurement Data and measurement work group comprises AHRQ, CDC, CMS, FDA, DoD, VA Data and measurement work group comprises AHRQ, CDC, CMS, FDA, DoD, VA D&M is charged with developing methodologies for measuring national incidence of HACs and readmissions throughout the initiative: D&M is charged with developing methodologies for measuring national incidence of HACs and readmissions throughout the initiative: – Establish 2010 baselines for each HAC and for readmissions – Track progress from 2010 to 2013 Summary, projections, goals, science base, and bibliography are provided as handouts Summary, projections, goals, science base, and bibliography are provided as handouts

20 P for P Operations Operations are directed from CMS’ Center for Medicare and Medicaid Innovations (CMMI) Operations are directed from CMS’ Center for Medicare and Medicaid Innovations (CMMI) Co-directors: Co-directors: – Paul McGann, CMMI – Dennis Wagner, CMMI Deputy director (HAC) – Jack Jordan, CMMI Deputy director (HAC) – Jack Jordan, CMMI Deputy director (CT*) – Jim Hester, CMMI Deputy director (CT*) – Jim Hester, CMMI AHRQ remains heavily involved as before AHRQ remains heavily involved as before * Care Transitions

21 Key AHRQ Role Partnership for Patients is Step 1 in galvanizing hospitals to improve their performance Partnership for Patients is Step 1 in galvanizing hospitals to improve their performance But there are still few widely-accepted national measures; Step 2 is to provide hospitals with a better way to assess their performance locally while using nationally-accepted measures But there are still few widely-accepted national measures; Step 2 is to provide hospitals with a better way to assess their performance locally while using nationally-accepted measures AHRQ’s Common Formats, particularly when embedded in EHRs (meaningful use), will provide an efficient tool for local improvement that will allow trending over time and comparison across hospitals nationally AHRQ’s Common Formats, particularly when embedded in EHRs (meaningful use), will provide an efficient tool for local improvement that will allow trending over time and comparison across hospitals nationally

22 We Expect Results Through collaboration among Federal agencies and with providers and consumers across the nation, we look forward to saving lives, reducing injury, and reducing costs – and changing the culture regarding what is achievable in safer healthcare for all Americans.

23 Discussion