1. The Elements of Health Care Quality and Current Improvement Efforts
Carolyn M. Clancy, MD
Director
Agency for Healthcare Research and Quality
Bipartisan Congressional Health Policy Conference
January 13, 2007

2. 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 is essential component*
Strong focus on public reporting is good
Motivates providers to improve
Not yet ‘consumer friendly’

3. Current Landscape
Numerous reports confirm substantial gap between best possible and actual care.
Increasing demands from purchasers that providers demonstrate quality delivered.
Public reporting of performance leads to improvements.
Recognition of urgent need to align disparate monitoring initiatives.
Initiatives that link payment with performance have proliferated in the private sector.

4. Challenges and Enablers
Quality assessment has been tightly linked with site of care or individual clinicians; few integrated or episode-based metrics.
Robust measures not yet developed for all physician specialties.
Quality alliances – collaboration between providers, purchasers, consumers and accreditors – have produced uniform public reporting for hospitals (HQA) and physicians (AQA).
HQA and AQA addressing gaps in existing measure sets, and need for measures that span care delivery.
Efficient data capture remains an aspiration – current electronic health records do not support.

5. Public Views on Quality, Cost and P4P25 62 87
Insurance companies identify and reward doctors and hospitals who achieve excellence in the quality and efficiency of care 22 18
Somewhat important 69 91
You have information about the costs of care to you BEFORE you actually get the care 77 95
You have information about the quality of care provided by different doctors or hospitals
Very important
Total very or somewhat important
How important is it to you that: (percent)
Source: Commonwealth Fund Survey of Public Views of the U.S. Health Care System, 2006.

6. National Reports on Quality and Disparities
Paired Reports
National Reports on Quality and Disparities
NHQR
Snapshot of quality of health care in America
Quality
Variation across states
NHDR
Snapshot of disparities in health care in America
Quality + Access
Variation across populations

7. Context for Current Quality Improvement Efforts
Good News: Quality is improving; disparities are narrowing…
Bad News: Progress is too slow
What moves the ball:
Public Reporting
Payment
Common Measures
(Health IT)
(Consumer engagement)

8. Disparities in Medicare Health Plans
Performance on four primary outcome measures is lower for blacks than whites
White Rate
Black Rate
80.2
72.2
72.2
71.6
62.9
60.2
57.2
53.4
Performance, %
Hemoglobin A Control
(Diabetes)
LDL-C Control (Diabetes)
Blood Pressure Control
(Hypertension)
LDL-C Control (Coronary Event)
JAMA October 25, 2006

9. Quality of Hospital Care for Heart Attack and Heart Failure: Poor Counties, Rich Counties
Source: Gannett News Service, Rating Hospital Heart Care, 2006.

10. Getting to high quality health care
The most powerful contribution
information technology can make
to improving health care quality…
Make the right thing to do
the easy thing to do

11. Growing HIT Evidence Base
Health IT helps improve quality of care in large health care organizations that create their own systems and devote substantial resources to EHR, CPOE,e-prescribing, and other applications
HIT has potential to enable dramatic transformation of health care safety, effectiveness and efficiency
Costs and Benefits of Health Information Technology
AHRQ Southern California
Evidence-Based Practice Center-
RAND Corporation, April, 2006

12. AHRQ Research: Improving Quality through HIT
Over 125 projects and demonstrations to better understand how health IT can improve the safety, quality and efficiency of health care
Projects in 43 states
Special attention to best practices that can improve quality of care in rural, small community, safety net and community health center care settings
AHRQ HIT Investment: $166 Million

13. Booklet Helps Consumers Understand and Get Quality Health Care
Helps consumers identify high-quality health care and take a more active role in their own health care
Explains clinical measures:
Track and improve the quality of care provided by doctors, hospitals, and others
Explains consumer ratings:
Indicate how satisfied people are with their health care
Lists Web sites and phone numbers for more resources
Part of a series to help patients take a more active role in their health care

14. “All Health Care is Local.”

15. 6 AQA Pilot Sites Wisconsin Collaborative for Healthcare Quality
Minnesota Community Measurement
Indiana Health Information Exchange
Massachusetts Health Quality Partners
California Cooperative
Healthcare Reporting
Initiative
Phoenix Regional Healthcare Value Measurement Initiative

16. Getting to Best Possible Care
Moving the ball right now:
Public Reporting – AND transparency
Payment Reforms*
Common Measures for public and private sectors
Enhanced support for local collaboratives
Specific Policy Opportunities:
P4P: absolute performance -- &/or improvement?
Rewarding the ‘leading edge’ and bringing others along
Support for unbiased consumer information – and for effective use of HIT
Insist on clear synthesis of results from public and private demonstrations

17. Q & A