1. Health System Reform: Doing the Right Thing AND Doing Things Right Carolyn M. Clancy, MD Director Agency for Healthcare Research and Quality Alliance for Health Care Reform Washington, DC – March 27, 2009

2. Treating Cardiac Patients “In the current, long-overdue debate about health care, the focus is almost entirely on health insurance. And there is no question that the country would be better off if everyone were covered. But the gaps in insurance aren’t the only problem with the medical system. They are not even the biggest problem.” New York Times New York Times March 7, 2007

3. The Importance of Reforming Health Care Delivery Making Reform of the Health Care Delivery System a Part of Health Care Reform Making Reform of the Health Care Delivery System a Part of Health Care Reform Success Stories Success Stories 21 st Century Health Care 21 st Century Health Care

4. AHRQ’s Mission Improve the quality, safety, efficiency and effectiveness of health care for all Americans

5. AHRQ Priorities Effective Health Care Program Medical Expenditure Panel Surveys Ambulatory Patient Safety Patient Safety Patient Safety  Health IT  Patient Safety Organizations  New Patient Safety Grants  Comparative Effectiveness Reviews  Comparative Effectiveness Research  Clear Findings for Multiple Audiences  Quality & Cost-Effectiveness, e.g. Prevention and Pharmaceutical Outcomes  U.S. Preventive Services Task Force  MRSA/HAIs  Visit-Level Information on Medical Expenditures  Annual Quality & Disparities Reports  Safety & Quality Measures, Drug Management and Patient-Centered Care  Patient Safety Improvement Corps Other Research & Dissemination Activities

6. Key Challenge We’re not going to get to high-quality high-value health care until we put a lot more focus on doing things right We’re not going to get to high-quality high-value health care until we put a lot more focus on doing things right – Comparative effectiveness research is about doing the right thing – System reform is about doing things right

7. Pronovost Study Settings: Volunteer MI hospital ICUs for adults (108 intention to treat) Settings: Volunteer MI hospital ICUs for adults (108 intention to treat) Primary hypothesis: Rate of CABSIs would be reduced during first 3 months of intervention v baseline Primary hypothesis: Rate of CABSIs would be reduced during first 3 months of intervention v baseline Multiple interventions (sequential and parallel) Multiple interventions (sequential and parallel) Outcome measure: Incidence-rate ratios for CABSIs Outcome measure: Incidence-rate ratios for CABSIs Pronovost et al., NEJM 355(26); Dec. 28, 2006 Analytic approach: Generalized linear latent and mixed model with robust variance estimation and random effects to account for clustering within hospitals and hospitals within regions, adjusted for hospital teaching status and number of beds Analytic approach: Generalized linear latent and mixed model with robust variance estimation and random effects to account for clustering within hospitals and hospitals within regions, adjusted for hospital teaching status and number of beds New Yorker, December 2007

8. CLBSI-Reduction Program: 10 State Pilot 10 States Experts will help hospital ICUs in these states: California California Colorado Colorado Florida Florida Massachusetts Massachusetts Nebraska Nebraska North Carolina North Carolina Ohio Ohio Pennsylvania Pennsylvania Texas Texas Washington Washington Builds on the Keystone Project

9. AHRQ Health IT Research Funding Long-term agency priority Long-term agency priority – More than 200 projects and demonstrations to improve the safety, quality and efficiency of health care in virtually every state – Focus on the adoption of health IT – Projects in 43 states AHRQ Health IT Investment: $260 Million

10. AHRQ-Sponsored Interactive Preventive Health Record (IPHR) Virginia Commonwealth University IPHR called My Preventive Health Care designed to increase the delivery of health care services Virginia Commonwealth University IPHR called My Preventive Health Care designed to increase the delivery of health care services Goals include determining whether the IPHR increases delivery and patients use it, and whether it increases shared decision making and improves communication Goals include determining whether the IPHR increases delivery and patients use it, and whether it increases shared decision making and improves communication Involves seven primary care practices in the Virginia Ambulatory Care Outcomes Network (ACORN) Involves seven primary care practices in the Virginia Ambulatory Care Outcomes Network (ACORN) Project End – August 31, 2010 Promoting Patient-Centered Care

11. Communication is a Core Component of HROs TeamSTEPPS Toolkit Team Strategies & Tools to Enhance Performance & Patient Safety Team Strategies & Tools to Enhance Performance & Patient Safety – Improves communication & teamwork skills among health care professionals – Collaboration between AHRQ and the Department of Defense’s military health system – Adopted in the U.S. and internationally, in places including Singapore and Southern Australia Evidence-Based Team Training and Implementation

12. AHRQ/DoD Initiatives Activities began in 2002 Activities began in 2002 AHRQ issued PSO Task Order Contract to American Institutes of Research (AIR) AHRQ issued PSO Task Order Contract to American Institutes of Research (AIR) Expert Panel Expert Panel Comprehensive Literature Review Comprehensive Literature Review Case Study Analysis Case Study Analysis Journals/Articles Journals/Articles Presentations Presentations Clinical Measures of Teamness (RAND evaluation contract Mod) Clinical Measures of Teamness (RAND evaluation contract Mod) Medical Team Training Curriculum TeamSTEPPS Medical Team Training Curriculum TeamSTEPPS Edited Handbook Edited Handbook Evidence- Based Methods Tools for Training and Measurement Principles and Guidelines

13. Collaboration Products Teamwork in ProfessionalEducation Relevant Evidence Teamwork in Healthcare Teamwork & Simulation

14. National Implementation Team Carilion TRC Duke TRC Creighton TRC Minnesota -TRC AIR Lumetra Delmarva Booz | Allen | Hamilton Trained more than 1,000 Master Trainers who have trained 8,000 trainees

15. New Book on Evidence-Based Nursing More than 90 experts, 51 peer- reviewed chapters More than 90 experts, 51 peer- reviewed chapters Intended for all nurses, especially those in universities and hospitals Intended for all nurses, especially those in universities and hospitals Provides practice implications for nurses and sets forth a research agenda Provides practice implications for nurses and sets forth a research agenda Links with curriculum on patient safety & quality improvement – developed by UNC Links with curriculum on patient safety & quality improvement – developed by UNC Patient Safety & Quality: An Evidence-Based Handbook for Nurses www.ahrq.gov/qual/nurseshdbk Co-sponsored by RWJF

16. Re-Engineered Hospital Discharge Program (RED) AHRQ-funded research program at Boston University Medical Center, Department of Family Medicine AHRQ-funded research program at Boston University Medical Center, Department of Family Medicine – RED patients had 30 percent fewer subsequent emergency visits and readmissions RCT-tested, designed to educate patients about their post-hospital care plans RCT-tested, designed to educate patients about their post-hospital care plans Ongoing research is testing the automation of discharge principles in RED Ongoing research is testing the automation of discharge principles in RED More than 1,400 hospitals have signed up to date

17. Delivery of Health Care is a Team Sport Having a common understanding and a common strategy for addressing the issues Having a common understanding and a common strategy for addressing the issues Collecting enough data to monitor progress Collecting enough data to monitor progress Adapting based on the specific circumstances involved Adapting based on the specific circumstances involved

18. 21 st Century Health Care Improving quality by promoting a culture of safety through Value-Driven Health Care 21 st Century Health Care Information-rich, patient- focused enterprises Information and evidence transform interactions from reactive to proactive (benefits and harms) Evidence is continually refined as a by-product of care delivery Actionable information available – to clinicians AND patients – “just in time”

19. Your questions?