Leadership by Example Coordinating Government Roles in Improving Health Care Quality (2003) / Chapter Skim
Currently Skimming:
6 A Research Agenda to Support Quality Enhancement Processes
6 A Research Agenda to Support Quality Enhancement Processes
Pages 129-152
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 129... ...
Recommendation 8: The government health care programs should work together to develop a comprehensive health services research agenda that will support the quality enhancement processes of all programs. The Quality Interagency Coordination (QulC)
|
From page 130... ...
Congress should ensure that the institutional organization and appropriations for health services research are adequate to meet this important objective. This chapter presents the committee's view of a research agenda to support the quality enhancement processes of the government health care programs.
|
From page 131... ...
The quality-related research ranges from outcomes research, to performance measurement, to patient safety initiatives. For example, included in the safety agenda are 24 projects examining different methods of collecting and analyzing data to identify factors that create a higher risk of medical errors, 22 projects analyzing how computer technology can be used to reduce errors and improve the quality of care, 8 projects exploring the effects of working conditions on patient safety, and 23 projects focusing on the development of new strategies to improve patient safety at health care facilities (Agency for Healthcare Research and Quality, 2001~.
|
From page 132... ...
The average amount of time required for research findings to affect direct patient care can be as long as two decades (Agency for Healthcare Research and Quality, 2000~. TRIP's purpose, divided into two phases, is to evaluate research dissemination models and tools
|
From page 133... ...
In addition to performance and outcome measurement, there has recently been increased interest in improving the use of comparative quality data by patients, purchasers, providers, and policy makers as a quality improvement tool. As interest has grown in evaluating patient perceptions of the care they receive to inform the future selection of health plans, AHRQ has begun working to develop and validate surveys of patient perceptions and to display their results to consumers in useful ways.
|
From page 134... ...
A great deal more research needs to be done in this area to support the efforts of the various government programs to provide useful information and reports to various stakeholders. Responding to the interest in using financial and other incentives to improve care through performance measurement and public disclosure strategies, AHRQ participates in the Robert Wood Johnson Foundation's initiative, Rewarding Results: Aligning Incentives with High-Quality Health Care (National Institutes of Health, 2002b)
|
From page 135... ...
For example, QuIC works with AHRQ to develop risk adjustment methods for performance measurement and collaborates with the Department of Labor in exploring the effects of working conditions in health care institutions on patient safety (Agency for Healthcare Research and Quality, 2001; Eisenberg et al., 2001~. By staffing QuIC in its implementation activities, AHRQ has expanded the contexts for collaboration with other agencies.
|
From page 136... ...
Accordingly, CMS has developed a research agenda aimed at exploring beneficiaries' readiness to use comparative information and at tailoring information to the decision-making processes actually employed by users (McPhillips, 2002~. CMS has devoted particular attention to developing tools for public disclosure of comparative quality data for nursing homes.
|
From page 137... ...
However, the creation of financial incentives to improve quality has not been the focus of research efforts (Klauser, 2002; Treiger, 2002~. Centers for Disease Control and Prevention Consistent with its public health mission, CDC has developed many projects for tracking the care delivered to patients, particularly when patient safety issues are involved.
|
From page 138... ...
Reflecting its scientific and medical research mission, NIH focuses much of its research on evaluating the relative effectiveness of different clinical interventions and delivery arrangements in producing desired outcomes; developing clinical data to lead to the development of treatment guidelines; and improving public access to medical and clinical information, such as the results of clinical trials. Similar to the TRIP initiative in AHRQ, research efforts also have focused on strategies to improve the assimilation of research findings into community practice.
|
From page 139... ...
Veterans' Health Administration VHA has engaged in a number of research initiatives consistent with its use of informatics in the implementation of quality improvement strategies. Its research is structured through a number of programs and centers, including the Patient Safety Centers of Inquiry and the Quality Enhancement Research Initiative.
|
From page 140... ...
The center also develops cognitive prompts to avoid perioperative events and examines fatigue effects on clinical performance (Gaba, 2002~. The Patient Safety Center of Inquiry in Vermont investigates the effectiveness of quality enhancement activities around organized themes of intervention, such as reductions in patient falls and adverse drug events.
|
From page 141... ...
Common research themes emerge among the programs: identification of priority areas, usually involving chronic illness or safety for quality improvement; synthesis of the evidence base around those areas; and development of performance measures from the evidence base. While the research strategies of the various government programs are similar, the committee believes greater coordination would be beneficial in the development of the research agenda to better support the specific roles of government in quality enhancement processes.
|
From page 142... ...
NIH should engage in coordination between its various institutes to shorten the time lag between the development of research findings and their implementation in practice through more effective evaluation and dissemination of its own research. Consistent with recommendation 8, presented at the beginning of this chapter, these research efforts should be coordinated through QuIC with the support of AHRQ to ensure congruence with the efforts of the government health care programs to strengthen and streamline their quality enhancement processes.
|
From page 143... ...
· Development and evaluation of the impact of alternative payment models and specific financial incentives on quality · Development of mechanisms for useful public access to comparative quality information.
|
From page 144... ...
As part of the national quality enhancement strategy, effort should also be directed at assessing the impact of quality enhancement processes in general. It will be important to evaluate whether actual improvements in care are occurring in the clinical areas being monitored and whether the attention devoted to areas of performance measurement deflects attention from areas of care less susceptible to measurement, such as care coordination among providers and between providers and community services (Anderson, 2002~.
|
From page 145... ...
Most of the efforts of QIOs are directed at hospitals, nursing homes, home health agencies, and managed care plans. The only comparative quality information currently available publicly is for health plans, hospitals, dialysis centers, and nursing homes.
|
From page 146... ...
The use of common standardized performance measures across settings would be most helpful in determining which settings are most capable of providing adequate care, and the access to such comparative data would better inform patient decisions. Alternative Payment Models Although the preponderance of this report has focused on quality measurement as the stimulus for quality improvement, the committee recognizes that measurement in combination with other strategies has the potential to produce substantial change.
|
From page 147... ...
The Rewarding Results initiative announced by the Robert Wood Johnson Foundation and AHRQ in early 2002 serves as an example of research designed to explore strategies for creating incentives to improve quality. It provides grants and technical assistance to purchasers and health plans to develop incentive structures that "align incentives with high quality care" (National Health Care Purchasing Institute, 2002~.
|
From page 148... ...
For example, since 1998, PacifiCare of California's Quality Index profile of physician organization performance has disclosed 58 measures of clinical quality, patient safety, service quality, and affordability to consumers, and PacifiCare enrollees have responded by increased selection of better performing providers (Ho, 2002~. There is evidence that the behavior of providers changes measurably when they are confronted with publicly disclosed comparative data, although the evidence on the effects of such changes is conflicting and the methods used in the different studies vary significantly.
|
From page 149... ...
These findings also underscore the importance of developing appropriate means of risk adjusting in publicly disclosed outcome information and promoting provider confidence in the validity of the risk adjustment. Without such risk-adjustment, comparative information could result in misconceptions regarding quality of care as well as incentives for risk selection by providers (Anderson, 2002~.
|
From page 150... ...
A good deal of research and evaluation will be necessary to determine how best to structure and organize the data in the repository and to identify ways of assisting different types of users in accessing and interpreting data. REFERENCES Agency for Healthcare Research and Quality.
|
From page 151... ...
2000. Quality Enhancement Research Initiative (QUERI)
|
From page 152... ...
2001. HHS to Provide Nursing Home Quality Information to Increase Safety and Quality in Nursing Homes: Presentation.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.