director’s update carolyn clancy, md national advisory council july 13, 2012 july 13, 2012

Directors Update Carolyn Clancy, MD National Advisory Council July 13, 2012 July 13, 2012

Member Updates New Roles: Katherine Schneider, MD, MPhil Medecision, Inc., Executive Vice President and Chief Medical Officer Katherine Schneider, MD, MPhil Medecision, Inc., Executive Vice President and Chief Medical Officer Ardis Dee Hoven, MD AMA, President-Elect Ardis Dee Hoven, MD AMA, President-Elect Welton ONeal, Jr., BS, RPh, PharmD Foundation for Managed Care Pharmacy, Executive Director and Academy of Managed Care Pharmacy, Vice President of Pharmacy Affairs Welton ONeal, Jr., BS, RPh, PharmD Foundation for Managed Care Pharmacy, Executive Director and Academy of Managed Care Pharmacy, Vice President of Pharmacy Affairs

Overview The Big Picture The Big Picture FY 2012 FY 2013 Budget Request Recent Accomplishments Recent Accomplishments In the News Impact Case Studies AHRQ Program Updates AHRQ Program Updates Todays Agenda Todays Agenda

FY 2012 Budget: $405M $16.6M for Patient-Centered Outcomes Research (+$24M from the PCORTF) $16.6M for Patient-Centered Outcomes Research (+$24M from the PCORTF) $15.9M for Prevention/Care Management (+$12M from the Prevention and Public Health Fund) $15.9M for Prevention/Care Management (+$12M from the Prevention and Public Health Fund) $3.7M for Value Research $3.7M for Value Research $25.6M for Health IT $25.6M for Health IT $65.6M for Patient Safety ($34M HAI) $65.6M for Patient Safety ($34M HAI) $108.4M for Cross-cutting ($15.9M in NEW grants) $108.4M for Cross-cutting ($15.9M in NEW grants)

FY 2013 Request: $408.8M $10M for Patient-Centered Outcomes Research (+$62.4M from the PCORTF) $10M for Patient-Centered Outcomes Research (+$62.4M from the PCORTF) $15.9M for Prevention/Care Management (+$12M from the Prevention and Public Health Fund) $15.9M for Prevention/Care Management (+$12M from the Prevention and Public Health Fund) $3.6M for Value Research $3.6M for Value Research $25.6M for Health IT $25.6M for Health IT $62.6M for Patient Safety ($34M HAI) $62.6M for Patient Safety ($34M HAI) $88.9M for Cross-cutting ($2.7M in NEW grants) $88.9M for Cross-cutting ($2.7M in NEW grants)

2011 National Healthcare Quality and Disparities Reports Released Key findings from annual reports: Key findings from annual reports: Quality of care improving slowly overall Heart care improving greatly: Reduced hospital admissions for congestive heart failure Reduced hospital admissions for congestive heart failure Fewer heart attack deaths in hospitals Fewer heart attack deaths in hospitals Access not improving for most minority groups New data on: New data on: Musculoskeletal diseases Childrens health EHR adoption www.ahrq.gov/qual/qrdr11.htm

Quality is Improving Slowly Nearly 60 percent of health care quality measures tracked showed improvement Nearly 60 percent of health care quality measures tracked showed improvement However, the median rate of change was 2.5 percent per year However, the median rate of change was 2.5 percent per year AHRQ 2011 National Healthcare Quality and Disparities Reports Quality measures that are improving, not changing or worsening, overall and for select populations

Few Disparities in Quality of Care Are Getting Smaller Few disparities in quality showed significant improvement Few disparities in quality showed significant improvement The number of disparities that were getting smaller exceeded the number that were getting larger The number of disparities that were getting smaller exceeded the number that were getting larger AHRQ 2011 National Healthcare Quality and Disparities Reports Quality measures for which disparities related to age, race, ethnicity and income are improving, not changing or worsening

National Quality Strategy First Annual Progress Report Released April 30, 2012 www.workingforquality.ahrq.gov Released April 30, 2012 www.workingforquality.ahrq.gov NQS Aims 1) Improve overall quality by making health care more patient-centered, reliable, accessible and safe 2) Improve population health by supporting proven interventions to address behavioral, social and environmental determinants of health, in addition to delivering higher-quality care. 3) Reduce the cost of quality health care for individuals, families, employers and government. NQS Priorities 1) Making care safer by reducing harm caused in the delivery of care 2) Ensuring that each person and family are engaged as partners in their care 3) Promoting effective communication and coordination of care 4) Promoting the most effective prevention and treatment practices for the leading causes of mortality, starting with cardiovascular disease 5) Working with communities to promote wide use of best practices to enable healthy living 6) Making quality care more affordable for individuals, families, employers, and governments by developing and spreading new health care delivery models

Next Steps for NQS Continue stakeholder engagement, particularly around the strategic opportunities for improvement identified by the National Quality Forum: Continue stakeholder engagement, particularly around the strategic opportunities for improvement identified by the National Quality Forum: Identify a national strategy for data collection, measurement, and reporting Develop organizational infrastructure at the community level that assumes responsibility for improvement efforts Reform payment and delivery systems Continue alignment and streamlining of measurement across HHS programs Continue alignment and streamlining of measurement across HHS programs Continue alignment of HHS programmatic goals with NQS priorities Continue alignment of HHS programmatic goals with NQS priorities

New: 2011 State Snapshots http://statesnapshots.ahrq.gov/snaps11/dashboard.jsp?menuId=4&state=MD&level=0 = Most Recent Year = Baseline Year Performance Meter: All Measures Very Weak Weak Average Strong Very Strong Maryland: Overall Care Quality vs. All States State-specific health care quality information, including strengths, weaknesses, and opportunities for improvement Enables users to explore the quality of a State's health care against national rates or best performing States State-specific health care quality information, including strengths, weaknesses, and opportunities for improvement Enables users to explore the quality of a State's health care against national rates or best performing States

Web Videonovela Helps Patients Compare Diabetes Treatments Spanish-language videonovela Aprende a vivir (Learn to Live) Spanish-language videonovela Aprende a vivir (Learn to Live) Three episodes of family drama portray challenges of managing diabetes Three episodes of family drama portray challenges of managing diabetes Nearly 12 percent of Hispanic adults age 20 and older have diabetes; Hispanics are twice as likely as whites to be hospitalized for diabetes complications Nearly 12 percent of Hispanic adults age 20 and older have diabetes; Hispanics are twice as likely as whites to be hospitalized for diabetes complications www.healthcare411.ahrq.gov/apre ndeavivir.aspx

Muscle Training Effective in Treating Urinary Incontinence in Women Urinary incontinence (involuntary loss of urine) is extremely common in adult women Urinary incontinence (involuntary loss of urine) is extremely common in adult women Review of treatments for urinary incontinence finds: Review of treatments for urinary incontinence finds: Pelvic muscle floor training is effective without side effects Drug-based treatments can work, but side effects are common www.effectivehealthcare.ahrq.gov

Arizona Health Care Cost Containment System AHRQs Vaginal Birth After Cesarean Section (VBAC): New Insights and Medicaid Medical Directors Learning Network AHRQs Vaginal Birth After Cesarean Section (VBAC): New Insights and Medicaid Medical Directors Learning Network Evidence report suggests that VBAC may be safe in large hospitals but research is mixed on outcomes in other settings, such as rural hospitals Medicaid officials used findings to identify settings where VBAC services could be performed safely (KT-COE-100)

Highmark (PA, WV) AHRQs Health Literacy Universal Precautions Toolkit and Questions Are The Answer public education campaign AHRQs Health Literacy Universal Precautions Toolkit and Questions Are The Answer public education campaign Used to educate physicians about relationship between health literacy and outcomes Provider Web site features AHRQs toolkit and a training module Downloadable tools for patients include Questions Are The Answer campaign resources (CP3-12-02)

Hospitals in NE, NM, and NY AHRQs Preventing Hospital- Acquired Venous Thromboembolism (VTE): A Guide for Effective Quality Improvement and QIO Learning Network AHRQs Preventing Hospital- Acquired Venous Thromboembolism (VTE): A Guide for Effective Quality Improvement and QIO Learning Network Some hospitals implemented new VTE protocols based on AHRQ Toolkit used by some hospitals to revise existing point-based VTE assessment New clinical approaches and protocols resulted in more appropriate VTE prevention tactics (KT-CQuIPS-97-99)

Hospitals in ME, GA, IN, MD, MO, and MI AHRQ-funded toolkit, Medications at Transition and Clinical Handoffs (MATCH) and QIO Learning Network AHRQ-funded toolkit, Medications at Transition and Clinical Handoffs (MATCH) and QIO Learning Network Identified need for single medication history list Hospitals redesigned their medication history lists based on toolkits One Source of Truth Medication reconciliation compliance improved in participating hospitals (KT-CQuIPS-89-94)

Arkansas Department of Health AHRQs MONAHRQ Learning Network AHRQs MONAHRQ Learning Network Provided resources and tools to enable State Health Department to launch public MONAHRQ Web site States Hospital Discharge Health Data Site includes county maps that compare potentially avoidable hospitalizations and patient conditions and procedures (KT-CDOM-96)

Maine Health Data Organization (MDHO) AHRQs MONAHRQ Learning Network AHRQs MONAHRQ Learning Network Learning Network provided in-person meetings, Web conferences, and online discussions on using MONAHRQ to publicly report data MDHOs MONAHRQ Web site includes State- specific inpatient discharge data from all non- specialty hospitals Policymakers and hospitals are primary users of MDHOs MONAHRQ Web site (KT-CDOM-96)

Utah Department of Health MONAHRQ MONAHRQ Used to create Utah Hospital Comparison Report Online report compares performance of Utah hospitals on quality ratings and average hospital charges Includes maps by county showing hospital rates of readmissions, adherence to care guidelines, and patient satisfaction Using MONAHRQ cut report production time in half (CDOM-12-03)

Ohio Medicaid AHRQs Maternal and Neonatal Outcomes of Elective Induction of Labor and Medicaid Medical Directors Learning Network AHRQs Maternal and Neonatal Outcomes of Elective Induction of Labor and Medicaid Medical Directors Learning Network Found increase in Cesarean deliveries when labor is induced vs. spontaneous Based on AHRQ report, Medicaid program reduced labor inductions without clear medical indications in near-term infants by 40% over 18 months Prevented nearly 200 neonatal intensive care unit admissions (KT-COE-101)

Woodhull Medical and Mental Health Center (part of New York City Health and Hospital Corp.) AHRQs Emergency Severity Index (ESI) triage system AHRQs Emergency Severity Index (ESI) triage system Annual ED visits increased from 65,000 in 1998 to 100,000 in 2011 Used ESI to handle the increase by improving emergency departments (ED) patient flow, prevent care delays, and save costs through greater efficiency Resulted in higher patient satisfaction scores and decreased ED waiting room times (CQuIPS-12-07)

Web Site Redesign AHRQs Web site is one of the primary communications channels between AHRQ and its audiences In 2009, AHRQ conducted a focus group on the Web site and found that the design, technology, and information architecture needed to be updated In 2009, AHRQ conducted a focus group on the Web site and found that the design, technology, and information architecture needed to be updated In 2010, AHRQ refreshed the Home Page of AHRQ.gov based on the focus group findings In 2010, AHRQ refreshed the Home Page of AHRQ.gov based on the focus group findings Evaluated current Web needs to identify the best process to manage content and enhance users Evaluated current Web needs to identify the best process to manage content and enhance usersexperience

Primary Navigation Labels: Health Information For Patients & Consumers For Professionals For Policymakers Research & Data Funding & Grants Centers, Portfolios & Initiatives News & Events Utility Navigation Labels: Home About AHRQ FAQs Site Map Contact Us Text size adjuster Proposed New Primary Navigation Hands-on user testing conducted in May 2012 shows overall improvement in locating content as compared with August 2011 usability study in same tasks.

Forthcoming Release of 2011 Employer Health Insurance Offerings and Premiums AHRQs MEPS Insurance Component is an annual survey of 40,000 establishments providing national and State-level estimates of employer sponsored health insurance coverage (ESI) AHRQs MEPS Insurance Component is an annual survey of 40,000 establishments providing national and State-level estimates of employer sponsored health insurance coverage (ESI) Used to assess trends in health insurance coverage, ESI, insurance take-up, eligibility for subsidies Used to determine the small employer health insurance tax credit (part of ACA) 2011 data release scheduled for this month

Collaboration With the National Cancer Institute and CDC Collaboration with AHRQ, NCI, CDC, American Cancer Society, and the Livestrong Foundation Collaboration with AHRQ, NCI, CDC, American Cancer Society, and the Livestrong Foundation Enhancing the Medical Expenditure Panel Survey (MEPS) Content to Support Cancer Survivorship Research Enhancing the Medical Expenditure Panel Survey (MEPS) Content to Support Cancer Survivorship Research Addition of questionnaire for households with cancer survivors to address cancer treatment and quality of care measures for cancer survivors and their families Addition of questionnaire for households with cancer survivors to address cancer treatment and quality of care measures for cancer survivors and their families Enhanced sample of cancer survivors included in MEPS, 2011-2012 Enhanced sample of cancer survivors included in MEPS, 2011-2012

Patient Safety Organizations (PSOs) 75 current PSOs in the United States and Washington, DC 75 current PSOs in the United States and Washington, DC PSOs working with over 2000 U.S. providers, including over 1,600 hospitals New PSOs include a component of the American College of Physicians Common Formats (CF) Update: Common Formats (CF) Update: Beta version of Readmissions CF to be published Summer 2012 Coordinating Readmissions CF pilot test in the Veterans Administration hospital system in July 2012 The Office of the National Coordinator sponsoring Purple Button Challenge Award The Office of the National Coordinator sponsoring Purple Button Challenge Award Calls for development of an application to enhance patient safety event reporting using Common Formats

2012 TeamSTEPPS Collaborative Meeting 6 th Annual TeamSTEPPS National Conference: From What? to How? 6 th Annual TeamSTEPPS National Conference: From What? to How? June 2012, Nashville,TN Unprecedented number of new attendees Many affiliated with a Hospital Engagement Network Shared best practices to promote executive leadership engagement for TeamSTEPPS Previewed upcoming modules: Long-Term Care, Primary Care, Limited English Proficiency

Healthcare-Associated Infections Agency Priority Goal (HAI-APG) Collaborative, cross-departmental effort: AHRQ, CMS (lead), CDC, and OASH Collaborative, cross-departmental effort: AHRQ, CMS (lead), CDC, and OASH HAI-APG: 1 of 6 HHS APGs being tracked by HHS and OMB Goals: Reduce hospital-acquired CLABSI and CAUTI by September 30, 2013 (with respect to 2010 baseline levels) Goals: Reduce hospital-acquired CLABSI and CAUTI by September 30, 2013 (with respect to 2010 baseline levels) CAUTI by 20% CLABSI by 25% Final project results due in September 2012 Final project results due in September 2012

Uniformed Services University of Health Sciences (USUHS) Pilot graduate-level course titled Patient Safety & Quality in an IT-driven World Pilot graduate-level course titled Patient Safety & Quality in an IT-driven World Novel partnership for USUHS and AHRQ Novel partnership for USUHS and AHRQ Content explored theoretical underpinnings and applications of patient safety and health IT legislation and initiatives Content explored theoretical underpinnings and applications of patient safety and health IT legislation and initiatives

Organisation for Economic Co-operation and Development (OECD) OECD is using AHRQ Quality Indicators for its Health at a Glance program tracks and compares health and health care across member countries OECD is using AHRQ Quality Indicators for its Health at a Glance program tracks and compares health and health care across member countries Patient Safety Indicators Preventable Quality Indicators for reporting on potentially preventable hospitalization rates *AHRQs HCUP/NHQR teams provide the U.S. statistics to OECD.

AHRQ Research Makes Health Affairs Top Ten List #2 New Federal Policy Initiatives To Boost Health Literacy Can Help The Nation Move Beyond The Cycle Of Costly Crisis Care (authors include AHRQs Carolyn Clancy and Cindy Brach, January 2012) #9 An Experiment Shows That A Well-Designed Report On Costs And Quality Can Help Consumers Choose High-Value Health Care (Judith Hibbard, et al, March 2012) Top 10 "Most-Read Articles January-June 2012

New Public Portal on Integration of Behavioral Health & Primary Care integrationacademy.ahrq.gov integrationacademy.ahrq.gov

New Self Management Support Resources

Update From the U.S. Preventive Services Task Force Five final recommendations released since last NAC meeting Five final recommendations released since last NAC meeting Counseling to Prevent Skin Cancer (May 8) Screening for Prostate Cancer (May 22) Interventions to Prevent Falls in Community-dwelling Older Adults (May 29) Screening for and Management of Obesity in Adults (June 26) Behavioral Counseling to Promote a Healthful Diet and Physical Activity for CVD Prevention in Adults (June 26) Five draft recommendations posted for public comment since last NAC meeting Five draft recommendations posted for public comment since last NAC meeting

New Materials for Consumers

Additional indicators and health topics 4 additional AHRQ QIs, including composite measures 4 additional AHRQ QIs, including composite measures 12 additional Hospital Compare measures 12 additional Hospital Compare measures New health topic on nursing sensitive care New health topic on nursing sensitive care New customization options Updated coding changes and new technical design features HCUP cost-to-charge ratios convert charges to costs HCUP cost-to-charge ratios convert charges to costs MONAHRQ New Version 3.0

New Materials for Clinicians

Guides independent pharmacies through the process of adopting e-prescribing Guides independent pharmacies through the process of adopting e-prescribing Illustrates how to assess pharmacy workflows to determine whether changes or updates are needed to a pharmacy software system Illustrates how to assess pharmacy workflows to determine whether changes or updates are needed to a pharmacy software system Discusses hurdles and problems that can arise when implementing e-prescribing Discusses hurdles and problems that can arise when implementing e-prescribing A Toolset for E-Prescribing Implementation in Independent Pharmacies

A Toolset for E-Prescribing Implementation in Physician Offices Designed for small, independent offices to large medical groups Designed for small, independent offices to large medical groups Supports implementation of e- prescribing, whether as a stand- alone system or as a component of a full EHR Supports implementation of e- prescribing, whether as a stand- alone system or as a component of a full EHR Useful for providers who have not achieved the full potential of their current e-prescribing system Useful for providers who have not achieved the full potential of their current e-prescribing system Both available at: http://healthit.ahrq.gov/eprescribingtoolsets

Enabling Patient-Centered Care Through Health Information Technology EPC Report While Health IT was shown to improve outcomes, few studies demonstrated impact on patient-centered care (as defined by the IOM) While Health IT was shown to improve outcomes, few studies demonstrated impact on patient-centered care (as defined by the IOM) 14 studies focused on improving responsiveness to the needs and preferences of individual patients 25 studies focused on improving shared decisionmaking or related measures of patient- clinician communication or access to information Available at http://www.ahrq.gov/clinic/tp/pcchittp.htm

Using Health IT in Workflow Redesign: Impact of Health IT on Workflow Two ACTION II task orders awarded Two ACTION II task orders awarded Study implementation of health IT to support practice redesign in ambulatory care settings Further understand causal relationships between health IT and workflow processes Billings Clinic Billings Clinic Three practices from Billings Clinic (Billings, MT) and Cabin Creek Health Systems (Dawes, WV), each Time and motion studies, observations, software logs, and interviews to study pre, during, and post implementation RTI RTI Six practices at different stages of implementing MyHealthTeam to support care coordination Observations, interviews, software tracking, and review of outcomes

Project ECHO Funded by AHRQ in 2004; subsequent funding from RWJF and now CMMI Funded by AHRQ in 2004; subsequent funding from RWJF and now CMMI Results published in NEJM last year: Results published in NEJM last year: Reduced rural disparities in care Improved provider satisfaction Adopted by the Veterans Health Administration 7/11/12 Adopted by the Veterans Health Administration 7/11/12

Electronic Data Methods (EDM) Forum ARRA grant to AcademyHealth to convene PROSPECT, DRN, and enhanced registry (for QI and CER) investigators and other stakeholders to: ARRA grant to AcademyHealth to convene PROSPECT, DRN, and enhanced registry (for QI and CER) investigators and other stakeholders to: Collect, synthesize, and share lessons learned in building an electronic data infrastructure for CER Advance methods to overcome common barriers in CER analytics, informatics, and governance Disseminate knowledge through electronic documents and Webinars posted at www.edm- forum.org and articles in journal supplements Disseminate knowledge through electronic documents and Webinars posted at www.edm- forum.org and articles in journal supplementswww.edm- forum.orgwww.edm- forum.org

First Journal Supplement 14 commissioned and invited papers 14 commissioned and invited papers Informed by ongoing ARRA-funded work Informed by ongoing ARRA-funded work Three domains: Three domains: Analytic Methods Clinical Informatics Governance Available at www.edm-forum.org Available at www.edm-forum.org www.edm-forum.org

Ongoing Activities Working on a JAMIA journal supplement Working on a JAMIA journal supplement Symposia, Webinars, and issue briefs Symposia, Webinars, and issue briefs eGEMS: electronic publications Generating Evidence and Methods (to improve outcomes) eGEMS: electronic publications Generating Evidence and Methods (to improve outcomes) New publication avenue starting in August Diverse products: original articles, protocols and best practices, conceptual frameworks, data visualizations, white papers, tutorials, continuing education tools Timely, useful, credible content

EDM Forum Consultants Mike Stoto, Wade Aubry, Jonathan Nebeker, Neil Sarkar Steering Committee Chair: Ned Calonge Subcommittees: Analytic Methods, Clinical Informatics, Data Governance EDM Forum: EDM Forum: Organizational Chart

Recently Released Translation Products ADHD in Children ADHD in Children ANA and RF tests for Musculoskeletal Complaints in Children ANA and RF tests for Musculoskeletal Complaints in Children Chronic Pelvic Pain Chronic Pelvic Pain Mechanical Thrombectomy Mechanical Thrombectomy Pain Management in Hip Fracture Pain Management in Hip Fracture Preventing Fractures in Low Bone Density Preventing Fractures in Low Bone Density Urinary Incontinence in Women Urinary Incontinence in Women

2012 AHRQ Annual Conference September 9-11, 2012 September 9-11, 2012 Bethesda North Marriott Hotel and Conference Center Bethesda North Marriott Hotel and Conference Center

2012 AHRQ Annual Conference General Schedule General Schedule Sunday, September 9 closed meetings Monday, September 10 open sessions all day and mAHRQet Place Caf with posters and AHRQ table top exhibits Tuesday, September 11 open sessions 10:00 am 12:00 pm Tuesday, September 11 open sessions 10:00 am 12:00 pm Two Plenary Sessions Two Plenary Sessions September 9, 4:30 5:30 Carolyn Clancy Unplugged: A Conversation about the Research September 9, 4:30 5:30 Carolyn Clancy Unplugged: A Conversation about the Research September 11, 10:00 12:00 Engagement and Use: Making Health Care More Patient-Centered, Reliable and Safe Carolyn Clancy, MD, MACP Carolyn Clancy, MD, MACP Reed Tuckson, MD, FACP, Executive Vice President and Chief of Medical Affairs, UnitedHealth Group Reed Tuckson, MD, FACP, Executive Vice President and Chief of Medical Affairs, UnitedHealth Group

Todays Agenda Directors Update Directors Update Health Care Costs Health Care Costs Public Comment Public Comment Lunch Lunch Executive Session Ambulatory Care Safety Ambulatory Care Safety Public Comment Public Comment Chairmans Wrap-up Chairmans Wrap-up

director’s update carolyn clancy, md national advisory council july 13, 2012 july 13, 2012

Documents

quality of care

new grants slide

public health fund

value research

patient safety

overall heart care

big picture fy

executive vice president