Director’s Update

Carolyn Clancy, MDNational Advisory Council

April 13, 2012

New Members

Jane Durney Crowley, Executive Vice President and Chief Administrative Officer, Catholic Health Partners

Michael P. Johnson, P.T., Ph.D., O.C.S.,  Division Director & Chief Clinical Officer, Home Health Practice, Bayada Home Health Care

Newell E. McElwee, III, Pharm.D., M.S.P.H., Executive Director, U.S. Outcomes Research, Merck Global Affairs

Henry H. Ng, M.D., M.P.H., F.A.A.P., F.A.C.P., Internist-Pediatrician MetroHealth Medical Center and Assistant Professor, Case Western School of Medicine

David Fredrick Penson, M.D., M.P.H., Director, Center for Surgical Quality and Outcomes Research, Vanderbilt University Medical Center Professor of Urologic Surgery, Vanderbilt University

Harry Paul Selker, M.D., M.S.P.H, Dean, Tufts Clinical and Translational Science Institute, Tufts University; Executive Director, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center

Re-appointed: Bruce Siegel, M.D., M.P.H., Chief Executive Officer, National Association of

Public Hospitals and Health Systems

Member Updates

New Roles: Andrea H. McGuire, M.D., M.B.A., President and

Chief Operating Officer – Meridian Health Plan Welton O’Neal, Pharm.D., VP, Medical Affairs –

CryerHealth, LLC

Awards: Helen Darling – recipient of a 2012 National

Committee for Quality Assurance Health Quality Award for her sustained leadership promoting health care quality as an issue of commercial competitiveness

Overview

The Big Picture– FY 2012 – FY 2013 Budget Request

Recent Accomplishments– In the News– Impact Case Studies

AHRQ Program Updates

Today’s Agenda

FY AHRQ 2012 Budget

$369 M – $3 M less than FY 2011 Plus:

– $12 M in Prevention and Public Health Funds – $24 M from Patient-Centered Outcomes

Research Trust Fund

Total AHRQ Funding in FY 2012 – $405 M

FY 2012 Budget Details

$16.6 M for Patient-Centered Outcomes Research (+$24 M from the PCORTF)

$15.9 M for Prevention/Care Management (+$12 M from the Prevention and Public Health Fund)

$3.7 M for Value Research $25.6 M for Health IT $65.6 M for Patient Safety ($34 M HAI) $108.4 M for Crosscutting ($15.9 M in

NEW grants)

FY AHRQ 2013 Budget Request

$334.4 M – $34.7 M less than FY 2012 Plus:

– $12 M in Prevention and Public Health Funds

– $62.4 M from Patient-Centered Outcomes Research Trust Fund

Total AHRQ Funding in FY13 – $408.8 M

FY 2013 Request Details

$10.0 M for Patient-Centered Outcomes Research (+$62.4 M from the PCORTF)

$15.9 M for Prevention/Care Management (+$12 M from the Prevention and Public Health Fund)

$3.6 M for Value Research $25.6 M for Health IT $62.6 M for Patient Safety ($34 M HAI) $88.9 M for Crosscutting ($2.7 M in NEW

grants)http://www.ahrq.gov/about/cj2013/cjweb13over.htm

AHRQ Move

GSA awarded a 15-year lease to the owners of the Parklawn Building– The entire building will be completely renovated which

will create a new, modern, and efficient facility– Only concrete and steel infrastructure will remain– HHS employees will be located in the A and B wings and

the A-B head house Four OPDIVs will move into this space:

– AHRQ– HRSA– IHS– SAMHSA– Components of the Program Support Center (PSC)

Old Parklawn Building

New Parklawn Building

Overview

The Big Picture– FY 2012 – FY 2013 Budget Request

Recent Accomplishments– In the News– Impact Case Studies

AHRQ Program Updates

Today’s Agenda

AHCPR-Funded Chronic Disease Self-Management Program

E-Prescribing Safe and Efficient,But Barriers Remain

Interviews with physician practices, community pharmacies, and mail-order pharmacies reveal:– E-prescribing generally

regarded as important tool to improve patient safety and save time

– Physicians and pharmacies both face barriers in realizing e-prescribing’s full potential

Grossman JM, Cross DA, Boukus ER, et al. Transmitting and processing electronic prescriptions: Experiences of physician practices and pharmacies. J Am Med Inform Assoc doi: 10.1136/amiajnl-2011-000515

AHRQ, Hispanic Groups Promote Use of Spanish-Language Resources

AHRQ launches Toma las riendas (Take the Reins) campaign to encourage Hispanics to take control of their own health and explore treatment options

Campaign partners include:– National Hispanic Medical

Association– Latino Student Medical

Association– National Association of

Hispanic Elderly– National Latina Health Network– Telemundo

www.ahrq.gov/consumer/espanoix.htm

www.facebook.com/AHRQehc.espanol

Consumers Choose High-Value Providers When Given Good Data

AHRQ-funded study in March 2012 issue of Health Affairs:– When asked to choose a provider based only on cost,

consumers choose the more expensive option, equating cost with quality

– When cost and quality data are combined, consumers more easily identify providers who deliver high-quality care at a lower cost

– Study explored ways to present cost and quality information, such as symbols, specific figures, and labels

– Implications for the design of public report cards

Hibbard JH, Greene J, Sofaer S, et al. An experiment shows that a well-designed report on costs and quality can help consumers choose high-value health care. Health Aff 2012 31:560-568.

AHRQ’s Health Literacy Universal Precautions Toolkit Incorporated into

curriculum on clear communication techniques

More than 1,200 students from seven professions took part in literacy seminars

Toolkit used during clinical rotations in outreach educational activities

Saint Louis University School of Medicine

Alliant/GFMC, the Medicare Quality Improvement Organization

for Georgia

AHRQ’s Nursing Home Survey on Patient Safety Culture and TeamSTEPPS™– Safety culture survey administered in 62 nursing

homes before TeamSTEPPS training; results inform best strategies to improve care

– QIO offered TeamSTEPPS training to every nursing home through State’s biennial regional meetings

– Training reached 118 administrators in 62 nursing homes

– Results showed improved communication and teamwork skills

Primary Health Care Centers (GA)

AHRQ’s Staying Active and Healthy with Blood Thinners– Used in educational program to

help patients manage their anticoagulation therapy and overall health

– Program helped boost number of patients coming in for regular blood tests from 56% to 81%

– Centers received patient safety awards for efforts in improving health and care of patients using anticoagulants

Alliant/GFMC, the Medicare Quality Improvement Organization for

Georgia

AHRQ’s Staying Active and Healthy with Blood Thinners– Used as part of educational

program to help Medicare patients manage anticoagulant therapy and overall health

– DVD and brochure provided to 1,400 Medicare Part D beneficiaries who filled warfarin prescriptions in Q1, 2009

– 14.5% reduction in warfarin prescriptions filled with another Rx that can cause adverse drug interaction

St. Barnabas Rehabilitation and Continuing Care (NY)

On-Time Quality Improvement in Long-Term Care (On-Time) Program – Residents with new pressure

ulcers decreased by 56%– Improved integration of clinical

information between certified nursing assistants (CNAs) and dietary staff, social workers, nursing staff

– CNAs advocate better for residents after On-Time implementation

Schuyler Ridge Nursing Home (NY)

On-Time Quality Improvement in Long-Term Care (On-Time) Program – Residents with new pressure

ulcers dropped from 6.5% before program to 2% after

– Implementation improved documentation completion to nearly 100%

– Reports helped identify 2 to 3 new high-risk patients each week

– Reports integrated into facility’s information system for increased accuracy, efficiency

StayWell Health Management (MN)

AHRQ’s Effective Health Care (EHC) Program Guides– Incorporated guides for

consumers into pool of organization’s resources

– StayWell health coaches help make consumers aware of program guides

– Company learned about AHRQ guides while participating in EHC Tools for Business Project

Overview

The Big Picture– FY 2012 – FY 2013 Budget Request

Recent Accomplishments– In the News– Impact Case Studies

AHRQ Program Updates

Today’s Agenda

AHRQ Nursing News

Beth Collins Sharp, Ph.D., R.N. Named AHRQ’s Senior Advisor for Nursing

New Effective Health Care Nursing Working Group comprising leading nursing organizations– Explore ways that the nursing community can play a

role – Explore the needs of the nursing community– Embrace innovation and collaboration driven by the

needs of the nursing community– Sustain a new dialogue between nursing organizations

and AHRQ with a goal of greater dissemination and implementation of Effective Health Care Program research and tools

March AHRQ-Sponsored Health AffairsArticles on Public Reporting

An Experiment Shows That A Well-Designed Report On Costs And Quality Can Help Consumers Choose High-Value Health Care (J. Hibbard, J. Greene, S. Sofaer, K. Firminger, J. Hirsh)

Multistakeholder Regional Collaboratives Have Been Key Drivers Of Public Reporting, But Now Face Challenges (G. Young)

How Report Cards On Physicians, Physician Groups, And Hospitals Can Have Greater Impact On Consumer Choices (A. Sinaiko, D. Eastman, M. Rosenthal)

A Five-Point Checklist To Help Performance Reports Incentivize Improvement And Effectively Guide Patients (M. Friedberg, C. Damberg)

Advancing Public Reporting Through A New ‘Aggregator’ To Standardize Data Collection On Providers’ Cost And Quality (H. Luft)

Introducing 6th Web SiteBased on MONAHRQ: Arkansas

Commonwealth of Kentucky Office of Health Policy Utah Department of Health Maine Health Data Organization Hawaii Health Information Corporation Nevada Division of Health Care Financing and Policy Arkansas Department of Health

Guides hospitals in using the AHRQ Inpatient and Patient Safety Quality Indicators™ to improve care

Explains the quality improvement process and offers tools

“Introduction and Roadmap” helps various users identify the best resources for their needs

Available at www.ahrq.gov/qual/qitoolkit

New Toolkit Supports Efforts To Improve Quality and Safety

New FindingsHealth IT Effects on Hospital Costs,

Outcomes, and Patient Safety

Findings:– While EMRs do not reduce rate of patient safety

events – once an event occurs, they DO reduce: Death by 34% Readmissions by 39% Spending by 16%

Conclusion: – EMRs contain costs by better coordinating care to

rescue patients from medical errors once they occur.

Encinosa WE, Bae, J. Health information technology and its effects on hospital costs, outcomes, and patient safety. Inquiry. 2011-2012 Winter;48(4):288-303.

New ACTION ProjectReducing Readmissions for

Medicaid Patients Background:

– Readmission rates are 50% - 90% higher for Medicaid patients

– Medicaid patients are more concentrated in safety-net hospitals

New ACTION project will:– Create strategies/tools to address unique challenges

of Medicaid patients– Test feasibility of strategies/tools at selected

safety-net hospitals In multiple States, collaborating with State

Medicaid agencies

– Refine strategies and tools based on test results

Research Efforts Tied to Implementation

of the Affordable Care Act

Determination of the amount of the small employer health insurance tax credit

Evaluations of the health insurance status of young adults and their health care use and costs, ages 22-25

Estimates of the tax subsidy for employer sponsored insurance (ESI)

Analysis of trends in the health insurance status of high-risk individuals and their health care use and costs

Inform allocation of Federal Medical Assistance Percentages (FMAP) matching funds for State Medicaid programs

Analysis of Modified Adjusted Gross Income (MAGI) to estimate future premium subsidies based on income eligibility

MEPS-Based Simulations

MEPS widely used inside and outside government in models to simulate ACA effects

Some ways we support these efforts:– Detailed reconciliation of MEPS with the National

Health Expenditure Accounts (CMS)– Tax simulations

Recently Released Summary Products

Materials for Clinicians and Patients– Analgesics for Osteoarthritis– Self-Measured Blood Pressure

Monitoring– Non-Pharmacological Therapies

for Treatment-Resistant Depression

Consumer and Clinician Products Coming Soon

Preventing Fractures in People with Low Bone Density

Treating Urinary Incontinence

Therapies for Chronic Pelvic Pain

Mechanical Thrombectomy for Acute Cardiac Syndrome

Healthy Bones: A Decision Aid for Women After Menopause

ADHD Medications and Risk of Serious Cardiovascular Events in Adults

AHRQ and FDA study of 440,000 adults aged 25-64 years, including over 150,000 adults treated with medications for ADHD

Assessed myocardial infarction, stroke, and sudden cardiac death

Use of ADHD medications was not associated with an increased risk of serious cardiovascular events– The result is consistent with the research

team’s early publication in NEJM, which found no evidence of cardiovacular risk of ADHD drugs among children and young adults

New study from Effective Health Care Program’s DEcIDE Network in JAMA

Habel LA, et al. ADHD medications and risk of serious cardiovascular events in young and middle-aged adults. JAMA. 2011 Dec 28;306(24):2673-83. Epub 2011 Dec 12.

Patients With Diabetes Who Undergo Bariatric Surgery Do Not Have Lower

Health Care Costs Six years following bariatric surgery,

individuals with type 2 diabetes did not have lower health care costs than they had before surgery

These patients did have fewer primary care visits in the years following surgery

The findings were based on health insurance data of 7,806 patients with type 2 diabetes who underwent bariatric surgery using data from 7 Blue Cross Blue Shield Plans

New study from Effective Health Care Program’s DEcIDE Network published in Medical Care

Bleich SN, Chang HY, Lau B, Steele K, Clark JM, Richards T, Weiner JP, Wu AW, Segal JB. Impact of bariatric surgery on health care utilization and costs among patients with diabetes. Med Care. 2012 Jan;50(1):58-65.

Comparative Effectiveness of Oral Antidiabetic Drugs on Kidney Function

Evaluated oral antidiabetic drugs & renal outcomes by using a national VHA database of 93,577 diabetic patients

Compared with patients using the metformin, patients using sulfonylureas had an increased risk of a decline in kidney function, end-stage renal disease, or death

Because of these new findings, the current recommendation to limit the use of metformin alone in patients with mild to moderate kidney disease should be re-examined

New study from Effective Health Care Program’s DEcIDE Network published in Nature’s Kidney International

Hung AM, Roumie CL, Greevy RA, Liu X, Grijalva CG, Murff HJ, Ikizler TA, Griffin MR. Comparative effectiveness of incident oral antidiabetic drugs on kidney function. Kidney Int. 2012 Apr;81(7):698-706.

4th Methods Symposium: From Efficacy to Effectiveness

Fourth symposium on original research methods for comparative effectiveness research (CER) and patient-centered outcomes research (PCOR)

June 12 and 13, 2012 at the AHRQ Conference Center and Webcast over internet

Theme is “From Efficacy to Effectiveness”

– The proceedings will be published as a special journal supplement in 2013

Registration at http://effectivehealthcare.ahrq.gov/

Collaborations in HHS Health Data Initiative (HDI)

HDI Helps:– Consumers take control of their health and health care– Employers promote health and wellness– Care providers deliver better care– Local leaders make better-informed decisions

HDI Initiatives:– Publish new HHS data for public access– Make existing HHS data much more accessible– Publicize HHS data to innovators

AHRQ Data Resources to be featured at forthcoming Health Data Initiative Forum

New PCMH Resources and Activities

Evidence and Evaluation White Papers and Briefs– Early Evidence on Patient-Centered Medical Home– Improving Evaluations of the Medical Home

Care Coordination White Papers and Briefs– Coordinating Care in the Medical Neighborhood: Critical Components and

Available Mechanisms – Ensuring that Patient Centered Medical Homes Effectively Serve Patients

with Complex Needs

Primary Care Practice Facilitation– Developing and Running a Practice Facilitation Program for Primary Care

Transformation: A How-To Guide– Learning Community for organizations interested in primary care practice

facilitation services

www.pcmh.ahrq.gov

Improving Care Coordination in Primary Care: Measure Development

Measures of care coordination processes can be used to generate evidence; evaluate current practices; design, implement, and assess improvement activities; and support payment initiatives

Two new reports from AHRQ address key issues in measuring care coordination in primary care: accountability and data sources

– Care Coordination Accountability Measures for Primary Care Practice (available now)

– Prospects for Care Coordination Measurement Using Electronic Data Sources (coming soon)

Update From the U.S. Preventive Services Task Force

First draft Research Plans posted for public comment– Screening for Peripheral Arterial Disease

December 15, 2011–January 12, 2012– Genetic Risk Assessment and BRCA Mutation Testing for Breast

and Ovarian Cancer SusceptibilityFebruary 28–March 27, 2012

Final Recommendation on Screening for Cervical Cancer released March 15

– Change from draft RS posted for public comment due to new evidence The USPSTF recommends screening for cervical cancer in women ages 21

to 65 years with cytology (Pap smear) every 3 years OR, for women ages 30 to 65 years who want to lengthen the screening interval, screening with a combination of cytology and human papillomavirus (HPV) testing every 5 years

– Coordinated release with the American Cancer Society & other groups

USPSTF Welcomed Four New Members

Linda Ciofu Baumann, Ph.D., R.N.Professor Emerita, School of NursingAffiliate Faculty, School of Medicine and Public HealthUniversity of Wisconsin, Madison, WI

Mark Ebell, M.D., M.S.Associate Professor, Epidemiology and Biostatistics The University of Georgia, Athens, GA

Jessica Herzstein, M.D., M.P.H.Global Medical DirectorAir Products, Allentown, PA

Douglas K. Owens, M.D., M.S.Associate Director, Center for Health Care Evaluation, VA Palo Alto Health Care SystemDirector, Center for Health Policy, Freeman Spogli Institute for International StudiesStanford University, Stanford, CA

Nominations for 2013 close May 15Submit Online!

Health Information in the Home – Human Factors Assessment

Case study of four families’ health information management tasks

Highlights:– 69 unique health information management tasks – Nine different locations– 22 different information storage artifacts (e.g.,

calendars, notebooks, cupboards)

Finding: Foundational consumer health IT design elements must be balanced with individual needs

Zayas-Cabán T. Health information management in the home: A human factors assessment. Work. 2012 Jan 1;41(3):315-28.

Health IT Videos

Dr. Kate Lapane, Brown-Virginia Commonwealth University

– Video highlights innovative approach to generate EHR-enabled culturally informed multi-media medication guidance in Spanish and English for older adults

First in a series of inspirational videos featuring AHRQ Health IT grantees

Next in the series: Dr. Lynne Nemeth, Medical University of South Carolina

Videos are available at http://healthit.ahrq.gov/HITFeaturedProjects

AHRQ Health IT Research Funding

AHRQ and the National Science Foundation: Advancing Health Services Through System Modeling Research

External interest in AHRQ Health IT FOAs:– Understanding User Need and Context to

Inform Consumer Health Information Technology Design

– Understanding Clinical Information Needs and Health Care Decision Making Processes in the Context of Health Information Technology

Health IT Research Published in JAMIA

The effectiveness of integrated health information technologies across the phases of medication management: a systematic review of randomized controlled trials (Grossman JM, Cross DA, Boukus ER, Cohen GR. Transmitting and processing electronic prescriptions: experiences of physician practices and pharmacies. J Am Med Inform Assoc. 2011 Nov 18. [Epub ahead of print] PubMed PMID: 22101907)

Transmitting and processing electronic prescriptions: experiences of physician practices and pharmacies (McKibbon KA, Lokker C, Handler SM, Dolovich LR, Holbrook AM, O'Reilly D, Tamblyn R, Hemens BJ, Basu R, Troyan S, Roshanov PS. The effectiveness of integrated health information technologies across the phases of medication management: a systematic review of randomized controlled trials. J Am Med Inform Assoc. 2012 Jan-Feb;19(1):22-30. Epub 2011 Aug 18. Review. PubMed PMID: 21852412; PubMed Central PMCID: PMC3240758)

Patient Safety Organizations and the Affordable Care Act

Section 399KK: Secretary shall make available a program for hospitals with high readmission rates to work with PSOs– AHRQ and CMS have undertaken some planning in

order to execute this part of ACA

– AHRQ PSO Web site enhancement launched March 6th to provide resources for PSOs to work with those hospitals

PSOs and Common Formats

PSO Annual Meeting and Software Developers Meeting– 166 registrants (as of March 19, 2012)– 11 PSO presentations

Hospital Common Formats v 1.2 published April 2012– Incorporates new modules for VTE and Device with

Health IT

IOM Report on Health IT and Safety

Health IT and Patient Safety: Building Safer Systems for Better Care (11/8/11)

Recommendation: – AHRQ and ONC work together closely on

health IT and safety AHRQ has been doing that and will continue to

do so – AHRQ fund more research on health IT

and patient safety AHRQ will do that

2011 National Healthcare Quality and Disparities Reports

NHQR / NHDR nearing release– Highlights organized around National

Quality Strategy priorities– New sections on

Adolescent health Musculoskeletal diseases Health care safety net Transgender people

Coming Soon: – NHQRDRnet – State Snapshots

2012 National Healthcare Quality and Disparities Reports

NHQR / NHDR– 2012 will be 10th in series– Addition of more NQS measures reflecting

population need– Focus on long-term trends– Focus on new HHS race / ethnicity

standards NHQRDRnet

– Addition of function to generate customized graphics

Nationwide Implementation of CUSP for CLABSI

Progress in 3 Years of the Project: 

Has expanded to 46 States, DC, and PR >1,100 hospitals and >1,800 teams recruited Interim Results:

– 39%↓ in CLABSI rates (736 units w/ baseline & 1-yr. data)

– 800 CLABSI cases prevented }– 200 CLABSI deaths prevented } 1st yr, 5 cohorts =

⅔ of adult ICUs – $13 M in excess costs averted}

Healthcare-Associated InfectionsPriority Performance Goal (HAI-PPG)

High priority for HHS Secretary 11/21/11: HAI-PPG kick-off presentation to HHS Senior

Leadership Will be tracked by HHS and OMB Collaborative effort of CMS (lead), AHRQ, CDC, and

OASH Goals:

– 25%↓ in hospital-acquired CLABSI– 20%↓in hospital-acquired CAUTI– To be achieved by 9/30/13 vs. 2010 baseline – Aligned with goals of HAI National Action Plan and PfP

AHRQ’s ongoing programs will contribute significantly

2012 AHRQ Annual Conference

September 9 - 12, 2012 Bethesda North Marriott Hotel and Conference

Center

Today’s Agenda

Director’s Update Update on AHRQ’s Medical Liability Initiative Public Comment Lunch

– Reducing Disparities in Healthcare (PLACE MATTERS)

AHRQ’s Investments Supported by Patient Centered Outcomes Research Trust Fund

Public Comment Chairman’s Wrap-up