William B. Munier, MDWilliam B. Munier, MD

Director, Center for Quality Improvement and Patient SafetyDirector, Center for Quality Improvement and Patient Safety

Agency for Healthcare Research and QualityAgency for Healthcare Research and Quality

National Advisory CouncilNational Advisory Council22 July 201122 July 2011

AHRQ CollaborationAHRQ Collaborationto Support theto Support the

Partnership for PatientsPartnership for Patients

2

AHRQ: A Highly Collaborative Agency

AHRQ’s mission entails collaboration in developing our own AHRQ’s mission entails collaboration in developing our own research and implementation projects, and integrating and research and implementation projects, and integrating and expanding on work done by others, e.g., NIH, CDC, FDA, and expanding on work done by others, e.g., NIH, CDC, FDA, and private-sector organizationsprivate-sector organizations

AHRQ is compact, and it potentiates its effectiveness by AHRQ is compact, and it potentiates its effectiveness by collaborating with agencies that can promote its findings, e.g., collaborating with agencies that can promote its findings, e.g., CMS through payment policyCMS through payment policy

The quality of output is usually higher as a result of collaboration The quality of output is usually higher as a result of collaboration with otherswith others

3

Examples of AHRQ Collaboration in Patient Safety

CAHPSCAHPS Federal partners, purchasers, patients, Federal partners, purchasers, patients, stakeholders and gatekeepersstakeholders and gatekeepers

HAIsHAIs HHS steering committee (members HHS steering committee (members include include CDC, CMS, NIH, others), CDC, CMS, NIH, others), private-sector organizationsprivate-sector organizations

NHQR/DRNHQR/DR Federal interagency workgroupFederal interagency workgroup

TeamSTEPPSTeamSTEPPS AHRQ and DoDAHRQ and DoD

PSOsPSOs

Partnership for PatientsPartnership for Patients

today’s primary examplestoday’s primary examples}

PSOs and Common FormatsPSOs and Common Formats

5

Patient Safety ActPatient Safety Act

Patient Safety and Quality Improvement Act of 2005 contains a Patient Safety and Quality Improvement Act of 2005 contains a provision authorizing the Secretary of HHS to promulgate provision authorizing the Secretary of HHS to promulgate common definitions and reporting formats (Common Formats) common definitions and reporting formats (Common Formats) to support uniform reporting of quality and safety performanceto support uniform reporting of quality and safety performance

Such Common Formats allow PSOs (and other interested Such Common Formats allow PSOs (and other interested parties) to collect information on quality and safety that is parties) to collect information on quality and safety that is “interoperable” and can be aggregated locally, regionally, and “interoperable” and can be aggregated locally, regionally, and nationally for accelerated learningnationally for accelerated learning

6

Common FormatsCommon Formats

AHRQ created a “Patient Safety Work Group” comprising all AHRQ created a “Patient Safety Work Group” comprising all relevant agencies in HHS, plus DoD and VA, to contribute to relevant agencies in HHS, plus DoD and VA, to contribute to the development of Common Formatsthe development of Common Formats

The National Quality Forum was retained to solicit public The National Quality Forum was retained to solicit public comment and to provide expert opinion on that comment and comment and to provide expert opinion on that comment and on the Formats themselveson the Formats themselves

Collaborative information is advisory to AHRQ, which Collaborative information is advisory to AHRQ, which publishes availability of the Formats in the Federal Registerpublishes availability of the Formats in the Federal Register

7

Common FormatsCommon Formats

There is no “final” version of the Formats, which are clinical instruments; There is no “final” version of the Formats, which are clinical instruments; AHRQ publishes iterative versions which are updated periodicallyAHRQ publishes iterative versions which are updated periodically

This process allows nimble accommodation of: 1) changes in science, This process allows nimble accommodation of: 1) changes in science, and 2) suggestions from users, and others, that improve the Formatsand 2) suggestions from users, and others, that improve the Formats

EveryoneEveryone has the opportunity to contribute to the evolution/improvement has the opportunity to contribute to the evolution/improvement of the Formats of the Formats

This collaborative process has itself been subject to public comment This collaborative process has itself been subject to public comment and is approved by OMBand is approved by OMB

Partnership for PatientsPartnership for Patients

9

Patient Safety Advocate Sorrel KingPatient Safety Advocate Sorrel King

10

Work

ing

Dra

ft - Last M

od

ified

04

/21

/23

11

:54

PM

The Affordable Care Act is best known for fixing broken health insurance laws and helping to cover millions of previously uninsured Americans.

What many people don’t know is all of the ways the new law is also reducing costs while improving the experience of being a patient, being a caregiver, and being a health care provider.

The Partnership for Patients: Better Care, Lower Costs is one example of how the President is using provisions of the Affordable Care Act to make health care in America safer, more efficient, and less costly.

11

Work

ing

Dra

ft - Last M

od

ified

04

/21

/23

11

:54

PM

• On any given day, about 5% of inpatients are affected by a hospital-acquired infection.

• Among chronically ill adults, 22 percent report a “serious error” in their care.

• According to the HHS OIG, nearly 30% of Medicare inpatients are harmed in the course of their care, directly costing the federal government over $4.4 billion each year.

• Despite pockets of success -- we still see massive variation in the quality and safety of care.

12

Work

ing

Dra

ft - Last M

od

ified

04

/21

/23

11

:54

PM

Secretary Sebelius has launched a new nationwide public-private partnership to tackle all forms of harm to patients. Our goals are:

1. Keep patients from getting injured or sicker. By the end of 2013, preventable hospital-acquired conditions would decrease by 40% compared to 2010. 

Achieving this goal would mean approximately 1.8 million fewer injuries to patients with more than 60,000 lives saved over the next three years.

2. Help patients heal without complication. By the end of 2013, preventable complications during a transition from one care setting to another would be decreased so that all hospital readmissions would be reduced by 20% compared to 2010. 

Achieving this goal would mean more than 1.6 million patients would recover from illness without suffering a preventable complication requiring re-hospitalization within 30 days of discharge.

Potential to save up to $35 billion dollars over three years.

13

AHRQ-Funded Project:AHRQ-Funded Project:Virtual Discharge AdvocateVirtual Discharge Advocate

Using Innovative Communication Using Innovative Communication Technology to Improve Health of Technology to Improve Health of Young African-American WomenYoung African-American Women

– Part of the Project RED Initiative to Part of the Project RED Initiative to reduce re-hospitalizationsreduce re-hospitalizations

– Boston University project using a Boston University project using a “virtual nurse” during the discharge “virtual nurse” during the discharge processprocess

– Simulates face-to-face interaction Simulates face-to-face interaction between a patient and nurse, based between a patient and nurse, based on individual patient’s medical dataon individual patient’s medical data

Project RED Avatar “Louise”Project RED Avatar “Louise”

14

P for P OrganizationP for P Organization

15

P for P OrganizationP for P Organization

AHRQ represented in yellow activities

16

Leadership

The Partnership for Patients is co-led by:The Partnership for Patients is co-led by:

– Don Berwick, Administrator, CMSDon Berwick, Administrator, CMS

– Carolyn Clancy, Director, AHRQCarolyn Clancy, Director, AHRQ

AHRQ (Bill Munier) chairs two work groups:AHRQ (Bill Munier) chairs two work groups:– ScienceScience– Data and MeasurementData and Measurement

AHRQ (Howard Holland) leads consumer engagement within Field/TAAHRQ (Howard Holland) leads consumer engagement within Field/TA

Other AHRQ personnel (Fraser, Eldridge, Jiang, Prasad, Battles) Other AHRQ personnel (Fraser, Eldridge, Jiang, Prasad, Battles) contribute a significant percentage of time, plus others as neededcontribute a significant percentage of time, plus others as needed

17

Science

Science work group comprises AHRQ, CDC, CMS, FDA, as well as Science work group comprises AHRQ, CDC, CMS, FDA, as well as the DoD and VAthe DoD and VA

Three months of research last fall revealed:Three months of research last fall revealed:

– There are no agreed-upon ways of measuring hospital-acquired There are no agreed-upon ways of measuring hospital-acquired conditions (HACs)conditions (HACs)

– There is no way to know precisely how many HACs are occurring now or There is no way to know precisely how many HACs are occurring now or have in the pasthave in the past

– Studies exist that provide information on estimated incidence and Studies exist that provide information on estimated incidence and effective prevention methods effective prevention methods

18

Science

Science work group has developed:Science work group has developed:

1.1. Estimates for each type of HACEstimates for each type of HAC Incidence – nationalIncidence – national

PreventabilityPreventability

2.2. Recommended goals for P for P, based on 1Recommended goals for P for P, based on 1

3.3. Evidence-based intervention toolsEvidence-based intervention tools

4.4. Bibliography to support 1-3 aboveBibliography to support 1-3 above

Science work group will “refresh” science base of P for P every six monthsScience work group will “refresh” science base of P for P every six months

19

Data and Measurement

Data and measurement work group comprises AHRQ, CDC, CMS, Data and measurement work group comprises AHRQ, CDC, CMS, FDA, DoD, VAFDA, DoD, VA

D&M is charged with developing methodologies for measuring D&M is charged with developing methodologies for measuring national incidence of HACs and readmissions throughout the national incidence of HACs and readmissions throughout the initiative:initiative:– Establish 2010 baselines for each HAC and for readmissionsEstablish 2010 baselines for each HAC and for readmissions– Track progress from 2010 to 2013Track progress from 2010 to 2013

Summary, projections, goals, science base, and bibliography are Summary, projections, goals, science base, and bibliography are provided as handoutsprovided as handouts

20

P for P OperationsP for P Operations

Operations are directed from CMS’ Center for Medicare and Medicaid Operations are directed from CMS’ Center for Medicare and Medicaid Innovations (CMMI)Innovations (CMMI)

Co-directors:Co-directors:

– Paul McGann, CMMIPaul McGann, CMMI

– Dennis Wagner, CMMIDennis Wagner, CMMI

Deputy director (HAC) – Jack Jordan, CMMIDeputy director (HAC) – Jack Jordan, CMMI

Deputy director (CT*) – Jim Hester, CMMIDeputy director (CT*) – Jim Hester, CMMI

AHRQ remains heavily involved as beforeAHRQ remains heavily involved as before

* Care Transitions

21

Key AHRQ RoleKey AHRQ Role

Partnership for Patients is Partnership for Patients is Step 1Step 1 in galvanizing hospitals to in galvanizing hospitals to improve their performanceimprove their performance

ButBut there are still few widely-accepted national measures; there are still few widely-accepted national measures; Step 2Step 2 is is to provide hospitals with a better way to assess their performance to provide hospitals with a better way to assess their performance locally while using nationally-accepted measureslocally while using nationally-accepted measures

AHRQ’s Common Formats, particularly when embedded in EHRs AHRQ’s Common Formats, particularly when embedded in EHRs (meaningful use), will provide an efficient tool for local improvement (meaningful use), will provide an efficient tool for local improvement that will allow trending over time and comparison across hospitals that will allow trending over time and comparison across hospitals nationallynationally

22

We Expect ResultsWe Expect Results

Through collaboration among Federal agencies and Through collaboration among Federal agencies and

with providers and consumers across the nation, we with providers and consumers across the nation, we

look forward to saving lives, reducing injury, and look forward to saving lives, reducing injury, and

reducing costs – and changing the culture regarding reducing costs – and changing the culture regarding

what is achievable in safer healthcare for all what is achievable in safer healthcare for all

Americans.Americans.

23

DiscussionDiscussion