Struggling to invent high-reliability organizations in health care settings: Insights from the field.
(41/114)
The Mission of the Agency for Healthcare Research and Quality (AHRQ) has been to support and conduct health services research and to disseminate those research findings. Recently the Agency has changed its mission to: "Improving the quality, safety, efficiency and effectiveness of health care for all Americans." For agency personnel working with the topic of patient safety, that change has created a need to develop greater awareness of the current patient safety initiatives underway at leading health care systems in order to determine where AHRQ might best play a role in helping these systems more rapidly adopt new practices to improve patient safety. In order to make that determination, AHRQ conducted a customer needs assessment of leaders in selected health care systems, asking them questions about their current implementation initiatives and their perceived needs for continued implementation of patient safety initiatives. Although not designed or conducted as a research study, the hour-long interviews produced rich insights into the implementation efforts of patient safety initiatives. The senior leaders interviewed in each of the health care systems, described implementing patient safety initiatives on multiple fronts-in some systems as many as 15 initiatives were underway. As the number of initiatives attests, there was no lack of knowledge about what patient safety practices should be implemented (CPOE, rapid response teams, reduction in surgical site infections) rather the major struggle these health care systems faced was the "how to" of implementation. Most initiatives were only newly begun, so these leaders were not yet confident about what they had learned from these efforts or whether they could be sustained over time. These health care systems drew many of the ideas for initiatives from outside of health care, for example, the nuclear power industry or aviation. The executives expressed concern about a number of issues including: how patient safety initiatives should be sequenced, the lack of benchmarking data to measure their systems against and the pressing need for IT standardization. The insights from this customer needs assessment revealed a wealth of implementation knowledge in the field and has led AHRQ to create an opportunity for leading edge health care systems to learn from each other via learning networks. (+info)
Beyond the initial indicators: lessons from the OECD Health Care Quality Indicators Project and the US National Healthcare Quality Report.
(42/114)
Interest in comparative quality measurement and evaluation has grown considerably over the past two decades because of factors such as the recognition of widespread variation in clinical practice, the increased availability of evidence about medical effectiveness, and increasing concern about the cost and quality of health care. This article describes and contrasts two current efforts to develop health performance reporting systems: one, an international initiative-the Health Care Quality Indicator (HCQI) Project, sponsored by the Organization for Economic Cooperation and Development (OECD); and the other, a national project-the National Healthcare Quality Report (NHQR), sponsored by the US Agency for Healthcare Quality and Research. There are a number of lessons learned from a comparison of the two efforts that are relevant for the future of each project and for other indicator-based reporting efforts in quality of health care. These lessons are discussed in the article and include: Conceptual frameworks should be established to guide the selection of indicators. Choices should be made early on in the process to focus on a wide range of clinical conditions or to report on a few priority areas. METHODS: should be developed to add and subtract indicators while maintaining a stable set of indicators to track over time. Resources should be allocated to communication strategies and how best to present data results to diverse audiences. Mechanisms should be put in place to maintain project momentum. (+info)
Developing a center for comparative effectiveness information.
(43/114)
Interest in objective, credible comparative clinical effectiveness information has been growing in the United States, both by those who support competitive behavior in health care and by those who support administered pricing. The Medicare drug benefit has heightened interest in better information, although the potential payoff is even greater for medical procedures than for drugs, since procedures account for more of the health care dollar. Careful consideration needs to be given regarding the appropriate structure, placement, financing, and function of an agency devoted to comparative effectiveness if it is to achieve its objective: a mechanism to support better decision making in health care. (+info)
The landscape of the AHRQ Health Information Technology Portfolio.
(44/114)
A major agenda item of the President and Congress is widespread adoption of health information technology (health IT) to improve the quality, safety, and efficiency of health care. This has allowed federal agencies to invest additional money into health IT research. The distribution and potential impact of research dollars spent by one agency supporting this agenda is examined here. (+info)
The AHRQ National Resource Center for Health Information Technology (Health IT) Public Web Resource.
(45/114)
The Agency for Healthcare Research and Quality (AHRQ) has invested $166 million in projects designed to test the effectiveness of health information technologies (health IT) as they relate to cost, quality and patient safety indicators. These projects embrace the breadth of health IT solutions and involve participants from across the United States. In order to systematically deliver the lessons learned from these projects to a diverse national audience and to assist those in the early stages of health IT deployment, AHRQ has created a national website which highlights the successes and challenges faced by its grantees and aggregates a compendium of useful and peer-reviewed health IT content. (+info)
Federal initiatives to support rapid learning about new technologies.
(46/114)
Health policy and financing reforms place increasing emphasis on the ability of doctors and patients to make informed, cost-conscious care decisions. The federal government is supporting new initiatives in Medicare to increase the supply of reliable information on the benefits and risks of health care technologies. Medicare also is working with the Agency for Healthcare Research and Quality (AHRQ) to evaluate the comparative effectiveness of prescription drugs and other items or services. The value of these efforts will depend on coordination among individuals and institutions in the public and private sectors; clarity about focus, purpose, and priorities; and adequate and reliable long-term funding. (+info)
Introduction: Medicare Section 1013 and AHRQ's Effective Health Care Program.
(47/114)
OBJECTIVE: To introduce Section 1013 of the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003 and the Agency for Healthcare Research and Quality's (AHRQ) Effective Health Care Program. BACKGROUND: AHRQ, under Section 1013 of the MMA of 2003, has been charged with conducting specific health care outcomes studies through the Effective Health Care Program. This research is aimed specifically at determining the safety and effectiveness of certain pharmaceuticals since comparative data is currently lacking. Highly utilized, high-cost (or both) treatments are the focus of the studies that will be conducted through AHRQ's Evidence-based Practice Centers (EPCs) and the Developing Evidence to Inform Decisions about Effectiveness (DEcIDE) Network. Current and completed projects are noted, including more detailed information on the reviews pertaining to treatment of rheumatoid arthritis with nonbiologic disease-modifying antirheumatic drugs (DMARDs) and biologics (anti-tumor necrosis factor [TNF]-alpha therapies). SUMMARY: AHRQ's EPCs and the DEcIDE Network are studying safety and the comparative effectiveness of a number of different pharmaceutical-related topics, including the safety and effectiveness of biologic and nonbiologic DMARDS (e.g., TNF antagonists). The final reports, once complete, will be translated (explained in terms that can be more easily understood by all decision makers) and then disseminated to all stakeholders. (+info)
The comparative safety and effectiveness of TNF-alpha antagonists [corrected].
(48/114)
OBJECTIVE: To describe the current knowledge on safety and effectiveness of the tumor necrosis factor (TNF)-alpha antagonists and identify current knowledge/ evidence gaps for study by the Agency for Healthcare Research and Quality (AHRQ) Effective Health Care Program. BACKGROUND: Evidence-based Practice Centers (EPCs) and the Developing Evidence to Inform Decisions about Effectiveness (DEcIDE) network of AHRQ's Effective Health Care Program will study the safety and effectiveness of biologic and nonbiologic disease-modifying antirheumatic drugs (e.g., TNF-alpha antagonists). The current knowledge of safety and effectiveness of TNF-alpha antagonists is reviewed. SUMMARY: Treatment of adult rheumatoid arthritis (RA) involves determining which agents are safe, effective, and cost effective for an individual. Each individual patient's health system may also play a role in which agents are chosen. Many agents are available for the management of RA, some with high cost and unknown safety. Section 1013 of the Medicare Modernization Act of 2003 authorizes AHRQ to study comparative effectiveness and safety of RA treatments through both EPCs and DEcIDE centers to develop scientific knowledge for RA management as well as through epidemiologic studies. Results will be compiled through a Clinical Decisions and Communications Science Center, then disseminated to all appropriate stakeholders, including patients, payers, and health care professionals. The current knowledge of safety and effectiveness of TNF-alpha antagonists in the treatment of RA is reviewed. Increased rates of serious infections, including Mycobacterium tuberculosis (MTB), or tuberculosis reactivation, may occur with the use of TNF-a antagonists. It is still unclear if RA increases the risk of developing cancer, or if use of TNF-alpha antagonists increases cancer risk. CONCLUSIONS: TNF-alpha antagonists are costly, yet effective treatments for early and late RA. Use of these agents provides rapid relief of RA symptoms and provides positive outcomes, defined as improvements in American College of Rheumatology 20, 50, 70 scores; Health Assessment Questionnaire ratings; activities of daily living; joint space narrowing; erosions; and acute-phase reactants. Reactivation of latent MTB or onset of other infections or cancers may occur in RA patients with TNF-alpha antagonists. (+info)