First AHRQ Summit on Improving Quality of Care
At a Glance
The Agency for Healthcare Research and Quality's summit on improving the Nation's health care quality was held on April 4, 2005. This summary highlights the key speakers and panel presentations.
AHRQ's first summit on improving the Nation's health care quality took place Monday, April 4, 2005, at the Renaissance Hotel in Washington, DC. More than 250 people attended the all-day event, including many health policy experts from the Washington area.
Attendees at "Improving Health Care Quality for All Americans—Celebrating Success, Measuring Progress, Moving Forward" heard speakers including:
- Carolyn M. Clancy, M.D., AHRQ Director.
- Donald M. Berwick, president and Chief Executive Officer of the Institute for Healthcare Improvement (IHI).
- Mike Huckabee, Governor of Arkansas.
The Summit included three panel presentations:
- Promising Quality Improvement Initiatives: Reports From the Field.
- Eliminating Health Care Disparities.
- Promising National Initiatives.
Key themes that emerged were:
- Progress has been made in creating awareness of the need for improvement in the quality of health care.
- Quality measurement has advanced and is being carried out by a number of organizations.
- There is a sense that the Nation may have arrived at a "turning point" in which substantial quality improvement may be possible.
- At the same time, improvement is slow, and very substantial disparities persist associated with race, income, and other factors.
- If improvements in quality are to make the hoped-for contributions to improved health and cost effectiveness of care, they must occur much more rapidly and systematically.
- Measurement of quality is crucial, and data need to be much better developed—but information is not enough to drive change.
- Providers want to improve and are anxious to know how to make change. Specific goals and procedures are especially helpful for them.
AHRQ Director Carolyn M. Clancy pointed out that fundamental quality problems persist, with a stubborn gap between what is known to work and what is practiced. Many recent strides have been made, including the release of Medicare's "Hospital Compare" and AHRQ's National Healthcare Quality Report and National Healthcare Disparities Report. However, quality remains "stubbornly short of where we want it to be, agonizingly short of where we know it could be, and still slow and sporadic in making improvement."
Dr. Clancy also presented a "Quality Challenge" based on a new attitude and a "new formula for giving our best." She identified the elements of the Quality Challenge as candor, comparison, consequences, courage, cooperation, and communication. She announced a new AHRQ $1 million initiative—AHRQ QualityConnect—to help uncover what works and share "lessons learned" with those at the frontline of improvement. Select for a video presentation.
Donald Berick of the Institute for Healthcare Improvement said "the lights are coming on" with new awareness of quality problems, but that this shows even more glaringly where gaps exist. He said health care quality in the United States lags significantly behind that of other major democracies, and current theories for quality improvement in America are inadequate. He called for:
- Transparency of information.
- Specific goals for improvement.
- Technical help for providers.
- Involvement of top leadership, including the board of directors level in the health care sector.
The IHI's "100,000 Lives" campaign aims at improvement in six specific areas, with a June 14, 2006 deadline. More than 1,000 hospitals are already committed to the initiative.
Arkansas Governor Mike Huckabee talked about the importance of disease prevention and health promotion, describing his personal experiences in taking responsibility for his health. At 280 pounds (110 pounds more than today), with high blood pressure and a diagnosis of diabetes, his doctor told him he wouldn't live another decade. He learned healthier habits of nutrition and exercise and ultimately was able to complete a marathon.
Relating his situation to the welfare of his State, he launched a "Healthier Arkansas" initiative, especially aimed at developing better health habits for young people. The initiative includes payments for preventive services and even measurement of body mass index for school children, especially to help them and their parents understand future health implications from unhealthy behaviors.
- Janice Bacon, M.D., director of clinical services, Carmichael Family Health Center, Canton, MS—Dr. Bacon's presentation demonstrated how consistent measurement of clinic-wide data and close management of patients could improve treatment of diabetes and asthma patients in a low-income area. Her experiences especially pointed to the importance of community-wide involvement.
- Robert J. Panzer, M.D., chief quality officer, Strong Memorial Hospital, Rochester, NY—Dr. Panzer's presentation showed how a high-volume hospital brought focus and specific procedures to bear to improve outcomes. In particular, by targeting infection problems through specified procedures, the hospital has virtually eliminated cases of ventilator-associated pneumonia. The hospital has also successfully used computerized provider order entry (CPOE) technology, adopting the CPOE product to be user friendly for the hospital's staff.
- Jo Ellen H. Ross, M.N.A., president and CEO of Lumetra, San Francisco, CA—Ms. Ross described her organization's activities in leading the DOQ-IT (Doctors Office Quality-Information Technology) project for the Centers for Medicare & Medicaid Services. Currently a pilot program in four States, DOQ-IT employs CMS Quality Improvement Organizations (QIOs) to provide technical help to small physician practices in planning and implementing electronic health records. This will become a nationwide program for Medicare's QIOs later this year, providing expanded technical assistance to help physicians transform their practices from 1950s-style paper-based structures to IT-based structures.
- Gary Yates, M.D., chief medical officer, Sentara Healthcare, Norfolk, VA—Dr. Yates talked about the need to develop a total culture of quality to bring about change in a health care setting. His organization looked outside the health care sector to find other useful examples and techniques for improving quality, even making use of some safety and quality approaches developed in the nuclear power industry. Changes made to inculcate a culture of quality included "behavioral based expectations" aimed both at general approaches and specific problem areas.
- Garth N. Graham, M.D., M.P.H., deputy assistant secretary for minority health, Department of Health and Human Services (HHS), Washington, DC—Dr. Graham described recent activities to strengthen the Office of Minority Health and better refine its strategic goals, especially: data collection, information dissemination to minority communities, cultural competence and health literacy; and workplace diversity. He described the objective of HHS' Health Disparities Council in bringing a stronger and more uniform approach to disparities reduction to health programs throughout the Department.
- John C. Nelson, M.D., M.P.H., president, American Medical Association, Chicago, IL—Dr. Nelson talked about the importance of making physicians aware that quality and disparities problems are not "someone else's" problem but need to be confronted by every doctor in his or her own practice. He underlined the need for motivation, not just information, to bring about change and eliminate health care disparities associated with race. On behalf of the AMA, he made a personal apology for his organization's one-time policy of excluding black physicians.
- Elena Rios, M.D., M.S.P.H., president, National Hispanic Medical Association, Washington, DC—Dr. Rios discussed the importance of bringing Hispanic physicians together in a network to speak with one voice in contributing to health care policy and helping bring about improvement in health care quality for Latinos. She said the NHMA can help non-Hispanic physicians by sharing approaches that have been shown to work in Latino communities in the United States.
- Randall W. Maxey, M.D., Ph.D., co-chair, Commission To End Health Care Disparities, Los Angeles, CA—Dr. Maxey discussed the complexity of the causes of health care disparities, including not only clinical and socioeconomic issues, but equally important, issues of culture and empowerment. He especially emphasized the importance of focusing on disease prevention and health promotion aimed at younger people and the importance of parenting.
- Janet M. Corrigan, Ph.D., senior board director for health care services, Institute of Medicine, Washington, DC—Dr. Corrigan addressed the need for better organizational structures to bring about quality improvement, including ways to harmonize traditional professional autonomy in the medical field with new team- and evidence-based approaches. The Institute of Medicine (IOM) plans a new series of reports on the role of health benefits design, payment policies, and technical assistance in improving quality of health care.
- Risa Lavizzo-Mourey, M.D., M.B.A., president and CEO, Robert Wood Johnson Foundation, Princeton, NJ—Dr. Lavizzo-Mourey emphasized the need to press further in challenging health care disparities as a key element of quality improvement. The RWJ Foundation has supported a four-part series to air on PBS, "Remaking American Medicine," to improve public understanding and discussion of health care issues. RWJ will also support a project, "Expecting Success," to develop means for measuring and reducing disparities at the hospital level.
- David G. Schulke, executive vice president, American Health Quality Association, Washington, DC—Mr. Schulke discussed accomplishments of Quality Improvement Organizations. He also described plans for a project aimed at improving discharge instructions for heart disease patients.