AHRQ Annual Highlights, 2010 (continued)
Prevention/Care Management Portfolio
The mission of the Prevention/Care Management Portfolio is to improve the quality, safety, efficiency, and effectiveness of the delivery of evidence-based preventive services and chronic care management in ambulatory care settings. This mission is accomplished by:
- Supporting clinical decisionmaking for preventive services through the generation of new knowledge, the synthesis of evidence, and the dissemination and implementation of evidence-based recommendations.
- Supporting the evidence base for and implementation of activities to improve primary care and clinical outcomes through:
- Health care redesign.
- Clinical-community linkages.
- Self management support.
- Integration of health information technology.
- Care coordination.
The programmatic work of the Portfolio is carried out through grants and contracts to generate new knowledge, to synthesize and disseminate evidence, and to facilitate implementation of evidence-based primary care. The Portfolio fulfills AHRQ's congressionally mandated role to convene and provide ongoing scientific, technical, administrative, and dissemination support to the United States Preventive Services Task Force.
Men's Preventive Health Campaign
In support of the Prevention/Care Management Portfolio, AHRQ, working with the Ad Council, launched its Men's Preventive Health Campaign. As part of this campaign, AHRQ created a Healthy Men Web site (http://www.ahrq.gov/healthymen) where men can find out more about the preventive medical tests they need. The site also features information for men on how to stay healthy, talk with their doctors, understand prescription medications, and how to make informed decisions about their health care.
AHRQ Support of the United States Preventive Services Task Force (USPSTF)
The USPSTF is an independent panel of non-federal experts in prevention and evidence-based medicine comprised of clinicians with primary care-relevant expertise with strong science backgrounds. The USPSTF conducts scientific evidence reviews of a broad range of clinical preventive health care services (such as screening, counseling, and preventive medications) and develops recommendations for primary care clinicians and health systems. These recommendations are published in the form of "Recommendation Statements."
The USPSTF was first convened by the U.S. Public Health Service in 1984 and in 1995 programmatic responsibility for the USPSTF was transferred to AHRQ. Since its inception, the USPSTF has worked to fulfill its mission of:
- Assessing the benefits and harms of preventive services in people asymptomatic for the target condition, based on age, gender, and risk factors for diseases.
- Making recommendations about which preventive services should be incorporated into primary care practice.
USPSTF recommendations are intended to improve clinical practice and promote public health. The USPSTF's scope is specific: its recommendations address primary or secondary preventive services provided in primary care settings, which target conditions that represent a substantial burden in the United States.
U.S. Preventive Services Task Force Web Site
A new USPSTF Web site was launched in FY10. The Web site contains the complete library of USPSTF recommendations and information about the USPSTF and its methods. In addition, the USPSTF implemented a new process by making its draft Recommendation Statements available for public comment before they are published as part of its ongoing effort to keep its work and methods clear to the public it serves. For more information, go to http://www.uspreventiveservicestaskforce.org.
Publications Based on USPSTF Recommendations
Many clinically effective preventive services are substantially under-used. To support broader uptake of services considered to be most important by the USPSTF, AHRQ has made available the following publications based on USPSTF recommendations:
- The Guide to Clinical Preventive Services includes USPSTF recommendations on screening, counseling, and preventive medication topics and includes clinical considerations for each topic. The 2010-2011 Guide offers recommendations on clinical preventive services made by the USPSTF from 2002 to March 2010. It is available both in published form as a pocket guide and on the AHRQ Web site.
- Men: Stay Healthy at Any Age and Women: Stay Healthy at Any Age show at a glance what the USPSTF recommends regarding screening tests and preventive medicine. Healthy lifestyle behaviors are also addressed. These two publications were updated for FY10 and are available in English. The Spanish versions will be available in early 2011.
- Men: Stay Healthy at 50+, Checklist for Your Health and Women: Stay Healthy at 50+, Checklist for Your Health show at a glance what the USPSTF recommends regarding screening tests and preventive medicine. Healthy lifestyle behaviors are also addressed. (Available in English and Spanish.)
IBM Integrated Health Services
A computer-aided screening initiative based on the USPSTF recommendations and delivered via an online annual Health Risk Assessment has been successfully implemented for employees at IBM Integrated Health Services. Known as the Preventive Care Rebate, the initiative is designed to improve compliance, awareness, and the completion of appropriate clinical preventive screenings based on age, gender, and family history of disease. In addition to the USPSTF A and B recommendations (those services that the USPSTF recommends), the Preventive Care Rebate Program requirement also incorporates consumer materials from AHRQ's Effective Healthcare Program and AHRQ Director Dr. Carolyn Clancy's series of consumer advice columns, "Navigating the Health Care System."
During IBM's annual health plan enrollment, employees are given the opportunity to elect to participate in any of the company's Healthy Living Rebates—one of which is the Preventive Care Rebate. In 2008, 67,000 employees registered to participate in the Preventive Care Rebate Program. Of those employees, 58,000 completed the "Overdue Test Action" step, one of three requirements needed in order to earn a $150 incentive.
Investing in prevention and well-being makes sense for IBM's employees and its business because healthy employees tend to experience a better quality of life, both in the workplace and in their personal lives. In addition, employees who discover health problems early may recover faster, spend less on medical care, and have decreased absenteeism.
Electronic Preventive Services Selector (ePSS)
The Electronic Preventive Services Selector (ePSS) is a tool that is both Web-based and downloadable to a PDA, iPhone, or iPad allowing clinicians to access USPSTF recommendations, clinical considerations, and selected practice tools at the point of care. It is designed to help primary care clinicians identify and offer the screening, counseling, and preventive medication services that are appropriate for their patients. The ePSS offers the current, evidence-based recommendations of the USPSTF and can be searched by specific patient characteristics, such as age, sex, and selected behavioral risk factors. In FY10, AHRQ created the ePSS widget. Embedding a short line of Web-based code will add the ePSS widget to any Web site and the content will be automatically updated. The ePSS widget provides easy and free access to the clinical preventive service recommendations from the USPSTF. Since its debut in July 2010, the widget has received over 64,000 visitors.
Additional information is available at http://epss.ahrq.gov.
Recent Research Findings on Prevention/Care Management
- An AHRQ-funded study found that collaboration between physicians and telephone quit-lines can boost smokers' chances of getting the support they need to quit smoking. A total of 1,817 smokers from 16 primary care practices participated in the study. Physicians used an expanded "vital sign" intervention that included asking patients if they smoke, advising tobacco cessation if they do, assessing their interest in quitting, and referring interested patients to a quit-line via fax. The quit-line offered four telephone counseling sessions as well as contact with the physician for possible drug therapy and followup. A control group of primary care practices just used the traditional tobacco use vital sign (identifying patients who never smoked, used to smoke, or currently smoke) without a system for patient assessment and referral. The percentage of smokers receiving cessation support was 40.7 percent in the intervention group and 28.2 percent in the control group. Implementing the systematic process resulted in a significant increase of in-office discussion of quitting smoking as well as referrals to quit-lines. The researchers found a greater frequency of cessation support in patients aged 35-54 years, and with male and more experienced primary care physicians (American Journal of Preventive Medicine, April 2010).
Primary Care Practice-Based Research Networks
AHRQ supports local, regional, and national networks of primary care practices, which work with academic researchers to conduct research and advance efforts to improve the quality and transform the practice of primary care. Currently, 115 primary care practice-based research networks (PBRNs) from across the country are registered with AHRQ's PBRN Resource Center and are thus eligible to receive technical and other support. This includes a group of 10 PBRNs that are under contract with AHRQ to rapidly develop and assess methods and tools to assure that new scientific evidence is incorporated into clinical care in real-world practice settings. These networks are comprised of over 2,000 community-based practices that are located across the country and provide primary care services for 12 million Americans. Since 2000, AHRQ has also funded over 68 PBRNs through grant and contract programs and has provided technical and networking assistance for many others.
AHRQ Support of PBRNs
AHRQ has supported the PBRN Resource Center since 2002. The Center manages a national registry of active primary care PBRNs across the country and provides resources and assistance to registered PBRNs engaged in clinical and health services research. In addition, AHRQ provides PBRNs with Peer Learning Groups, which consist of conference calls and presentations to assist researchers and support staff in topical areas such as PBRN operations, quality improvement research, heath information technology, and research methodology. These opportunities for information exchange empower the participants through expert consulting and training to share and improve skills.
The Electronic Repository of PBRN Research is a virtual library of research conducted in primary care center PBRNs. Such publications may include peer reviewed published journal articles (copyright permitting), pre-print articles, review articles, book chapters, conference papers, and supplemental journal article information. The PBRN Extranet provides secure Web space for PBRNs to share documents, collaborate, and communicate and develop resources with others within and outside the network.
American Recovery and Reinvestment Act Awards
In FY10, AHRQ awarded over $20 million in grants through the Recovery Act to primary care PBRNs for comparative effectiveness research projects. Network awardees include:
- Clinicians Enhancing Child Health (CECH) at Dartmouth University for a comparison of methods to address teen mental health in primary care settings (Principle Investigator, Ardis Olson).
- Great Lakes Research into Practice Network (GRIN) at Michigan State University for a study of provider versus health plan delivered care management of chronic conditions. (Principle Investigator, Jodi Holtrop).
- Mecklenburg Area Partnership for Primary Care Research (MAPPR) for a comparison of community-based asthma interventions. (Principle Investigator, Michael Dulin).
- Utah Health Research Network (UHRN) for a study of strategies for primary care practice redesign. (Principle Investigator, Michael Magill).
- Distributed Ambulatory Research in Therapeutics Network (DARTNet), based in Denver, for a study of methods of conducting therapeutics inquiries. (Principle Investigator, Lisa Schilling).
Recent PBRN Research Findings
Findings from numerous AHRQ-funded projects conducted within PBRN settings were reported in 2010, and include the following.
- Investigators from the Pediatric Research Consortium at Children's Hospital of Philadelphia investigated whether a clinical decision support (CDS) system embedded in an EHR improves clinician adherence to national asthma guidelines. The guidelines include recommendations for writing prescriptions for controller medications, using spirometry for monitoring asthma, and having an asthma care plan. The study showed that primary care practices that used CDS in the EHR had improved compliance with national asthma guidelines over practices that did not have CDS in their EHR. Asthma is a chronic disease affecting millions of children in the United States and is also an AHRQ priority condition for research (Pediatrics, March 2010).
- Researchers working with the Mecklenburg Area Partnership for Primary Care Research used a Geographical Information System to study patterns of health care use among Hispanics in North Carolina. The researchers were able to create utilization maps based on emergency department use, clinic use, and insurance type. Based on this data, the researchers were then able to create maps of areas to target for increasing the Hispanic community's use of primary care (Journal of the American Board of Family Medicine, January 2010).
- Investigators from the Iowa Research Network, the North Carolina Network Consortium and the State Networks of Colorado Ambulatory Practices and Partners completed work on how to improve the delivery of primary care to patients with community-acquired methicillin-resistant Staphylococcus aureus (MRSA) infections. Findings from these projects included a demonstrated need for improved documentation and coding of MRSA infections by providers, improved training in incision and drainage techniques, and increased patient education on wound care, hygiene, and follow-up care.
For more information on the PBRNs and their research projects, go to http://pbrn.ahrq.gov.
Value Portfolio and Related Activities
AHRQ's Value Portfolio and related activities aim to find a way to achieve greater value in health care—reducing unnecessary costs and waste while improving quality—by producing the measures, data, tools, evidence, and strategies that health care organizations, systems, insurers, purchasers, and policymakers need to improve the value and affordability of health care. The goal is to create a high-value system, in which providers produce greater value, consumers and payers choose value, and the payment system rewards value.
MONAHRQ—Input Your Data—Output Your Web site
In May 2010, AHRQ released MONAHRQ (My Own Network, powered by AHRQ), a Web-based application developed to enable State and local data organizations, community quality collaboratives, hospitals, health plans, and providers to input their own hospital administrative data and generate a data-driven Web site. MONAHRQ software analyzes, summarizes, and presents information on the quality of care at the hospital level, health care utilization at the hospital level, preventable hospitalizations at the county level, and rates of conditions and procedures at the county level.
MONAHRQ is built on the Windows version of AHRQ's Quality Indicators but expands its capability to analyze, summarize, and present information on health care utilization, rates of conditions and procedures, and quality of care in a format ready for use by consumers and other decisionmakers. MONAHRQ can be used to meet data analysis and reporting needs and to better understand health care in areas and hospitals. MONAHRQ can be used to:
- Generate reports and statistics to be used internally within organizations.
- Create a limited-access Web site for member organizations.
- Produce an open-access Web site for consumers and other decisionmakers to compare facilities in an area or to present health care outcomes in geographic regions.
In fall 2010, AHRQ launched the MONAHRQ Learning Network, a group of State and private organizations that are using MONAHRQ or plan to use MONAHRQ to build their own Web sites. Learning Network activities will include in-person and electronic meetings and will focus on issues such as potential uses of MONAHRQ, possible enhancements to MONAHRQ, and adoption of MONAHRQ. The State of Nevada was the first to publish a MONAHRQ-based Web site—Nevada Compare Care at http://nevadacomparecare.net/Monahrq/home.html.
In addition, Hawaii also released its Web site at http://hhic.org/publicreports.asp.
For more information, see http://monahrq.ahrq.gov.
MONAHRQ Learning Network Knowledge Transfer Project
This Knowledge Transfer project formed a Learning Network composed of current and potential adopters of MONAHRQ. Using in-person meetings, Web conferences, and a virtual collaborative workspace, the Learning Network solves problems, shares experiences, and works toward the goal of implementing the MONAHRQ software at their organizations. Accomplishments in FY10 include:
Community Quality Collaboratives
Community quality collaboratives are community-based organizations of multiple stakeholders, that are working together to transform health care at the local level. These collaboratives include AHRQ's 24 Chartered Value Exchanges (CVEs)—multi-stakeholder initiatives with a mission of quality improvement and transparency. CVE stakeholders comprise a rich and diverse group that spans purchasers, consumer organizations, health plans, providers and others such as State data organizations or QIOs. In aggregate, these collaboratives involve more than 550 healthcare leaders and represent more than 124 million lives, more than one-third of the U.S. population.
In FY10, AHRQ continued its partnership with the CVEs by providing technical assistance to them through a Learning Network. Through the Learning Network, CVE members learn from each other and from experts, sharing experiences and best practices in areas such as collaborative leadership and sustainability, consumer engagement, public reporting, provider and consumer incentives, health information technology, and strategies to improve quality and efficiency.
Several new resources were released in FY10 to support the work of the CVEs and other community quality collaboratives. For example, Selecting Quality and Resource Use Measures: A Decision Guide for Community Quality Collaboratives, was designed for collaboratives to guide their strategic and operational planning related to performance measurement. The Decision Guide presents evidence-based answers to 26 questions, identified in collaboration with CVE stakeholders themselves.
AHRQ also released the Best Practices in Public Reporting series, which provides practical approaches to designing public reports that make health care performance information clear, meaningful, and usable by consumers. Report 1 focuses on the presentation of comparative health care performance data. Report 2 focuses on the explanatory information in public reports, beyond the performance data itself that helps to accurately communicate quality ratings to consumers and motivate them to use the ratings in making informed health care decisions. Report 3 applies social marketing and other principles to explore how to target reports to specific audiences, develop messages to promote the report with key audiences, engage consumer advocacy and community groups in promoting reports and helping people use them, disseminate reports through trusted channels, and ensure that consumers see and use comparative quality reports.
Finally, the Learning Network convened several Web conferences each month in FY10, covering topics such as strategies for payment reform, tracking and reducing hospital readmissions, engaging consumers on the topic of health care quality, PCMH models and the latest evidence on pay-for-performance.
For more information on community quality collaboratives and the CVEs, go to http://www.ahrq.gov/qual/value/localnetworks.htm.