AHRQ Annual Highlights, 2010 (continued)
Healthcare 411 en Español provides vital health care information to Spanish speakers
Healthcare 411 en Español is a new audio news series to provide Spanish speakers with evidence-based consumer information to help them stay healthy, prevent diseases, compare the effectiveness of various medical treatments, and obtain high-quality and safe health care. AHRQ is producing two 60-second audio reports each month and distributing them to Spanish-language radio stations nationwide. Each audio segment includes an interview with a native Spanish-speaking AHRQ physician who discusses current issues such as the importance of regular screening exams for people with diabetes or how to prepare for a doctor's appointment. AHRQ posts the audio to its Healthcare 411 Web site, where consumers can subscribe and download the segments to a computer or portable media device such as an MP3 player.
To listen to the Healthcare 411 audio segments in Spanish, visit http://www.healthcare411.ahrq.gov and select "En Español."
Recent Research Findings on Disparities and Minority Health
In addition to its work on the NHDR, AHRQ is leading Federal research efforts to develop knowledge and tools to help eliminate health care disparities in the United States. AHRQ supports and conducts research and evaluations of health care with emphasis on disparities related to race, ethnicity, socioeconomic status, and geographic variation. The Agency focuses on priority populations: minorities, women, children, elderly adults, low-income individuals, and people with special health care needs such as people with disabilities or those who need chronic or end-of-life care. Several studies, published during FY10, are summarized below.
- Material disadvantages, such as inadequate housing, lack of food, and being uninsured or underinsured, are linked to declines in walking ability and self-rated health among older Americans. Researchers examined data from both the 2004 and 2006 Health and Retirement Study on walking ability, an important predictor of disability and the need for later long-term care, as well as three factors: health insurance coverage, food insufficiency, and housing quality/affordability. All three factors contributed to declines in walking ability and self-reported health. Most Americans experienced at least one form of material disadvantage. Individuals with multiple forms of material disadvantage were at particularly increased risk of health decline and functional impairment as they aged. Common problems cited by older persons included issues with neighborhood safety (27.7 percent) and being either uninsured or underinsured (30.9 percent). More blacks (9 percent) than whites (2 percent) were disadvantaged in all three areas of health care, housing, and food. The same was true for 7 percent of participants with less than a high school education compared with 2 percent of those with a high school diploma (American Journal of Public Health, November 2009).
- To contain health care costs and promote high quality care, States often require health care facilities to obtain approval before offering certain new or expanded services, such as coronary angiography facilities. When New Jersey eased these restrictions, access to angiography (an imaging technique used to diagnose heart problems) increased and eliminated a longstanding racial disparity. Researchers examined the effect of regulatory reforms between 1996 and 2003 and found that a doubling of angiography facilities closed the gap in blacks' and whites' access to these services. The average number of angiography procedures for blacks rose 46 percent for all New Jersey hospitals between the mid-1990s and 2001, with urban hospitals seeing the biggest influx of black patients. Annual utilization among whites rose a more modest 15 percent over the same period, closing the blackwhite gap in procedure rates (Health Affairs, September/October 2009).
- Parents of children with special health care needs (CSHCN) often have to take time off work, reduce their number of work hours, or even quit a job altogether to care for their sick child. More than half of the CSHCN had some or a great deal of functional limitations due to their condition. Just over a third (35 percent) had changing health care needs. Nearly a quarter of parents (23.7 percent) reported some type of work loss, with 13.3 percent of families reporting that a member had to stop work to care for their child. Factors associated with increased odds of work loss included having a younger CSHCN, increasing functional limitation and/or condition instability, being uninsured, and having public insurance. The odds of work loss were lower for families with post-high school education and those with a medical home. A medical home can save a family time and frustration by coordinating medical appointments and referrals, streamlining communication between primary care doctors and other providers, and reducing duplicative services (Pediatrics, December 2009).
- An estimated 2.7 million U.S. children are severely obese. This number jumped more than 300 percent since 1976 and 70 percent since 1994. Researchers examined data representing 71 million U.S. children from the National Health and Nutrition Examination Survey and found that black and Mexican American boys aged 12 to 19 are most likely to be severely obese. Poverty is also a risk factor. More than a third of severely obese children face significant health risks and meet criteria of the adult metabolic syndrome: large waistlines, high triglyceride levels, high cholesterol, high blood pressure, and high blood sugar levels. Further, more than 400,000 adolescents may meet criteria to have bariatric surgery; that is, their BMIs classify them as morbidly obese (Academic Pediatrics, September/October 2009).
Consumer Assessment of Healthcare Providers and Systems (CAHPS®)
AHRQ has been the lead Federal agency in developing and disseminating standardized, evidence-based surveys and related tools for assessing patients' experiences with the U.S. health care system. The Agency's Consumer Assessment of Healthcare Providers and Systems (CAHPS®) program has become the focal point of a national effort to measure, report on, and improve the quality of health care from the perspective of consumers and patients. For example, almost all U.S. hospitals use the Hospital Survey (H-CAHPS) component to report patients' perspectives on their experience of care while hospitalized. (http://www.HospitalCompare.hhs.gov). CAHPS® develops and supports the use of a comprehensive and evolving family of standardized surveys that ask consumers and patients to report on and evaluate their experiences with different aspects of the health care system.
CAHPS® Item Set for Addressing Health Literacy
In FY10, AHRQ released the CAHPS® Item Set for Addressing Health Literacy in English and Spanish. The primary purpose of the CAHPS Item Set for Addressing Health Literacy is to measure, from the patients' perspective, how well health care professionals communicate with their patients. This survey also:
- Identifies specific topic areas for quality improvement (e.g., communication about test results, medications, and forms).
- Assesses health care professionals' health literacy practices.
- Identifies behaviors that inhibit effective communication (e.g., talking too fast).
- Provides information to help providers develop an environment where patients feel comfortable discussing their health concerns (e.g., by showing interest in their questions).
The CAHPS Item Set for Addressing Health Literacy consists of 29 supplemental items designed for use with the CAHPS® Clinician and Group Survey. It covers the following seven topics:
- How well nurses address health literacy.
- How well doctors address health literacy.
- Communication about tests.
- Communication about discharge planning and self-care post discharge.
- Communication about medicines.
- Interpreter services.
- Communication about forms.
Surgical Care Survey Approved as CAHPS® Product
A team led by the Surgical Quality Alliance developed a survey of patients' experiences with surgical care. After extensive review of questionnaire content, data reliability and validity, and the development process, AHRQ's CAHPS® Consortium agreed in FY10 to grant use of the CAHPS trademark to this instrument. This survey expands on the current Clinician and Group Survey by incorporating domains relevant to surgical care, such as informed consent, provision of anesthesia, shared decisionmaking, and postoperative followup. Respondents are also asked to rate the anesthesiologist and the surgeon. The Surgical Care Survey asks respondents about a surgical episode, including care before, during, and after the procedure, rather than care received across a specified time period (e.g., 6 or 12 months) or just care over time or during a specific visit.
For more information about CAHPS®, go to http://cahps.ahrq.gov.
National Guideline Clearinghouse™
The National Guideline Clearinghouse™ (NGC) provides physicians and other health professionals, health care providers, health plans, integrated delivery systems, purchasers, and others an accessible mechanism for obtaining objective, detailed information on clinical practice guidelines and to further their dissemination, implementation, and use. The NGC is a Web-based resource for information on over 2000 evidence-based clinical practice guidelines. Since becoming fully operational in 1999, the NGC has had over 63 million visits and receives approximately 500,000 visits each month.
In FY10, the NGC redesigned its Web site with updated design elements, new guideline summary display, enhanced searching, and easier access to all content. Users of the new and improved site will notice significant upgrades to the accessibility of information, which have been accomplished through the following:
- Improved site architecture designed according to Web usability standards.
- Improved home page and site navigation that allow users to more easily understand and access the sites' content (also, per Web usability standards).
- Improved presentation of summaries for guidelines , for ease of navigation both within the summary and to related content at the Clearinghouse.
- Improved browse and search functionality that better leverages the classification of guidelines using key vocabulary standards.
In FY10, the Web site for AHRQ's National Quality Measures Clearinghouse™ (NQMC) was also updated and revised. New upgrades include the same updates and revisions as the NGC site.
This is the third year in which AHRQ's NGC, in conjunction with the NQMC, has published a series called Expert Commentary. Together, the two resources published eight new Expert Commentaries which are editorial insights on current issues of importance to the guideline and/or measure fields including perspectives on trends in guideline and/or measure development, reviews/critiques of guidelines/measures, comments on topics related to evidence-based medicine, or similar themes. The topics of the commentaries included challenges of measuring and improving quality in ambulatory care, the improved function and content for the NGC Web site, recommendations for initiating antiretroviral therapy, and developing health care guidelines and measures. Also covered was the Grading Recommendations Assessment, Development, and Evaluation approach, as well as health care information technology and the evidence classification scheme from the American Academy of Neurology. These commentaries were authored either by members of the NGC/NQMC Editorial Board or by experts working in conjunction with the board.
Accelerating Change and Transformation in Organizations and Networks
Accelerating Change and Transformation in Organizations and Networks (ACTION) is a 5-year implementation model of field-based research that fosters public-private collaboration in rapid-cycle, applied research. With a goal of turning research into practice, ACTION links many of the Nation's largest health care systems with its top health services researchers. As a network, ACTION provides health services in a wide variety of organizational care settings to at least 100 million Americans. From 2006 through 2010, ACTION partnerships have received close to 100 awards totaling more than $74 million.
ACTION funding has focused on task orders that relate directly to AHRQ's portfolio goals and performance measures. Examples of ACTION research include:
- HAI Reduction: In FY10, AHRQ awarded over $10 million for ACTION contract task orders that target HAI prevention in acute care hospitals, and ambulatory, hemodialysis, and long-term care facilities. A major focus of the HAI prevention work in ACTION involves nationwide spread of CUSP to reduce central line-associated blood stream infections in intensive care units (see Patient Safety Portfolio, Preventing Healthcare-Associated Infections).
- TeamSTEPPS® Spread: Another ACTION project is achieving national spread of TeamSTEPPS, an evidence-based teamwork system designed for improving communication and other teamwork skills among health care professionals (go to Patient Safety Portfolio, TeamSTEPPS). TeamSTEPPS includes a comprehensive set of ready-to-use materials and training curricula necessary to integrate teamwork principles successfully into a health care system. In FY10, 18 TeamSTEPPS 3-day master trainer courses were held at 5 Team Resource Centers across the country. There are now over 1,000 Master Trainers, who have in turn trained over 5,000 persons in TeamSTEPPS. AHRQ has funded follow-on work to continue training, evaluate impact, and sustain adoption.
- Improving Health Literacy: AHRQ's Pharmacy Health Literacy Center Web site (https://www.ahrq.gov/pharmhealthlit/) was developed as part of an ACTION contract designed to assess organizational responses to four tools designed to help pharmacists meet the needs of patients with low health literacy. The new Web site allows interested users to download the tools and to access online technical assistance in using them. The Web site also provides a variety of other health literacy resources for pharmacists. The four tools featured on the site were developed under an earlier ACTION contract.
- Improving Emergency Preparedness: Many of the emergency preparedness tools and products featured on AHRQ's Web site for Public Health Emergency Preparedness (https://www.ahrq.gov/prep/) were developed and tested in ACTION. AHRQ's publishing, marketing, and media efforts have resulted in the dissemination of 4,500 tools, tens of thousands of Web site visits, and 13,000 more subscribers to Public Health Emergency Preparedness GovDelivery list, which now has more than 23,000 subscribers.
Physical therapists use AHRQ's Research Activities for communicating with both clinicians and patients
For over 15 years, Kauffman-Gamber Physical Therapy in Pennsylvania has used AHRQ's Research Activities () as a reliable source of evidence-based information in communicating with both clinicians and patients.
Timothy L. Kauffman, Ph.D., PT, says, "I find this publication invaluable as a diverse collection of pertinent health care and societal issues. The work published in Research Activities frequently becomes part of our office staff meetings." With a professional staff of five physical therapists and four physical therapist assistants, the clinics—one in Lancaster and another in Millersville—provide approximately 1,200 patient treatments monthly.
As an example of how valuable the publication is to his practice, Kauffman found the October 2009 article on back pain and exercise especially useful to share with physicians, nurse practitioners, and physician assistants. The AHRQ-funded research findings in that issue helped demonstrate and support his clinic's treatment approach as important in promoting good patient outcomes.
The cited research, led by Timothy Carey, M.D., M.P.H., and colleagues at the Cecil G. Sheps Center for Health Services Research, showed that treatment by physical therapists or chiropractors was the strongest predictor of a patient's receiving an exercise prescription. In addition, compared with physicians and chiropractors, physical therapists were more likely to supervise the exercise program and prescribe strengthening and stretching exercises. The research also showed that physicians rely too much on prescribing narcotics and not enough on prescribing specific exercises to treat back and neck pain. Kauffman says, "This information is very important and must get out to other providers."
In addition to using Research Activities with his physical therapy staff and other clinicians, Kauffman uses the information in discussions with patients. He finds it helpful in educating patients about the value of a specific therapeutic exercise program—tailored to their individual situation—as an essential part of their physical therapy plan of care.
More information on ACTION partnerships and projects can be found on the AHRQ Web site at https://www.ahrq.gov/research/action.htm.
To build upon and maintain ACTION's successes, AHRQ made new 5-year awards to 17 new partnerships in September 2010. These ACTION II partnerships include over 350 collaborating organizations. Like ACTION, collectively these partnerships span all States. They now provide access and care to an estimated 50 percent of the U.S. population, representing a broad geographic, demographic, and payer mix for care recipients. The partnerships are composed of diverse organizations involved in health care delivery and dissemination and spread of findings, including: inpatient, ambulatory and long-term care health care providers, health plans, health services research organizations/networks, consumer and patient safety groups, professional or trade associations/organizations, and quality Improvement organizations.
ACTION II partnerships conduct practice-based implementation research focused on achieving one or more of the following four objectives:
- Test or expand investigation of innovations that are new to the health care field, (proofs of concept).
- Implement, in additional settings, interventions or improvement approaches that have been demonstrated to have worked in a limited type or number of settings.
- Spread, or take to scale, one or more proven innovations or delivery system improvements.
- Evaluate/support sustainability.
A particular focus of ACTION II will be to increase understanding not only of whether particular innovations "work," but how and why they work or not. ACTION II research is intended to be practice-based, implementation oriented, and rapid cycle. Information on ACTION II partnerships and projects is available on the AHRQ Web site at https://www.ahrq.gov/research/actionII.htm.
Health Care Innovations Exchange
AHRQ's Health Care Innovations Exchange is a comprehensive program designed to accelerate the development and adoption of innovations in health care delivery. This program supports the Agency's mission to improve the safety, effectiveness, patient-centeredness, timeliness, efficiency, and equity of care—with a particular emphasis on reducing disparities in health care and health among racial, ethnic, and socioeconomic groups.
The Innovations Exchange aims to increase awareness of innovative strategies and activities among health care providers in a timely manner by providing a central repository of searchable innovations and QualityTools. It consists of a compilation of practical tools for assessing, measuring, promoting, and improving the quality of health care that enables health care decisionmakers to quickly identify ideas and tools that meet their needs, a standardized description of innovations and QualityTools, and opportunities for learning and networking with like-minded adopters of innovations.
The Innovations Exchange has the following components:
Currently, the Health Care Innovations Exchange hosts 480 Innovation Profiles and more than 1,500 quality tools. The site also supports a learning network focused on coordination of community care for at-risk populations and offers occasional Web conferences. An example of some of the Web conferences held in FY10 are below:
Connecting Those at Risk to Care: A Guide to Building a Community "HUB" To Promote a System of Collaboration, Accountability, and Improved Outcomes that discussed AHRQ's newly published guide that lays out a step-by-step process for developing the infrastructure within a local community to improve the quality and coordination of health and social services for at-risk populations.
Innovative Roles of Pharmacists in Health Service Delivery that featured two innovative service delivery strategies that tap into the skills and qualifications of clinical pharmacists to influence patient medication management.
For more information, go to http://www.innovations.ahrq.gov.
In FY11, AHRQ is continuing to further its mission to improve the quality, safety, efficiency and effectiveness of health care for all Americans, in addition to its work to eliminate healthcareassociated infections, promote health IT, and provide data and information for decisionmaking. The evidence developed through AHRQ-sponsored research and analyses helps everyone involved in patient care make more informed decisions about what treatments work for whom, when and, at what point in their care. AHRQ will continue to invest in successful programs that develop and translate into evidence, knowledge and tools that can be used to make measurable improvements in health care in America through improved quality of care and patient outcomes.
ACTION—Accelerating Change and Transformation in Organizations and Networks
AHRQ—Agency for Healthcare Research and Quality
CAHPS®—Consumer Assessment of Healthcare Providers and Systems
CDC—Centers for Disease Control and Prevention
CER—Comparative Effectiveness Review
CERT—Center for Education and Research on Therapeutics
CMS—Centers for Medicare & Medicaid Services
CUSP—Comprehensive Unit-based Safety Program
CVE—Chartered Value Exchange
DEcIDE—Developing Evidence to Inform Decisions about Effectiveness
EHR—electronic health record
EMR—electronic medical record
EPC—Evidence-based Practice Center
ePSS—Electronic Preventive Services Selector
FY10—fiscal year 2010
health IT—health information technology
HCUP—Healthcare Cost and Utilization Project
HHS—Health and Human Services
HIE—health information exchange
HRSA—Health Resources and Services Administration
MEPS—Medical Expenditure Panel Survey
MONAHRQ—My Own Network, powered by AHRQ
NHDR—National Healthcare Disparities Report
NHQR—National Healthcare Quality Report
NRC—National Resource Center for Health Information Technology
PBRN—practice-based research networks
PCMH—Patient-Centered Medical Home
PSO—Patient Safety Organization
QIO—Quality Improvement Organization
TeamSTEPPS®—Team Strategies and Tools to Enhance Performance and Patient Safety
USPSTF—U.S. Preventive Services Task