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Remaking American Medicine

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Carolyn M. Clancy, M.D., Director of the Agency for Healthcare Research and Quality (AHRQ)

Remaking American Medicine Symposium in Washington, DC, September 27, 2006

Good afternoon. As always, it is a great pleasure and honor to speak on the same dais as my colleague, Don Berwick.  His dedication to health care quality and safety has made a measurable difference in the health care we receive every day.

I am very pleased to be here today to kick off the groundbreaking series "Remaking American Medicine" and to support ongoing promising efforts to improve quality through outreach campaigns across the country. I am extremely proud that the Agency for Healthcare Research and Quality, or AHRQ, is a national partner in this extraordinary effort.

I congratulate Frank Christopher and his colleagues for focusing on the very critical problems facing our health care system.  As we all know, knowing that a problem exists is only one small step in the process of improvement.  

This remarkable series takes many of the additional steps needed.  It will help accelerate the pace of improvement because it highlights promising practices that address the quality problems facing this nation.  In doing that, it pays tribute to the great champions for change who are working to ensure that our nation's health care system is safe and provides high-quality care. 

What is also thrilling about Remaking American Medicine is the nationwide network—or "quiet revolution"—that it has created.  The passion to transform our nation's health care system is clearly evident in this room, and we can almost feel the energy that it has created around the country. It has been very exiting to read about the events and discussions that are taking place nationwide, and rarely do I go to a meeting or conference where it is not mentioned.  People are looking forward to watching the series and, more importantly, to the impact that it will have.

At AHRQ, we felt an immediate connection to Remaking American Medicine because its themes are very close to our mission to improve the quality, safety, efficiency, and effectiveness of health care. 

These four themes clearly and articulately capture what our health care system must do to provide high-quality, safe, appropriate health care:

  • Involving patients and their families in their own care is a key element to improving health care quality.
  • Encouraging health care providers to collaborate and learn from each other how to improve the quality of health care, fostering transparency and inspiring creative solutions.
  • Encouraging partnerships between patients and providers in designing quality health care solutions to help ensure more efficient and effective delivery of health care.
  • Recognizing that nothing can be achieved if the concept of transparency is not fully embraced by health care institutions.  This is the cornerstone to remaking American medicine for all. 

We know that this is what the American people want because they aren't happy with the status quo. Earlier today, the Kaiser Family Foundation and AHRQ released an updated survey capturing the public's views and knowledge of medical errors and their experiences in taking steps aimed at improving the quality of their care.  This survey, which was conducted in August, is an update of surveys conducted by Kaiser, in conjunction with AHRQ, in 2002, and 2004.  Here are some highlights. 

In general, the 2006 survey found that there are more Americans—51 percent—who report being dissatisfied with the quality of health care—than those who say they are satisfied—41 percent.

More specifically, the survey found that more Americans reported that they understand the term "medical error"—55 percent in 2006, up from 43 percent in 2004 and 31 percent in 2002.  After being given a common definition of medical errors, some 43 percent say preventable medical errors occur "very often" or "somewhat often" when people seek care from a health professional.

The good news is that Americans are taking steps themselves to improve the quality of care they receive. 

  • 83 percent ask their doctor questions about their health or any treatment that he or she has prescribed.
  • 70 percent report that they check the medication given by their pharmacist against the doctor's prescription.
  • 54 percent bring a list of all their medications to a doctor's appointment—up from 48 percent in 2004.
  • 45 percent report bringing a friend or relative to a doctor's appointment to help ask questions.
  • One in three Americans say they or a family member has created a set of their medical records to ensure that their health care providers have all their medical information.

I'm glad that our efforts to help consumers and patients become more informed and empowered seem to be paying off.   Patients and their families are becoming increasingly involved in their own health and health care.  However, an empowered patient isn't enough to ensure high-quality, safe health care.  

As my predecessor, the late John Eisenberg, used to say, improving the quality and safety of health care is a team sport, and patients and clinicians need to be equal players.  Remaking American Medicine provides four excellent examples of how teamwork in health care can yield measurable improvements in health care.

I was very pleased to be interviewed for Program 4 of the series, titled "Hand in Hand," which discusses the evolving relationship between patients and clinicians, and chronicles the incredible Center for Patient and Family Centered Care at the Medical College of Georgia. Inspired by patients and their families, the Center is a model for the nation on creating a true partnership among patients, families, and clinicians.  The Center's staff and the institution are dedicated to keeping the patient at the center of all that it does. 

As a physician—and as an occasional patient and family member of a patient—I know from experience that patients and their families are the best advocates.  However, for their advocacy to be truly effective, the health care system must not only give them a voice, but also respect that voice.  

Currently, patients and families often have to be very forceful to be heard.  That's not acceptable, and we need to make the health care system better for patients and families, as well as for our nation's health care professionals.  One way we will get there is by making the health care system more transparent. The concept is integral to the themes of Remaking American Medicine and it is a top priority for HHS [Department of Health & Human Services] Secretary Mike Leavitt.  His goal is to make useful, understandable information on the quality and price of health care readily available to anyone who needs it. This information will help level the playing field between clinicians and patients because they both have the information needed to make health care decisions.

His initiative has four cornerstones:

  • Connect the System. Every medical provider will have some system for health records.  Increasingly, these systems are electronic.  Standards need to be set so all health information systems can quickly and securely communicate and exchange data.
  • Measure and Publish Quality. Every case, every procedure has an outcome.  Some are better than others.  To measure quality, we must work with doctors and hospitals to define benchmarks for what constitutes quality care.
  • Measure and Publish Price. Price information is useless unless cost is calculated for identical services.  Agreement is needed on what procedures are covered in each "episode of care."
  • Create Positive Incentives.  All parties—providers, patients, insurance plans, and payers—must be subject to contractual arrangements that reward those who offer and those who purchase high-quality, competitively priced health care.

These seem like lofty goals; however they are within our reach.  Last month, President Bush signed a White House executive order requiring federal agencies to use the four cornerstones as the foundation of the services they provide and the health care contracts they sign.  The President is looking to the federal government to set an example for the Nation.

Secretary Leavitt has galvanized the staff at HHS around this initiative.  He is traveling the country, meeting with clinicians, employers, hospitals, and others, to promote this effort.   The Centers for Medicare & Medicaid Services and AHRQ, working with the AQA [Ambulatory Care Quality Alliance] and Hospital Quality Alliances, are sponsoring what is now a six-site pilot project to get to a transparent health care system more quickly.  We soon will be adding additional sites.

As a nation, we know that we have a lot of work to do to improve the quality of our health care system.  It is worse than unacceptable that the U.S. health care system scored 66 out of 100 in the quality measures used by the Commonwealth Fund in its international survey of health care.  We spend more on health care than any other nation in the world and unfortunately we don't measure up.

I do have hope.  We've gone beyond documenting the problems to solving them, and Remaking American Medicine can re-energize our efforts and spur more action among clinicians, health systems, patients and their families.  Together we can transform the American health care system into one that provides the highest quality of care for all of its citizens.

Current as of September 2006


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