Director’s Update

1. Director’s Update Carolyn Clancy, MD National Advisory Council July 13, 2012

2. Member Updates New Roles: • Katherine Schneider, MD, MPhil – Medecision, Inc., Executive Vice President and Chief Medical Officer • Ardis Dee Hoven, MD – AMA, President-Elect • Welton O’Neal, Jr., BS, RPh, PharmD – Foundation for Managed Care Pharmacy, Executive Director and Academy of Managed Care Pharmacy, Vice President of Pharmacy Affairs

3. Overview • The Big Picture • FY 2012 • FY 2013 Budget Request • Recent Accomplishments • In the News • Impact Case Studies • AHRQ Program Updates • Today’s Agenda

4. FY 2012 Budget: $405M • $16.6M for Patient-Centered Outcomes Research (+$24M from the PCORTF) • $15.9M for Prevention/Care Management (+$12M from the Prevention and Public Health Fund) • $3.7M for Value Research • $25.6M for Health IT • $65.6M for Patient Safety ($34M HAI) • $108.4M for Cross-cutting ($15.9M in NEW grants)

5. FY 2013 Request: $408.8M • $10M for Patient-Centered Outcomes Research (+$62.4M from the PCORTF) • $15.9M for Prevention/Care Management (+$12M from the Prevention and Public Health Fund) • $3.6M for Value Research • $25.6M for Health IT • $62.6M for Patient Safety ($34M HAI) • $88.9M for Cross-cutting ($2.7M in NEW grants)

6. Overview • The Big Picture • FY 2012 • FY 2013 Budget Request • Recent Accomplishments • In the News • Impact Case Studies • AHRQ Program Updates • Today’s Agenda

7. 2011 National Healthcare Quality and Disparities Reports Released • Key findings from annual reports: • Quality of care improving slowly overall • Heart care improving greatly: • Reduced hospital admissions for congestive heart failure • Fewer heart attack deaths in hospitals • Access not improving for most minority groups • New data on: • Musculoskeletal diseases • Children’s health • EHR adoption www.ahrq.gov/qual/qrdr11.htm

8. Quality is Improving Slowly Quality measures that are improving, not changing or worsening, overall and for select populations • Nearly 60 percent of health care quality measures tracked showed improvement • However, the median rate of change was 2.5 percent per year AHRQ 2011 National Healthcare Quality and Disparities Reports

9. Few Disparities in Quality of Care Are Getting Smaller Quality measures for which disparities related to age, race, ethnicity and income are improving, not changing or worsening • Few disparities in quality showed significant improvement • The number of disparities that were getting smaller exceeded the number that were getting larger AHRQ 2011 National Healthcare Quality and Disparities Reports

10. National Quality Strategy – First Annual Progress Report • Released April 30, 2012 – www.workingforquality.ahrq.gov

11. Next Steps for NQS • Continue stakeholder engagement, particularly around the strategic opportunities for improvement identified by the National Quality Forum: • Identify a national strategy for data collection, measurement, and reporting • Develop organizational infrastructure at the community level that assumes responsibility for improvement efforts • Reform payment and delivery systems • Continue alignment and streamlining of measurement across HHS programs • Continue alignment of HHS programmatic goals with NQS priorities

12. New: 2011 State Snapshots • State-specific health care quality information, including strengths, weaknesses, and opportunities for improvement • Enables users to explore the quality of a State's health care against national rates or best performing States Maryland: Overall Care Quality vs. All States Average Weak Strong Very Weak Very Strong Performance Meter: All Measures = Most Recent Year = Baseline Year http://statesnapshots.ahrq.gov/snaps11/dashboard.jsp?menuId=4&state=MD&level=0

13. Web ‘Videonovela’ Helps PatientsCompare Diabetes Treatments • Spanish-language videonovela ‘Aprende a vivir’ (Learn to Live) • Three episodes of family drama portray challenges of managing diabetes • Nearly 12 percent of Hispanic adults age 20 and older have diabetes; Hispanics are twice as likely as whites to be hospitalized for diabetes complications www.healthcare411.ahrq.gov/aprendeavivir.aspx

14. Muscle Training Effective in TreatingUrinary Incontinence in Women • Urinary incontinence (involuntary loss of urine) is extremely common in adult women • Review of treatments for urinary incontinence finds: • Pelvic muscle floor training is effective without side effects • Drug-based treatments can work, but side effects are common www.effectivehealthcare.ahrq.gov

15. Arizona Health Care Cost Containment System • AHRQ’s “Vaginal Birth After Cesarean Section (VBAC): New Insights” and Medicaid Medical Directors Learning Network • Evidence report suggests that VBAC may be safe in large hospitals but research is mixed on outcomes in other settings, such as rural hospitals • Medicaid officials used findings to identify settings where VBAC services could be performed safely (KT-COE-100)

16. Highmark (PA, WV) • AHRQ’s Health Literacy Universal Precautions Toolkit and “Questions Are The Answer” public education campaign • Used to educate physicians about relationship between health literacy and outcomes • Provider Web site features AHRQ’s toolkit and a training module • Downloadable tools for patients include “Questions Are The Answer” campaign resources (CP3-12-02)

17. Hospitals in NE, NM, and NY • AHRQ’s “Preventing Hospital-Acquired Venous Thromboembolism (VTE): A Guide for Effective Quality Improvement” and QIO Learning Network • Some hospitals implemented new VTE protocols based on AHRQ • Toolkit used by some hospitals to revise existing point-based VTE assessment • New clinical approaches and protocols resulted in more appropriate VTE prevention tactics (KT-CQuIPS-97-99)

18. Hospitals in ME, GA, IN, MD, MO, and MI • AHRQ-funded toolkit, “Medications at Transition and Clinical Handoffs (MATCH)” and QIO Learning Network • Identified need for single medication history list • Hospitals redesigned their medication history lists based on toolkit’s “One Source of Truth” • Medication reconciliation compliance improved in participating hospitals (KT-CQuIPS-89-94)

19. Arkansas Department of Health • AHRQ’s MONAHRQ® Learning Network • Provided resources and tools to enable State Health Department to launch public MONAHRQ Web site • State’s Hospital Discharge Health Data Site includes county maps that compare potentially avoidable hospitalizations and patient conditions and procedures (KT-CDOM-96)

20. Maine Health Data Organization (MDHO) • AHRQ’s MONAHRQ® Learning Network • Learning Network provided in-person meetings, Web conferences, and online discussions on using MONAHRQ to publicly report data • MDHO’s MONAHRQ Web site includes State-specific inpatient discharge data from all non-specialty hospitals • Policymakers and hospitals are primary users of MDHO’s MONAHRQ Web site (KT-CDOM-96)

21. Utah Department of Health • MONAHRQ® • Used to create Utah Hospital Comparison Report • Online report compares performance of Utah hospitals on quality ratings and average hospital charges • Includes maps by county showing hospital rates of readmissions, adherence to care guidelines, and patient satisfaction • Using MONAHRQ cut report production time in half (CDOM-12-03)

22. Ohio Medicaid • AHRQ’s “Maternal and Neonatal Outcomes of Elective Induction of Labor” and Medicaid Medical Directors Learning Network • Found increase in Cesarean deliveries when labor is induced vs. spontaneous • Based on AHRQ report, Medicaid program reduced labor inductions without clear medical indications in near-term infants by 40% over 18 months • Prevented nearly 200 neonatal intensive care unit admissions (KT-COE-101)

23. Woodhull Medical and Mental Health Center (part of New York City Health and Hospital Corp.) • AHRQ’s Emergency Severity Index (ESI) triage system • Annual ED visits increased from 65,000 in 1998 to 100,000 in 2011 • Used ESI to handle the increase by improving emergency department’s (ED) patient flow, prevent care delays, and save costs through greater efficiency • Resulted in higher patient satisfaction scores and decreased ED waiting room times (CQuIPS-12-07)

24. Overview • The Big Picture • FY 2012 • FY 2013 Budget Request • Recent Accomplishments • In the News • Impact Case Studies • AHRQ Program Updates • Today’s Agenda

25. Web Site Redesign AHRQ’s Web site is one of the primary communications channels between AHRQ and its audiences • In 2009, AHRQ conducted a focus group on the Web site and found that the design, technology, and information architecture needed to be updated • In 2010, AHRQ refreshed the Home Page of AHRQ.gov based on the focus group findings • Evaluated current Web needs to identify the best process to manage content and enhance users’ experience

26. Proposed New Primary Navigation • Primary Navigation Labels: • Health Information • For Patients & Consumers • For Professionals • For Policymakers • Research & Data • Funding & Grants • Centers, Portfolios & Initiatives • News & Events • Utility Navigation Labels: • Home • About AHRQ • FAQs • Site Map • Contact Us • Text size adjuster Hands-on user testing conducted in May 2012 shows overall improvement in locating content as compared with August 2011 usability study in same tasks.

28. Forthcoming Release of 2011 Employer Health Insurance Offerings and Premiums • AHRQ’s MEPS Insurance Component is an annual survey of 40,000 establishments providing national and State-level estimates of employer sponsored health insurance coverage (ESI) • Used to assess trends in health insurance coverage, ESI, insurance take-up, eligibility for subsidies • Used to determine the small employer health insurance tax credit (part of ACA) • 2011 data release scheduled for this month

29. Collaboration With the National Cancer Institute and CDC • Collaboration with AHRQ, NCI, CDC, American Cancer Society, and the Livestrong Foundation • Enhancing the Medical Expenditure Panel Survey (MEPS) Content to Support Cancer Survivorship Research • Addition of questionnaire for households with cancer survivors to address cancer treatment and quality of care measures for cancer survivors and their families • Enhanced sample of cancer survivors included in MEPS, 2011-2012

30. Patient Safety Organizations (PSOs) • 75 current PSOs in the United States and Washington, DC • PSOs working with over 2000 U.S. providers, including over 1,600 hospitals • New PSOs include a component of the American College of Physicians • Common Formats (CF) Update: • Beta version of Readmissions CF to be published Summer 2012 • Coordinating Readmissions CF pilot test in the Veterans Administration hospital system in July 2012 • The Office of the National Coordinator sponsoring “Purple Button Challenge Award” • Calls for development of an application to enhance patient safety event reporting using Common Formats

31. 2012 TeamSTEPPS®Collaborative Meeting • 6th Annual “TeamSTEPPS® National Conference: From What? to How?” • June 2012, Nashville,TN • Unprecedented number of new attendees • Many affiliated with a Hospital Engagement Network • Shared best practices to promote executive leadership engagement for TeamSTEPPS • Previewed upcoming modules: Long-Term Care, Primary Care, Limited English Proficiency

32. Healthcare-Associated Infections Agency Priority Goal (HAI-APG) • Collaborative, cross-departmental effort: AHRQ, CMS (lead), CDC, and OASH • HAI-APG: 1 of 6 HHS APGs being tracked by HHS and OMB • Goals: Reduce hospital-acquired CLABSI and CAUTI by September 30, 2013 (with respect to 2010 baseline levels) • CAUTI by 20% • CLABSI by 25% • Final project results due in September 2012

33. Uniformed Services University of Health Sciences (USUHS) • Pilot graduate-level course titled “Patient Safety & Quality in an IT-driven World” • Novel partnership for USUHS and AHRQ • Content explored theoretical underpinnings and applications of patient safety and health IT legislation and initiatives

34. Organisation for Economic Co-operation and Development (OECD) • OECD is using AHRQ Quality Indicators for its Health at a Glance program – tracks and compares health and health care across member countries • Patient Safety Indicators • Preventable Quality Indicators for reporting on potentially preventable hospitalization rates *AHRQ’s HCUP/NHQR teams provide the U.S. statistics to OECD.

35. AHRQ Research Makes Health Affairs’ Top Ten List #2 New Federal Policy Initiatives To Boost Health Literacy Can Help The Nation Move Beyond The Cycle Of Costly ‘Crisis Care’ (authors include AHRQ’s Carolyn Clancy and Cindy Brach, January 2012) #9 An Experiment Shows That A Well-Designed Report On Costs And Quality Can Help Consumers Choose High-Value Health Care (Judith Hibbard, et al, March 2012) Top 10 "Most-Read“ Articles January-June 2012

36. New Public Portal on Integration of Behavioral Health & Primary Care integrationacademy.ahrq.gov

37. New Self Management Support Resources

38. Update From the U.S. Preventive Services Task Force • Five final recommendations released since last NAC meeting • Counseling to Prevent Skin Cancer (May 8) • Screening for Prostate Cancer (May 22) • Interventions to Prevent Falls in Community-dwelling Older Adults (May 29) • Screening for and Management of Obesity in Adults (June 26) • Behavioral Counseling to Promote a Healthful Diet and Physical Activity for CVD Prevention in Adults (June 26) • Five draft recommendations posted for public comment since last NAC meeting

39. New Materials for Consumers

40. MONAHRQ – New Version 3.0 • Additional indicators and health topics • 4 additional AHRQ QIs, including composite measures • 12 additional Hospital Compare measures • New health topic on nursing sensitive care • New customization options • Updated coding changes and new technical design features • HCUP cost-to-charge ratios convert charges to costs

41. New Materials for Clinicians

42. A Toolset for E-Prescribing Implementation in Independent Pharmacies • Guides independent pharmacies through the process of adopting e-prescribing • Illustrates how to assess pharmacy workflows to determine whether changes or updates are needed to a pharmacy software system • Discusses hurdles and problems that can arise when implementing e-prescribing

43. A Toolset for E-Prescribing Implementation in Physician Offices • Designed for small, independent offices to large medical groups • Supports implementation of e-prescribing, whether as a stand-alone system or as a component of a full EHR • Useful for providers who have not achieved the full potential of their current e-prescribing system Both available at: http://healthit.ahrq.gov/eprescribingtoolsets

44. Enabling Patient-Centered Care Through Health Information Technology – EPC Report • While Health IT was shown to improve outcomes, few studies demonstrated impact on patient-centered care (as defined by the IOM) • 14 studies focused on improving responsiveness to the needs and preferences of individual patients • 25 studies focused on improving shared decisionmaking or related measures of patient-clinician communication or access to information Available at http://www.ahrq.gov/clinic/tp/pcchittp.htm

45. Using Health IT in Workflow Redesign: Impact of Health IT on Workflow • Two ACTION II task orders awarded • Study implementation of health IT to support practice redesign in ambulatory care settings • Further understand causal relationships between health IT and workflow processes • Billings Clinic • Three practices from Billings Clinic (Billings, MT) and Cabin Creek Health Systems (Dawes, WV), each • Time and motion studies, observations, software logs, and interviews to study pre, during, and post implementation • RTI • Six practices at different stages of implementing “MyHealthTeam” to support care coordination • Observations, interviews, software tracking, and review of outcomes

46. Project ECHO • Funded by AHRQ in 2004; subsequent funding from RWJF and now CMMI • Results published in NEJM last year: • Reduced rural disparities in care • Improved provider satisfaction • Adopted by the Veterans Health Administration 7/11/12

47. Electronic Data Methods (EDM) Forum • ARRA grant to AcademyHealth to convene PROSPECT, DRN, and enhanced registry (for QI and CER) investigators and other stakeholders to: • Collect, synthesize, and share lessons learned in building an electronic data infrastructure for CER • Advance methods to overcome common barriers in CER analytics, informatics, and governance • Disseminate knowledge through electronic documents and Webinars posted at www.edm-forum.org and articles in journal supplements

48. First Journal Supplement • 14 commissioned and invited papers • Informed by ongoing ARRA-funded work • Three domains: • Analytic Methods • Clinical Informatics • Governance • Available at www.edm-forum.org

49. Ongoing Activities • Working on a JAMIA journal supplement • Symposia, Webinars, and issue briefs • eGEMS: electronic publications Generating Evidence and Methods (to improve outcomes) • New publication avenue starting in August • Diverse products: original articles, protocols and best practices, conceptual frameworks, data visualizations, white papers, tutorials, continuing education tools • Timely, useful, credible content

50. EDM Forum: Organizational Chart