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Twenty Quality Priority Areas. Internet 2 J. Michael Fitzmaurice, Ph.D. Agency for Healthcare Research and Quality. Agenda. AHRQ/Landscape Setting Priorities Priority Areas Future. FY 1995 - FY 2003 Appropriation History Dollar in Millions. September 3, 2002 J:/fms/FY90-03apphist.ppt.

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twenty quality priority areas

Twenty Quality Priority Areas

Internet 2

J. Michael Fitzmaurice, Ph.D.

Agency for Healthcare Research and Quality

  • AHRQ/Landscape
  • Setting Priorities
  • Priority Areas
  • Future
fy 1995 fy 2003 appropriation history dollar in millions
FY 1995 - FY 2003 Appropriation HistoryDollar in Millions

September 3, 2002


ahrq mission
AHRQ Mission
  • To support, conduct, and disseminate research that improves the outcomes, quality, access to, and cost and utilization of health care services
    • AHRQ is the lead Federal agency in research for improving the quality of care
    • Research to improve clinical, health care system, and public policy decisions
secretary tommy thompson march 21 2003
Secretary Tommy ThompsonMarch 21, 2003

In the modern era, every century has had its major

advance that has brought medical science another

giant step forward. In the 18th century, vaccination

offered precious immunity from age-old plagues.

The 19th century introduced knowledge of bacteria

and disease transmission. The 20th century brought

us the miracle of antibiotics. What will the major

advance of the 21st century be? Iam convinced that

the medical revolution of our children’s lifetimes will be the application of information technology to health care.

ahrq quality indicator qi sets
Prevention Quality


Inpatient Quality Indicators

Patient Safety Indicators

(released March 2003)

Ambulatory care sensitive


Mortality following procedures

Mortality for medical conditions

Utilization of procedures

Volume of procedures

Post-operative complications

Iatrogenic conditions

AHRQ Quality Indicator (QI) Sets
current qi activities
User-friendly package for Prevention QI module

User-friendly package for Inpatient QI module

Stanford completes Patient Safety Indicators

User-friendly package for Patient Safety QI module

Continued development

CMS collaboration

Analysis for National Quality Report








Current QI Activities
  • IOM, To Err is Human, Building a Safer Health System (2002)
    • Patient safety is a major problem in the US
    • Between 44,000 and 98,000 lives are lost annually as a result of medical errors in hospitals
    • Health systems do not adequately support health professionals and patients
  • IOM, Crossing the Quality Chasm:
    • Large gaps in health care quality exist
    • Inadequate health care delivery system to implement effective treatments
  • A New Health System for the 21st Century (2001)
    • More responsive to patients’ needs
    • More capable of delivering science-based care
  • How to improve quality--Chasm guidance
    • Promote a focus on improving care in a limited set of priority areas
    • Chronic conditions
      • Should have emphasis
      • They account for much of the health care burden and use of resources
    • Invoke collaborative efforts
bridging the quality chasm
Bridging the Quality Chasm

Where Where We

We Are Want To Be







ten highest cost conditions
Heart Disease ($58B)

Cancer ($46B)

Trauma ($44B)

Mental Disorders ($30B)

Pulmonary Conditions ($29B)

Diabetes ($20B)

Hypertension ($18B)

Cerebrovascular Disease ($16B)

Osteoarthritis ($16B)

Pneumonia ($16B)

Ten Highest Cost Conditions

Source: J. Cohen and N. Krauss, “Spending and Service Use Among People with the Fifteen Most Costly Medical Conditions, 1997,” Health Affairs, March/April 2003.

which priority areas
Which priority areas?
  • HHS contracted with IOM
    • To select criteria for screening potential priority areas
    • To develop a process for applying those criteria
    • To generate a list of 12-20 candidate areas
priority areas for national action transforming health care quality
Priority Areas for National Action: Transforming Health Care Quality
  • IOM (2003) Goal
    • To identify priority areas that presented the greatest opportunity to narrow the gap between what the health care system is routinely doing now and what we know to be the best medical practice
      • Improve the delivery of existing best practice treatments.
  • Based on
    • Foundation for Accountability (1997)
    • IOM, National Health Care Quality Report (2001)
  • Five domains
    • Staying healthy (preventive care)
    • Getting better (acute care)
    • Living with illness/disability (chronic care)
    • Coping with end of life (palliative care)
    • Cross-cutting systems interventions (coordination of care)
priority area selection criteria
Priority Area Selection Criteria
  • Impact
    • Burden: disability, mortality, economic costs
  • Improvability
    • Gap between current and evidence-based best practice --size and probability of improvement
  • Inclusiveness
    • Range--(equity) of individuals (socioeconomic, r/e, gender)
    • Generalizability--(representativeness) to many conditions
    • Breadth--(reach) across settings and providers
what s the process
What’s the process?
  • Determine a framework for the priority areas
  • Identify candidate areas
  • Establish criteria for selecting final priority areas
  • Apply impact and inclusiveness to the candidates
  • Apply criteria of improvability and inclusiveness to the preliminary set of areas obtained in the step above
what s the process 2
What’s the process? (2)
  • Identify priority areas, reassess, and approve
  • Finally
    • Implement strategies for improving care in he priority areas,
    • Measure the impact of implementation
    • Review/update the list of areas\
what are the priority areas
What are the priority areas?
  • Care coordination (cc)
  • Self-management/health literacy (cc)
  • Asthma--appropriate treatment for persons with mile/moderate asthma
  • Cancer screening that is evidence-based--focus on colorectal and cervical cancer
priority areas 2
Priority Areas (2)
  • Children with special health care needs
  • Diabetes--focus on appropriate management of early disease
  • End of life with advanced organ system failure--focus on congestive heart failure and chronic obstructive pulmonary disease
  • Frailty associated with old age--preventing falls and pressure ulcers, maximizing function, and developing advanced care plans
priority areas 3
Priority Areas (3)
  • Hypertension--focus on appropriate management of early disease
  • immunization--children and adults
  • Ischemic heart disease--prevention, reduction of recurring events, and optimization of functional capacity
  • Major depression--screening and treatment
priority areas 4
Priority Areas (4)
  • Medication management--preventing medication errors and overuse of antibiotics
  • Nosocomial infections--prevention and surveillance
  • Pain control in advanced cancer
  • Pregnancy and childbirth--appropriate prenatal and intrapartum care
priority areas 5
Priority Areas (5)
  • Severe and persistent mental illness--focus on treatment in the public sector
  • Stroke--early intervention and rehabilitation
  • Tobacco dependence treatment in adults
  • Obesity (an emerging area)
what for the future
What for the future?
  • Data collection and measurement systems for ... quality improvement efforts
  • Support development of … standardized measures of quality
  • Report measures of key attributes and outcomes to the public
  • Revise selection criteria and priority area list
what for the future1
What for the future?
  • Review evidence based and update priorities every 3-5 years
  • Assess changes in society’s attributes that could affect health and alter priorities
  • Disseminate the results of strategies for QI in the priority areas
  • This is the development of a strategy for addressing the high priority areas of health care
  • Determining the priorities is a collaborative process
  • These priorities are for everyone
twenty quality priority areas1

Twenty Quality Priority Areas

Internet 2

J. Michael Fitzmaurice, Ph.D.

Agency for Healthcare Research and Quality

practice based research networks
Practice-Based Research Networks
  • AHRQ supports research in groups of physician practices on such topics as: automated electronic reminders to
    • Improve compliance with guidelines for managing patients with diabetes
    • Improve screening and detection of patients at higher risk for tuberculosis using CDC guidelines
    • Improve lipid management (improving cholesterol and calculating the risk of cardiovascular disease for a patient)
practice based research networks pbrns
Practice-Based Research Networks (PBRNs)

36 new PBRN grants awarded in 2002

19 PBRN grants awarded in 2000