An Overview of the Agency for Healthcare Research and Quality

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An Overview of the Agency for Healthcare
Research and QualityThe Patient Safety and
Quality Improvement ActWilliam B. Munier, MD

• Michigan Health Safety Coalition Conference
• 29 March 2006

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Todays Agenda

• Agency for Healthcare Research and Quality (AHRQ)
• Center for Quality Improvement and Patient Safety
  (CQuIPS)
• Patient Safety and Quality Improvement Act

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AHRQ Mission

• AHRQ is the lead Federal agency charged with
  improving the quality, safety, efficiency, and
  effectiveness of health care for all Americans
• One of 12 agencies within DHHS
• Supports health services research that will
  improve the quality of care and promote
  evidence-based decisionmaking

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AHRQ Facts

• Director Carolyn Clancy, MD
• Staff Approximately 300
• FY 06 Budget 318.7 million
• Research comprises 80 of budget, invested in
  grants and contracts focused on improving health
  care

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CQuIPS within AHRQ
Office of the Director
Center for Primary Care, Prevention Clinical
Partnerships
Office of Performance, Accountability,
Resources Technology
Center for Quality Improvement Patient Safety
Office of Extramural Research, Education
Priority Populations
Center for Delivery, Organizations Markets
Center for Financing, Access Cost Trends
Office of Communications Knowledge Transfer
Center for Outcomes Evidence
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CQuIPS

• Patient safety research, education and
  training, development and dissemination of
  information
• National Healthcare Quality and Disparities
  Reports
• National report on quality
• National report on disparities
• Disease-specific reports
• State snapshots

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• Making the case
• Whats the data
• Turning data into information
• Learning from others
• Developing a QI plan
• Moving the agenda forward

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CQuIPS

• Consumer Assessment of Healthcare Providers and
  Systems (CAHPS)
• Quality improvement
• Conducting and supporting user-driven research
• Disseminating reports and information
• Patient Safety and Quality Improvement Act PL
  109-41

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PSQIA PL 109-41

• Purpose of Act
• To provide for the improvement of patient safety
• To reduce the incidence of events that adversely
  affect patient safety

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Major Provisions of Act

• Creates Patient Safety Organizations (PSOs)
• Establishes Network of Patient Safety Databases
  (NPSD)
• Mandates Comptroller General to study
  effectiveness of Act (by 2010)
• Is a completely voluntary system

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What is the Problem?

• Providers fear that patient safety analyses can
  be used against them in court (malpractice) or in
  disciplinary proceedings
• State laws offer inadequate protection (e.g.,
  large providers cannot share analyses system-wide
  without risk)
• Patient safety improvement is hampered by the
  inability to aggregate data by analyzing large
  numbers of events, patterns of failures could be
  more rapidly identified

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The Act Addresses These Issues

• Authorizes creation of PSOs that enter into
  contracts with providers to assist them in
  analyzing threats to patient safety and
  correcting or preventing them
• Requires PSOs to work with more than one provider
  so that PSOs can aggregate data across providers
  and with other PSOs
• Provides Federal confidentiality protections for
  these analyses and significantly limits their use
  in criminal, civil, and administrative proceedings

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Principal Implementation Strategies

• Build on existing work
• Sharp end infrastructure
• Private sector resources
• Previous conceptual work (JCAHO NQF)
• Coordinate DHHS/Federal efforts
• Use IT to maximum extent practical
• Keep it simple

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Two Basic Tracks

• Development and operation of PSOs
• Fostering an operational network of patient
  safety databases

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Supporting Activities

• Public listening sessions (just concluded)
• Developing regulations to govern the operations
  of the PSO program
• Compiling an inventory of operational patient
  safety reporting systems
• Scope, operations, and output of reporting
  systems
• Patient safety incident definitions (data element
  level)

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Issues Requiring Rulemaking

• AHRQ PSOs
• Certification, operation, and revocation of
  certification
• Office of Civil Rights Confidentiality
• The Act necessitates new confidentiality
  standards as well as guidance on how and when to
  assess civil monetary penalties

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PSO Program

• PSO certification processing system
• Reviewing accepting initial, subsequent PSO
  certifications
• Certification statements
• Optional narratives (under consideration)
• Disclosures
• Handling complaints revoking acceptance of
  certification
• Technical assistance
• Collecting, analyzing reports
• Providing strategies to improve patient safety
• Annual meeting

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Issues Requiring Clarification

• The Act establishes two novel concepts
• Patient Safety Work Product
• Patient Safety Evaluation System
• To be protected, information must be considered
  patient safety work product and be in the
  patient safety evaluation system
• Raises the issue of who where patient safety
  reporting, analysis, etc. are carried out

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NPSD Objectives

• To generate information relevant to preventing
  harm to patients from health care
  (aggregate/analyze incident data disseminate
  results)
• To employ interoperable terms, definitions of
  patient safety incidents
• To simplify task of reporting incidents
• To provide benchmarking and trend reports
• To share de-identified data for use in improving
  patient safety

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Next Steps

• Finish inventory of data elements, definitions
  encoding schemes used currently to
• Inform development of common formats
• Provide technical assistance to PSOs
• Consider options for fostering development of
  network of patient safety databases
• Plan for inclusion of patient safety information
  on performance, trends AHRQs NHQR/DR

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Discussion
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For Additional Information

• http//www.ahrq.gov
• William.Munier_at_ahrq.hhs.gov