Budget Estimates for Appropriations Committees, Fiscal Year 2009: Online Performance Appendix

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Discontinued Performance Measures Table

Patient Safety

Quality/Safety of Patient Care

Long Term Goal: By 2010, prevent, mitigate and decrease the number of medical errors, patient safety risks and hazards, and quality gaps associated with health care and their harmful impact on patients.

Measure	FY	Target	Result
Identify the Threats By 2010, patient safety event reporting will be standard practice in 90% of hospitals nationwide. Outcome	2007	Initiate network of patient safety databases (NPSD) to identify emerging patient safety threats Dec-07	95% event reporting in hospitals
	2007	Continue use of the National Health Quality Report (NHQR), National Healthcare Disparities Report (NHDR), Patient Safety Indicators (PSIs) to monitor and report on changes in patient safety/quality	Complete
	2006	Use NHQR, NHDR, PSIs to monitor changes in patient safety/quality	2006 National Healthcare Quality Report 2006 National Healthcare Disparities Report
	2005	Continue support for data standards and taxonomy development for improved patient safety event reporting, data integration/usability	Data standards development is ongoing: Supported NQF taxonomy consensus building. Taxonomy approved 2005
	2005	Redesign PSIRS database system to produce NPSD which includes data specifications, standardized taxonomy	Dec-06
	2004	Develop a data warehouse and vocabulary server to process patient safety event data	Completed
	2003	Develop reporting mechanism and data structure through the National Patient Safety Network	Completed
Educate, Disseminate, and Implement to Enhance Patient Safety/Quality By 2010, successfully deploy practices such that medical errors are reduced nationwide. Outcome	2007	50 participants in the Patient Safety Improvement Corps (PSIC) Train-the-Trainer program will initiate local patient safety training activities	Dec-07
	2006	Implement and evaluate best practice use of NHQR-DR Asthma Quality Improvement Resource Guide and Workbook for State Leaders in 2 to 5 States	Dec-06 Michigan Arizona New Jersey
	2005	5 health care organizations/units of State/local governments will evaluate the impact of their patient safety best practices interventions.	Completed: 17 grant awards made for implementing patient safety improvement practices.
	2005	Implement and evaluate best practice use of NHQR-DR Diabetes Quality Improvement Resource Guide and Workbook for State Leaders in 2-5 States.	Completed: Diabetes workbook has been developed and 2 States (Delaware and Vermont) are engaged in using it and setting an action agenda.
	2004	6 health facilities or regional initiatives to implement interventions and service models on patient safety improvement will be in place	Completed
	2003	Awards to be made to at least 6 facilities or initiatives	Completed: 6 awards made
Educate, Disseminate, and Implement to Enhance Patient Safety/Quality By 2010, successfully deploy practices such that medical errors are reduced nationwide. Outcome	2007	50 participants in the PSIC Train-the-Trainer program will initiate local patient safety training activities	Dec-07
	2007	Hold annual patient safety/healthcare information technology conference	Dec-07
	2006	15 additional States/major health care systems will have on-site patient safety experts trained through the PSIC program	Completed: 16 States and 19 hospitals/health care systems participated in the PSIC
	2005	15 additional States/major health care systems will have on-site patient safety experts trained through the PSIC program	Completed: 19 States and 35 hospitals/health care systems participated in the PSIC
	2004	10 States/major health care systems will have on-site patient safety experts trained through the PSIC program	Completed: 15 States 13 hospitals-health care systems
	2004	5 health care organizations or units of State/local government will implement evidence-based proven safe practices	Completed: 7 organizations received grants to implement evidence-based safe practices
	2004	Develop 4 NHQR-DR Knowledge Packs on Quality for priority populations and care settings	Completed: Knowledge Packs were replaced by reports on gender, children, and inpatient care.
	2004	Conduct annual patient safety conference transferring research findings, products, and tools to users	Completed: Annual patient safety conference held Sept. 26-28, 2004
	2003	Established a Patient Safety Improvement Corp (PSIC) training program.	Completed
	2003	Award to 5 health care organizations or units of State/local government grants to implement evidence-based proven safety practices	Completed
Maintain vigilance By 2010, deploy and use measures of safety and quality for improvement in various care settings Outcome	2007	Initiate Network of Patient Safety Databases (NPSD)	Dec-07
	2007	Deliver fifth NHQR-DR	Dec-07
	2007	Use NPSD, NHQR, NHDR, PSIs to monitor changes in patient/safety quality	Dec-07
	2006	Deliver fourth NHQR-DR and continue use of NHQR, NHDR, PSIs to monitor changes in patient safety/quality	Completed: 4^th Annual NHQR/DR
	2005	Develop measures of patient safety culture (ambulatory and longer term care)	Dec-06 Contract award in FY2005
	2004	Develop measures of patient safety culture (hospital-based)	Completed
	2003	N/A	N/A

Data Source: Patient Safety Resource Coordinating Center (PSRCC) databases; NHQR/DR database

Data Validation: Spreadsheets are created and maintained for accepted applications to the program.

Cross Reference: HHS Goals and Objectives: 1.3; HP2010-1/17/23; HHS Priorities: Value-Driven Health Care

Health Information Technology (Health IT)

Long Term Goal: Most Americans will have access to and utilize a Personal Electronic Health Record by 2014.

Measure	FY	Target	Result
Hospitals using Computerized Physician Order Entry (CPOE) by 10%. (Retired measure that has exceeded its target). Outcome 1.3.6	2007	Increase to 15%	Completed: 27% American Hospital Association (AHA) Report
	2006	Provider utilization of computerized provider order entry (CPOE) increased to 15%	Completed: 21.9% of physician practices use e-prescribing
	2005	10% of hospitals using CPOE	Completed: 25% increase in the utilization of CPOE systems
	2005	10% of providers using CPOE	Completed: 14% of all medical group practices utilize a CPOE³
	2004	N/A	N/A
By 2008, in hospitals funded for CPOE, maintain a lowered medication error rate. Outcome 1.3.7	2007	Decrease preventable adverse drug events (ADEs) by 10%	Dec-07
	2006	Increase rate of detection by 75%	Duke hospital implementation completed early; extending work to ambulatory clinics. Funded eRx pilot at Brigham & Women's which focuses on ambulatory ADEs.
	2005	Increase the rate of detection by 50%	Funded implementation study
	2004	N/A	N/A

Data Source: Hospital CPOE usage as documented by the annual Healthcare Information and Management Systems Society (HIMSS) survey; Detection of ADEs noted in recent published articles (JAMA, Archives of Internal Medicine); Medical Group Management Association (MGMA) survey of Health IT uptake in physician offices; Leapfrog annual survey; Health System Change (HSC), Community Tracking Study (CTS).

Data Validation: Data obtained regarding ADE detection published in peer reviewed journals. HIMSS data verified by other smaller efforts. E-prescribing data validated by other surveys.

Cross Reference: HHS Goals and Objectives:1.2, 1.3, 4.4; HP2010-11/23;

HHS Priorities: Health Information Technology; Departmental Objectives: 7

Long-term Care

Long Term Goal: Improve quality and safety in all long-term care settings and during transitions across settings.

Measure	FY	Target	Result
Improve quality and safety in all long-term care settings and curing transitions across settings. Outcome 1.3.10	2007	Develop annual nursing home injurious falls draft measure in partnership with the Centers for Medicare & Medicaid Services (CMS); quantify baseline draft measure.	Dec-07
	2007	Develop partnerships, and access needs and barriers to the adoption of a 2nd generation injurious falls program in nursing homes.	Completed: Final report May 2007
	2007	Initiate dissemination activities for adoption of 2nd generation pressure ulcer intervention.	Dec-07 Completed
	2007	Implement and evaluate, in at least 30 nursing homes and in partnership with the State's Quality Improvement Organizations (QIOs), 2^nd generation nursing home pressure ulcer intervention.	Dec-08³
	2006	Synthesize recent research findings on what aspects of nursing home care prevents inappropriate hospitalizations.	Completed: Final Report Sep-06
	2006	Distribute report on implementation of evidence-based protocols for pressure ulcers prevention in nursing homes	Dec-08 Grantee requested a no-cost extension
	2006	Disseminate findings from AHRQ nursing home (NH) fall prevention program (FPP)	Completed: Journal publication. FPP Manual available in QIO Web site. QIO received FPP training.
	2005	Partner with a second NH chain that is embarking on fall prevention program.	Complete
	2004	Develop multi-faceted falls prevention program focused on high risk fallers based on evidence-based research and pilot in NH chain.	Complete
Improve coordination of formal long-term care with hospital care, primary care, and informal caregivers to facilitate clinical decisionmaking and assure timely transfer of clinical data. Outcome 1.3.11	2007	Complete initial identification of user needs and barriers associated with 2^nd generation e-communication tool use	Currently, there is little interest in home care industry to implement the communication tools.
	2007	Draft contractual award materials for 2008 multiple provider implementation of 2^nd generation e-communication tool in diverse geographic settings	Currently, there is little interest in home care industry to implement the communication tools.
	2007	Disseminate e-communication user aids and expanded network of provider partnerships to jumpstart use of e-communication tools by multiple provider organizations	E-user aids and tools developed; however, currently there is little interest in home care industry to implement the tools.
	2006	Initiate dissemination of e-communication tool (i.e., a Web-based tool to improve coordination between hospital, primary care and home care clinicians and patients and their informal care providers to improve care planning and self-care)	Completed: Initiated discussion with CMS. Presentation at professional meetings and with potential adopters.
	2005	N/A	N/A
	2004	N/A	N/A
Improve community-based care to maximize function and community participation, and prevent inappropriate institutionalization and hospitalizations. Outcome 1.3.12	2007	In partnership with CMS, develop annual draft measure of re-hospitalization from long-term care settings of persons receiving formal home health care; quantify baseline draft measure	Dec-07 Partnership with CMS established. Data analysis is in progress
	2006	New Freedom Initiative: Initiate evaluation plan to assess findings from youth in transition (from pediatric to adult services) projects.	Draft Resource Manual
	2006	Synthesize recent research findings on what aspects of community-based services and care in assisted living can prevent inappropriate institutionalization and hospitalizations	Complete: Final Report on Hospitalizations
	2005	N/A	N/A
	2004	N/A	N/A
Improve information about services and quality so that consumers can make informed choices about the care they receive. Outcome 1.3.13	2007	Initiate cognitive testing on 1st generation of assisted living/residential care consumer tools and resources (1^st priority measures)	Dec-08
	2006	Produce report on the state-of-the art instruments and tools available to profile assisted living/residential care	Report completed
	2006	Publish report on how States monitor assisted living/residential care facilities and how States report to consumers	Report posted: http://www.ahrq.gov/research/residentcare
	2006	Determine final sampling methodology and plan of implementation to enhance measurement on the long-term care population	Sample design memo completed in June 2006 as a contract deliverable.
	2005	N/A	N/A
	2004	N/A	N/A

Data Source: National Healthcare Quality Report based on CMS's Minimum Data Set and Outcome and Assessment Information Set (OASIS) data.

Data Validation: AHRQ products under go extensive peer review for merit and relevance.

Cross Reference: HHS Goals and Objectives: 1.3; HP2010-1; HHS Priorities: Value drive health care, Health IT, Medicaid Modernization, Personalized Health Care, Prevention

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