AHRQ Summit—Improving Health Care Quality for All Americans
Promising National Initiatives
Institute of Medicine
Janet M. Corrigan, Ph.D.
Senior Board Director for Health Care Services
Structural changes within health care organizations are needed to accelerate quality improvement efforts and address disparities.
We have made major progress in changing awareness about health care quality issues and have reached a turning point in addressing these issues.
When the Institute of Medicine (IOM) first published its report on medical errors, it met with much skepticism. We have learned since then about how to present reports to providers and communities:
- Align measures.
- Highlight priority areas.
- Give examples of population- and community-based initiatives.
To improve quality, we need better organizational support structures
To accelerate quality improvement efforts, we need better organizational support structures, including ways to harmonize traditional professional autonomy in the medical field with new team- and evidence-based approaches. In addition, we need:
- Better technological systems to track and improve patient outcomes.
- Better supports for team-based systems of care.
- Better payment mechanisms and systems.
- Ways to address cultural resistance to change.
We can take advantage of tools that have been developed and used in other industries—for example, the engineering sector.
It is critically important to look at our payment systems
We need to integrate population health and personal health care delivery. The highest rate of return is in population-level efforts to improve health, but our financing system puts the money in personal health care delivery.
The IOM has concluded that for systemic change, we need fundamental changes in our environment of care. It is planning the development of four new reports addressing the environmental levers of benefits design, payment policies, quality improvement, and technical assistance.
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Robert Wood Johnson Foundation
Risa Lavizzo-Mourey, M.D., M.B.A.
President and CEO
The Robert Wood Johnson (RWJ) Foundation has several initiatives to help Americans identify quality health care and to bring to light successful strategies and solutions that raise the bar on quality for minority populations..
Zero is the only acceptable disparity. We must press further in challenging health care disparities as a key element of quality improvement.
The American public has not been brought into the discussion of disparities in a meaningful way. As defined in the Quality Challenge, we do indeed need more candor regarding quality and disparities. We need to help consumers and policymakers understand what quality, patient-centered care looks like.
Issues of quality and disparities must be translated into plain language
The Robert Wood Johnson (RWJ) Foundation is supporting a four-part television series to air on PBS called Remaking American Medicine to translate issues of quality and disparities into plain language and improve public understanding and discussion regarding health care in this country.
The Foundation's "We Speak Together" program is aimed at improving communications and language within health care institutions to increase quality and collaboration. For example, this program has begun to identify universal symbols to use in health care facilities to reduce language barriers.
RWJ's "Expecting Success" project targets solutions that reduce disparity gaps
The RWJ Foundation is also addressing two more of the Quality Challenge Cs—comparison and consequences—with a project called "Expecting Success." This project will investigate the best solutions in inpatient and outpatient care for reducing disparity gaps related to specific issues or conditions (e.g., cardiovascular disease or patient safety) and raising the bar on quality for minority populations.
Finally, we can take heart that many leaders and providers are taking up the Quality Challenge. There are many people of courage who are instituting changes big and small to address quality and disparities. There is increased cooperation among quality improvement organizations and others focused on reducing disparities that is creating important, positive energy.
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American Health Quality Association
David G. Schulke
Executive Vice President
Quality improvement organizations are working within communities to share practical strategies for integrating quality improvement into their health care practices.
Quality improvement organizations (QIOs) address issues of how, when, and where to start changes to address quality improvements and disparities. To address the slow rate of progress in these areas, the QIOs are learning to work more closely together to expand their efforts.
The purpose of QIOs is to offer the practical, how-to information about promoting quality improvements within health care organizations. In areas such as nursing home care and heart disease, partnerships with QIOs have seen improvements.
To improve and expand the rate of progress, quality improvement organizations are:
- Sharing strategies on what works with the Office of Minority Health.
- Integrating the importance of changing to a culture of quality into the next round of QIO designation requirements
- Working more closely and actively with their communities to develop new alliances for quality, responding to community needs. One special initiative is focused particularly around discharge policies and practices for cardiac patients.
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We must fill in the information gaps faced by both the public and professionals
We cannot function on the belief that if we publish data and reports, some invisible hand will take over. The invisible hand does not know what to do. We must fill in the information gaps faced by both the public and professionals with greater networking, information sharing, and marketing.
The CDC is reorganizing two new centers to help address this gap: one devoted to health informatics and electronic health records and the other focused on health marketing. Both of these centers will address data collection and dissemination and explore how we can put channels into place to communicate more efficiently across different sectors.
Global changes may not address quality and disparities in diverse communities
Quality and disparities can vary across conditions and communities, so across-the-board changes may not be appropriate.
For example, in large urban areas such as Los Angeles, racial and ethnic definitions are too narrow to describe the wide diversity of cultures and subpopulations.
We need to encourage more dialogue and creative ways to disseminate information
In the past, QIO reviews were kept closed and secret, and they were seen as working at cross-purposes with purchasers. Over time, QIOs have shifted to promoting public reporting of results and focused more attention on the need for technical assistance to share results and strategies for improving quality.
We need to encourage more dialog with purchasers and providers to address issues such as return on investments in quality improvements or how to disseminate information that is valuable to consumers.
Children's health care quality and disparity issues should focus on prevention
The topic of children and their quality and disparity issues has been absent from this discussion. Yet children are disproportionately represented among the poor.
We need to include children in the discussion, particularly in health care provider education and among professional organizations. With children, we need to emphasize a preventive approach that focuses on both public policy and behavior changes. Cigarette smoking and asthma represent examples of children's health areas where a combination of approaches produces results that are far greater than the sum of the parts.
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AHRQ Publication No. 05-0084
Current as of June 2005
Previous Section Contents
AHRQ Summit—Improving Health Care Quality for All
Americans: Celebrating Success, Measuring Progress, Moving Forward.
Conference Summary. AHRQ Publication No. 05-0084, June 2005. Agency for
Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/qual/qsummit/