Health IT Enables Quality Measurement, but Obstacles Remain

Electronic Newsletter, Issue 353

The AHRQ Electronic Newsletter is issued periodically and summarizes Agency research and programmatic activities.

August 29, 2012

AHRQ Stats

In 2009, treating high blood pressure cost $47.5 billion, almost half of which went to pay for prescription medicines. [Source: Agency for Healthcare Research and Quality, MEPS Statistical Brief #371: Expenditures for Hypertension among Adults Age 18 and Older, 2009: Estimates for the U.S. Civilian Noninstitutionalized Population.

Today's Headlines

  1. Health IT enables quality measurement, but obstacles remain.
  2. Preventable hospitalizations decline among patients covered by Medicare managed care.
  3. Research review finds insufficient evidence on coronary artery disease treatments for women.
  4. Effectiveness of multidisciplinary rehab programs for traumatic brain injury patients is unclear.
  5. Web conference on e-prescribing: Overcoming barriers with successful implementation techniques.
  6. Comment period on health it enabled quality measurement extended to September 21.
  7. AHRQ in the professional literature. 

1. Health IT Enables Quality Measurement, but Obstacles Remain

AHRQ-funded research helped produce a range of improvements in how to measure quality using health information (IT) technologies, which are captured in a new report. Based on the experiences of 17 researchers, the synthesis report, Findings and Lessons from the Enabling Quality Measurement Through Health IT Grant Initiative, incorporates results from AHRQ-funded grants that examined the development of electronic quality measures, methods of capturing and integrating quality data in electronic health records (EHRs), the accuracy of IT-enabled measurements, methods for providing meaningful feedback to clinicians, and ways that health IT could improve the efficiency of quality measurement. In one example, Rainu Kaushal, M.D., of Weill Cornell Medical College led an initiative to generate and test the reliability of prioritized quality measures. Fifteen of these measures were subsequently included in Stage 1 Meaningful Use requirements. Select to access Dr. Kaushal's video. A second example describes how data can be transformed into meaningful feedback that clinicians can use to improve practice. Judith Logan, M.D., of Oregon Health Sciences University worked with clinicians to generate and report prioritized quality measures through interactive Web-based quality reports. Select to access Dr. Logan's video. To learn more about these projects, select to read their success stories. Select to the full synthesis report. 

2. Preventable Hospitalizations Decline Among Patients Covered by Medicare Managed Care

Preventable hospitalization rates for the patients enrolled in Medicare managed care plans declined significantly in Arizona, Massachusetts, and New York between 1995 and 2005, results of a new AHRQ-funded study show. Using Healthcare Cost and Utilization Project (HCUP) hospital discharge data, the study found that enrollment in Medicare managed care plans increased substantially during this period; the decline in preventable hospitalization rates became weaker over time. The purpose of the study was to determine the net result of Medicare changes enacted through the Balanced Budget Act of 1997 and the Medicare Modernization Act of 2003 and their impact on beneficiaries' access to quality primary care. AHRQ researcher Jayasree Basu, Ph.D., said the findings are important in light of an accelerated enrollment in private fee-for-service managed care plans after 2003, and a growing debate on their performance. The study, "Preventable Hospitalizations and Medicare Managed Care: A Small Area Analysis," was published in the August 20 issue of The American Journal of Managed Care. A reprint copy is available by sending an Email to ahrqpubs@ahrq.hhs.gov. 

3. Research Review Finds Insufficient Evidence on Coronary Artery Disease Treatments for Women

Current evidence is too limited to draw firm conclusions about the comparative benefits or harms of different treatment strategies for women with coronary artery disease, a new research review from AHRQ's Effective Health Care Program finds. However, some evidence suggests that women may respond differently than men to certain treatment strategies. More research is needed to assess how women respond to each heart disease treatment approach at various points in their care and to understand how demographic characteristics and clinical factors may affect treatment results. Select to access the review, Treatment Strategies for Women With Coronary Artery Disease. 

4. Effectiveness of Multidisciplinary Rehab Programs for Traumatic Brain Injury Patients is Unclear

Insufficient evidence exists to determine the effectiveness of multidisciplinary postacute rehabilitation programs for patients with moderate to severe traumatic brain injury (TBI), a new AHRQ Effective Health Care Program review concludes. These programs aim to improve the physical, cognitive, and behavioral health of the estimated 1.7 million people diagnosed annually with TBI. The differences and complexity of patient populations and treatment approaches within studies—including time since injury, injury severity, impairment type and severity, and different intervention approaches to address needs—make it difficult to carry out, combine, and draw firm conclusions from these studies. TBI occurs when an outside force causes a change of brain activity; severe injuries can lead to long-term disability. These findings and others can be found in the review, Multidisciplinary Postacute Rehabilitation for Moderate to Severe Traumatic Brain Injury in Adults. 

5. Web Conference on E-prescribing: Overcoming Barriers with Successful Implementation Techniques

IE-prescribing has the potential to improve health outcomes, yet providers face obstacles to implementation. Join AHRQ September 5 from 1:30-3:00 p.m. EST for a Web conference to discuss current challenges and strategies for physician practices and pharmacies to effectively use e-prescribing. Presenters will discuss toolsets developed for health care organizations and independent pharmacies to support more effective e-prescribing and challenges surrounding the adoption of e-prescribing of federally-controlled substances. Participants can earn credit hours for their participation if they attend the entire Web conference. Participants must complete an online evaluation in order to obtain a CE certificate. A link to the online evaluation system will be sent to participants who attend the Web Conference within 48 hours after the event. 

6. Comment Period on Health IT Enabled Quality Measurement Extended to September 21

AHRQ has issued a one-month extension on ways to improve quality measurement through health IT in the Federal Register for "Request for Information (RFI) on Quality Measurement Enabled by Health IT." Originally due by August, 21, the comment period is now open through September 21. The RFI seeks ideas and input from stakeholders such as health IT system developers, vendors, payers, quality measure developers, clinicians, and health care consumers, on successful strategies and remaining challenges in the creation of health IT-enabled quality measure development and reporting. An AHRQ-hosted webinar on July 31 provided background on the RFI and highlights of the report Quality Measurement Enabled by Health IT: Overview, Possibilities, and Challenges. Select to access the background report. Select to access the archived webinar. Select to access the August 22 Federal Register notice extending the comment period. 

7. AHRQ in the Professional Literature

We are providing the following hyperlinks to journal abstracts through PubMed® for your convenience. Access to the abstracts may be blocked because of firewalls or specific settings on individual computer systems. If you experience problems in accessing articles, ask your technical support staff for possible remedies.

Sankoff J, Hopkins E, Sasson C, Al-Tayyib A, et al. Payer status, race/ethnicity, and acceptance of free routine opt-out rapid HIV screening among emergency department patients. Am J Public Health 2012 May; 102(5):877-83. Select to access the abstract on PubMed.®

Bradley EH, Curry LA, Spatz ES, et al. Hospital strategies for reducing risk-standardized mortality rates in acute myocardial infarction. Ann Intern Med 2012 May 1; 156(9):618-26. Select to access the abstract on PubMed.®

Smith GL, Xu Y, Buchholz TA, Giordano SH, et al. Association between treatment with brachytherapy vs whole-breast irradiation and subsequent mastectomy, complications, and survival among older women with invasive breast cancer. JAMA 2012 May 2; 307(17):1827-37. Select to access the abstract on PubMed.®

Wakefield DS, Kruse RL, Wakefield BJ, et al. Consistency of patient preferences about a secure Internet-based patient communications portal: contemplating, enrolling, and using. Am J Med Qual 2012 Apr 18 [Epub ahead of print.] Select to access the abstract on PubMed.®

Sommers BD, Tomasi MR, Swartz K, et al. Reasons for the wide variation in Medicaid participation rates among States hold lessons for coverage expansion in 2014. Health Aff 2012 May; 31(5):909-19. Select to access the abstract on PubMed.®

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Current as of August 2012
Internet Citation: Health IT Enables Quality Measurement, but Obstacles Remain: Electronic Newsletter, Issue 353. August 2012. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/newsletters/e-newsletter/353.html