Quality of Care

AHRQ's National Healthcare Quality and Disparities Reports: An Ever-Expanding Road Map for Improvement. J. Brady, K. Ho, E. Kelley, C. Clancy, Health Services Research 42(3): June 2007, xi-xxi. Discusses refinements that have been made in the National Healthcare Quality Report and National Healthcare Disparities Report and describes a new Web site and online resources for quality and disparities data. (AHRQ 07-R061)

All or None Measurement: Why We Know So Little About the Comprehensiveness of Care. E. Kelley, International Journal for Quality in Health Care 19(1):2007, 1-3. Discusses the benefits and limitations of using an "all or none" approach to assessing quality of care by looking at data at the patient level to examine whether a bundle or set of evidence-based interventions that are supposed to be done for the patient are actually done for the patient. (AHRQ 07-R058)

Assessing the Validity of Self-Reported Medication Adherence in Hepatitis C Treatment. S. Smith, A. Wahed, S. Kelley, et al., Annals of Pharmacotherapy 41: July/August 2007, 1116-1123. Assesses the validity of self-reported medication adherence provided by individuals in treatment for hepatitis C virus infection with a regimen of peginterferon and ribavirin. (AHRQ 08-R003)

Asthma Care Quality Improvement. Agency for Healthcare Research and Quality, 2006. A resource guide and workbook to help State leaders implement quality improvement plans or enhance existing plans for asthma care in their States.
Resource Guide. 151 pp. (AHRQ 06-0012-1)
Workbook. 39 pp. (AHRQ 06-0012-2)

Best Practice Implementation: Lessons Learned from 20 Partnerships. P. Sharek, C. Mullican, A. Lavanderos, et al., Joint Commission Journal on Quality and Patient Safety 33(12 Suppl): December 2007, 16-26. Identifies the most important perceived barriers to implementation witnessed in the 20 multiyear AHRQ Partnerships for Quality projects and describes successful and unsuccessful strategies reported by these partnerships to overcome the most significant of these barriers. (AHRQ 08-R038)

Board Engagement in Quality: Findings of a Survey of Hospital and System Leaders. H. Jiang, C. Lockee, K. Bass, et al., Journal of Healthcare Management 53(2): March/April 2008, 121-135. Presents and discusses the results of a survey of hospital and system leaders that was conducted in the first half of 2006 with 562 respondents to determine leadership involvement in quality improvement planning and activities. (AHRQ 08-R057)

Board Oversight of Quality: Any Differences in Process of Care and Mortality? H. Jiang, C. Lockee, K. Bass, et al., Journal of Healthcare Management 54(1):January/February 2009, 15-30. Examines differences in hospital quality performance associated with the adoption of particular practices in oversight of quality by hospital governing boards. (AHRQ 09-R041)

Building Capacity for a Transformation Initiative: System Redesign at Denver Health. M. Harrison, J. Kimani, Health Care Management Review, 34(1):January-March 2009, 42-53. Examines the development of transformation initiatives—deliberate attempts to achieve systemic changes and rapid performance improvements—over a 2-year period at an integrated safety net health system. (AHRQ 09-R017)

Design of the Physical Environment for Changing Healthcare Needs. C. Clancy, S. Isaacson, K. Henriksen, Health Environments Research & Design Journal 1(1): Fall 2007, 10-11. Discusses the role of the physical environment—including light, noise, air quality, toxic exposures, temperature, humidity, and so on—in health care organizations and how improvements in the physical environment might lead to improvements in quality of care. (AHRQ 08-R027)

Designing and Implementing Medicaid Disease and Care Management Programs: A User's Guide. Agency for Healthcare Research and Quality, March 2008, 180 pp. Presents information, examples, and checklists to help States design, implement, and evaluate Medicaid care management programs for the chronically ill. (AHRQ 07(08)-0063)

Diabetes Care Quality Improvement. Agency for Healthcare Research and Quality, 2004. A resource guide, supplement, and workbook to help State leaders implement quality improvement plans or enhance existing plans for diabetes care in their States.
Resource Guide. 162 pp. (AHRQ 04-0072)
Supplement to the Resource Guide. 4 pp. (AHRQ 04(05)-0072-1)
Workbook. 42 pp. (AHRQ 04-0073)

Disseminating QI Interventions. G. Boratgis, S. Broderick, M. Callahan, et al., Joint Commission Journal on Quality and Patient Safety 33(12 Suppl): December 2007, 48-65. Describes the AHRQ's Partnerships for Quality Dissemination Planning Tool, which was used to identify the most appropriate partners to disseminate the quality improvement interventions for three projects-that is, the partners most likely to reach and influence the target audience(s). (AHRQ 08-R041)

Effects of Hospital Competition on Inpatient Quality of Care. R. Mutter, H. Wong, M. Goldfarb, Inquiry 45:Fall 2008, 263-279. Applies AHRQ's Quality Indicator software to the 1997 Healthcare Cost and Utilization Project State Inpatient Databases to create three versions of 38 distinct measures of inpatient quality and assesses 12 different hospital competition measures against the quality measures. (AHRQ 09-R042)

Emergency Departments in Crisis: Implications for Accessibility, Quality, and Safety. C. Clancy, American Journal of Medical Quality 22(1): January/February 2007, 59-62. Examines the role of hospital emergency departments in providing emergency care and more routine treatment, including current challenges and efforts to ensure continued quality and safety of care. (AHRQ 07-R038)

Emergency Departments in Crisis: Opportunities for Research. C. Clancy, Health Services Research 42(1, Part 1): February 2007, xiii-xx. Discusses the state of emergency medicine and describes opportunities for research on ways to improve the quality of emergency medicine and care in hospital emergency departments. (AHRQ 07-R041)

Enhancing Quality Improvement. C. Clancy, Healthcare Papers, 6(3):2006, 46-50. Discusses the significant opportunities for improvements in quality of care in most, if not all, developed nations. (AHRQ 07-R005)

Evaluating the Impact of Partnerships to Improve Clinical Quality. N. Donaldson, S. Horn, J. Edwards, et al., Joint Commission Journal on Quality and Patient Safety 33(12 Suppl): December 2007, 27-36. Describes the AHRQ's Partnerships for Quality Framework for Evaluating the Impact of Partnerships on research translation and presents a pragmatic tool for evaluating the impact of partnership-driven translation and implementation research projects. Includes examples of the application of the tool to evaluate the impact of real-world partnerships, demonstrating its utility across varied partnerships. (AHRQ 08-R039)

Finding Order in Heterogeneity: Types of Quality Improvement Intervention Publications. L. Rubenstein, S. Hempel, M. Farmer, et al., Quality and Safety in Health Care, 17(6):December 2008, 394-395. This commentary explores the heterogeneity in clinical quality improvement intervention publications. (AHRQ 09-R022)

Frontiers in Gender-Based Research: Health Care Quality Data. E. Moy, E. Dayton, Women's Health Issues 17(6): November/December 2007, 334-337. Editorial discusses underused data sources included in the appendixes of AHRQ's National Healthcare Disparities Report that can be used to examine disparities in health care based on sex. (AHRQ 08-R048)

Hospital and Demographic Influences on the Disposition of Transient Ischemic Attack. J. Coben, P. Owens, C. Steiner, et al., Academic Emergency Medicine 15(2): February 2008, 171-176. Examines the influence of clinical, sociodemographic, and hospital characteristics on emergency department dispositions of patients diagnosed with transient ischemic attack. (AHRQ 08-R063)

Hospital Quality, Efficiency, and Input Slack Differentials. V. Valdmanis, M. Rosko, R. Mutter, Health Services Research, 43(5):December 2008, 1830-1848. Examines the effects of hospital inefficiency on quality of care in public, not-for-profit, and teaching hospitals. (AHRQ 09-R005)

How Do Hospital Organizational Structure and Processes Affect Quality of Care? A Critical Review of Research Methods. L. Hearld, J. Alexander, I. Fraser, et al., Medical Care Research and Review, 65(3): June 2008, 259-299. Reviews the literature on the relationship between the structural characteristics and organizational processes of hospitals and quality of care. (AHRQ 08-R083)

Identification of Hospital-Acquired Catheter-Associated Urinary Tract Infections from Medicare Claims. C. Zhan, A. Elixhauser, C. Richards, et al., Medical Care 47(3):March 2009, 364-369. Discusses the positive predictive value and sensitivity in identifying patients in Medicare claims who had urinary catheterization and developed hospital-acquired catheter-associated urinary tract infections. (AHRQ 09-R046)

Improving Efficiency and Value in Health Care: Introduction. I. Fraser, W. Encinosa, S. Glied, Health Services Research, 43(5 Part II):October 2008, 1781-1786). Introduces a new theme issue for the journal, which is focused on ideas and programs to reduce waste, increase efficiency, and better allocate resources to improve value in health care. (AHRQ 09-R004)

Improving Quality and Reducing Disparities: The Role of Nurses. K. Ho, J. Brady, C. Clancy, Journal of Nursing Care Quality, 23(3):July-September 2008, 185-188. Summarizes findings from AHRQ's national reports on quality and disparities and the role of nurses in health care communication and quality improvement. (AHRQ 08-R085)

Improving the Quality of Nursing Care Using the Medical Expenditure Panel Survey Data. R. Hughes, C. Clancy, Journal of Nursing Care Quality, 22(2): April-June 2007, 93-96. Describes the Medical Expenditure Panel Survey and discusses how nurses in practice, research, and policymaking can use MEPS data for the benefit of patients and organizational improvement. (AHRQ 07-R055)

Integrating Literacy, Culture, and Language to Improve Health Care Quality for Diverse Populations. D. Andrulis, C. Brach, American Journal of Health Behavior 31:Sept/Oct 2007, S122-S132. Examines the interrelationship of literacy, culture, and language and the importance of addressing their interactions in order to improve health care quality for low-literacy and other vulnerable individuals. (AHRQ 07-R079)

Is Our Pharmacy Meeting Patients' Needs? A Pharmacy Health Literacy Assessment Tool: User's Guide. Agency for Healthcare Research and Quality, October 2007, 66 pp. Presents a tool to measure how well an organization is serving patients with limited health literacy. It is designed for use primarily in outpatient pharmacies of large, urban, public hospitals that serve low-income populations with a high incidence of chronic disease and limited health literacy skills. (AHRQ 07-0051)

Issues in the Design of Training for Quality and Safety. K. Henriksen, E. Dayton, Quality and Safety in Health Care 15(Suppl I):2006, 17-24. Explores changes in the practice of medicine and the health care delivery environment and describes how health care training and education can benefit from findings in the behavioral and cognitive sciences. (AHRQ 07-R042)

Measuring Hospital Inefficiency: The Effects of Controlling for Quality and Patient Burden of Illness. R. Mutter, M. Rosko, H. Wong, Health Services Research, 43(6):December 2008, 1992-2013. Assesses the impact of employing a variety of controls for hospital quality and patient burden of illness on the mean estimated inefficiency and relative ranking of hospitals as generated by stochastic frontier analysis (SFA), a statistical method used for economic modeling. (AHRQ 09-R011)

Missed Opportunities for Quality Improvement. K. Ho, E. Kelley, J. Brady, et al., American Journal of Medical Quality 22(4): July/August 2007, 296-299. Discusses the data presented in the 2006 National Healthcare Quality Report and National Healthcare Disparities Report, briefly describes AHRQ's "Questions Are the Answer" campaign, and talks about the important role of prevention in health care quality improvement. (AHRQ 07-R075)

Modifying DRG-PPS to Include Only Diagnoses Present on Admission: Financial Implications and Challenges. C. Zhan, A. Elixhauser, B. Friedman, et al., Medical Care 45(4): April 2007, 288-291. Uses 2003 data from two States (New York and California) currently coding their data for conditions that are present on admission (POA) to assess the financial impact if Medicare decides to pay based on POA conditions only. Also examines the challenges involved in implementing POA coding. (AHRQ 07-R081)

2008 National Reports on Quality and Disparities Agency for Healthcare Research and Quality, March 2009. Reports focus on quality of care and disparities in health care in America, overall and for AHRQ's priority populations. 2008 National Healthcare Quality Report. 153 pp. Finds that health care quality continues to improve, but the rate of improvement has slowed. In addition, variations in the quality of health care across the Nation are decreasing but not for all measures. The safety of health care also has worsened, and more needs to be done. (AHRQ 09-0001) 2008 National Healthcare Disparities Report. 290 pp. Finds that although some of the biggest disparities in quality remain, progress has been made in reducing disparities in several areas, such as dialysis, hospital admissions for perforated appendix, and childhood vaccinations. This year, the NHDR also reports on the biggest disparities in quality documented over the years where there has not been improvement, such as new AIDS cases.(AHRQ 09-0002)

Pay for Performance: A Decision Guide for Purchasers. AHRQ Final Contract Report, April 2006, 28 pp. Isolates and sequences 20 questions purchasers face in considering pay for performance, reviews options and any available evidence—from empirical evaluations and economic theory—that may inform future decision-making, and discusses potential effects and unintended consequences. (AHRQ 06-0047)

The Performance of Performance Measurement. C. Clancy, Health Services Research 43(5): October 2007, 1797-1800. Discusses the use of performance measurement to drive clinical improvements and inform choices made by health care purchasers and consumers. (AHRQ 08-R017)

Preventing Hospital-Acquired Venous Thromboembolism: A Guide for Effective Quality Improvement. Agency for Healthcare Research and Quality, August 2008, 50 pp. Presents information to help quality improvement (QI) practitioners—such as physicians, pharmacists, nurses, and risk managers—lead an efficient, reliable effort to improve prevention of hospital-acquired venous thrombolism, one of the most critical problems facing hospitalized patients. (AHRQ 08-0075)

Quality Indicators Brochures
Agency for Healthcare Research and Quality, September 2006. AHRQ Quality Indicators (QIs), measures of health care quality that make use of readily available hospital inpatient administrative data, consist of four modules measuring various aspects of quality. Go to http://qualityindicators.ahrq.gov for announcement of updates to AHRQ QI software.
Prevention QIs. (AHRQ 06-M049-1)
Inpatient QIs. (AHRQ 06-M049-2)
Pediatric QIs. (AHRQ 06-M049-4)

Redesigning Health Systems for Quality: Lessons from Emerging Practices. M. Wang, J. Hyun, M. Harrison, et al., Joint Commission Journal on Quality and Patient Safety 32(11): November 2006, 599-611. Discusses the progress that has been made in improving health care quality in the 5 years since the Institute of Medicine's landmark report, Crossing the Quality Chasm. Also discusses lessons that have been learned and provides suggestions for moving forward. (AHRQ 07-R030)

The Role of the Physical Environment in Crossing the Quality Chasm. K. Henriksen, S. Isaacson, B. Sadler, C. Zimring, Joint Commission Journal on Quality and Patient Safety 33(11): November 2007, 68-80. Discusses the use of evidence-based design findings to help inform hospital decisionmakers about opportunities for ensuring that quality and safety are designed into new and refurbished facilities. (AHRQ 08-R028)

SCIP: Making Complications of Surgery the Exception Rather than the Rule. C. Clancy, AORN Journal 87(3): March 2008, 621-624. Commentary describes the Surgical Care Improvement Project (SCIP), a multi-year, national campaign involving 10 national organizations that was started in 2005 to substantially reduce the incidence of surgical complications though collaborative efforts. (AHRQ 08-R060)

Simulation in Health Care: Setting Realistic Expectations. K. Henriksen, M. Patterson, Journal of Patient Safety, 3(3): September 2007, 127-134. Examines the role of simulation technology in training clinicians and discusses some of the challenges—such as setting realistic expectations, identifying relevant research questions, and developing well-rounded curricula—that need to be addressed. (AHRQ 08-R009)

State Snapshots AHRQ's State Snapshots provide State-specific health care quality information, including strengths, weaknesses, and opportunities for improvement. State-level information is presented for every State and Washington, DC. Information used to create the Snapshots is derived from AHRQ's National Healthcare Quality Report. The goal is to help State officials and their public- and private-sector partners better understand health care quality and disparities in their State. State Snapshots can be found at http://statesnapshots.ahrq.gov.

Sustainability of Partnership Projects: A Conceptual Framework and Checklist. J. Edwards, P. Feldman, J. Sangl, et al., Joint Commission Journal on Quality and Patient Safety, 33(12 Suppl):December 2007, 37-47. Describes the framework developed to incorporate elements for sustainability into AHRQ's Partnerships for Quality projects and the checklist that was developed to provide concrete assistance in planning for sustainability. (AHRQ 08-R040)

The Third National Reports on Healthcare Quality and Disparities in the United States. National Data for Targeting Improvements. M. Hand, F. Chesley, K. Ho, et al., Journal of Nursing Care Quality, 21(4):2006, 283-289. Discusses AHRQ's 2005 National Healthcare Quality Report and National Healthcare Disparities Report and their implications for nursing practice, policy, and research. (AHRQ 07-R002)

The "3Ts" Road Map to Transform U.S. Health Care: The "How" of High-Quality Care. D. Dougherty, P. Conway, Journal of the American Medical Association, 299(19):May 2008, 2319-2321. Commentary on quality of care proposes a model intended to accelerate the pace at which innovations are implemented in clinical settings by addressing the "how" of health care delivery. (AHRQ 08-R054)

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