Making Quality Count: Tools, Strategies, and Resources

Slide Presentation by Edward Kelley, Ph.D.

On February 10, 2004, Edward Kelley, Ph.D., made a presentation in a Web Conference at Event 1, which was entitled "The Role of the NHQR and the NHDR in Improving the Quality of Health Care."

This is the text version of Dr. Kelley's slide presentation. Select to access the PowerPoint® slides (278 KB).

The Role of the NHQR and the NHDR in Improving the Quality of Health Care

Edward Kelley, Ph.D.
Director
National Healthcare Quality Report
Center for Quality Improvement and Patient Safety
Agency for Healthcare Research and Quality
U.S. Department of Health and Human Services

Slide 1

Background

Mandated by Congress in the Healthcare Research and Quality Act (PL. 106-129)

• "Beginning in fiscal year 2003, the Secretary, acting through the Director, shall submit to Congress an annual report on national trends in the quality of health care provided to the American people."

Slide 2

Why Do We Need a National Report?

• "Chasm" between actual and ideal performance in the U.S. health care system.
• Overwhelming amount of health care information available to doctors/patients, yet lack of useable quality information.
• Consumers care about quality and are increasingly demanding more information.

Slide 3

NHQR-DR Summary (1)

High quality health care is not a given in the U.S. health care system.

• 37 of 57 areas with trend data presented in the NHQR show no improvement or have deteriorated.
• Fewer than one in five people with hypertension have it under control.
• About one in five elderly Americans prescribed inappropriate/potentially harmful medications.

This slide also contains a bar graph entitled, "Patient Safety: Inappropriate drug prescription for community-dwelling elderly Americans." The horizontal axis is labeled to show data for the years 1996 and 1998, and the vertical axis is labeled "percent of the elderly." To the right of this graph is a legend that describes what each differently colored bar on the graph represents. According to the legend, a dotted bar represents "11 drugs that should always be avoided," a solid black bar represents "8 drugs that are rarely appropriate," and a solid white bar represents "14 drugs that have some indications but are often misused." In that order, dotted bar, solid black bar, and solid white bar, the values included in this graph are as follow: 1996-~3, ~9, and ~13; 1998-~ 3.5, ~9, and ~12.

Slide 4

NHQR-DR Summary (2)

Gaps in health care quality are particularly acute for certain racial, ethnic, and socioeconomic groups.

• Blacks and Hispanics—score lower than whites on about half of quality measures.
• Hispanics and Asians—score lower than whites on about two-thirds of access measures.
• Poor people—score lower on about two-thirds of quality and access measures.

Slide 5

NHQR-DR Summary (3)

Quality and disparity gaps are worse in preventive services.

• Only 40% of people get smoking cessation counseling in the hospital. Only 60% get counseling during office visits.
• Black, Hispanic, poor adults—less likely to receive colorectal and breast cancer screening, influenza immunization.
• Black, Hispanic, American Indian women—less likely to receive prenatal care.
• Black, Hispanic, poor children—less likely to receive dental care.
• Black, Hispanic, poor elderly—less likely to receive pneumococcal vaccination.

This slide also contains a bar graph entitled, "Smoking Cessation Counseling." The graph shows that only 60% of smokers receive advice to quit smoking, and that 40% of AMI patients are given smoking cessation counseling in hospitals.

Slide 6

NHQR-DR Summary (4)

Improvement in quality and disparities is possible.

• Use of beta-blockers for heart attack patients rose from 21% of eligible patients in the early 1990s to 79%. 45 States are at or above 70% on this measure.
• 70% of women over 40 get mammograms for breast cancer. This exceeds Healthy People 2010 objective.
• Black women have higher screening rates for cervical cancer. Death rates among black women are falling at twice the rate as white women.
• Quality improvement efforts have resulted in reductions in black-white differences in hemodialysis.

This slide also contains a color-coded map of the United States that is entitled, "Percent of AMI patients prescribed a beta blocker at discharge by State." States in this map are colored with 3 different colors: yellow, red, and blue. A legend below the map shows that yellow represents "significantly below average," red is "no different from national average," and blue is "significantly above national average." On this map, the only States colored yellow are California, Mississippi and Arkansas. The States colored blue are Utah, Colorado, Iowa, Michigan, Virginia, New Hampshire and Maine. All other States are colored red.

Slide 7

How the Reports Fit into AHRQ's Focus on Implementation

Purpose of the Reports:

• To promote awareness of the status of health care quality and disparities in America; and
• To lead to action and support AHRQ's overall mission "to improve the quality... of health care for all Americans."

Slide 8

From Knowing to Doing: Implementing the NHQR-DR

This slide contains a matrix that is entitled "A Model of Diffusion Stages and Tactics (Derived from Rogers, 1995). The rows represent the diffusion stages of: Awareness, persuasion, decision, implementation, and confirmation. The columns represent the diffusion tactics of mass media, customization, vicarious modeling, how-to specifics, and evaluation. The word "knowledge" has been placed in the box where awareness and mass media intersect. From this box is a diagonal arrow that travels through the chart and ends at the intersection of the evaluation and confirmation components. In this box is the word "Improvement."

Slide 9

NHQR Conceptual Framework

This slide contains a screen shot of a page entitled "National Healthcare Quality Report Framework" Underneath the title is a matrix. The rows represent health care needs and are labeled as follow: staying healthy; getting better, living with illness or disability; and end of life care. The columns represent components of health care and are labeled as follow: effectiveness; safety; timeliness; and patient centeredness.

Below this grid are three bullets with text. The first reads: Equity is a component of health care quality that applies to all cells in the matrix. The second states: Resource generation is another component discussed in the National Healthcare Reports. The last reads: The first NHQR is due to Congress in 2003.

Slide 10

State Data in the NHQR

• Behavioral Risk Factor Surveillance System
• Medicare Quality Improvement Organizations (QIO) Program
• Minimum Data Set (CMS nursing home data)
• National CAHPS® Benchmarking Database
• National Immunization Survey
• Outcome and Assessment Information Set (OASIS; CMS home health data)
• United States Renal Data System
• University of Michigan Kidney Epidemiology and Cost Center (ESRD data)
• Vital Statistics

Slide 11

A Workbook for Crossing the Quality Chasm in Health Care: A State Leader's Guide to Diabetes Care, Quality, Improvement

Purpose:

• Provide overview of factors affecting quality of care for diabetes.
• Present core elements of health care quality improvement.
• Provide best practices/policy approaches on diabetes quality improvement from national organizations, State and Federal governments.
• Help State policy makers/health care leaders use NHRQ data to plan State-level quality improvement initiatives.

Slide 12

A Workbook for Crossing the Quality Chasm in Health Care: A State Leader's Guide to Diabetes Care, Quality, Improvement

Audience

• State elected leaders—governors, legislators and staff actively involved in health issues.
• State executive branch officials—State health department, Medicaid and State employee benefits administrators and staff.
• Non-governmental State and local health care leaders—members of professional societies, provider associations, quality improvement organizations, voluntary health organizations, health plans, business coalitions, etc.

Slide 13

How Do I Use The Report Data? Example From The Chasm Workbook

State 1 is better than the national norm in terms of HbA1c testing, but has room for improvement. The percent of adults with diabetes in State 1 who have this test (70.5 percent) is nine points higher than the national average and the difference is statistically significant, indicating that State 1 is more successful in this regard than the typical State in the nation. However, compared to the States with the highest rates ("best in class" States), State 1 has some room for improvement. The average of the top decile of States is 82.3 percent of adults with diabetes receiving an HbA1c test.

Slide 14

For Further Information

AHRQ's web site for the NHQR and NHDR: www.qualitytools.ahrq.gov

Contact information:

Dr. Ed Kelley
Director, National Healthcare Quality Report
Agency for Healthcare Research and Quality
540 Gaither Road, Suite 300
Rockville, MD 20850
(301) 427-1321 (phone)
(301) 427-1341 (fax)
(EKelley@ahrq.gov)

Current as of June 2004

Internet Citation:

The Role of the NHQR and the NHDR in Improving the Quality of Health Care. Text Version of a Slide Presentation at a Web Conference. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/ulp/qcount/kelleytxt.htm

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