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Working for Quality > About the NQS > Agency-Specific Quality Strategic Plans

National Strategy for Quality Improvement in Health Care

Agency-Specific Quality Strategic Plans


Contents

Agency Leadership
Agency for Healthcare Research and Quality (AHRQ) Agency-Specific Quality Strategic Plan
   Brief Introduction/Overview
   Agency-Specific Quality Strategic Plan Table
Centers for Disease Control and Prevention (CDC) Agency-Specific Quality Strategic Plan
   Agency-Specific Quality Strategic Plan Table
Centers for Medicare and Medicaid Services (CMS) Agency-Specific Quality Strategic Plan
   Agency-Specific Quality Strategic Plan Table
Health Resources and Services Administration (HRSA) Agency-Specific Quality Strategic Plan
   Brief Introduction/Overview
   Agency-Specific Quality Strategic Plan Table
Food and Drug Administration (FDA) Agency-Specific Quality Strategic Plan
   Agency-Specific Quality Strategic Plan Table
Indian Health Service (IHS) Agency-Specific Quality Strategic Plan
   Brief Introduction/Overview
   Agency-Specific Quality Strategic Plan Table
National Institutes of Health (NIH) Agency-Specific Quality Strategic Plan
   Agency-Specific Quality Strategic Plan Table
Substance Abuse and Mental Health Services Administration (SAMHSA) Agency-Specific Quality Strategic Plan
   Brief Introduction/Overview
   Agency-Specific Quality Strategic Plan Table

Agency Leadership

The Department of Health and Human Services (HHS) created a template to guide agencies in the development of agency-specific quality strategic plans, with broad, recommended categories to create consistency across the plans and ensure alignment with the National Quality Strategy (NQS). Using these templates, agencies explained how their own principles, priorities, and aims correspond with those of the NQS; elaborated on their existing and future efforts to implement the NQS; and discussed the methodology for evaluating these efforts.

Some agencies have begun incorporating the NQS into their strategic planning and programmatic activities. The Substance Abuse and Mental Health Services Administration (SAMSHA) developed a draft National Behavioral Health Quality Framework (NBHQF), incorporating two rounds of public comments, and is identifying and finalizing a set of core measures. The NBHQF successfully aligns SAMSHA's mission with the NQS and retains the three aims of NQS as an overarching guideline, while outlining six unique priorities that parallel those in the NQS. In this document, SAMSHA defines its role in fighting national substance abuse, explains how its efforts directly align with the aims of NQS, and illustrates how its own priorities will advance the quality of care in behavioral health. The NBHQF provides a model that HHS will leverage as an example for future agency-specific plans and demonstrates a successful approach for executing the aims of the NQS while achieving measurable improvement across all six priority areas.

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Agency for Healthcare Research and Quality (AHRQ) Agency-Specific Quality Strategic Plan

Brief Introduction/Overview

AHRQ's mission is to improve the quality, safety, efficiency, and effectiveness of health care for all Americans. The Agency works to fulfill this mission through one overarching program: Health Services Research. Health services research examines how people get access to health care, how much care costs, and what happens to patients because of the care they receive. The principal goals of health services research are to identify the most effective ways to organize, manage, finance, and deliver high-quality care; reduce medical errors; and improve patient safety. AHRQ conducts and supports health services research within the Agency as well as in leading academic institutions, hospitals, physicians' offices, health care systems, and many other settings across the country.

This mission directly aligns with the priorities of the NQS.

Agency-Specific Quality Strategic Plan Table

  1. Title
  2. Description
  3. Scope of Issue
  4. Rationale for Approach
  5. Metrics/Goals

NQS Aims, Priorities, and Alignment Program / Initiative
Aims

Better Care
Improve quality by making health care more person-centered, reliable, accessible, and safe.

  1. The Consumer Assessment of Healthcare Providers and Systems (CAHPS) family of surveys.
  2. These surveys measure consumer perspectives and experience of care across care settings and among various patient populations. Surveys assess consumer experience of health plans, clinician and group practices, dental care, surgical care, home health care, in-center hemodialysis, and nursing homes.
  3. The surveys cover topics that are important to consumers and focus on aspects of quality that consumers are best qualified to assess, such as the communication skills of providers and ease of access to health care services.
  4. Over the past 15 years, the CAHPS Consortium has established a set of principles to guide the development of CAHPS surveys and related tools. These principles include identifying and supporting the consumer or patient's information needs, conducting thorough scientific testing, ensuring comparability of data, maintaining an open development process, and keeping products in the public domain.
  5. CAHPS results.

Healthy People/Healthy Communities
Support proven interventions to address behavioral, social, and environmental determinants of health.

  1. Potentially Preventable Admissions Mapping Tool.
  2. Many hospital admissions, such as those for asthma and diabetes, are preventable with adequate primary care, self-care, and community/public services. This tool enables communities, local health departments, and others to identify counties with high levels of potentially preventable admissions for each of these diagnoses, providing both a color-coded map and a cost calculator to estimate savings possible through reduced rates.
  3. The tool uses AHRQ's Prevention Quality Indicators, which are National Quality Forum (NQF)-endorsed measures. It is embedded in MONAHRQ, a Web builder that enables localities to create a Web site using their own local data. Public reporting at the facility level can use these data, which can also enable tracking of potentially preventable admissions using AHRQ's Prevention Quality Indicators. The tool also includes links to evidence on ways to reduce rates of potentially preventable admissions for each disease.
  4. Five States are now using MONAHRQ to create public reporting Web sites, and others are using the mapping tool to reduce potentially preventable admissions.
  5. AHRQ's Healthcare Cost and Utilization Project (HCUP) and National Healthcare Quality Report track State and national rates of potentially preventable admissions.

Affordable Care
Reduce the cost of quality health care for individuals, families, employers, and government.

  1. The Medical Expenditure Panel Survey (MEPS).
  2. This survey collects data on health insurance coverage, health care access, and health care costs for a national sample of the U.S. community-dwelling population and is used by policymakers, providers, and consumers to evaluate the current state of the health care system and the effects of proposals for change.
  3. The survey includes an employer component, used to examine health insurance offer rates, takeup rates, and enrollment, as well as employer and employee premium costs, for private employers in the United States and in individual States. The computation of the U.S. Gross Domestic Product involves use of these data.
  4. The survey results provide the basis for modeling the effects of changes in the financing and provision of care on use of services, the distribution of payments by source—including out-of-pocket, private insurers, and public programs—and financial burdens for individuals and families.
  5. The survey results are used to estimate the contribution of chronic illnesses to the concentration and growth in overall medical spending.
Priorities

Making care safer by reducing the harm caused in the delivery of care.

  1. Patient Safety Portfolio.
  2. The Portfolio's mission is to prevent, mitigate, and decrease the number of medical errors, patient safety risks, and hazards associated with health care and their harmful effect on patients. Specific objectives include to increase the number of U.S. health care organizations using AHRQ-supported tools to improve patient safety; increase the number of evidence-based tools available in AHRQ's inventory to improve patient safety; and reduce costs associated with hospitalizations related to infections resulting from medical care.
  3. Since the 1999 publication of "To Err Is Human,” the landmark Institute of Medicine report on patient safety, there has been significant progress in identifying and verifying practices that improve safety. However, additional work is needed in demonstrating how practices are implemented and integrated into clinical practices and how to promote a culture that fully supports providing the safest care possible.
  4. The initiative relies on grant and contract funding mechanisms, as well as a variety of communication strategies.
  5. Quantitative and qualitative measures are used to evaluate the various components of the Patient Safety Portfolio. Outcome data are very important and gathered from a variety of sources, including reporting systems, Web sites, survey data, and interviews with stakeholders.

Ensuring that each person and family are engaged as partners in their care.

  1. Questions Are the Answers.
  2. This initiative encourages patients to become more engaged in their own health care and aims to improve communication between patients and clinicians—all with the goal of helping to make health care safer.
  3. Poor communication among clinicians and patients can lead to a variety of problems, including medication errors, preventable hospital readmissions, and other issues that harm patients and drive up health care costs unnecessarily.
  4. The initiative uses a combined patient/clinician education model that includes a public service advertising campaign featuring general market advertisements, a Web site, patient education materials, videos, and clinician-targeted advertisements to reach patients, caregivers, doctors, nurses, and other members of the heath care team.
  5. Web metrics and orders placed to AHRQ's Publications Clearinghouse.

Promoting effective communication and coordination of care.

  1. Primary Care Medical Home Initiative.
  2. Revitalizing the nation's primary care system is foundational to achieving high-quality, accessible, and efficient health care for all Americans. The primary care medical home, also referred to as the patient-centered medical home (PCMH), advanced primary care, and the health care home, is a promising model for transforming the organization and delivery of primary care.
  3. As part of this initiative, AHRQ convenes the Federal PCMH Collaborative, which is designed to bring together executive branch employees in agencies or departments that are doing work related to the primary care medical home with nonfederal experts to develop a common base of knowledge about this new health care delivery model. AHRQ also hosts a Web-based PCMH resource center that provides both policymakers and researchers with access to evidence-based resources about the medical home and facilitates the exchange of information (www.pcmh.ahrq.gov).
  4. Care coordination is a core pillar of the PCMH. As part of AHRQ's PCMH initiative, in 2011, AHRQ published the “Care Coordination Measures Atlas,” which provides a framework and describes existing measures of ambulatory care coordination for potential adoption to monitor the effectiveness of this new delivery model.
  5. N/A

Promoting the most effective prevention and treatment practices for the leading causes of mortality, starting with cardiovascular disease.

  1. HHS Million Hearts™ Campaign.
  2. This is a national initiative to prevent 1 million heart attacks and strokes over the next 5 years by promoting aspirin for people at risk, blood pressure control, cholesterol management, and smoking cessation (the “ABCS” of cardiovascular disease).
  3. Heart disease and stroke are two of the leading causes of death in the United States.
  4. AHRQ will support Million Hearts through conferences and communications that will speed the identification and diffusion of innovative strategies along with evidence-based reports to improve the delivery of the Million Hearts ABCS in communities and health care systems.
  5. HHS campaign metrics.

Working with communities to promote wide use of best practices to enable healthy living.

  1. Extension for Community Healthcare Outcomes (ECHO).
  2. AHRQ funded researchers at the University of New Mexico Health Sciences Center to develop and pilot health information technology (IT) to bring state-of-the-art medical knowledge about the effective treatment of persons with hepatitis C virus (HCV) infection to primary care providers and nurses in underserved areas.
  3. Approximately 3.2 million Americans are chronically infected with HCV, which causes 12,000 deaths per year. It is the leading cause of liver transplantation. Although treatment is available and effective, it can cause serious side effects and, therefore, must be carefully managed by a medical team. Typically, such care and treatment is not available outside of university medical centers.
  4. Project ECHO demonstrates that health IT can help solve the problems of underserved communities by empowering primary care clinicians to provide high-quality specialty care locally.
  5. N/A

Making quality care more affordable for individuals, families, employers, and governments by developing and spreading new health care delivery models.

  1. Value Portfolio.
  2. The mission of the Value Portfolio is to reduce unnecessary costs and waste while maintaining or improving quality. The aim is to help the Department fulfill its mission to help Americans receive high-quality, efficient, and affordable care by creating a high-value system, in which providers produce greater value, consumers and payers choose value, and the payment system rewards value.
  3. To meet these needs, the Portfolio produces quality and efficiency measures, data, and tools; conducts research on system redesign, public reporting, and payment strategies; and facilitates translation and implementation of evidence-based strategies into policy and practice.
  4. Evidence is built through grants and contracts, and strategies are implemented through practice-based or community-based networks. An example of the latter is the 24-community quality collaborative, known as Chartered Value Exchanges, which implements across communities and entire States research findings on public reporting, payment, waste reduction, and quality improvement. The Portfolio also relies heavily on quality and cost data produced through AHRQ efforts such as MEPS, HCUP, and the National Healthcare Quality and Disparities Reports (NHQR/DR).
  5. The cumulative number of AHRQ measures, tools, upgrades, and syntheses available on health care value and the cumulative number of AHRQ measures and tools used in national, State, or community public report cards.
Areas of Coordination or Alignment

Demonstration of coordination or alignment with other federal agencies (i.e., involvement of other agencies in program planning or execution, mechanisms for sharing best practices, steps to reduce duplication of effort).

AHRQ participates in and leads various interagency working groups, including the following:

  • NHQR/DR Interagency Quality Measures Group
  • HHS Healthcare–Associated Infections Steering Committee
  • HHS Quality Work Group
  • Federalwide Interagency Working Group on Health Care Quality
  • Patient Safety Organization Work Group

Demonstration of coordination or alignment with the private sector or States (i.e., stakeholder meetings, public comment periods, open-door forums, workshops).

AHRQ participates or leads a variety of multistakeholder alliances, including the following:

  • National Priorities Partnership
  • Measures Application Partnership
  • NQF
  • Ambulatory Care Quality Alliance
  • Patient-Centered Outcomes Research Institute

Use of measures or benchmarks for performance measures and/or monitoring that align with the NQS.

To be determined by HHS leadership.

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A Federal Government Web site managed by the Agency for Healthcare Research and Quality