A Federal Government Web site managed by the Agency for Healthcare Research and Quality
Priorities in Action features some of our nation’s most promising and transformative quality improvement programs, and describes their alignment to the NQS’ six priorities. Updated monthly, these programs represent private sector, Federal, State, and local efforts.
We want to hear from you! If your program aligns with the priorities, e-mail NQStrategy@ees.hhs.gov with details.
Inclusion in the Priorities in Action program listing does not constitute endorsement by the U.S. Department of Health and Human Services.
The New York State Health Foundation's Diabetes Campaign, "Reversing the Trend," seeks to address one of the State's most pervasive epidemics—diabetes. Nearly 10 percent of New Yorkers—or 1.4 million—are afflicted with this disease, and almost 4 million more suffer from prediabetes, causing harm to a significant portion of the State's population. Additionally, diabetes costs the state almost 13 billion dollars a year in health care costs and productivity losses. The New York State Health Foundation, or NYSHealth, developed a three-pronged strategy to attack diabetes: (1) improve the way New York physicians treat chronic disease; (2) develop community-based prevention and management initiatives; and (3) progressively transform the chronic care system to a pay-for-performance mode.
NYSHealth has made significant strides in improving chronic care management in New York. To promote effective diabetes care, the campaign has helped more than 2,000 physicians achieve National Committee for Quality Assurance (NCQA) and Bridges to Excellence (BTE) Diabetes Recognition Certification. To mobilize communities to improve diabetes prevention, screening, and management, NYSHealth has established more than 200 diabetes prevention and self-management programs across the State. These programs change how health centers currently provide chronic care through the adoption of the Chronic Care Model and a more patient-centered approach. Also critical to these efforts is the establishment of adequate preventive measures to mitigate future adverse effects.
NYSHealth recently launched the next phase of its diabetes campaign, called "Meeting the Mark." This program builds upon existing efforts, and encourages additional primary care practices and health systems to apply for funding to help physicians receive NCQA and BTE Diabetes Prevention Recognition. This will help the program reach its goal of 3,000 newly NCQA- or BTE-certified physicians and health care practitioners in New York State.
NYSHealth has succeeded largely because it secured support from a wide range of stakeholders—payers, providers, and elected officials—to build a collaborative and comprehensive solution to diabetes prevention. Additionally, NYSHealth partners with Health Care Association of New York, Community Health Center Association of New York State, American College of Physicians—New York State Chapter, the Institute for Leadership, the Alliance of New York State YMCA, Inc., and the Institute for Health. These partners are instrumental in helping to improve diabetes prevention and reducing the human and financial toll of diabetes.
This campaign is aligned to two National Quality Strategy priorities: it promotes the most effective prevention and treatment practices for diabetes, and works with communities to promote wide use of best practices to enable healthy living.
This program is directed by the New York State Health Foundation, and more information can be found at: http://nyshealthfoundation.org/priority-areas/improving-diabetes-prevention/ .
The Patient Safety and Clinical Pharmacy Services Collaborative (PSPC), organized by the Health Resources and Services Administration, or HRSA, improves health care quality by providing patients suffering from complex conditions with evidence-based clinical pharmacy services. Now in its 5th year, PSPC works with teams of community health care providers to advance their medication and care management systems and improve patient safety.
Patients with complex conditions often receive care and medication from multiple providers. A lack of coordination among these providers could lead to adverse drug events or a duplication of therapy and interactions. Therefore it is critical that these doctors, specialists, and nurses work collaboratively to provide effective health care.
The PSPC enables this collaboration by helping to spread practices that improve patient safety and health outcomes. PSPC equips teams with a “change package,” a set of field-tested best practices developed by expert national faculty and adapted from high-performing organizations. Provider teams also participate in integrated learning sessions that teach the Institute for Healthcare Improvement (IHI) Model for Improvement, allowing teams to measure, share, and track their progress.
Additionally, PSPC helps participating providers integrate their clinical pharmacy services into a Primary Health Care Home model. Each team of providers has a designated lead Primary Health Care Home, which reduces the complexity of managing patient information and health care services by integrating them into a central location. It enables providers and pharmacists to effectively coordinate care for a defined population of patients.
As of May 2013, 344 teams of community health providers participated in PSPC, representing more than 885 organizations of community-based health care providers across 48 states, the District of Columbia, Puerto Rico, and the Virgin Islands. By 2015, PSPC aims to have 400 teams in 3000 communities across the country participating in the program.
Efforts such as these make care safer by reducing harm caused in the delivery of care and promote effective communication and coordination of care. Evaluation of this program is completed by the teams themselves, who share their progress monthly on multiple improvement measures, which include health outcomes and reductions in adverse drug events.
The Patient Safety and Clinical Pharmacy Collaborative is sponsored by the Health Resources and Services Administration. You can learn more at http://www.hrsa.gov/publichealth/clinical/patientsafety/index.html.
The Patient-Centered Medical Home (PCMH) model holds promise as a means to improve health and health care in America by transforming how primary care is organized, delivered, and funded. Building on the work of a large and growing community, the Agency for Healthcare Research and Quality (AHRQ) envisions the PCMH as a model of primary care that delivers patient–centered, high–quality care safely and efficiently through improved communication and coordination.
In order to facilitate widespread PCMH transformation, AHRQ established the PCMH Resource Center to give researchers and health policy makers the information they need. The Web site defines the PCMH and provides a series of in-depth white papers, focused policy briefs, systematic evidence reviews, and guides to innovative evaluation methods. These resources cover topics ranging from care coordination to patient engagement to health information technology. In the past year, the site has expanded to include more practical tools to support implementation of complex practice change.
The “Developing and Running a Primary Care Practice Facilitation Program: A How-to Guide” (PDF: Plugin help) provides instructions and resources for state and regional organizations with an interest in primary care quality improvement. The Guide highlights the potential of practice facilitation as a strategy for supporting widespread, systematic practice improvement across communities. It addresses important considerations for practice facilitation programs, such as administration, workforce management, financing, and evaluation, and details the steps necessary to address these issues. Four additional in-depth case studies (PDF: Plugin help) of successful practice facilitation programs complement the lessons of the How-to-Guide. AHRQ established the Primary Care Practice Facilitation Learning Community to allow organizations interested in practice facilitation share their experiences and learn from one another.
AHRQ also facilitates and convenes the Federal PCMH Collaborative, bringing together partners from across the Federal Executive Branch to share lessons learned in work related to PCMH transformation.
Efforts such as this drive the transition of new delivery models forward, and support multiple NQS priorities, including patient safety, delivery of person- and family-centered care, effective communication and care coordination, and making quality care affordable.
The program is directed by the Agency for Healthcare Research and Quality, and more information can be found at: http://pcmh.ahrq.gov/.
Initiated in late 2009, this grant-funded program seeks to help reverse the childhood obesity epidemic, especially in lower-income communities and in populations at greatest risk. It provides four years of grant funding and technical assistance to 49 multidisciplinary partnerships across the country to implement policies, systems, and environmental change strategies to create sustainable community change.
Partnerships focus on different venues, such as neighborhoods, parks, and public housing developments to engage a range of strategies. These include developing and implementing farmers' markets, healthier corner stores, community gardens, healthy vending policies, physical activity and nutrition standards, complete streets and joint-use policies, and safe routes to schools and parks.
These efforts promote healthy living and well-being and work to improve the social, economic, and environmental factors within each of the grantee communities, directly aligning with one of the six NQS priorities: community health. Evaluation for this program includes tracking work plan milestones, assessing policy and environmental changes, engaging in group model building in each community, and conducting cross-site analyses among communities that are working on similar issues. A final report will be released in 2014 that addresses results, accomplishments, and lessons learned.
The program is directed by the Healthy Kids, Healthy Communities National Program Office, which is part of Active Living By Design at the Gillings School of Global Public Health at the University of North Carolina in Chapel Hill, NC. More information is available at www.healthykidshealthycommunities.org/ .
In 2010, the Health Resources and Services Administration (HRSA) launched the Flex Medicare Beneficiary Quality Improvement Program to improve the quality of care for Medicare beneficiaries served by critical access hospitals (CAHs). CAHs are rural community hospitals that have 25 or fewer inpatient beds, are at least 35 miles from another facility or are designated as a necessary providers, and receive cost-based reimbursement from Medicare and, in some states, Medicaid. This program helps CAHs prioritize quality measurement and improvement despite their limited resources and staff. In the post–health reform environment, CAHs may soon be compared with their urban counterparts to ensure public confidence in their quality of health services. This initiative enables CAHs to demonstrate the quality of care they provide.
The Flex Medicare Beneficiary Quality Improvement Program supports quality improvement initiatives through increased reporting on quality measures that are relevant to rural health care. Through expanded public reporting, the program allows for clear benchmarking of hospitals' performance and the identification of best practices. The program assists CAHs in developing their quality improvement and patient engagement efforts. The program also supports health system development and community partnerships, helping hospitals make the most of their funding and identify stakeholders to collaborate with on quality improvement activities. Currently, more than 1,200 of the 1,331 CAHs located in 45 states are voluntarily participating in the Flex Medicare Beneficiary Quality Improvement Program, and the program continues to strive for 100 percent engagement.
These efforts promote person and family engagement in care and work to improve the experience of care related to quality, safety, and access. Evaluation for this program includes tracking CAH participation, quality improvement measures, patient satisfaction, and outcome measures for each CAH in the program. The Medicare Rural Hospital Flexibility Monitoring team, which is made up of the Universities of Minnesota, North Carolina-Chapel Hill, and Southern Maine, provides monitoring and evaluation support.
The Flex Medicare Beneficiary Quality Improvement Program is directed by the Health Resources and Services Administration. More information is available at the National Rural Health Resource Center, at http://www.ruralcenter.org/tasc/resources/medicare-beneficiary-quality-improvement-project-mbqip .
Making care safer by reducing harm caused in the delivery of care.
Ensuring that each person and family are engaged as partners in their care.
Promoting effective communication and coordination of care.
Promoting the most effective prevention and treatment practices for the leading causes of mortality, starting with cardiovascular disease.
Working with communities to promote wide use of best practices to enable healthy living.
Making quality care more affordable for individuals, families, employers, and governments by developing and spreading new health care delivery models.