Improving Quality of Care and Patient Safety with Evidence-based Management Practices
Ann Scheck McAlearney, Sc.D., M.S.
Associate Dean for Health Services Research
Distinguished Professor in the Department of Family and Community Medicine
Ohio State University College of Medicine
“With AHRQ funding, I have been able to look at how we can use management practices, rather than just clinical practice improvements, to address performance and patient safety issues, and then widely disseminate this information so that it can be applied.”
Over the last decade or so, providers have implemented a range of new technologies and tools to improve patient care, but without appropriate management processes in place, healthcare quality and safety are still at risk.
Ann Scheck McAlearney, Sc.D., M.S., Associate Dean for Health Services Research and Distinguished Professor in the Department of Family and Community Medicine at The Ohio State University (OSU) College of Medicine in Columbus, is helping to augment new techniques in healthcare quality and safety by studying effective evidence-based management practices in health information technology implementation and use and around healthcare-associated infection (HAI) prevention and reduction. Over the past 14 years, with funding from AHRQ, Dr. McAlearney has developed structures and processes for patients and providers to communicate more easily and to help providers more effectively implement best practices in patient care.
Dr. McAlearney served as lead on an AHRQ contract in 2008 to study how healthcare organizations can use innovative human resources practices to promote safety and quality in healthcare. Based on the study’s findings, Dr. McAlearney and her team developed an AHRQ resource, Using Workforce Practices to Guide Quality Improvement: A Guide for Hospitals. The researchers also developed a predictive model linking particular workforce practices and quality outcomes in healthcare.
In 2010, Dr. McAlearney began her work to reduce HAIs—a leading threat to patient safety that affects one out of every 31 hospital patients at any given time. “Efforts to eliminate HAIs have had mixed results across organizations and interventions, possibly due to variations in work culture and management practices,” notes Dr. McAlearney. Through an AHRQ contract, she explored the role of hospital management practices in facilitating adoption of interventions for preventing central line-associated bloodstream infections. Insights from the research, such as the importance of leadership support and sharing information, are helping to guide HAI prevention studies.
In 2015, Dr. McAlearney received two AHRQ grants to study the safe and effective use of inpatient portal technology—a tethered personal health record that links to the patient's electronic health record and can facilitate patient engagement with healthcare providers. “Portals empower patients to engage in better management of their care, which can result in healthier populations and lower costs,” says Dr. McAlearney. Her study, “Portals in Inpatient Care,” explored patient motivations to adopt and continue to use portals. It also looked at features that patients considered important for self-management of their conditions. The research results were used to develop a logic model that provides specific evaluation suggestions for hospital managers and researchers seeking to implement and assess the impacts of this technology.
Dr. McAlearney’s second study on portals, “High Tech and High Touch,” focused on portal usage by hospitalized patients both while they were in the hospital and post discharge. For patients with multiple chronic conditions, evidence has shown that engagement with their own disease management can lead to better control of their chronic conditions. The study examined how portals can influence that personal engagement. According to Dr. McAlearney, “The work with inpatient portals enabled the medical center involved in the research to improve the ways they interacted with patients, and the ways that patients communicated with their doctors.”
Dr. McAlearney also was chosen in 2015 to serve as the Project Director of an AHRQ-funded Patient Safety Learning Laboratory (PSLL) for which she then became Principal Investigator. The five-year project examined how management practices could reduce the risks posed by too much information, and Dr. McAlearney and her transdisciplinary team studied ways to improve the flow of information at OSU’s Wexner Medical Center. They focused on the hospital’s use of cardiac alarms, HAI surveillance, and secure messaging in electronic health records. In one part of the project, the team evaluated how they could change alarm tones and frequencies to reduce distractions—work that enabled the PSLL to reduce the alarm burden of bedside monitors and secondary notifications delivered on nurses' phones.
Dr. McAlearney is currently building on her previous management studies through an AHRQ-funded study of HAI prevention practices that ends in 2022. The research aims to provide hospitals with new evidence-based tools to support HAI reduction and prevention. These include a management practices toolkit that contains an organization-specific data dashboard for monitoring progress in support of HAI-prevention efforts as well as toolkit implementation training guidance.
In addition, Dr. McAlearney received competitive funding from AHRQ’s predecessor organization, the Agency for Health Care Policy and Research, in 1993 to support her dissertation research. Her study focused on examining disparities in care, comparing the experiences and perceptions of black and white Medicaid and Medicare patients about their access to and satisfaction with care.
Dr. McAlearney is a member of the Academy of Management, AcademyHealth, the American College of Healthcare Executives, the American Medical Informatics Association, and the North American Primary Care Research Group.
Related AHRQ Resources
- Multiple Chronic Conditions Chartbook (PDF, 10.6 MB)
- Health Information Technology for Engaging Patients in Diagnostic Decision Making in Emergency Departments
Principal Investigator: Ann Scheck McAlearney, Sc.D., M.S.
Institution: The Ohio State University
Grantee Since: 2008
Type of Grant: Various
Consistent with its mission, AHRQ provides a broad range of extramural research grants and contracts, research training, conference grants, and intramural research activities. AHRQ is committed to fostering the next generation of health services researchers who can focus on some of the most important challenges facing our Nation's health care system.
To learn more about AHRQ's Research Education and Training Programs, please visit https://www.ahrq.gov/training.