Quality of Care

The Agency for Healthcare Research and Quality's National Healthcare Quality and Disparities Reports: Action Agendas for the Nation. D. McNeill, E. Moy, C. Clancy, American Journal of Medical Quality 21(3): May/June 2006, 206-209. Discusses the 2005 National Healthcare Quality Report and National Healthcare Disparities Report, tracking the Nation's progress in improving health care quality and reducing health care disparities across a broad range of conditions, services, and population groups. (AHRQ 06-R048)

AHRQ 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 Quality Indicators. Identify hospital admissions that evidence suggests could have been avoided, at least in part, through high-quality outpatient care. (AHRQ 06-M049-1)

Inpatient Quality Indicators. Reflect quality of care inside hospitals including inpatient mortality for medical conditions and surgical procedures. (AHRQ 06-M049-2)

Pediatric Quality Indicators. Reflect quality of care inside hospitals and identify potentially avoidable hospitalizations among children. (AHRQ 06-M049-4)

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)

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)

The CAHPS Hospital Survey: Development, Testing, and Use. C. Crofton, C. Darby, M. Farquhar, et al., Journal of Quality and Patient Safety 31(11): November 2005, 655-659. Describes how the CAHPS consortium developed the CAHPS Hospital Survey instrument, how it was tested, and expectation for its use. (AHRQ 06-R017)

Consumer Assessment of Health Providers and Systems (CAHPS®): Evolving to Meet Stakeholder Needs. C. Darby C. Crofton, C. Clancy, American Journal of Medical Quality 21(2): March/April 2006, 144-147. Describes the evolution of the CAHPS family of survey instruments, from the project's beginning in the mid-1990s to the present. Currently, there are about 30 instruments in use or in development. (AHRQ 06-R047).

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)

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)

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)

Factors Associated with High-Quality/Low-Cost Hospital Performance. H. Jiang, B. Friedman, J. Begun, Journal of Health Care Finance 32(3): Spring 2006, 139-152. Explores organizational and market characteristics associated with superior hospital performance in both quality and cost of care, using the Healthcare Cost and Utilization Project State Inpatient Databases for 10 States in 1997 and 2001. (AHRQ 06-R054)

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)

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)

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)

Informing Quality Health Care. C. Clancy, Healthcare Financial Management March 2006, 64-68. Commentary on the importance of quality in the health care system. Discusses the role of the government, AHRQ's Effective Health Care Program, and quality-improvement principles. (AHRQ 06-R057)

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)

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)

2007 National Reports on Quality and Disparities Agency for Healthcare Research and Quality, February 2008. Reports focus on quality of care and disparities in health care in America, overall and for AHRQ's priority populations. 2007 National Healthcare Disparities Report. 244 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 08-0041) 2007 National Healthcare Quality Report. 136 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 improved since 2000, but more needs to be done. (AHRQ 08-0040)

National Quality Measures Clearinghouse™ Tutorial. Agency for Healthcare Research and Quality, October 2003, CD-ROM tutorial provides information on specific evidence-based health care quality measures and measure sets. (AHRQ 04-0009-CD)

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)

Payment Matters? The Next Chapter. P. McNamara, Medical Care Research and Review Supplement, 63(1): February 2006, 5S-10S. Latest in a series of coordinated efforts by AHRQ to contribute to an ongoing national dialogue related to payment. Addresses the research gap and adds to the collective understanding of pay-for-performance. (AHRQ 06-R050)

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)

Process Utility in Breast Biopsy. J. Swan, W. Lawrence, J. Roy, Medical Decision Making 26: July-August 2006, 347-359. Describes the use of waiting trade-off in a circumstance where measuring preferences via waiting for results of testing and treatment may not be plausible for patients, owing to the urgency of the medical situation. (AHRQ 06-R083)

Provider-Specific Report Cards: A Tool for Health Sector Accountability in Developing Countries. P. McNamara, Advanced Access 23: January 2006, 101-109. Discusses universal design options for report cards, summarizes the evidence base, presents developing country examples, reviews challenges, and outlines implementation steps. (AHRQ 06-R023)

Purchaser Strategies to Influence Quality of Care: From Rhetoric to Global Applications. P. McNamara, Quality & Safety in Health Care 15: June 2006, 171-173. Highlights and frames purchasers' strategies explicitly crafted to enhance the quality and safety of care. (AHRQ 06-R051)

Quality-Based Purchasing in the United States: Applications in Developing Countries? P. McNamara, Spending Wisely: Buying Health Services for the Poor. In: Preker AS and Langenbrunner JC, eds. World Bank, Chapter 22, 2005, pp. 375-388. Discusses the quality-based purchasing movement globally, nationally, and regionally, and talks about barriers, strategies to promote health accountability for quality, and impact of employer strategies on quality. (AHRQ 06-R009)

Quality Tools to Improve Care and Prevent Errors. M. Nix, M. Coopey, C. Clancy, Journal of Nursing Care Quality 21(1): January-March 2006, 1-4. Provides a commentary on patient safety in nursing practice, discussing quality tools to assist health care professionals, policymakers, health plans, employers, patients, and consumers in the development, promotion, and enhancement of quality within a practice or organization. (AHRQ 06-R034)

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)

Resource Guides for State Action Complementary products help State leaders implement quality improvement plans for their States or enhance existing programs. Uses State-level data from National Healthcare Quality Reports to help States assess the quality of care in their States and fashion quality improvement strategies suited to State conditions. Asthma Care Quality Improvement: A Resource Guide for State Action. 143 pp. (AHRQ 06-0012-1) Asthma Care Quality Improvement: A Workbook for State Action. 35 pp. (AHRQ 06-0012-2) Diabetes Care Quality Improvement: A Resource Guide for State Action. 152 pp. (AHRQ 04-0072) Supplement. 4 pp. (AHRQ 04(05)-0072-1) Diabetes Care Quality Improvement: A Workbook for States. 38 pp. (AHRQ 04-0073)

Report of Nationally Representative Values for the Noninstitutionalized U.S. Adult Population for 7 Health-Related Quality-of-Life Scores. J. Hanmer, W. Lawrence, J. Anderson, et al., Medical Decision Making 26: July/August 2006, 391-400. Presents age- and sex-stratified nationally representative values for several commonly used preference-based and non-preference-based health-related quality-of-life scores. Uses data from the 2001 wave of the Medical Expenditure Panel Survey. (AHRQ 06-R082)

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)

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)

Unintended Consequences of Information Technologies in Health Care—An Interactive Sociotechnical Analysis. M. Harrison, R. Kopel, S. Bar-Lev, Journal of the American Medical Informatics Association, 14:2007, 542-549. Develops and illustrates a conceptual model of interactions between health information technology (Health IT) and a health care organization's sociotechnical system—including its workflow, culture, social interactions, and technologies—and discusses some unanticipated consequences that only become evident during Health IT implementation. (AHRQ 08-R008

Using the National Healthcare Quality and Disparities Reports for Executive Decision Making. A. Poker, M. Farquhar, E. Dayton, Nurse Leader, December 2005, 1-3. Discusses how the National Healthcare Quality and Disparities Reports can assist nurse leaders in making key decisions about quality and patient safety. (AHRQ 06-R030)

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