Video Summary Transcript
The Agency for Healthcare Research and Quality (AHRQ) summit entitled "Improving Health Care Quality for All Americans—Celebrating Success, Measuring Progress, Moving Forward" was held on April 4, 2005. Below is a transcript of the video summary of this summit.
Dr. Carolyn M. Clancy:
In April 2005, the Agency for Healthcare Research and
Quality convened its first national summit on the quality of
health care in America. Leaders from throughout the
health care system were on hand to look at how far
we've come in measuring quality, and how we can
translate what we know into better quality practices at
hospitals and doctors' offices throughout our country.
These health care leaders confirmed that there is a
growing understanding of what we mean by quality and
what we need to do to improve it. Not just a vague goal
that can't be measured and not, as some used to think,
merely the most expensive care. High quality health care
means the right care at the right time to address the
patient's needs. That may be a preventive service or a
medication or coordinated care for a chronic condition.
The important fact is that we're learning more every day
based on evidence and research what "the right care" is for
specific conditions—what works best. But we're still a
long way from putting what we know into practice in
every health care setting.
Dr. Carolyn Clancy (as a soundbite):
Let's state our predicament right
up front: When it comes to quality and health care delivery,
we actually do have many answers, answers about best
practices, answers about what works, proven science-based answers. What we don't have yet is results.
Dr. Clancy (as voiceover):
There was a sense of urgency at the Summit because
focusing on quality can help us address so many
problems in our health care system, including costs.
Quality of care is cost effective care. When we use what
works we're getting our money's worth. It means not
wasting our resources through overuse or mistakes or by
letting a patient's health problems build up and become
more expensive because of underuse of care. It's
estimated that a third or more of our health care spending
may be wasted or preventable. That means hundreds of
billions of dollars every year not to mention poorer health
for our patients. The quality approach is about doing
better with the resources we have. Don Berwick
talked about the help that our health
professionals need.
Don Berwick:
But most of all I think we need technical help. If we make
knowledge for improvement a proprietary good, if we
make it ownable and hideable, we will without any doubt
in my mind at all slow progress in this country. I
think that would happen even among our major medical
centers which could be far more efficient in improving
their care if they share knowledge about improvement at
the process level the way they do at the science level. But
it's definitely going to be true of the thousands of rural
hospitals, the tens of thousands of doctors and three and
four person practices, the many, many sites that simply
are not going to be able to rediscover time after time, the
process improvement sciences that AHRQ could help
them get to.
Dr. Clancy:
The main purpose of the Summit was to learn from each
other, and some of the most important participants were
on a panel called "Reports from the Field." This panel
brought perspectives from different circumstances and
different parts of the country, from Mississippi to New
York, from Virginia to California.
Dr. Janice Bacon:
This was a different approach for us in that we were used
to doing audits and quality assurance sessions and
looking at individual patients. But was only by becoming
a part of this process we were able to say on any given
day, what is the average hemoglobin A1C for the patient
population you serve?
Dr. Clancy:
Dr. Janice Bacon is director of clinical services for the
Carmichael Family Health Center in Canton,
Mississippi serving a low income area with 40 percent
uninsured and very high rates of diabetes and asthma.
The Center used proven quality approaches to improve
health outcomes, not expensive treatments but better use
of information, patient involvement and better teamwork
in the clinic to get better health results.
Dr. Bacon:
This is just an example of the model that we were trained
on. It was initially known as the chronic care model. We're
calling it more and more now the plan care model, in that it
gives you a schematic of all the components involved in
achieving these positive outcomes. So you have to look
at the community, you're looking at your organization. The
key to it is you're trying to make sure you have a proactive
prepared patient on one side and an informed team ready to
work on the other so that you can achieve these positive
outcomes.
Dr. Clancy:
The Carmichael Center improved quality with a patient-centered measurement-based approach. Not only did they
regularly measure how their patients were doing, they
also involved the patients closely with their own treatment
and progress. And they used evidence-based guidance as
targets for this progress. They built teamwork in the clinic
staff and they reached out to the entire community to help
support the patients in managing their conditions.
Dr. Bacon:
We also decided we needed to work with the mayors
and the sheriffs and all the elected officials, because it is
very important to have the mayor of a town come to
your health fair and shake the hands of those people there
and say I'm glad you're working on your diabetes or
I'm a diabetic, or my mother is a diabetic, or for the
sheriff to do the same thing. So we had them come and
greet the clients and that increased the value of this
condition for the entire community.
Dr. Clancy:
These are not expensive steps, but in this case they
improved health status in one of the nation's poorest
regions. Dr. Robert Panzer came from a very different
facility, the 739-bed Strong Memorial Hospital in
Rochester New York. Strong Memorial's approach was
also patient centered with a daily goal sheet for each
patient. In addition, defined systematic approaches were
important along with focusing on specific problem areas.
The hospital also used health information technology with
a basic IT product that was modified to be user friendly
for their staff. For ventilator-associated pneumonia these
approaches reduced mortality to near zero, with annual
savings in the hundreds of thousands of dollars. Better
quality, lower costs. Health information technology is
important for quality improvement.
JoEllen Ross talked
about the challenges faced by doctors in adopting health
IT. She's president of Lumetra, working
with the Medicare program to help small-practice
physicians adopt electronic health records. The best
known benefit of health IT is its ability to deliver a
complete up-to-date patient record when and where it's
needed. But health IT will also do more—it can deliver
clinical information at the bedside, helping the clinician get
the treatment right. And with information and electronic
formats we'll have access to much more data to build our
evidence research base, meaning we'll learn more and
faster about what works best.
Dr. Gary Yates of Sentara
Health Care talked about specific steps for
creating a "culture of health care quality." Sentara
looked at industries outside of health care to
see how they have improved quality. Communications and
teamwork were the first step and attention to detail was
next in creating a quality culture. Sentara
devised specific processes for its staff and it put a special
emphasis on the hazards of transition periods—when one
medical team hands off to another, or a patient is
discharged.
The power of the metrics, setting specific
goals and measuring results, the importance of team
work, the promise of health IT, and the need to make
care truly patient-centered were some of the key lessons
at the Summit. Speakers also made clear that our
payment and benefit policies can actually undermine
quality, unless they are geared to reward results, or at
least avoid punishing quality care. And two more over-arching themes that are closely engrained with quality of
care: health care disparities and disease prevention.
AHRQ's annual report on quality of care includes a
companion report on health care disparities because it's
not really possible to understand the quality issue in
America without understanding the persistent problem of
health care disparities based especially on race, ethnicity
and income. John Nelson, president of the American
Medical Association, was one of those who said
disparities must be addressed.
John Nelson:
We know we can do better and we know the evidence
will help us to do better. Once we have that evidence
base and care about our patients, the ethics demand that
we do something about it. And that is why I'm excited to
announce with my colleagues that we're going to that
very thing. Once we identify what the disparities are, the
next issue is to try to make sure that doctors understand
that the disparities occur in their practices too, not just in
mine. And so what we want to do then is once we have
identified these is to work together in ways we
previously have not worked together to make sure that
these things become something of the past.
Dr. Clancy:
Of course many of the causes of health care disparities lie
outside the health care system. But at the Summit a panel
agreed that steps can be taken in health care to address
disparities regardless of other problems facing minorities
and the poor.
John Nelson:
We may not be able to correct in the near future all the
inequities about which you speak, but as clinicians we can
absolutely change the ones where the evidence tells us
what to do. If you and I were to go into the hospital
tonight you ought to have the same chance to have survival
as I do, or you ought to have better—you're younger than what I am.
But the point is instead of getting frustrated about what
we can't do we have got to be excited about what we
can do. The thing of physicians and nurses and others in
the health care fields can do is to make sure we use the
evidence and treat all patients correctly.
Dr. Clancy:
Dr. Elena Rios of the National Hispanic Medical
Association talked about the needs of Latinos. And Dr.
Randall Maxey of the Commission to End Health Care
Disparities pointed to the importance of culture and
parenting as key factors in health status. And finally,
disease prevention. Our quest speaker, Arkansas Governor
Mike Huckabee, talked about his own personal journey
to good health and his vision for improving the health of
his State.
Mike Huckabee:
The culture of health means that rather than simply decide that
we're going to continue to find and try to treat the diseases,
we would attack the causes of them. And essentially it's
lifestyle choices. Three basic behaviors are driving most
of the chronic disease today: lack of exercise, obesity
and tobacco addiction. And so those three particular
behaviors we've targeted when we launched the
Healthy Arkansas Initiative, and we decided that we would
set some very specific goals to try to change the behavior
and the culture and the attitudes towards those behaviors
in our State.
Dr. Clancy:
A few final thoughts. First, the importance of listening to the
patients. A patient's perceptions of quality may not be the
same as the doctor's or researcher's. But we'll be missing
the point if we don't hear what patients are saying to us
about what they want. And second, quality improvement
can be achieved. In fact, we have a dramatic example in
this year's report. Nursing homes got an early taste of
quality measurement as a result of the CMS Nursing Home
Quality Initiative. And the improvements in this year's
report were dramatic. For the five measures of nursing
home quality, performance improved by almost 15 percent in a
year. There was a decrease of 37 percent in patients who have
moderate to severe pain. And for nursing homes that
received special and intensive help as part as the CMS
Initiative, the reduction in pain was 46 percent.
This spring we've
seen new progress in HHS agencies. CMS has
launched its "Hospital Compare" Web site. And along with our
annual quality report, AHRQ presented State-specific
measures to help each State target its quality efforts where
they are most needed. We're also launching a new
AHRQ "Quality Connect" initiative to lend help to States.
Quality of care—the right treatment at the right time for the
patients needs—gives us a productive and efficient way to
look at our health care system. It gives us specific goals
and measurable results that add up to cost-effective care
and better health.
Improving quality will mean a new
culture in health care: Openness and candor above
quality performance, and comparison of one provider with
another. It will take courage on the part of our health
care professionals, and cooperation to share the
approaches that work. With all the challenges our health
care system faces, the quality approach is an important,
hopeful, movement. A way to make better use of our vast
health care resources, a measurable means to achieve cost-effective care, and the chance to deliver proven good
quality care to all Americans.
Current as of April 2005
Internet Citation:
AHRQ Summit on Improving Quality of Care. Video Summary Transcript. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/qual/qsummit/qsumvidtr.htm
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