EHC Program: AHRQ 2008 Conference in Bethesda, Maryland

AHRQ held its annual conference Sept. 7-10, highlighting the Agency’s unique role in health services research and its goal of improving the effectiveness of health care delivery. The conference showcased many of the activities of the Effective Health Care Program and allowed attendees to discuss the larger issues of how to improve health care in the United States and how AHRQ research can facilitate that improvement.

The conference featured discussions that followed several different tracks, including Health Information Technology; Patient Safety; Effective Health Care; Prevention and Care Management; and Value, Innovations, and Emerging Issues. Also included was the “mAHRQet Place Café,” which featured displays of quality improvement tools and applications that attendees could try out.

At the closing plenary session on Sept. 10, Dr. Carolyn Clancy, AHRQ Director, posed this question: “What is it we need to do right now so we’re not having this same discussion in 5 years?”

This question was answered by members of an expert panel, who brought differing perspectives on the important priorities. Dr. Arthur Kellermann, associate dean for health policy at the Emory University School of Medicine, identified three innovations that would profoundly change the face of health care over the next 5 years: universal coverage; a basic set of universally available clinical services; and a cheap, simple electronic health record. “We are not possibly ever going to achieve the goals we aspire to in quality, safety, and effectiveness unless we cover everyone in this country,” said Dr. Kellermann. In describing a universal set of services, he used the analogy of “tap-water health care,” stating that the United States has a healthcare system today that is buying “Fiji water in supertankers.” “The fact of the matter is tap water works,” he said. “What I want all of you to do or your colleagues to do is, let’s figure out what tap-water health care in this country is… What are the interventions? What’s the primary care? What vaccinations? What disease management strategies should be on everybody’s benefit list?” Dr. Kellermann also suggested using public funds to bring electronic health records up to date, then giving the system to public health systems and selling it to private health systems on a sliding scale.

Carol Cronin, executive director of the Informed Patient Institute, gave four “paradigm shifts” that were integral to changing health care delivery: moving from a fragmented system to an integrated one, moving from a passive patient to an active one, taking responsibility, and moving from a focus on sickness to a focus on health. Ms. Cronin described an active patient model, in which patients want to feel better, don’t want to worry about money, and want to be respected. “Those three aspects… are universal across racial, cultural, and educational groups,” she said. “Two others that many people want: they want to be informed… and they want to ask questions and get them answered. And people to a certain extent want to be involved, but they don’t want to be the doctor. And I worry about some of the rhetoric about the informed patient. Pushing a lot of the responsibility of decision-making and the burden of choice on patients, it sometimes goes too far.”

Dr. Darrell Kirch, president and CEO of the Association of American Medical Colleges, said hospitals need to spend as much time and money on cultural assessment and organizational change as they do on consultant-driven strategic plans that search for new reimbursement streams. “As long as we’re on strategic planning, we’re short on cultural assessment and cultural change,” Dr. Kirch said. “When you become a patient today, we want it to be patient-centric, collaborative, communicative… All our rewards are designed to perpetuate the old culture, and the key step, I believe, is to purposefully assess the culture deficit and work to change it.”