Question

The Agency for Health Care Research and Quality (AHRQ) supports research that improves the quality of health care and performance improvement. Select and describe one of the data sources available from AHRQ. Include in your discussion the role of the health care leader in promoting safe, effective evidence-based patient care.

Answer 1

The Agency for Healthcare Research and Quality (AHRQ) is the lead federal agency charged with improving the quality and safety of America's health-care system. AHRQ develops the knowledge, tools, and data needed to improve health system performance and help patients, health-care professionals, and policy makers make informed health decisions. The research, tools and training, and data and measures that AHRQ produces enable close collaboration with U.S. Department of Health and Human Services (HHS) agencies and other partners to ensure that the evidence produced is understood and used to achieve the goals of better care, smarter spending of health-care dollars, and healthier people.

The 2010 Patient Protection and Affordable Care Act has made great strides in transforming American health care, with an estimated 17.6 million additional Americans receiving health-care coverage1 compared with 49.9 million uninsured in 2010.2 Although expansion of the Affordable Care Act's coverage has garnered the most attention, the law's quality and safety provisions may have even more impact on U.S. health system performance in the long term. The latest evidence is shown in an HHS report released in December 2015 on hospital-acquired conditions (HACs).3

According to the report, from 2010 to 2014, hospital patients had an estimated 2.1 million fewer HACs than they would have had if rates of adverse events had remained at the 2010 level of 145 HACs per 1,000 hospital discharges. Fewer HACs resulted in 87,000 fewer patients dying in hospitals and a reduction of nearly $20 billion in health-care costs.3 These findings build on results reported in December 2014, which showed that 50,000 fewer patients died in hospitals and $12 billion in health-care costs were saved from 2010 to 2013.4 Overall, from 2010 to 2014, the number of adverse events declined by 17%, dropping from 145 adverse events per 1,000 hospital discharges to 121 adverse events per 1,000 hospital discharges.3

Improving patient safety requires efforts from many actors. Clinicians and staff members in hospitals across the United States were fundamental to this progress. The Affordable Care Act also played a key role in these efforts through the HHS Partnership for Patients initiative, a public-private collaboration of health-care providers, employers, patients, and federal and state governments. The initiative, launched in 2011, focused on improving health-care safety by lowering the rate of HACs and decreasing preventable complications that can result in hospital readmissions.5 Progress was further incentivized by changes in Medicare payment, which galvanized the attention of hospital leaders. For example, under the Affordable Care Act, Medicare reduced payments to the 25% of hospitals whose rate of HACs fell within the highest quartile.6 Translating HHS's policy aims of better care, smarter spending, and healthier people into practice requires strong, diverse public-private partnerships, including frontline clinicians, institutions, and patients and families. In addition to the Partnership for Patients initiative, these efforts include hospital engagement networks, quality improvement organizations, and many other public and private partners.

TOOLS, RESOURCES, AND DATA

Tools, resources, and data from AHRQ are essential to these efforts. The tools, knowledge, and data that AHRQ develops and funds are foundational to creating a health-care system that is safe, timely, effective, efficient, equitable, and patient-centered.7 AHRQ contributes to creating a higher-performing health system in three major ways.

Investing in research and evidence to understand how to improve the safety and quality of health care

AHRQ supports research to improve U.S. health system performance. AHRQ generated much of the basic evidence about how to improve the safety of hospital care, starting with evidence on how to reduce central line-associated bloodstream infections.8 Central line-associated bloodstream infections can occur when bacteria or other germs enter a central line or catheter placed in a patient's large vein to facilitate medical treatment. These infections can lead to death and add billions of dollars in health-care costs each year. Until the mid-2000s, it was generally accepted by physicians that central line infections were a cost of doing business in the intensive care unit (ICU). Some ICU patients needed central lines, and some of those central lines would become infected, leading to bloodstream infections that contributed to longer hospital stays and high mortality rates. AHRQ-funded research demonstrated that central line infections could be prevented, and data from a 2015 report on HACs showed a 72% reduction in central line infections nationwide from 2010 to 2014. The 2010 baseline measure for central line infections was 18,000; by 2014, it had decreased to 5,000, fueled by national education and outreach through Partnership for Patients and with tools and resources, many of which were based on AHRQ-funded research.9

Other AHRQ-funded projects include our Evidence-based Practice Centers, 13 academic and research organizations that review scientific literature on a wide spectrum of clinical and health services topics10 and provide evidence for the U.S. Preventive Services Task Force. AHRQ also supports investigator-initiated research. One example of this AHRQ-funded research is an innovative model for training and supporting primary clinicians in rural communities in New Mexico to provide specialized care for their patients.11

Creating materials to teach and train health-care professionals to catalyze system-wide improvements in care

AHRQ has credibility and an excellent ongoing relationship with the health-care provider community. Tools and resources such as the Surveys on Patient Safety Culture12 and TeamSTEPPS® training materials, an evidence-based teamwork system aimed at improving communication and teamwork skills among health-care professionals,13 are widely used in hospitals, physician practices, and other settings of care. These materials vary widely in scope but together translate the latest evidence from bench to bedside.

One prominent example of AHRQ's work with providers is the development and implementation of the Comprehensive Unit-based Safety Program (CUSP). CUSP is a customizable program that combines clinical best practices with the science of safety, improved safety culture, and an increased focus on teamwork. Developed by Johns Hopkins researchers with AHRQ funding, it has been a major force in reducing central line infections.14 CUSP was later applied to catheter-associated urinary tract infections, reducing such infections in more than 950 hospitals by about 15% from 2011 to 2015.15 The CUSP Toolkit brings together practical resources based on the experiences of thousands of hospitals that have used CUSP with learning materials that help providers understand key principles that increase safety. Add-on modules target safety issues and settings of care.

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