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Conference Report: AHRQ


 

The Agency for Healthcare Research and Quality (AHRQ) held its annual Patient Safety and Health IT (internet technology) Conference June 4-7, 2006, at the Renaissance Hotel in Washington, D.C. This annual meeting provides grantees, quality improvement and risk assessment managers, and all members of the healthcare team the opportunity to learn how AHRQ-funded patient safety and health IT research contributes to improved healthcare quality.

This was AHRQ’s sixth national conference with a focus on patient safety, and it was the second time the conference had a combined focus on patient safety and health IT. To highlight the importance of these two focus areas working together, the conference was entitled “Strengthening the Connections.” The significance of this relationship was further emphasized by holding the conference during the inaugural “National Health IT Week” and closing the sessions with a handoff (on National Health IT Day) to a health IT Summit held by the Healthcare Information and Management Systems Society (HIMSS).

This year’s conference opened with remarks from AHRQ Director Carolyn Clancy, MD, and opening keynote speaker David M. Sundwall, MD, director of the Utah Department of Health.

Dr. Clancy set the focus of the week by emphasizing that the pursuit of quality must be the shared ambition of patient safety and health IT. Quality healthcare is “the right treatment, for the right patient, at the right time” and the objectives of patient safety and health IT are best aligned when these goals are kept in sight by both focus areas. Dr. Clancy noted that AHRQ has helped pursue quality in patient safety and health IT by “fund[ing] some 240 Patient Safety and Health IT projects, and award[ing] more than $400 million in grants and contracts for both programs [since 2001].” Ultimately, “AHRQ’s efforts,” Dr. Clancy said, “are helping to light the path and measure the benefits for the average practice and community hospital. … [And they are] helping [to] show these providers [that] how to make a successful transition to health IT practice is a keystone in successfully adopting health IT.”

This was AHRQ’s sixth national conference with a focus on patient safety, and it was the second time the conference had a combined focus on patient safety and health IT.

To share the work of this year’s presenting grantees, the sessions were categorized by topic into nine different, but concurrent, tracks. This allowed individuals with particular interests to easily identify which sessions would be most valuable to them. These tracks included:

  • Track 1: Patient Safety and Health IT across Settings and Populations: These sessions covered the use of health IT in special populations, in outpatient clinics and physician offices, in emergency care, for the elderly, and in distance/telemedicine.
  • Track 2: Implementation Issues in Patient Safety and Health IT: The track’s two sessions discussed how health IT will move into the 21st century, the relationship between clinical redesign and improved safety, process approaches to improving clinical performance, and the establishment and implementation of standards for e-prescribing.
  • Track 3: Improving the Health of Communities through Regional Health Information Exchange (HIE): Track three featured ways to get started in HIE by gaining stakeholder support, ways to design and implement HIE at the front lines, and the development of sustainable business models for HIE, and offered updates on the shaping of the health IT vision at the Office of the National Coordinator.
  • Track 4: Assessing Value and Evaluating Project Impact: Track four presentations covered the impact of certain health IT tools, a brainstorming session for rural health IT initiatives, an evaluation of medication administration technologies, an assessment of clinical decision support, new tools for assessing value, and an evaluation of regional health information exchange systems.
  • Track 5: Achieving and Sustaining Improvements: This series of sessions highlighted the frequency of adverse medical-device events, socio-technical approaches to planning and assessing redesign with health IT, clinical decision support and reporting systems to improve population health and minimize harm in patient handoff settings, and ways to recognize and manage unintended consequences of health IT.
  • Track 6: Using Reporting Systems for Safety and Quality Improvement: Track six presentations covered efforts to improve the accuracy and utility of reporting systems, ways to track changes over time through reporting systems, methods to track adverse drug events through reporting systems, and innovative applications of reporting systems.
  • Track 7: Working Conditions Challenges in Patient Safety: Track seven described how health IT impacts provider working conditions and performance, how working conditions, and culture can impact performance of providers and patient outcomes, and how programs can be used to promote patient safety cultures.
  • Track 8: Patient and Family Centered Health IT and Safety: The sessions in track eight presented strategies for improving medication management across transitions in care, as well as perceptions and approaches to patient-centered health IT.
  • Track 9: Emerging Approaches to Drive Change in Healthcare: The ninth track discussed examples of how IT solutions intended to reduce error can sometimes induce new error, current uses of and research involving AHRQ’s patient safety indicators, appropriate and inappropriate use of technology in developing high reliability hospital systems, an introduction to and overview of using positive deviance as a quality improvement methodology, and the use of lean methodology in healthcare.

Of particular note is the involvement of five hospitalists in AHRQ-funded research. Jeff Greenwald, MD, Brian Jack, MD, Greg Maynard, MD, MS, Tosha Wetterneck, MD, and Mark Williams, MD, are each involved with quality improvement and patient safety research through AHRQ grants. (See The Hospitalist, June issue, p. 35.)

Doctors Jack and Greenwald are partners in researching the re-engineering of the hospital discharge process—a process that they note is not standardized and is often marked with poor quality as observed by the frequency of post-discharge adverse events and 30 day re-hospitalization rates—to improve patient safety. They have grants through AHRQ’s Partnerships in Implementing Patient Safety (PIPS) and Safe Practices Risk Assessment Challenge Grants (SPRACGS) research initiatives and presented their work as a part of track two.

Dr. Maynard is also funded through AHRQ’s PIPS research initiative as his research pursues the elimination of hospital-acquired venous thromboembolism (VTE). Noting that easy and cost effective prophylactic treatment exists, but is underutilized, Greg’s project involves the creation of a toolkit that allows institutions to acquire optimal prevention of hospital-acquired VTE, ultimately reducing morbidity, mortality, and the associated but unnecessary costs.

Dr. Wetterneck presented her work on medication administration technologies as a part of track four. Her research has focused on the development and evaluation of Smart IV pump technology that has been designed with human factors in mind.

Dr. Williams presented, along with John Bajha, PhD, his research on Hospital Patient Safe-D(ischarge). This initiative is funded by a PIPS grant and was presented as a part of track five. The project intends to first implement a “discharge bundle” that consists of medication reconciliation, patient-centered hospital discharge education, and a post-discharge continuity check by a clinician. Once the discharge bundle is established, its level of adoption and acceptance will be evaluated before the researchers develop an “implementation toolkit” for dissemination of the bundle. The bundle will be disseminated with the intended result of safer discharges.

The Patient Safety and Health IT Conference concluded on National Health IT Day and the start of the HIMSS Summit. Speakers included Dr. Clancy; Newt Gingrich, former speaker of the House and founder of the Center for Health Transformation; David Brailer, national coordinator for Health Information Technology; and Mark McClellan, MD, PhD, administrator of Centers for Medicare and Medicaid Services.

Additional panels throughout the day included leaders from outside of healthcare: David Hom, vice president, human resources strategic initiatives, Pitney Bowes; Bruce Bradley, director, health plan strategy and public policy, General Motors; and Dale Whitney, corporate health care manager, United Parcel Service; as well as a number of leaders from within the healthcare field who are actively involved with health IT implementation.

Ultimately, the day’s topics highlighted the importance of leveraging health IT in the pursuit of improved patient safety from the perspectives of policymakers, business leaders, and healthcare leaders and successfully served as a transition to the HIMSS Summit. TH

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