Assessment of the AHRQ Patient Safety Initiative: Moving from Research to Practice Evaluation Report II (2003-2004)

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The Agency for Healthcare Research and Quality (AHRQ) is carrying out its congressional mandate to establish a patient-safety research and development initiative to help health care providers reduce medical errors and improve patient safety. In September 2003, AHRQ entered into a four-year contract with the RAND Corporation to serve as the Patient Safety Evaluation Center for its patient safety initiative. The evaluation center is responsible for performing a longitudinal evaluation of the full scope of AHRQ2s patient safety activities and for providing regular feedback to support the continuing improvement of this initiative over the four-year project period. This report covers the period October 2003 through September 2004. It is the second of what will be four annual reports prepared by RAND during the formative evaluation. It builds on the preceding evaluation report, which covers the period October 2002 through September 2003. This report provides an update on the policy context that frames the AHRQ patient safety initiative, documents the evolution and current status of the priorities and activities being undertaken in the initiative, and lays out a framework and possible measures for evaluating the effects of the initiative on patient outcomes and stakeholders other than patients. Implications of the evaluation findings are discussed with respect to future AHRQ policy, programming, and research, and suggestions are presented for strengthening AHRQ activities as the initiative moves forward. The content and format of each report are designed to provide a stable structure for the longitudinal evaluation; the results of each year2s assessment contribute to a cumulative record of the initiative2s evolution. The contents of this report will be of interest to national and state policymakers, health care organizations and clinical practitioners, patient-advocacy organizations, health researchers, and others with responsibilities for ensuring that patients are not harmed by the health care they receive.
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About the author

Donna O. Farley (RAND Graduate School, Santa Monica, California Doctor of Philosophy in Policy Analysis) is a Senior Health Policy Analyst at RAND.

Cheryl Damberg (Ph.D., RAND Graduate School of Policy Studies) is a Health Policy Fellow. Research interests include employment-based health insurance, health care reform, quality of care, health promotion/disease prevention.

Susan Ridgely (J.D., 1995, University of Maryland School of Law) is a Co-Investigator, UCLA/RAND Research Center on Managed Care and Psychiatric Disorders and a Co-Investigator, RAND Drug Policy Research Center.

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Additional Information

Rand Corporation
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Published on
Dec 31, 2007
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Health & Fitness / Health Care Issues
Medical / Family & General Practice
Medical / Health Policy
Political Science / Public Policy / General
Social Science / Sociology / General
Technology & Engineering / General
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Accurate models are needed to help the USAF develop retention policies that will retain a sufficient number of officers having the right qualities. The Air Force, and researchers working on personnel issues for the Air Force and other services, have long used an annualized cost of leaving (ACOL) model to help determine how changes in compensation would affect retention. However, the ACOL model does not handle two important factors in retention decisions particularly well: future uncertainty and random "shocks." The advantage of the Dynamic Retention Model is that it allows us to model how officers might value future career flexibility in the face of uncertainty. This is important in evaluating how people will respond to contracts that obligate them to multiple years of service, such as those available under the ACP program. Advances in computer hardware and software have now made estimation of the DRM feasible on even low-end personal computers. The DRM can be used to explore different policy options by taking individual retention decisions and running them through various policy alternatives. For example, it can analyze the effect proposed changes to the ACP program, such as eliminating the until-20-YAS option or the elimination of the ACP program altogether. The DRM shows that eliminating the until-20-YAS option (while keeping the five-year contract option) results in only a small change to overall retention, while eliminating the ACP program altogether would result in the Air Force losing up to 15 percent of its most experienced officers.
This report is one of five volumes providing detailed information on the QA Tools, RAND's comprehensive, clinically based system for assessing quality of care for children and adults. The QA Tools indicators encompass screening, diagnosis, treatment, and follow-up in 46 clinical areas and cover a variety of modes of providing care, including history, physical examination, laboratory study, medication, and other interventions and contacts.Development of each indicator was based on the ratings of a panel of experts in the relevant fields and on a focused review of the scientific literature, which is clearly documented for each clinical condition. This volume focuses on indicators for care of women. Each chapter summarizes the results of the literature review for a particular condition, provides RAND staff's recommended indicators based on that review, and lists the cited studies. In addition, this work details the process by which the expert panelevaluated the indicators and the final disposition of each indicator. Clinical conditions covered in this volume are: Acne, alcohol dependence, allergic rhinitis, asthma, breast mass, cesarean delivery, cigarette use counseling, depression, diabetes mellitus, family planning/contraception, headache, hypertension, acute low back pain, prenatal care, preterm labor-cortisosteroids for fetal maturation, preventive care, upper respiratoryinfections, urinary tract infection, vaginitis and sexually transmitted diseases. Other RAND Health titles on the QA Tools system focus on indicators for general medicine, oncology and HIV, cardiopulmonary conditions, and care of children and adolescents.
The Patient Safety Improvement Corps (PSIC), part of the Agency for Healthcare Research and Quality's (AHRQ's) patient safety initiative, is a program of three one-week sessions (didactic lessons, homework, and a team project) operated collaboratively by the AHRQ and the Veterans' Affairs (VA) National Center for Patient Safety (NCPS). Its purpose is to improve patient safety in the nation by increasing the number and capacity of health care professionals with patient safety knowledge and skills, achieved through training teams from all 50 U.S. states over three years. This report presents findings from RAND's evaluation of the first two years of the PSIC. Data were collected through in-person, group interviews with trainees at the final training session in May 2004 and May 2005, and through individual telephone interviews with the first-year trainees one year later. Overall, reported experiences were positive. Participants valued the broad perspective gained, and the tools and skills they learned and continue to use. They appreciated and continued to draw upon the technical aspects, the hands-on exercises, the knowledge gained through team projects, and the reference materials. Additionally, they value the networking opportunities, and they have made efforts to spread their knowledge. Significantly, there are strong indications that the program has contributed to actions in the field to improve patient safety. Key barriers challenging trainees' program participation and ability to make changes at their home organizations included lack of resources and cultural obstacles (such as blaming individuals for system problems). A need for continued training and programs to train larger, more-diverse teams was also noted. The findings suggest that the PSIC is making important contributions toward building a national infrastructure to support implementation of effective patient safety practices.
One-liner: A set of policy recommendations to promote the development and maintenance of communities in which children with asthma can be swiftly diagnosed, effectively treated, and protected from exposure to harmful environmental factors. An estimated 5 million U.S. children have asthma. Too many of these children are unnecessarily impaired. Much of the money spent on asthma is for high-cost health care services to treat acute periods of illness. Many asthma attacks could be avoided--and much suffering prevented and many medical costs saved--if more children received good-quality, ongoing asthma care and if the 11 policy recommendations presented in this report were implemented in a oordinated fashion. A national call to action, the policy recommendations span public and private interests and compel integration of public health activities across local, state, and federal levels. This report summarizes the findings of an effort funded by the Robert Wood Johnson Foundation as part of the Pediatric Asthma Initiative, whose purpose is to address current gaps in national childhood asthma care. It is the first national initiative that simultaneously addresses treatment, policy, and financing issues for children with asthma at the patient, provider, and institutional levels. The purpose of RAND's effort was to:--identify a range of policy actions in both the public and private sectors that could improve childhood asthma outcomes nationwide--select a subset of policies to create a blueprint for national policy in this area--outline alternatives to implement these policies that build on prior efforts.The effort developed a comprehensive policy framework that maps the identified strategies to one overall policy objective: to promote the development and maintenance of asthma-friendly communities--communities in which children with asthma are swiftly diagnosed, receive appropriate and ongoing treatment, and are not exposed to environmental factors that exacerbate their condition. This report is intended as a working guide for coordinating the activities of both public and private organizations at the federal, state, and local community levels.
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