Leveraging research into healthcare quality, costs, outcomes, and patient safety

A Profile of Dr. Carolyn M. Clancy, Director, Agency for Healthcare Research and Quality U.S. Department of Health and Human Services

Healthcare remains one of the most pressing issues of today, with a system mired in ever-increasing costs, inconsistent quality, and access pressures. Many of the healthcare reform proposals being reviewed in Congress attempt to remedy one or more of these issues. Research continues to identify ways to improve the quality and safety of healthcare, ensure access to care, increase the use of health information technology (IT), and find new ways to translate clinical research into practice. “The mission of the Agency for Healthcare Research and Quality,” explains Dr. Carolyn Clancy, director of AHRQ, “is to improve the quality, safety, efficiency, and effectiveness of healthcare for all Americans. We pursue this goal by supporting research and working very closely with those who provide care—clinicians of all disciplines—as well as with patients and policymakers, so that they can use information to improve the delivery of healthcare.”

Dr. Clancy manages a broad portfolio of scientific research that promotes enhancements to clinical and health system practices. “About 80 percent of our budget goes to grants and contracts with many academic institutions, community health centers, and hospitals focusing on improving healthcare. We now fund work in almost all 50 states,” explains Clancy. She describes her main responsibility as one of ensuring that all parts of AHRQ work together. “My day-to-day work,” notes Clancy, “is actually communicating what it is that we’re trying to do—connecting the dots between the research we’re supporting and healthcare you’re going to get.” AHRQ comprises five research centers and three offices, but she states that, “We really organize our work around portfolios: comparative effectiveness; patient safety and quality; health IT; improving value in healthcare; prevention and care management; and innovations.”

The U.S. spends more on healthcare than any other nation, yet numerous studies have found that there is really no relationship between spending and the quality of care. For Clancy, it is critical to make sure that “what we do for patients matches their needs and preferences and actually helps them to get on with their lives.” Comparative effectiveness research (CER )—systematic research that compares different interventions and strategies to prevent, diagnose, treat and monitor health conditions—offers promise. According to Dr. Clancy, the purpose of this research is to inform patients, providers, and decision makers by responding to their needs about which interventions are most effective for patients under specific circumstances. The Recovery Act allocated about 1.1 billion dollars for CER , with some $300 million allocated to AHRQ’s already-established CER portfolio. “We live in a very exciting time,” admits Clancy, “because of all of the advances in biomedical science. More and more, it’s not the case that there’s one thing to do for a particular condition—there are multiple choices. How do you make those choices?” CER is looking to fill that gap. “We think this research will help make sense of all of the rapidly expanding options and innovations in medicine. It’s all about focusing on patients’ needs, and applying the best of science to meet those individual needs,” says Clancy. 

As the nation’s lead research agency on healthcare quality, safety, efficiency, and effectiveness, AHRQ plays a critical role in the drive to adopt health IT. “I think many people don’t grasp that healthcare today is, by and large, a paper enterprise.” Her agency funds research that identifies ways to expand health IT adoption and use. It seeks to identify best practices for making health IT work and tools that can help hospitals and clinicians successfully adopt it. According to AHRQ-funded research, electronic health record adoption continues to increase slowly. The initial capital investment continues to be a significant barrier to adoption. “We believe,” asserts Clancy, “that health IT can improve the quality of care….At the same time, it can deliver customized information to the point of decision making, based on scientific evidence. That’s our goal, and we are very excited about it.” 

According to the Centers for Disease Control and Prevention, nearly 2 million patients suffer from a healthcare-associated infection in U.S. hospitals each year, resulting in 99,000 deaths and annually incurring an estimated $28-$33 million in excess healthcare costs. AHRQ funds research that aims to identify risks and hazards that result in medical errors, while seeking to find ways to prevent patient injury associated with delivery of care. “This is a growing problem,” admits Clancy, “We’ve seen people suffering serious consequences because of these infections, which are largely avoidable.” Clancy describes the Michigan Keystone ICU Project as a successful example of how to foster a culture of patient safety. It is a joint partnership between Johns Hopkins University and the Michigan Health and Hospital Association, funded by an AHRQ grant. “We supported a team from Johns Hopkins,” notes Clancy, “They focused on reducing serious bloodstream infections, using some relatively straightforward steps that can actually reduce the infection rate dramatically.” 

 ARHQ-funded research means little until its findings and lessons learned are disseminated. Dr. Clancy declares that the ultimate goal is to translate AHRQ’s research findings into clinical practice—hopefully resulting in healthier, more productive individuals and an enhanced return on our nation’s substantial investment. “We work extensively to communicate what we’re doing and to disseminate it in practical ways.”

Listen to:  The Business of Government Hour Interview with Dr. Clancy

Risky Business

Recovery Act guidance from OMB requires agencies to identify the risk associated with each program and develop a plan of action to reduce such risks.  After all, if a program gets 3,100 %  increase in funding, like the home weatherization program did, there must be some risk involved!  Vice President Biden has said he would like to see the entire government to adopt the new standards being developed under Recovery Act programs.  Well, just in time, the IBM Center has just published a new report, “Managing Risk in Government:  An Introduction to Enterprise Risk Management,” by Karen Hardy.

Hardy observes that, typically, agencies tend to deal with new risk-reduction requirements on a discrete, program-by-program basis.  They put in place compliance mechanisms to meet new IT security risk reduction requirements, or new financial management requirements, or new internal control requirements, or new erroneous payment reduction requirements, etc.  She says all of these requirements are geared to one end – improved risk management.  She says leading organizations in the private sector have undertaken enterprise-wide risk management efforts.  Holistic efforts across an organization can reduce risk – and administrative burdens – at the same time.

Identifying and keeping track of possible events, and classifying them into opportunities or risks, requires a taxonomy or classification scheme and a common language for understanding these risks. Improved data management allows a large organization to take advantage of modern analytical methods to quantify and track current trends and potential risks.

While the concept of enterprise-wide risk management may be new, the federal government has been adopting this approach on an ad hoc basis.  Hardy gives concrete examples of enterprise-wide efforts in government, noting that “for the first time in its 75-year history, the Federal Housing Administration (FHA) announced intentions to hire its first chief risk officer.”  She also describes efforts underway to address health risks (Food and Drug Administration and Centers for Disease Control and Prevention), security risks (Defense and Homeland Security), financial  risks (Ginnie Mae), transportation safety risks (National Transportation Safety Board), and operational risks (Internal Revenue Service and Student Aid).

Hardy notes that a group of government managers have self-organized into a Federal Executive Steering Group for Enterprise Risk Management and they’ve created an unofficial website to foster and continue a conversation on the topic.  You can join!