Quality of Care

As Obesity Epidemic Escalates, Need for More Screening and Counseling Grows. C. Clancy, Journal of Nursing Care Quality, January-March 2011; 26(1):1-3. Commentary discusses the scope of the obesity epidemic in the United States and new opportunities for counseling and other preventive services made possible by the recent health care reform legislation. (AHRQ 11-R039)

Asthma Care Quality Improvement. Agency for Healthcare Research and Quality, 2006. A resource guide and workbook to help State leaders implement quality improvement plans or enhance existing plans for asthma care in their States.
Resource Guide. 151 pp. (AHRQ 06-0012-1)
Workbook. 39 pp. (AHRQ 06-0012-2)

Board Oversight of Quality: Any Differences in Process of Care and Mortality? H. Jiang, C. Lockee, K. Bass, et al., Journal of Healthcare Management, January/February 2009; 54(1):15-30. Examines differences in hospital quality performance associated with the adoption of particular practices in oversight of quality by hospital governing boards. (AHRQ 09-R041)

Building Capacity for a Transformation Initiative: System Redesign at Denver Health. M. Harrison, J. Kimani, Health Care Management Review, January-March 2009; 34(1):42-53. Examines the development of transformation initiatives—deliberate attempts to achieve systemic changes and rapid performance improvements—over a 2-year period at an integrated safety net health system. (AHRQ 09-R017)

Building the Path to High-Quality Care. C. Clancy, Health Services Research, February 2009; 44(1):1-4. Editorial focuses on the challenges inherent in transitioning from the current, highly fragmented health care system to one that is evidence based and patient focused. (AHRQ 09-R090)

Can Incentives to Improve Quality Reduce Disparities? K. Ho, E. Moy, C. Clancy, Health Services Research, February 2010; 45(1):1-5. Editorial discusses the ability of quality improvement efforts to reduce disparities in care associated with race, ethnicity, socioeconomic status, and other factors. (AHRQ 10-R051)

Changes in Patient Flow Among Five Hospitals Participating in a Learning Collaborative. M. McHugh, K. Van Dyke, E. Howell, et al., Journal for Healthcare Quality, September 2011; epub. Evaluates the efforts of five hospitals that participated in a collaborative aimed at improving patient flow and reducing emergency department crowding. (AHRQ 12-R003)

Chasing Zero: Can Reality Meet the Rhetoric? C. Denham, P. Angood, D. Berwick, et al., Journal of Patient Safety, 5(4):216-222. Presents opinion interviews from leaders who spoke at a 2008 national leadership meeting on hospital-acquired infections. (AHRQ 10-R031)

The Chasing Zero Department: Making Idealized Design a Reality. C. Denham, P. Angood, D. Berwick, et al., Journal of Patient Safety, December 2009; 5(4):210-215. Summarizes a discussion and consensus-building session to discuss whether zero hospital acquired infections should be the improvement target for hospitals and what a "chasing zero" department should be like. (AHRQ 10-R030)

Complexity, Bullying, and Stress: Analyzing and Mitigating a Challenging Work Environment for Nurses. R. Hughes, C. Clancy, Journal of Nursing Care Quality, July-September 2009; 24(3):180-183. Commentary discusses some of the challenges and stressors nurses face in their day-to-day jobs and what they can do to foster a positive and supportive working environment. (AHRQ 09-R081)

Creating a Framework for Getting Quality into the Public Health System. P. Honore, D. Wright, D. Berwick, et al., Health Affairs, April 2011; 30(4):737-745. Describes two reports from the Department of Health and Human Services that define what is meant by public health quality, establish quality aims, and highlight priority areas needing improvement. Provides real-world examples of how a framework of quality concepts can be applied in the National Vaccine Safety Program and in a State office of minority health. (AHRQ 11-R053)

Defining and Measuring Successful Emergency Care Networks: A Research Agenda. S. Glickman, M. Delgado, J. Hirshon, et al., Academic Emergency Medicine, December 2010; 17(12):1297-1305. Explores the concept of integrated emergency care delivery and prioritizes a research agenda for how to best define and measure successful networks of emergency care. (AHRQ 11-R034)

Defining the Emergency Care Sensitive Condition: A Health Policy Research Agenda in Emergency Medicine. B. Carr, P. Conway, Z. Meisel, et al., Annals of Emergency Medicine, December 2009; e-pub. Presents a new concept, the emergency care sensitive condition, as a framework on which to build emergency quality measures and through which to improve evolving emergency care delivery systems. (AHRQ 10-R041)

Designing and Implementing Medicaid Disease and Care Management Programs: A User's Guide. Agency for Healthcare Research and Quality, March 2008, 180 pp. Presents information, examples, and checklists to help States design, implement, and evaluate Medicaid care management programs for the chronically ill. (AHRQ 07(08)-0063)

Developing Quality of Care Measures for People with Disabilities: Summary of Expert Meeting. L. Iezzoni, Agency for Healthcare Research and Quality, September 2010, 36 pp. Summarizes the discussion and recommendations from a workshop focused on developing quality of care measures for people with disabilities. (AHRQ 10-0103)

Diabetes Care Quality Improvement. Agency for Healthcare Research and Quality, 2004. A resource guide, supplement, and workbook to help State leaders implement quality improvement plans or enhance existing plans for diabetes care in their States.
Resource Guide. 162 pp. (AHRQ 04-0072)
Supplement to the Resource Guide. 4 pp. (AHRQ 04(05)-0072-1)
Workbook. 42 pp. (AHRQ 04-0073)

The Diabetes Primary Prevention Initiative Interventions Focus Area: A Case Study and Recommendations. D. Porterfield, L. Hinnant, D. Stevens, et al. American Journal of Preventive Medicine, September 2010; 39(3):235-242. Describes the Diabetes Primary Prevention Initiative Interventions Focus Area (DPPI-IFA), which was funded by the Centers for Disease Control and Prevention in 2005 and involved five State diabetes prevention and control programs, and presents case studies of the five programs. (AHRQ 11-R009)

Effects of Hospital Competition on Inpatient Quality of Care. R. Mutter, H. Wong, M. Goldfarb, Inquiry, Fall 2008; 45:263-279. Applies AHRQ's Quality Indicator software to the 1997 Healthcare Cost and Utilization Project State Inpatient Databases to create three versions of 38 distinct measures of inpatient quality and assesses 12 different hospital competition measures against the quality measures. (AHRQ 09-R042)

Emergency Severity Index, Version 4. Agency for Healthcare Research and Quality, November 2011. Presents a five-level emergency department triage algorithm that provides clinically relevant stratification of patients into five groups from most urgent to least urgent on the basis of acuity and resource needs. Updated edition with a new section on using the ESI algorithm with pediatric populations.
Everything You Need to Know, Set of two DVDs (AHRQ 05-0046-DVD)
Implementation Handbook, 2012 Edition. Spiral bound, 104 pp, and poster (AHRQ 12-0014)

Enhancing Board Oversight on Quality of Hospital Care: An Agency Theory Perspective. H. Jiang, C. Lockee, I. Fraser, Health Care Management Review, June 2011; epub. Explores the role and practices of governing boards in quality oversight through the lens of agency theory and compares hospital quality performance in relation to the adoption of those practices. (AHRQ 11-R068)

Enhancing Quality Oversight. H. Jiang, Healthcare Executive, March/April 2010; 25(2):80-83. Discusses the attention being paid by hospitals to quality improvement and the role that hospital boards are playing in these efforts. (AHRQ 10-R068)

Facilitators and Barriers to the Implementation of Patient Flow Improvement Strategies. K. Van Dyke, M. McHugh, J. Yonek, D. Moss, Quality Management in Health Care, July/September 2011; 20(3):223-233. Discusses the results of a study to identify common facilitators and barriers to the implementation of patient flow improvement strategies in hospital emergency departments, as well as successful approaches for overcoming the barriers. (AHRQ 12-R031)

Finding Order in Heterogeneity: Types of Quality Improvement Intervention Publications. L. Rubenstein, S. Hempel, M. Farmer, et al., Quality and Safety in Health Care, December 2008; 17(6):394-395. This commentary explores the heterogeneity in clinical quality improvement intervention publications. (AHRQ 09-R022)

Getting to Zero: New Resources Aim to Reduce Health Care-Associated Infections. C. Clancy, American Journal of Medical Quality, July-August 2010, 25(4):319-321. Commentary discusses recent progress in efforts to reduce health care-associated infections and describes HHS's expanded efforts in this area through newly awarded grants and contracts. (AHRQ 10-R079)

Health Literacy Impact on Patient-Provider Interactions Involving the Treatment of Dental Problems. L. Cohen, A. Bonito, C. Eicheldinger, et al., Journal of Dental Education, September 2011; 75(9):1218-1224. Examines several health literacy-related markers among patients seeking treatment in hospital emergency departments and physician and dentist offices for dental problems and injuries. (AHRQ 12-R001)

Healthcare Quality and Disparities: Attacking Problems at Their Root. C. Clancy, Journal of Nursing Care Quality, October-December 2009; 24(4):269-272. Commentary reflects on patient safety in nursing practice, briefly notes some progress and continuing problems identified in the most recent AHRQ national reports on quality and disparities in health care, and discusses ways to move forward with quality improvement. (AHRQ 10-R012)

High-Performance Work Systems in Health Care Management, Part 1: Development of an Evidence-Informed Model. A. Garman, A. McAlearney, M. Harrison, et al., Health Care Management Review, July-September 2011; 36(3):201-213. Describes a conceptual model developed on the basis of prior research from health care as well as other industries that could be used to inform important contextual considerations for improving health care quality. (AHRQ 11-R065)

High-Performance Work Systems in Health Care Management, Part 2: Qualitative Evidence from Five Case Studies. A. McAlearney, A. Garman, P. Song., et al., Health Care Management Review, July-September 2011; 36(3):214-226. Discusses the use of high-performance work systems in health care organizations and describes the contributions of such systems to quality of care and patient safety improvements. (AHRQ 11-R066)

Hospital Quality, Efficiency, and Input Slack Differentials. V. Valdmanis, M. Rosko, R. Mutter, Health Services Research, December 2008; 43(5):1830-1848. Examines the effects of hospital inefficiency on quality of care in public, not-for-profit, and teaching hospitals. (AHRQ 09-R005)

Identification of Hospital-Acquired Catheter-Associated Urinary Tract Infections from Medicare Claims. C. Zhan, A. Elixhauser, C. Richards, et al., Medical Care, March 2009; 47(3):364-369. Discusses the positive predictive value and sensitivity in identifying patients in Medicare claims who had urinary catheterization and developed hospital-acquired catheter-associated urinary tract infections. (AHRQ 09-R046)

Improving Efficiency and Value in Health Care: Introduction. I. Fraser, W. Encinosa, S. Glied, Health Services Research, October 2008; 43(5 Part II):1781-1786). Introduces a new theme issue for the journal, which is focused on ideas and programs to reduce waste, increase efficiency, and better allocate resources to improve value in health care. (AHRQ 09-R004)

Improving Patient Flow and Reducing Emergency Department Crowding: A Guide for Hospitals. Agency for Healthcare Research and Quality, October 2011, 44 pp. Presents step-by-step instructions for use by hospitals in planning and implementing emergency department patient flow improvement strategies. (AHRQ 11(12)-0094)

Kidney-Related Diseases and Quality Improvement: AHRQ’s Role. C. Clancy, Clinical Journal of the American Society of Nephrology, October 2011; 6(10):2531-2533. Describes patient-centered care and discusses AHRQ’s role in quality improvement activities related to kidney disease. (AHRQ 11-R077)

Leveraging Certified Nursing Assistant Documentation and Knowledge to Improve Clinical Decision Making: The On-Time Quality Improvement Program to Prevent Pressure Ulcers. S. Sharkey, S. Hudak, S. Horn, W. Spector, Advances in Skin & Wound Care, April 2011; 24(4):182-188. Explains the On-Time Quality Improvement for Long-Term Care Program, a practical approach to embed health information technology into quality improvement in long-term care facilities to support front-line clinical decisionmaking and proactive intervention for pressure ulcer prevention. (AHRQ 11-R049).

Measuring Hospital Inefficiency: The Effects of Controlling for Quality and Patient Burden of Illness. R. Mutter, M. Rosko, H. Wong, Health Services Research, December 2008; 43(6):1992-2013. Assesses the impact of employing a variety of controls for hospital quality and patient burden of illness on the mean estimated inefficiency and relative ranking of hospitals as generated by stochastic frontier analysis (SFA), a statistical method used for economic modeling. (AHRQ 09-R011)

Measuring Patient-Centered Communication in Cancer Care: A Literature Review and the Development of a Systematic Approach. L. McCormack, K. Treiman, D. Rupert, et al., Social Science & Medicine, April 2011; 72(7):1085-1095. Describes a comprehensive inventory of domains and subdomains for patient-centered communication and discusses considerations for developing measures of patient-centered communication for use in research, quality assessment, and surveillance. (AHRQ 11-R054)

Methodological Considerations in Generating Provider Performance Scores for Use in Public Reporting: A Guide for Community Quality Collaboratives. Agency for Healthcare Research and Quality, September 2011, 106 pp. Reviews a number of the key methodological decision points community quality collaboratives face in producing public reports of health care providers’ performance on measures of quality, cost, and resource use; patient experience; and health outcomes. (AHRQ 11-0093)

2011 National Reports on Quality and Disparities Agency for Healthcare Research and Quality, March 2012. Reports focus on quality of care and disparities in health care in America, overall and for AHRQ's priority populations. National Healthcare Quality Report 2011. 228 pp. Finds that health care quality and access are suboptimal, urgent attention is warranted to ensure improvements in quality, and progress is uneven with respect to eight national priority areas. (AHRQ 12-0005) National Healthcare Disparities Report 2011. 252 pp. Finds that health care quality and access are suboptimal, especially for minority and low-income groups, quality is improving but access and disparities are not improving, and urgent attention is warranted to ensure progress on reducing disparities. (AHRQ 12-0006)

Pay for Performance: A Decision Guide for Purchasers. AHRQ Final Contract Report, April 2006, 28 pp. Isolates and sequences 20 questions purchasers face in considering pay for performance, reviews options and any available evidence—from empirical evaluations and economic theory—that may inform future decisionmaking, and discusses potential effects and unintended consequences. (AHRQ 06-0047)

Physician Leadership for High-Quality Care. C. Clancy, Chest, December 2009; 136(6):1452-1454. AHRQ director discusses data collection and selection of measures for use by clinicians for public reporting of health care quality information to Medicare and other entities. (AHRQ 10-R043)

Population Mobility, Globalization, and Antimicrobial Drug Resistance. D. MacPherson, B. Gushulak, W. Baine, et al., Emerging Infectious Diseases, November 2009; 15(11):1727-1732. Presents an approach to global public health risk management that integrates population factors with effective and timely application of policies and processes. (AHRQ 10-R039)

Preventing Healthcare-Associated Infections: Initiating Promising Solutions and Expanding Proven Ones. C. Clancy, Patient Safety & Quality Healthcare, March/April 2010; 50(2):e-pub. Gives examples of several initiatives that have been successful in lowering the rate of health care-associated infections and discusses new research underway in this area. (AHRQ 10-R067)

Preventing Hospital-Acquired Venous Thromboembolism: A Guide for Effective Quality Improvement. Agency for Healthcare Research and Quality, August 2008, 50 pp. Presents information to help quality improvement (QI) practitioners—such as physicians, pharmacists, nurses, and risk managers—lead an efficient, reliable effort to improve prevention of hospital-acquired venous thrombolism, one of the most critical problems facing hospitalized patients. (AHRQ 08-0075)

The Quality and Disparities Reports: Why is Progress so Slow? J. Brady, K. Ho, C. Clancy, American Journal of Medical Quality, September/October 2008; 23(5):396-398. Discusses geographic variations in quality of care and racial/ethnic disparities related to patient safety as reported in annual editions of AHRQ’s National Healthcare Quality Report and National Healthcare Disparities Report. (AHRQ 12-R029)

Quality in the OR: The New AHRQ Reports. C. Clancy, AORN Journal, August 2009; 90(2):269-271. Commentary discusses the implications of AHRQ's annual National Healthcare Quality Report and National Healthcare Disparities Report for improving safety in the operating room and the role of operating room nurses in keeping patients safe. (AHRQ 10-R005)

Quality Indicators Brochures
Agency for Healthcare Research and Quality, August 2010. AHRQ Quality Indicators (QIs), measures of health care quality that make use of readily available hospital inpatient administrative data. Available at: http://qualityindicators.ahrq.gov for announcement of updates to AHRQ QI software.
Inpatient QIs. (AHRQ 10-M043-2)
Patient Safety QIs. (AHRQ 10-M043-4)
Pediatric QIs. (AHRQ 10-M043-3)
Prevention QIs. (AHRQ 10-M043-1)

Quality Indicators Toolkit for Hospitals. Agency for Healthcare Research and Quality, January 2012, Web only. Online toolkit designed to help hospitals understand and support use of AHRQ’s Quality Indicators (QIs) to improve quality and patient safety. Provides a general guide to using improvement methods, with a particular focus on the QIs, including the 17 Patient Safety Indicators (PSIs) and the 28 Inpatient Quality Indicators (IQIs). Available at http://www.ahrq.gov/qual/qitoolkit/.

Reducing Central Line-Related Bloodstream Infections. C. Clancy, AORN Journal, June 2009; 89(6):1123-1125. Commentary explains five steps involved in a simple, low-cost intervention to reduce rates of central line-associated bloodstream infections (CLABSI) in hospital intensive care units (ICUs). (AHRQ 10-R009)

Selecting Quality and Resource Use Measures: A Decision Guide for Community Quality Collaboratives. Agency for Healthcare Research and Quality, May 2010, 95 pp. Serves as an evidence-based primer and decisionmaking framework to guide community-based leaders in their strategic and operational planning related to quality improvement and performance measurement. (AHRQ 09(10)-0073)

State Snapshots AHRQ's State Snapshots provide State-specific health care quality information, including strengths, weaknesses, and opportunities for improvement. State-level information is presented for every State and Washington, DC. Information used to create the Snapshots is derived from AHRQ's National Healthcare Quality Report. The goal is to help State officials and their public- and private-sector partners better understand health care quality and disparities in their State. State Snapshots can be found at http://statesnapshots.ahrq.gov.

The Stress of the Care Environment. C. Clancy, R. Hughes, AORN Journal, April 2009; 89(4):751-753. Commentary discusses the role of nurses in providing high quality, safe care and the day-to-day stresses inherent in the system that can affect their performance and job satisfaction. (AHRQ 09-R066)

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