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Agency for Healthcare Research and Quality (AHRQ)

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The Agency for Healthcare Research and Quality (AHRQ) was first established in 1989 in the hopes of improving the quality and efficiency of healthcare in the United States using evidence-based approaches [1]. The AHRQ contributes to improving health systems in the United States primarily by investing in research and evidence generation efforts, creating training materials and resources, and by sponsoring performance and evaluation initiatives[2]. It is important to understand the role and impact of the AHRQ when considering ways to improve one’s own clinical practice, and in making decisions about initiatives through the agency one may like to support and advocate for moving forward.

The AHRQ funds basic research in an effort to improve the safety and quality of hospital care. Some have attributed the decrease in hospital acquired infections (HACs) to the Affordable Care Act’s expanded quality and safety provisions, that are supported by the tools, resources, and data generated by the AHRQ. For instance, basic research on central line infections that was supported by the AHRQ motivated and informed the Partnership for Patients (PfP) initiatives for national education and outreach programming [2, 3]. Additionally, as part of their research initiatives, the AHRQ designed the Evidence-based Practice Center (EPC) program. The EPC program initially included 12 centers across the U.S. recruited to conduct systematic reviews of the evidence available on important questions in healthcare. These questions were nominated by leaders in the medical field who would later be tasked with utilizing the results of these studies to improve clinical practices. There are now 13 centers, the majority of which are generalist EPCs that review a wide range of topics decided by outside partners [1].

The AHRQ plays an important role in nurturing system-wide change by reshaping, restructuring, supporting and supplementing provider training. TeamSTEPPS, for instance, is an evidence-based set of teamwork tools that is available on the AHRQ website aimed at improving communication and collaboration skills between health care professionals, making study evidence applicable and usable in direct patient practice [4]. One of the essential resources they have made available is the AHRQ Guideline Clearing House, which lost it’s funding and has since shut down in 2018 [5]. The Guideline Clearing House was a comprehensive national clinical guideline resource created in 1998, which summarized over 10,000 clinical practice guidelines over its lifetime. The Clearing House was born from a clinical guidelines program established by AHRQ between 1990 and 1996, which received pushback from specialists who interpreted the guidelines as an attempt to limit expensive procedures as well as a large contingency of professionals who wanted to limit government involvement in clinical policy [1].

Data resources, reports, and national surveys provided by AHRQ are essential information pools for researchers, providers, and policy makers. Important data projects on patient experience and quality improvement have been spearheaded by AHRQ. This includes the largest family of databases on hospital care in the United States under The Healthcare Cost and Utilization Project as well as The Medical Expenditure Panel Survey, which is the most complete dataset on healthcare costs and insurance in the U.S [2].

Incredible work has been done by the AHRQ to create evidence-based standards and guidelines across the United States for improving the quality of healthcare while also investing efforts into creating training resources and access to national data and important population-level information. As with any agency with high hopes of changing and improving systems to safely and effectively treat all patients with the same quality standard of care, the AHRQ still has much to strive for. Early criticism of AHRQ guidelines highlighted the slow and expensive process of developing such guidelines, as well as the need for further adaptation of guidelines for local practices due to the challenge of creating standardized guidelines that consider and include all possible scenarios. The agency continues to investigate new ways to improve practices outside of the hospital, wherever patients need and receive care through grants that support opioid use reduction in rural areas, as well as community health physician training programs in New Mexico [2, 6, 7]. Moving forward, it is the hope that AHRQ will continue to improve their processes to make information more accessible to patients, policy makers, physicians, and researchers in a timely manner, and to find innovative ways to make better healthcare decisions using evidence-based approaches. 

References

1.         David Atkins, K.F., Jean Slutsky, Better Information for Better Health Care: The Evidence-based Practice Center Program and the Agency for Healthcare Research and Quality Annals of Internal Medicine, 2005. 142(12): p. 1035-1041.

2.         Kronick, R., AHRQ’s Role in Improving Quality, Safety, and Health System Performance. Public Health Reports, 2016. 131(2): p. 229-232.

3.         Department of Health and Human Services (US), Office of the Assistant Secretary for

Planning and Evaluation, Saving lives and saving money: hospital-acquired conditions

update. 2015.

4.         Department of Health and Human Services (US), Office of the Assistant Secretary for

Planning and Evaluation, TeamSTEPPS®: Strategies and Tools to Enhance Performance

and Patient Safety.

5.         Physicians, A.A.o.F., AHRQ: National Guideline Clearinghouse to Shut Down July 16. 2018.

6.         Department of Health and Human Services (US), Office of the Assistant Secretary for

Planning and Evaluation, AHRQ announces grant opportunities to address opioid abuse

disorder in rural areas.

7.         Department of Health and Human Services (US), Office of the Assistant Secretary for

Planning and Evaluation. Project ECHO: Extension for Community Healthcare Outcomes

(New Mexico) Available from: https://healthit.ahrq.gov/ahrq-funded-projects/project-echo-extension-community-healthcare-outcomes.

An Overview of the Quality Payment Program (QPP)

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The Quality Payment Program, also referred to as the QPP, is a program implemented by the Department of Health and Human Services through the Centers for Medicare and Medicaid Services (CMS). In brief, the QPP is a reimbursement mechanism that is designed to place a high value, and hence reimbursement, on physicians that are delivering high-quality care, while separating these from physicians who are not meeting national or specific standards of quality of care. The QPP is a program in multiple parts, including data collection, summarization, feedback generation, and finally, calculation of payment[1]. Not only is the QPP a means of ascertaining the financial reimbursement for physicians serving Medicare-insured populations, but also, it is a mechanism by which physicians can be included in the decision-making process. Launched in 2017, the QPP is currently now in its second year of program participation across the United States, with preliminary results promising.

Before a discussion of the current state of the QPP, it is important to understand how exactly the program functions. To participate in the program, physician practices must agree to meet extensive data collection objectives. In line with this, the QPP urges practices to demonstrate how technology, specifically advanced technology, has aided with the collection and generation of data. The next step requires practices to send in summarization reports of collected metrics to the program, under deadlines. Following this stage, CMS will conduct an analysis of your data, matching your outcomes on specific objectives to nationally recognized benchmarks in the field. CMS will then share these results with you, along with the determination of your projected reimbursement. This number may include any incentives given for above-average delivery of care. In addition, if you participate in one of the other CMS programs, for example an advanced APM, then you may be eligible for further incentives.

This is the theoretical framework of the program. However, in the last two years, how has the program functioned in practice? CMS recently released results that provide an illustration of the QPP in