Advancing Excellence in Health Care: Complexities of Co-Occurring Conditions
Helen Burstin, M.D., M.P.H.
Dr. Helen Burstin, director of the Center for Primary Care, Prevention, and Clinical Partnerships at the Agency for Healthcare Research and Quality (AHRQ), stressed that AHRQ’s research is different in that it is more patient-centered, as opposed to disease-specific,
and that AHRQ’s mission is to improve the quality, safety, efficiency, and effectiveness of healthcare for all Americans. The AHRQ currently sponsors 13 evidence-based
practice centers that review scientific literature on clinical, behavioral, and organization and financing topics; conducts research on the methodologies and effectiveness of their implementation; and requires nomination by an organization that will use the reports to support quality improvement. Burstin also focused on AHRQ’s goal to improve the quality of healthcare and reduce disparities
in healthcare delivery, citing statistics that address limitations. She also discussed AHRQ’s initiatives to focus on mental health and substance abuse issues, such as the prevalence of chronic conditions in adults, depression and healthcare utilization, supporting practice-based research networks, and working with the U.S. Preventive Services Task Force. Burstin concluded by addressing opportunities and challenges, particularly what she calls the “quality chasm” between where we are and where we want to be in terms of implementation, innovation, health information technology, diffusion, adoption, and translating research into practice.
Measuring What Counts—AND—Making it Count for Quality
Constance Horgan, Sc.D.
Dr. Constance Horgan, of Brandeis University and director of the Schneider Center for Behavioral Health, began by asking if we can measure what counts and how we can make it count for driving quality. Her presentation covered the background on quality and performance measurement and using performance measures in the role of stakeholders, particularly purchasers. Performance measurement is a tool to evaluate a managed care plan, health plan or program, hospital, or healthcare practitioner, and implies that the entity providing healthcare is responsible, can be identified and held accountable, and has control over the aspect of care being evaluated. She presented information on how we are doing in terms of providing medical care—selected behavioral health initiatives, particularly the Washington Circle; service facilities where adults with co-occurring disorders are being seen; and challenges to performance measures for co-occurring conditions.
Five Dimensions of Quality
David Rosenbloom, Ph.D.
Dr. David Rosenbloom, director of Join Together and the NIAAA Center to Prevent Alcohol-Related Problems Among Young People, addressed how to define quality, how to measure it, identify, and remove barriers to it, and how to reward better results. He explored these issues by presenting five dimensions of quality—patient satisfaction, information and emotional support, amenities/convenience, decisionmaking efficiency, and outcomes—and suggested measuring these dimensions, perhaps through a patient-feedback system. Rosenbloom also enumerated specific outcomes to measure, such as home care, cancer care, and functional improvement in rehabilitation. He concluded by addressing components of quality, measuring these components, and suggested barriers to quality.
Paying for Performance—Sounds Good…. But What Performance Are WE Paying For?
Nancy Wolff, Ph.D.
Dr. Nancy Wolff, Director of the Center for Mental Health Services and Criminal Justice Research in the Institute for Healthcare Policy and Aging Research, offered a more conceptual perspective of paying for performance in healthcare services. She focused on
different levels of performance—facility, client, and society—and on obtaining the type of services needed. Wolff recommended targeted efficiency so money will have its most powerful effect and the return on the investment dollar will be higher. This can be achieved by evaluating cost distribution and areas of need
and asking what is leading spending—funding or need? Wolff ended her
presentation by exploring the connection between immediate and sustained client outcomes, client and social outcomes, and the notion of rewarding performance.