sábado, 11 de agosto de 2012

New Closing the Quality Gap Evidence Reports Are Available

EPC Evidence Reports



New Closing the Quality Gap Evidence Reports Are Available

AHRQ released the first two of eight evidence reports in its new series, Closing the Quality Gap: Revisiting the State of the Science.  The series is a follow-up to Closing the Quality Gap: A Critical Analysis of Quality Improvement Strategies, a collection of seven evidence reports published between 2004 and 2007. The new Closing the Quality Gap series broadens the areas of investigation of the series with regard to settings, interventions, and clinical conditions, while continuing the focus on improving the quality of health care through critical assessment of relevant evidence. Targeting multiple audiences and uses, the new series assembles evidence about strategies aimed at closing the difference between what is expected to work well for patients based on known evidence and what actually happens in day-to-day clinical practice across populations of patients. The first two reports in this new series are:

  • The Patient-Centered Medical Home: Duke University Evidence-based Practice Center researchers found that studies of the Patient-Centered Medical Home (PCMH) often had similar elements, but the precise components of care varied widely. While the studies suggest that the PCMH is promising for improving the experiences of patients and staff, there is insufficient evidence to date that shows these interventions improve patient clinical outcomes or reduce total costs. Studies now taking place have the potential to greatly expand our knowledge of the PCMH.
  • Public Reporting as a Quality Improvement Strategy: Oregon Evidence-based Practice Center researchers found that public reporting of health care quality information is more likely to change behaviors in health care providers than it does consumers’ choice of providers. The researchers also found that quality measures that are publicly reported tend to improve over time. In addition, the number of studies on potential harms from public reporting was limited and those that did examine the issue do not confirm potential harms.

Closing the Quality Gap Series: The Patient-Centered Medical Home: Structured Abstract

The Patient-Centered Medical Home

July 2012

In 2004, AHRQ launched a collection of evidence reports, Closing the Quality Gap: A Critical Analysis of Quality Improvement Strategies, to bring data to bear on quality improvement opportunities. These reports summarized the evidence on quality improvement strategies related to chronic conditions, practice areas, and cross-cutting priorities.
This evidence report is part of a new series, Closing the Quality Gap: Revisiting the State of the Science. This report was commissioned to identify completed and ongoing efforts to evaluate the comprehensive patient-centered medical home (PCMH) model, summarize current evidence for this model, and identify gaps in the evidence.
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Structured Abstract

Objectives: As part of the Closing the Quality Gap: Revisiting the State of the Science series of the Agency for Healthcare Research and Quality (AHRQ), this systematic review sought to identify completed and ongoing evaluations of the comprehensive patient-centered medical home (PCMH), summarize current evidence for this model, and identify evidence gaps.
Data Sources: We searched PubMed®, CINAHL®, and the Cochrane Database of Systematic Reviews for published English-language studies, and a wide variety of databases and Web resources to identify ongoing or recently completed studies.
Review Methods: Two investigators per study screened abstracts and full-text articles for inclusion, abstracted data, and performed quality ratings and evidence grading. Our functional definition of PCMH was based on the definition used by AHRQ. We included studies that explicitly claimed to be evaluating PCMH and those that did not but which met our functional definition.
Results: Seventeen studies with comparison groups evaluated the effects of PCMH (Key Question [KQ] 1). Older adults in the United States were the most commonly studied population (8 of 17 studies). PCMH interventions had a small positive impact on patient experiences (including patient-perceived care coordination) and small to moderate positive effects on preventive care services (moderate strength of evidence [SOE]). Staff experiences were also improved by a small to moderate degree (low SOE). There were too few studies to estimate effects on clinical or most economic outcomes.
Twenty-one of 27 studies reported approaches that addressed all 7 major PCMH components (KQ 2), including team-based care, sustained partnership, reorganized care or structural changes to care, enhanced access, coordinated care, comprehensive care, and a systems-based approach to quality. A total of 51 strategies were used to address the 7 major PCMH components. Twenty-two of 27 studies reported information on financial systems used to implement PCMH, implementation strategies, and/or organizational learning strategies for implementing PCMH (KQ 3).
The 31 studies identified in the horizon scan of ongoing PCMH studies (KQ 4) were broadly representative of the U.S. health care system, both in geography and in the complexity of private and public health care payers and delivery networks.
Conclusions: Published studies of PCMH interventions often have similar broad elements, but precise components of care varied widely. The PCMH holds promise for improving the experiences of patients and staff, and potentially for improving care processes. However, current evidence is insufficient to determine effects on clinical and most economic outcomes. Ongoing studies identified through the horizon scan have potential to greatly expand the evidence base relating to PCMH.

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Closing the Quality Gap: Revisiting the State of the Science Series: The Patient-Centered Medical Home.
Evidence-based Practice Center: Duke EPC
Current as of July 2012

Internet Citation:
Closing the Quality Gap: Revisiting the State of the Science Series: The Patient-Centered Medical Home. Structured Abstract, July 2012. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/clinic/tp/gappcmhtp.htm



Public Reporting as a Quality Improvement Strategy

July 2012

In 2004, AHRQ launched a collection of evidence reports, Closing the Quality Gap: A Critical Analysis of Quality Improvement Strategies, to bring data to bear on quality improvement opportunities. These reports summarized the evidence on quality improvement strategies related to chronic conditions, practice areas, and cross-cutting priorities.
This evidence report is part of a new series, Closing the Quality Gap: Revisiting the State of the Science. This report evaluates the effectiveness of public reporting of health care quality information as a quality improvement strategy.
View or download Report

Structured Abstract

Objectives: The goal of this review was to evaluate the effectiveness of public reporting of health care quality information as a quality improvement strategy. We sought to determine if public reporting results in improvements in health care delivery and patient outcomes. We also considered whether public reporting affects the behavior of patients or of health care providers. Finally we assessed whether the characteristics of the public reports and the context affect the impact of public reports.
Data Sources: Articles available between 1980 and 2011 were identified through searches of the following bibliographical databases: MEDLINE®, Embase, EconLit, PsychINFO, Business Source Premier, CINAHL, PAIS, Cochrane Database of Systematic Reviews, EPOC Register of Studies, DARE, NHS EED, HEED, NYAM Grey Literature Report database, and other sources (experts, reference lists, and gray literature).
Review Methods: We screened citations based on inclusion and exclusion criteria developed based on our definition of public reporting. We initially did not exclude any studies based on study design. Of the 11,809 citations identified through title and abstract triage, we screened and reviewed 1,632 articles. A total of 97 quantitative and 101 qualitative studies were included, abstracted, entered into tables, and evaluated. The heterogeneity of outcomes as well as methods prohibited formal quantitative synthesis. Systematic reviews were used to identify studies, but their conclusions were not incorporated into this review.
Results: For most of the outcomes, the strength of the evidence available to assess the impact of public reporting was moderate. This was due in part to the methodological challenges researchers face in designing and conducting research on the impact of population-level interventions. Public reporting is associated with improvement in health care performance measures such as those included in Nursing Home Compare. Almost all identified studies found no evidence or only weak evidence that public reporting affects the selection of health care providers by patients or their representatives. Studies of health care providers' response to public reports suggest they engage in activities to improve quality when performance data are made public. Characteristics of public reports and the context, which are likely to be important when considering the diffusion of quality improvement activities, were rarely studied or even described.
Conclusions: The heterogeneity of the outcomes and the moderate strength of evidence for most outcomes make it difficult to draw definitive conclusions. However, some observations were supported by existing research. Public reporting is more likely to be associated with changes in health care provider behaviors than with selection of health services providers by patients or families. Quality measures that are publicly reported improve over time. Although the potential for harms is frequently cited by commentators and critics of public reporting, the amount of research on harms is limited and most studies do not confirm the potential harm.

Download Report

Closing the Quality Gap: Revisiting the State of the Science Series: Public Reporting as a Quality Improvement Strategy
Evidence-based Practice Center: Oregon EPC
Current as of July 2012

Internet Citation:
Closing the Quality Gap: Revisiting the State of the Science Series: Public Reporting as a Quality Improvement Strategy. Structured Abstract, July 2012. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/clinic/tp/gapqistp.htm

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