Meeting Minutes, March 2018
National Advisory Council
Contents
Summary
Call to Order and Approval of November 3, 2017, Summary Report
Director's Update
Healthcare Cost and Utilization Project (HCUP) Update
Public Comment
Chair's Wrap-Up and Adjournment
Summary
NAC Members Present
Donald A. Goldmann, M.D., Boston Children鈥檚 Hospital, Institute for Healthcare Improvement, Harvard Medical School (Chair)
Alice S. Bast, Beyond Celiac
Christina J. Calamaro, Ph.D., CRNP, Children鈥檚 Healthcare of Atlanta
Robert S. Dittus, M.D., M.P.H., Vanderbilt University Medical Center
Jos茅 Julio Escarce, M.D., Ph.D., University of California, Los Angeles
Monica E. Peek, M.D., M.P.H., M.Sc., The University of Chicago
Lucy A. Savitz, Ph.D., M.B.A., Intermountain Healthcare
Alternates Present
Liza M. Catucci, U.S. Department of Veterans Affairs (for David Atkins)
Kate Goodrich, M.D., Centers for Medicare & Medicaid Services
Michael Lauer, M.D., National Institutes of Health
大象视频Staff Members Present
Francis D. Chesley, Jr., M.D., Acting Deputy Director
Jeffrey Brady, M.D., M.P.H., Director, Center for Quality Improvement and Patient Safety
Joel W. Cohen, Ph.D., Director, Center for Financing, Access, and Cost Trends
Lucie M. Levine, Chief Financial Officer
David Meyers, M.D., Chief Medical Officer
Jaime Zimmerman, M.P.H., PMP, Designated Management Official
Karen Brooks, CMP, NAC Coordinator
Call to Order and Approval of November 3, 2017, Summary Report
Donald A. Goldmann, M.D., Chair of the National Advisory Council (NAC), 大象视频 (AHRQ), called the group to order at 11 a.m. and welcomed the NAC members, other participants, and visitors. He referred to the draft minutes of the previous NAC meeting (November 3, 2017) and asked for changes and approval. The NAC members voted unanimously to approve the November meeting minutes with no changes.
Dr. Goldmann introduced Francis D. Chesley, Jr., M.D., who was recently appointed Acting Deputy Director of AHRQ. Dr. Chesley introduced the session for the Director鈥檚 Update.
Director's Update
Dr. Chesley conveyed warm regards to the NAC members from 大象视频Director Gopal Khanna, M.B.A., who was unable to join the meeting, and noted the appointment of Ginger Mackay-Smith, M.P.H., as Acting Director of AHRQ鈥檚 Center for Delivery, Organization, and Markets. Leaders within four 大象视频departments then provided updates on recent 大象视频activities.
大象视频Budget
Lucie M. Levine stated that the Agency currently is operating under a continuing resolution for fiscal year (FY) 2018. An omnibus bill may be presented within a week. Ms. Levine then provided details on the President鈥檚 proposed FY 2019 budget for 大象视频 that addresses the possible transition of AHRQ鈥檚 highest priority activities to a new entity, the National Institute for Research on Safety and Quality, which would be within the National Institutes of Health. The President鈥檚 FY 2019 budget request for the new entity is $380.3 million, a decrease of $41.3 million from FY 2018. The proposal includes $256 million in discretionary funds and $124.3 million in mandatory funds from the Patient-Centered Outcomes Research (PCOR) Trust Fund. 大象视频representatives will be attending House and Senate budget committee meetings to provide information in the upcoming months. House markup for the FY 2019 budget will be released in June. The Senate markup will follow.
The President鈥檚 proposed budget includes $69.8 million for patient safety research, $72.2 million for the Medical Expenditure Panel Survey (MEPS), $7.4 million for the U.S. Preventive Services Task Force, $1 million for the Evidence-Based Practice Center (EPC) Program, $10 million for the Healthcare Cost and Utilization Project (HCUP), $35.2 million for ongoing investigator-initiated research and training grants (no new grants are proposed), and $4.5 million for developing evidence in preventing and treating opioid misuse in primary care. The figure for MEPS includes support for new plans to expand the MEPS sample to improve national estimates, subgroup analysis, and the capacity for State estimates. The MEPS program also will develop and field new self-administered mental health questionnaires.
The proposed budget indicates reductions in portfolios for Health Information Technology Research and Health Services Research, Data, and Dissemination, including the elimination of programs in Quality Indicators, data analytics support, dissemination and implementation contracts, and the Consumer Assessment of Healthcare Providers and Systems.
Practice
David Meyers, M.D., FAAFP, reported on AHRQ鈥檚 efforts to address the opioid crisis, providing the following examples:
- An 大象视频grantee in Washington worked with 20 rural primary care practices and identified successful strategies for using team-based care to improve chronic pain management.
- An ARHQ grantee in New Mexico developed and tested a novel, reproducible model for translating and communicating evidence from EPC reports to rural, low-income, underserved, multiethnic communities.
- 大象视频has now posted 250 tools for delivering medication-assisted treatment.
- 大象视频has developed a platform and architecture for electronic clinical decision support (CDS Connect).
Dr. Meyers noted that AHRQ鈥檚 EvidenceNOW program has reached more than 1,500 small primary care practices. The program features partnerships to improve heart health care using PCOR evidence. Future plans by the Agency include scaling efforts in the opioid crisis, advancing the dissemination of PCOR findings, and supporting progress in learning health systems.
Safety
Jeffrey Brady, M.D., M.P.H., reported on 大象视频efforts to address safety threats, providing the following examples.
- AHRQ鈥檚 Patient Safety Learning Laboratories, through 13 grant projects, are designing and testing solutions to address health care risks and hazards.
- A new funding opportunity seeks the alignment of aims and research findings with information needed by C-suite officers and other stakeholders in health care systems. Part of that is to learn from grant holders the impact of their grant work.
- Two examples of current grants are a project employing human-centered designs (e.g., the built environment) to improve perioperative outcomes and a project examining qualitative and quantitative approaches to problems in radiology and imaging procedures.
- The Agency produced an updated guide/toolkit, 鈥淚mproving Your Laboratory Testing Process,鈥 to improve standardization and systemization of laboratory testing processes.
- 大象视频is developing the Quality and Safety Review System for efficient measurement of hospital-acquired conditions (HACs) at the national level and in hospitals. Pilot testng is underway. The system will serve as a robust platform for patient safety and quality improvement, offering data to guide decisions.
Dr. Brady provided a graphic that noted changes in rates of various causes of HACs in recent years. For example, rates of HACs related to adverse drug events have been falling for the past 5 years.
Data and Insights
Joel W. Cohen, Ph.D., focused on AHRQ鈥檚 MEPS program. He asked a series of questions regarding various health data then showed how the MEPS can answer the questions readily. For example, the answer to the question 鈥淲hat is the average cost of employer-sponsored health insurance in Michigan?鈥 can be found easily in the MEPS database ($5,906 for a single plan and $17,113 for a family plan in 2016). Recent advancements in MEPS include the posting of flexible, user-friendly summary data tables on the website and an expanded sampling of veterans鈥 health care data for the database. In the near future, 大象视频intends to expand the sampling for the MEPS household survey and intends to add a supplemental questionnaire on mental health care.
Dr. Cohen provided screen shots of the new summary data tables, which address the areas of health insurance, medical conditions, prescribed drugs, accessibility/quality of care, and use/expenditures/populations. He noted some recent uses of MEPS data, such as in an article in the Journal of the American Medical Association, for which 大象视频provided a graphical presentation of medical expenditures relating to adult obesity.
Discussion
Ms. Levine explained that the term 鈥渄iscretionary鈥 refers to funding that lies within a certain budget authority鈥攊n this case, Congress鈥攁s opposed to mandatory funding, which is funding mandated by law each year, such as Medicare funding. Dr. Goldmann wondered whether the elimination of AHRQ鈥檚 work in Quality Indicators might mean a shifting of that effort to other agencies. Ms. Levine noted that Congress has asked for a study of health services research and likely will wait for that study to finish before making large changes to AHRQ.
Dr. Goldmann asked about integrating the streams of effort in an area such as the opioid crisis response. Dr. Meyers responded that 大象视频is spending much time in coordinating across the various streams and attending to the five priorities of the HHS Secretary. 大象视频is participating in activities with many stakeholder partners. Lucy A. Savitz, Ph.D., M.B.A., asked about a recent problem with claims data for people with substance abuse diagnosis. Jenny A. Schnaier, M.A., responded that the HCUP program did not lose the data. Considering the current efforts responding to the opioid crisis, Dr. Savitz urged 大象视频to ensure that quality improvement work is included in evidence syntheses. Dr. Meyers responded that 大象视频is seeking ways to ensure that the EPC program promotes such evidence. Christina J. Calamaro, Ph.D., CRNP, raised the idea of crosswalking primary care data and surgical data to help illuminate issues of communication in opioid prescribing.
Dr. Brady noted that the measures in the Quality and Safety Review System are aligned with those in the National Health Safety Network. The methods of the former are new and feature a population approach. Monica E. Peek, M.D., M.P.H., M.Sc., wondered whether 大象视频has considered broadening the definition of the term 鈥減atient safety鈥 beyond hospital settings. Dr. Brady stated that 大象视频has expanded its focus to all settings of care and to transitions of care. Dr. Chesley added that 大象视频has a funding announcement focused on research that spans the continuum of settings of care.
Dr. Savitz applauded the MEPS feature allowing one to download codes and adapt them to apply to a particular dataset.
HCUP Update
Jenny A. Schnaier, M.A., Program Analyst, 大象视频Center for Delivery, Organization, and Markets, and Kevin C. Heslin, Ph.D., 大象视频Center for Delivery, Organization, and Markets
Ms. Schnaier described AHRQ鈥檚 HCUP, which is a comprehensive set of publicly available, all-payer, health care data covering 97 percent of the U.S population. HCUP collects data on hospital inpatients and from emergency departments and ambulatory surgery sites. HCUP data allow for analyses of common and uncommon conditions and procedures. The data are national and derive from the States. The data are record level, simple to use, and available on the HCUP website. Forty-seven States and the District of Columbia provide the data, derived from administrative billing records. HCUP features seven types of databases: State inpatient, State emergency department, a national inpatient sample, a kids inpatient sample, a nationwide emergency department sample, national readmissions, and State ambulatory surgery and services (the last is coming soon).
HCUP produces user-friendly information packaged as methods, topical reports, and statistical briefs. For example, a recent brief is titled 鈥淧atient Characteristics of Opioid-Related Inpatient Stays and Emergency Department Visits Nationally and by State, 2014.鈥 The project also offers Fast Stats that presents displays of trends in hospital use and HCUPnet, an online query system accessing HCUP statistics. The latter allows users to generate tables of outcomes by diagnoses and procedures. A new HCUP tool allows for county-level comparisons of hospitalization rates for opioids, alcohol, stimulants, and other drugs.
Dr. Heslin spoke of HCUP鈥檚 value in addressing the opioid epidemic. He stated two challenges:
- The opioid epidemic is a national problem, but health care is delivered at the local level.
- State data are valuable, but there is variation within each State. Dr. Heslin presented screen shots from the HCUPnet Community-Level Statistics, which feature maps and tables.
In particular, he presented graphic pages that show rates of hospital stays relating to alcohol and other drugs by county within each State. The results for each State revealed wide variations in rates between counties.
Dr. Heslin suggested that the county-level statistics be downloaded from HCUPnet and linked to other county-level data sources to support research. He reported that 大象视频is developing an opioid 鈥渉ot spot鈥 study that will feature the merging of county statistics and external data sources to inform local responses to the opioid epidemic. The HCUP group is considering ways to bring the information to researchers and would like to speak with State and local officials to discuss ways in which the information could be more actionable.
Discussion
Dr. Savitz noted that her group has employed HCUP statistical codes while using up-to-date data. She thanked the HCUP group for its hard work. Dr. Goldmann wondered whether 大象视频has received feedback on the statistics from State legislators. Dr. Heslin noted that the Agency will be reaching out to organizations such as the National Governors Association and the National Conference of State Legislatures. The latter has a strong database of information on State legislation relating to opioid abuse. Dr. Goldmann asked about local media coverage when the data become available and suggested that 大象视频examine such possible media coverage. Howard Holland, Director of AHRQ鈥檚 Office of Communications, reported that AHRQ鈥檚 outreach efforts will include the targeting of media in regions where press can reach localities. 大象视频has a media distribution service in place. A hope is that such outreach will result in local stories in the press.
Dr. Chesley asked the NAC members to consider and discuss two questions:
- What future challenge or question do you see facing the health care system over the next 10 years?
- What do you see or want AHRQ鈥檚 role to be in answering the question of challenge?
Dr. Savitz cited the issue of access to care. How should that be defined? We need to advance our understanding of population health and learning health systems. How are we interacting? We need to build a science around social determinants. We need to address the issue of the high costs of drugs.
Dr. Calamaro stated the need to create crosswalks between or through databases. In light of the opioid crisis, we need to create an infrastructure of data that allows the data to be used readily.
Dr. Peek stated that 大象视频has been a leader in data issues, pushing the science of health care delivery. It now might consider and help coordinate how health systems can integrate all data that reflect population health, social determinants, and disparities.
Dr. Goldmann recalled a recent meeting that addressed the idea of democratizing the advancement in data technologies to the benefit of populations. Perhaps 大象视频could market data, leading to better engagement. People are not using data optimally.
Robert S. Dittus, M.D., M.P.H., stated that more data about systems and processes of care will lead to opportunities in care improvement, and 大象视频should consider focusing on that issue. He agreed with the call to engage population health and its related systems. He called for more implementation science and more research on the impacts of care systems.
Dr. Chesley stated that Director Gopal Khanna is stressing issues of data and data use and has noted that health care access has many determinants. The Director has called for a focus on the 鈥減erson-360,鈥 with more inclusive and transdisciplinary approaches. The integration of systems is important to realizing the potential of data. How can we use data sources to produce data solutions and make the solutions attractive to people?
Public Comment
Peggy Binzer, Executive Director of the Alliance for Quality Improvement and Patient Safety (AQIPS), spoke briefly about the Alliance鈥檚 work. AQIPS is a nonprofit professional association that represents patient safety organizations and their providers. It hopes to bring projects to AHRQ. One focus being addressed is the challenge of interoperability. Another is the issue of providers working with new technologies. The Alliance especially would like to work with 大象视频in the area of safety and health information technology, attacking issues such as standards and usability. It envisions creating a national collaborative of vendors and others to address health information technology issues.
Chair's Wrap-Up and Adjournment
Drs. Goldmann and Chesley thanked the NAC members and speakers for their input. Dr. Goldmann applauded AHRQ鈥檚 wisdom and experience. He noted that the next NAC meeting will take place July 18, 2018. He adjourned the meeting at 1p.m.
Respectfully submitted,
Donald A. Goldmann, M.D., Chair
National Advisory Council
大象视频
