Priorities established to help close the health care quality gap

American Association of Clinical Endocrinologists 17th Annual Meeting & Clinical Congress

Efforts to improve health care in the United States are underway and many are available; however, challenges still exist, Carolyn M. Clancy, MD, said at the American Association Clinical Endocrinologists 17^th Annual Meeting & Clinical Congress, held here today.

“We know a whole lot about what to do to improve quality and safety, we know very little about how to do that,” she said. “How is it that we take the information that is in our heads and make sure that happens? We desperately need to build what I call 'the science of improvement' and we know very little about it.”

Last year, $2.3 trillion was spent on health care, but quality patient treatment did not measure up, according to Clancy, director of the Agency for Healthcare Research and Quality at the U.S. Department of Health and Human Services.

“All of the attention the system is getting today gives us an opportunity to do something about this – to ensure that we are improving the quality, safety, efficacy and effectiveness of health care for all Americans,” she said.

Clancy, highlighted trends and issues that are helping to make patient safety a priority of the national agenda.

Major priorities

To help course-correct problems in the health care industry, AHRQ has identified several major priorities for 2008 that include patient safety, effective health care programs, medical expenditure panel surveys, ambulatory patient safety, and other research and dissemination activities. One area for improvement is patient safety systems. Clancy said physicians don’t receive feedback about adverse events from these systems, and therefore are unaware of existing issues.

“The biggest challenge we face in improving care for people with diabetes is that a whole lot of people do not have just diabetes. This leads us into a very difficult set of challenges in addressing multiple conditions,” she said.

Clancy highlighted the current evidenced based guidelines for diabetes: the National Guidelines Clearinghouse and National Quality Measures Clearinghouse. Efforts are ongoing to tighten the relationships between guidelines and measures.

“Conversion of guidelines into measures can be improved by promoting cooperation. Medicine needs to speak with one voice; physician’s organizations need to move upstream to develop guidelines and measures concurrently,” she said.

Several evidence based practice centers are available or underway: Comparative Effectiveness and Safety of Oral Medications in Type 2 Diabetes (July 2007); Comparative Effectiveness and Safety of Pre-mix Insulin Analogues in Type 2 Diabetes (in progress); Diabetes Education and Medical Nutrition Therapy Education for Families with Children with Type 1 Diabetes (in progress).

Another resource is the availability of summary guidelines of the benefits and potential adverse events of diabetes medications for clinicians and consumers. These guidelines - Comparing Oral Medications for Adults with Type 2 Diabetes (clinician summary guideline) and Pills for Type 2 Diabetes: A Guide for Adults (consumer summary guideline) – became available in December of 2007.

Ultimately, continued communication, more information and research and sharing of health care information between consumers, clinicians and corporations is key to improve health care.

“What we all share is a passion that is information-rich, but also patient focused,” she said. - by Tara Grassia

For more information:
Clancy CM. Transformation, policy development and change: Improving patient safety through value-driven health care. Presented at: the American Association of Clinical Endocrinologists 17^th Annual Meeting & Clinical Congress; May 14-18, 2008; Orlando, Fla.