The Agency for Healthcare Research and Quality (AHRQ) has funded creation of tools and resources that will help meet the needs of today's U.S. health care system. This report describes AHRQ tools and resources that are available.
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By Barbara L. Kass-Bartelmes, M.P.H., C.H.E.S.
Introduction
Background
AHRQ Data Resources and Tools
AHRQ Assessment Tools
AHRQ Clinical Care Tools
AHRQ Quality Measurement Tools
Conclusion
For More Information
References
Health policymakers, health care administrators, employers who purchase health insurance, and clinicians want high-quality, safe health care that is accessible and affordable for Americans. They need current information to:
Recognizing these needs, the Agency for Healthcare Research and Quality (AHRQ) has devoted significant funding to the creation of tools and resources that will help meet the needs of the U.S. health care system.
This report briefly describes the tools and resources that AHRQ has made available, such as data sets, assessment and performance measures, clinical care guidelines, and quality measurement indicators. These tools and resources are being used by Federal, State, and local governments; private industry; health service providers; hospital associations; and health maintenance organizations to improve health care quality and help consumers make more informed choices.
Making a Difference
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Health care decisionmakers require accurate and timely information to be able to identify problems in health care delivery and develop a strategy to overcome them. State legislators, legislative staff members, and State health agency managers have indicated that reading all of the available health research is challenging simply because of its volume.1 These policymakers further said that when they need information, they turn to experts and simple, easily understood materials to find their answers.1
To assess availability of health insurance, access to care, and costs as well as to prevent overuse, underuse, and misuse of health care services, tools must be available to measure patient outcomes and the quality of health care that patients receive.2 The tools and resources that AHRQ has developed can help decisionmakers by providing information they can use for comparison and as quality indicators to assess their own performance.
Data resources provide survey information to help track and identify trends in health insurance, health services, hospitalizations, cost, access, and quality of care. AHRQ data resources include:
Assessment tools capture patients' experiences with their health care services. They also evaluate the ability of the Nation's health system to meet the public's health needs. Assessment tools provided by AHRQ include:
Clinical care tools assist providers in delivering needed health services. AHRQ clinical care tools include:
Quality measurement tools can be used to assess clinical performance. AHRQ provides access to the following quality measurement tools:
Links to AHRQ tools and resources on the Internet are shown in Box 1.
Box 1. Links to AHRQ Tools on the Internet Data resources:
Assessment tools:
Clinical care tools: Quality measurement tools:
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MEPS is designed to provide policymakers, health care administrators, business executives, and others with timely, comprehensive information about health care use and costs in the United States.3 Information is collected either by talking directly with people in households, nursing homes, and hospitals, and with businesses, physicians, and home care providers, or by gathering data from databases. MEPS data provide answers about:
The information collected is organized into three components:
Decisionmakers can compare their experience with national trends using these findings. For example, MEPS HC data show that during the first half of 2001, 23.1 percent of children under age 18 were covered by public health insurance, primarily Medicaid (Figure 1, 5 KB). However, 14.5 percent of children remained uninsured during this time.17 Data on expenses from the 1998 MEPS HC indicate that most medical expenses were paid for by either private or public insurance (Figure 2, 6 KB).18
MEPS HC data are very detailed, so data on health services spending and health insurance can be linked to the demographic, employment, economic, health status, and other characteristics of the people who are surveyed.3 It is the only national survey whose findings can be used to help estimate how changes in sources of payment and insurance coverage impact different people, such as the poor, elderly, families, veterans, the uninsured, and racial and ethnic minorities.3 While the MEPS HC can provide this information only on a national level, not at the State level, decisionmakers can use national estimates to evaluate how local communities compare with the Nation as a whole and identify areas that are doing well, along with those areas that need improvement.
MEPS can also help evaluate Americans' experiences with health care based on questions taken from CAHPS®. For instance, MEPS respondents were asked CAHPS®-based questions about the timeliness of the urgent and routine medical care they received. People without insurance were more likely than those with coverage to report that they sometimes or never received urgent care as soon as they wanted (Figure 3, 4 KB).
The MEPS Insurance Component uses the health insurance information gathered from people in the Household Component and interviews their employers and union officials about that health insurance, and it also interviews a sample of employers nationwide.3 Specifically, the MEPS IC collects information on the amount, types, and costs of health insurance available to Americans at their work places.3 This information is available at the State level for all 50 States. For example, MEPS IC data for 2000 show that nearly 60 percent of private-sector establishments in the United States offer health insurance (Figure 4, 7 KB). However, the percent of private employers varies widely among States, from Connecticut at 69.4 percent to South Dakota at 42.4 percent.19
MEPSnet is an online tool that allows anyone to get MEPS statistics immediately. MEPSnet/HC currently provides access to 1997 and 1998 information on family composition, geographic and demographic variables, income and tax filing, employment, health insurance, health status, health care use, expenditures, and sources of payment. MEPSnet/IC provides easy access to national statistics and trends about health insurance offered by private employers and State and local governments for 1996 through 2000.3
MEPS data have been used by government, private, and public organizations:
HCUP can be used to examine hospital use, access to care, charges, quality, and outcomes for diseases and hospital procedures, and to study the care furnished to population subgroups such as minorities, children, women, and the uninsured. HCUP data come from AHRQ-funded databases: the Nationwide Inpatient Sample (NIS), the State Inpatient Databases (SID), the State Ambulatory Surgery Databases (SASD), and the Kids' Inpatient Database (KID). Researchers and policymakers use HCUP data to identify, track, analyze, and compare hospital statistics at the national, regional, and State levels.5 For example, for some common conditions, hospitalization charges increased between 1993 and 2000 but the average length of stay decreased (Figures 5, 9 KB, and 6, 8 KB).21
HCUPnet is an online interactive tool that can be used to identify, track, analyze, and compare statistics on hospital care at the national level as well as for selected States. Users can conduct analyses on outcomes and measures of specific conditions, including length of stay, total hospital charges, in-hospital deaths, and discharge status. These can then be compared with data on patients by age, sex, primary payer and income, and on types of hospitals.6
Clinical Classifications Software (CCS) is a tool developed for HCUP data that clusters patient diagnoses and procedures into a manageable number of clinically meaningful categories. CCS collapses diagnosis and procedure codes from the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM), and the International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10).
CCS is used for grouping conditions and procedures without having to wade through thousands of codes. This "clinical grouper" makes it easier to quickly understand patterns of diagnoses and procedures so that health plans, policymakers, and researchers can analyze costs, utilization, and outcomes associated with particular illnesses and procedures. 7,8
HCUP and CCS measure the quality of health care delivered by providers:
HIVnet is an online tool that provides information on inpatient and outpatient use by people with HIV disease. HIVnet provides easy access to selected statistics on patterns of HIV-related care based on data collected by the HIV Research Network. The HIV Research Network obtains, analyzes, and disseminates current information on the delivery of services to people with HIV infection. It presently includes 18 medical practices located across the United States that treat more than 14,000 patients. Each practice collects information on clinical and demographic characteristics, medications prescribed, frequency of outpatient clinic visits, and number of inpatient admissions for each patient with HIV infection.9
AHRQ cosponsors the HIV Research Network with other Federal agencies: the Center for Substance Abuse Treatment in the Substance Abuse and Mental Health Services Administration, the HIV/AIDS Bureau in the Health Resources and Services Administration, and the Office of AIDS Research in the Office of the Director of the National Institutes of Health.9
CAHPS® is a family of rigorously tested and standardized questionnaires and reporting formats that can be used to collect and report meaningful and reliable information about the experiences of consumers with a variety of health services. The goal of CAHPS® is for consumers to use its data to make informed decisions about their health care services. Supplemental questions have been added to a core set of items to address specific populations such as Medicaid recipients, Medicare beneficiaries, people with chronic conditions, and children with special health care needs, as well as particular health care services such as prescriptions and transportation. The latest version, the CAHPS® 3.0 Survey and Reporting Kit, contains a set of questions that ask consumers about their experiences with their health plans, sample formats for reporting results to consumers, software to assist in data analysis, and guidance and instructions. The questionnaires are in both English and Spanish.10
Examples of questions include:
To receive copies of the survey instruments and reporting tools or for guidance in implementation, please contact the CAHPS® Helpline at 1-800-492-9261 or E-mail cahps1@westat.com.
CAHPS® is used to monitor the quality of health plans:
The hospital bioterrorism preparedness tool helps assess the current capacity of hospitals and health systems to respond to a bioterrorist attack, in particular the capacity of existing hospital and public health systems to communicate and to develop an effective medical response to a bioterrorist threat. The methodology for assessing regional medical capacity and plans involves use of the data collection tool, model criteria, and a simulation and analysis model. The Bioterrorism Emergency Planning and Preparedness Questionnaire for Healthcare Facilities is available in both PDF and text format.
Examples of questions asked include:
The methodology could be further refined in a larger study and pilot tested in a region to identify additional needs and requirements. Once completed, this methodology could be used by city and State planners to assess medical capacity and the adequacy of emergency medical response plans. Developing this standardized approach would help State planners better communicate medical resource needs for a bioterrorist event or other mass casualty event.11
Put Prevention Into Practice (PPIP) is a program sponsored by AHRQ to increase the appropriate use of clinical preventive services, such as screening tests, immunizations, chemoprevention, and counseling.23 PPIP is derived from the evidence-based recommendations of the U.S. Preventive Services Task Force.
New and updated Task Force recommendations and important evidence reviews are available in two convenient three-ring binders and on the AHRQ Web site. PPIP tools enable health care providers to determine which services their patients should receive and provide guidance on setting up a system to facilitate their delivery. PPIP patient materials make it easier for patients to understand and keep track of their preventive care.12,23
PPIP materials include:
PPIP has been used by clinicians and health systems:
The National Guideline Clearinghouse™ (NGC), sponsored by AHRQ in partnership with the American Medical Association and the American Association of Health Plans, is an online database of evidence-based clinical practice guidelines. The NGC contained 200 guidelines when it was launched in December 1998. Since then, the content of the NGC has grown to over 1,000 clinical practice guidelines submitted by more than 165 health care organizations and other entities in the United States and other countries. Its key components include:
Clinical practice guidelines included in the NGC meet the following criteria:
The NGC has been used by clinicians, medical schools, and health systems: