The Role of Government in
Transforming Quality
Gregg S. Meyer, MD, MSc
Director, Center for Quality Improvement and
Patient Safety, Agency for Healthcare Research
and Quality
Critical Issues for a New Administration
Conference
1 February 2001
Views on the Role of Federal
Government
“The … duty of the sovereign or commonwealth is that of
erecting and maintaining those public institutions and those
public works, which, though they may be in the highest
degree advantageous to a great society, are, however, of
such a nature, that the profit could never repay the expense
to any individual or small number of individuals, and which it
therefore cannot be expected that any individual or small
number of individuals should erect or maintain.”
Adam Smith
Views on the Role of Federal
Government
Federal government should be engaged “…in a course of measures
which had for their object the protection of everything that was dear,
and the acquisition of everything that could be desirable to the people
at large.”
James Madison
The Federalist Papers
Basic Roles of Government
n Provides public goods
n Provides for those who
cannot provide for
themselves
n Protects and/or
regulates limited
resources
n Monitors the status of
the Nation via a variety
of indicators
n Regulates market forces
n Assures accountability
n Promotes intellectual,
scientific, societal,
progress
n Mobilize a variety of
other parties toward a
common goal
n Serves as a leader for
national progress
Provides Public Goods
n Provides health care (DoD, VA, I.H.S and
prison populations)
n Purchases health care (OPM, VA)
Provides for Those Who Cannot
Provide for Themselves
n Purchases health care (HFCA’s Medicaid and
Medicare)
n Supports programs to provide care for
vulnerable populations
Protects and/or Regulates Limited
Resources
n Assures access to care for the most
vulnerable populations
Monitors the Status of the Nation
n Collects data on the indicators of health
status, quality of care, etc.
Regulates Market Forces
n Establishes rules for health care
commerce
n Inform health decisionmakers
Assures Accountability
n Assures accountability of public programs
n Provides consumer
protection/ombudsmen programs
n Protects the privacy of medical
information
Promotes Intellectual, Scientific,
Societal, and Progress
n Supports medical and health services research
n Supports the development of health technology
and practices
n Develop the health care workforce
n Archive research to date
Mobilize a Variety of Other Parties
Toward a Common Goal
n Convene stakeholders from across the
health care system
Serves as a Leader for
National Progress
n Lead the Nation in efforts to improve health
n
n
n
care quality
Introduce new techniques of continuous quality
improvement and performance measurement
Continuously set standards for quality
performance measures
Demonstration programs
Federal Roles in Quality
Roles
1. Purchase
6. Convene
2. Provide
7. Regulate
3. Monitor quality
8. Inform
4. Research
9. Develop workforce
5. Develop and evaluate
10. Assure access for the
most vulnerable
technology
Institute of Medicine:Four-tiered Approach for
Improving Patient Safety
n Establish national focus on patient safety
n Identify and learn from medical errors through
mandatory and voluntary reporting systems
n Raise standards and expectations for
improvement
n Implement safe practices at the delivery level
Public Views on Reporting
Which comes closer to your views on how medical errors that result in serious
injury or harm should be handled?
The government should
REQUIRE health care
providers to report all serious
medical errors to make sure
this information is publicly
available
73%
21%
Reporting of serious medical
errors should be done on a
VOLUNTARY basis to ensure t
personal privacy of patients/st
involved
6%
Don’t know/Refused
Source: Kaiser Family Foundation / Agency for Healthcare Research and Quality National Survey on Americans as Health Care Consumers: An Update on The Role of
Quality Information, December 2000 (Conducted July 31-Oct. 13, 2000)
Levels of Decision-making
n Policy Decisions
In the legislative chamber
n Systems Decisions
In the boardroom
n Clinical Decisions
In the clinic
The Federal Response to the
Patient Safety Challenge
n Purchase Health Care
n HCFA will require participating hospitals to
maintain medical error reduction programs
n OPM will encourage plans’ preferred hospitals
to use integrated data systems
n Provide Health Care
n DoD, VA, and IHS will expand its use of
electronic patient records
The Federal Response to the
Patient Safety Challenge
n Assure access to quality care for vulnerable
populations
n HRSA Community Health Centers will
participate in patient safety activities with
federal partners
n Regulate health care markets
n FDA will institute new patient safety standards
for drug development and manufacture
The Federal Response to the
Patient Safety Challenge
n Support acquisition of new knowledge
n CQuIPS will conduct and disseminate research
on medical errors
n Develop and evaluate health technologies and
practices
n Federal agencies will encourage use of medical
technologies that will enhance the safety of the
health care system
The Federal Response to the
Patient Safety Challenge
n Monitor health care quality
n AHRQ’s national quality report will provide
statistics on medical errors
n Inform health care decision makers
n Reporting systems will inform the public of
patient safety practices adopted by hospitals
and institutions
The Federal Response to the
Patient Safety Challenge
n Develop the health care workforce
n Federal agencies will help develop skills for
analysis of adverse events and near misses
n Convene stakeholders from across the health
care system
n QuIC recommendations call for collaboration
with many partners, including the National
Quality Forum
n Federal agencies will hold national summits to
share information on patient safety
The Geneology of Quality:
From Quality Research to Quality Care
Biomedical Research
Clinical Trials
Outcomes and Effectiveness Research
Evidence Based Medicine
Performance
Measures
CME
Clinical Practice
Guidelines
Quality Measurement
Quality
Assurance
Quality
Improvement
The Geneology of Quality In Diabetes
From Quality Research to Quality Care - The Need for
Collaboration
Research on Mechanisms of Complications
DCTT: Diabetes Control and Treatment Trial
Diabetes PORT
Evidence-based reports on process and outcomes
Performance
Measures
CME
Clinical Practice
Guidelines
DQIP:Diabetes Quality Improvement Project
Quality
Assurance
Quality
Improvement
Public - Private Sector Collaborations
n Patient Safety Research Summit drilling down on the agenda
n Evaluation of State Based
Reporting Systems - NASHP with
Commonwealth, RWJ, and CHCF
n Collaboration on measures with the
National Quality Forum - use of
AHRQ EPC