AGENCY PERSPECTIVE
From Research to Nationwide Implementation The Impact of AHRQ’s HAI Prevention Program James B. Battles, PhD,* Stacy L. Farr, PhD, MPH,w and Daniel A. Weinberg, MBA, PhDw
Introduction: The Agency for Healthcare Research and Quality (AHRQ’s) Patient Safety Program is responsive to AHRQ’s mission of quality improvement in healthcare. As part of this program, AHRQ has invested in projects to prevent healthcare–associated infections (HAIs), and funding has increased significantly over the last decade. AHRQ-funded projects have focused on generating new knowledge and promoting the nationwide implementation of proven HAI prevention measures in diverse healthcare settings. Objectives: To provide insight to AHRQ’s HAI prevention strategies by: first, discussing the context and structure of AHRQ’s HAI research portfolio and funding decisions; secondly, describing the process of prevention practice implementation and lessons learned; and third, explaining the outcomes and national impact of the AHRQ program. Results and Conclusions: In the early 2000s, AHRQ identified HAIs as an important and preventable public health threat and built their HAI-prevention portfolio based on National Action Plan priorities, available resources, advice from experts, and the state of science. This paper describes major contributions that have emerged from AHRQ-funded HAI projects. The projects examined, many of which focus on implementation of HAI prevention practices, yield useful lessons learned for future implementation and research endeavors and show significant impact of AHRQ’s program in reducing HAIs. Key Words: healthcare–associated infections (HAIs), infection prevention, quality improvement, federal agency (Med Care 2014;52: S91–S96)
BACKGROUND Healthcare–associated infections (HAIs) are a significant cause of illness and death in all healthcare settings. They affect 1 out of every 20 hospital patients at any given time. The Agency for Healthcare Research and Quality (AHRQ) recognizes this From the *Center for Quality Improvement and Patient Safety (CQulPS), The Agency for Healthcare Research and Quality (AHRQ), Rockville; and wIMPAQ International LLC, Columbia, MD. The views expressed in this article are those of the authors, and no official endorsement by the US Department of Health and Human Services or Agency for Healthcare Research and Quality is intended, or should be inferred. The authors declare no conflict of interest. Reprints: James Battles, PhD, Center for Quality Improvement and Patient Safety (CQulPS), The Agency for Healthcare Research and Quality, 500 Gaither Road, Rockville, MD 20850. E-mail: [email protected]. Copyright r 2014 by Lippincott Williams & Wilkins ISSN: 0025-7079/14/5202-0S91
Medical Care
Volume 52, Number 2 Suppl 1, February 2014
tremendous public health problem. As a lead Federal agency charged with improving healthcare, AHRQ has patient safety responsibilities spanning 3 broad areas1: (1) identify the risks and hazards that cause or have the potential to cause healthcare– associated injury or harm; (2) design, implement, and evaluate tools resources and patient safety practices that eliminate known hazards, reduce the risk of injury to patients, and create a positive safety culture; and (3) provide technical assistance to institutions to facilitate the adoption-effective safe practices for the elimination or mitigation of healthcare–associated infections throughout the US healthcare community. The period between 2000 and 2007 was pivotal to setting the stage for AHRQ’s future HAI portfolio. The timeline of critical milestones and related policies begins in 2000 with the Institute of Medicine’s publication of To Err is Human. This study put a spotlight on the issue of patient safety in America’s healthcare system.2 AHRQ’s Patient Safety Portfolio was established in 2001 and seeks to prevent, mitigate, and decrease medical errors and risks to patients. The Portfolio accomplishes its goals by funding health services research in a number of key areas, including HAIs.3 In October 2003, the Michigan Hospital Association launched a 2-year AHRQ grant-funded initiative, MHA Keystone: ICU, to reduce HAIs in patients in intensive care units.4 In 2006, Pronovost and colleagues reported the successful results in the New England Journal of Medicine showing up to a 66% reduction in catheter-related bloodstream infection rates over the 18-month study period.5,6 Shortly thereafter, AHRQ established the Patient Safety Organization Privacy Protection Center (PSOPPC) to support implementation of the Patient Safety and Quality Improvement Act of 2005.7 The PSOPPC offers technical assistance to healthcare providers to develop and implement patient-safety improvement strategies, as well as assistance in submitting information on patient safety events to the Network of Patient Safety Databases.8 During FY 2007–2010, AHRQ funded a number of contracts and grants focused on expanding the HAI research base and implementing prevention strategies. To address the national epidemic of HAIs, in 2009, the Department of Health and Human Services (HHS) developed the HHS Action Plan to Prevent Healthcare-associated Infections,9,10 which focused on HAI prevention in acute care hospitals. AHRQ was one of 4 agencies leading the development of the Action Plan, along with CMS, the Centers for Disease Control and Prevention (CDC), and the Office of the www.lww-medicalcare.com |
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Assistant Secretary of Health. AHRQ’s focus was on: prioritizing measures and 5-year national targets for HAI reduction and prevention; aligning and standardizing data definitions across agencies; and working with state and regional groups on program and project implementation. This leveraged previous HAI efforts by the Agency. The second version of the Action Plan, which included a broadened scope into other health settings, called the National Action Plan to Prevent Healthcare-associated Infections: Roadmap to Elimination (National Action Plan), was released in April 2012.11 AHRQ’s role was largely focused on research in terms of both supporting and conducting research on ways to prevent and reduce HAIs and on how to produce quality healthcare. In addition, AHRQ expanded the Comprehensive Unit-based Safety Program (CUSP) initiative nationwide, managed the Network of Patient Safety Databases, and oversaw the evaluation of the Action Plan.11 This paper provides insight to AHRQ’s Patient Safety Portfolio and, specifically, HAI prevention strategies by: first, discussing the structure of AHRQ’s HAI research portfolio; secondly, describing the process of HAI prevention practice implementation and lessons learned; and third, explaining outcomes and impacts of the AHRQ program. Researchers, policymakers, and healthcare professionals will gain a better understanding of the AHRQ HAI prevention research portfolio and national impact in relation to the National Action Plan.
STRUCTURE OF AHRQ’s HAI RESEARCH PORTFOLIO AHRQ’s Patient Safety Portfolio aims to prevent, mitigate, and decrease the number of medical errors, patient safety risks, and quality gaps associated with healthcare.1,3 AHRQ has invested in projects and programs to prevent HAIs, both internally and through its extramural funding vehicles. The HAI emphasis evolved through a growing national and congressional focus, as described in the introduction and background section of this paper. Funding has grown markedly, from
From Research to Nationwide Implementation The Impact of AHRQ’s HAI Prevention Program James B. Battles, PhD,* Stacy L. Farr, PhD, MPH,w and Daniel A. Weinberg, MBA, PhDw
Introduction: The Agency for Healthcare Research and Quality (AHRQ’s) Patient Safety Program is responsive to AHRQ’s mission of quality improvement in healthcare. As part of this program, AHRQ has invested in projects to prevent healthcare–associated infections (HAIs), and funding has increased significantly over the last decade. AHRQ-funded projects have focused on generating new knowledge and promoting the nationwide implementation of proven HAI prevention measures in diverse healthcare settings. Objectives: To provide insight to AHRQ’s HAI prevention strategies by: first, discussing the context and structure of AHRQ’s HAI research portfolio and funding decisions; secondly, describing the process of prevention practice implementation and lessons learned; and third, explaining the outcomes and national impact of the AHRQ program. Results and Conclusions: In the early 2000s, AHRQ identified HAIs as an important and preventable public health threat and built their HAI-prevention portfolio based on National Action Plan priorities, available resources, advice from experts, and the state of science. This paper describes major contributions that have emerged from AHRQ-funded HAI projects. The projects examined, many of which focus on implementation of HAI prevention practices, yield useful lessons learned for future implementation and research endeavors and show significant impact of AHRQ’s program in reducing HAIs. Key Words: healthcare–associated infections (HAIs), infection prevention, quality improvement, federal agency (Med Care 2014;52: S91–S96)
BACKGROUND Healthcare–associated infections (HAIs) are a significant cause of illness and death in all healthcare settings. They affect 1 out of every 20 hospital patients at any given time. The Agency for Healthcare Research and Quality (AHRQ) recognizes this From the *Center for Quality Improvement and Patient Safety (CQulPS), The Agency for Healthcare Research and Quality (AHRQ), Rockville; and wIMPAQ International LLC, Columbia, MD. The views expressed in this article are those of the authors, and no official endorsement by the US Department of Health and Human Services or Agency for Healthcare Research and Quality is intended, or should be inferred. The authors declare no conflict of interest. Reprints: James Battles, PhD, Center for Quality Improvement and Patient Safety (CQulPS), The Agency for Healthcare Research and Quality, 500 Gaither Road, Rockville, MD 20850. E-mail: [email protected]. Copyright r 2014 by Lippincott Williams & Wilkins ISSN: 0025-7079/14/5202-0S91
Medical Care
Volume 52, Number 2 Suppl 1, February 2014
tremendous public health problem. As a lead Federal agency charged with improving healthcare, AHRQ has patient safety responsibilities spanning 3 broad areas1: (1) identify the risks and hazards that cause or have the potential to cause healthcare– associated injury or harm; (2) design, implement, and evaluate tools resources and patient safety practices that eliminate known hazards, reduce the risk of injury to patients, and create a positive safety culture; and (3) provide technical assistance to institutions to facilitate the adoption-effective safe practices for the elimination or mitigation of healthcare–associated infections throughout the US healthcare community. The period between 2000 and 2007 was pivotal to setting the stage for AHRQ’s future HAI portfolio. The timeline of critical milestones and related policies begins in 2000 with the Institute of Medicine’s publication of To Err is Human. This study put a spotlight on the issue of patient safety in America’s healthcare system.2 AHRQ’s Patient Safety Portfolio was established in 2001 and seeks to prevent, mitigate, and decrease medical errors and risks to patients. The Portfolio accomplishes its goals by funding health services research in a number of key areas, including HAIs.3 In October 2003, the Michigan Hospital Association launched a 2-year AHRQ grant-funded initiative, MHA Keystone: ICU, to reduce HAIs in patients in intensive care units.4 In 2006, Pronovost and colleagues reported the successful results in the New England Journal of Medicine showing up to a 66% reduction in catheter-related bloodstream infection rates over the 18-month study period.5,6 Shortly thereafter, AHRQ established the Patient Safety Organization Privacy Protection Center (PSOPPC) to support implementation of the Patient Safety and Quality Improvement Act of 2005.7 The PSOPPC offers technical assistance to healthcare providers to develop and implement patient-safety improvement strategies, as well as assistance in submitting information on patient safety events to the Network of Patient Safety Databases.8 During FY 2007–2010, AHRQ funded a number of contracts and grants focused on expanding the HAI research base and implementing prevention strategies. To address the national epidemic of HAIs, in 2009, the Department of Health and Human Services (HHS) developed the HHS Action Plan to Prevent Healthcare-associated Infections,9,10 which focused on HAI prevention in acute care hospitals. AHRQ was one of 4 agencies leading the development of the Action Plan, along with CMS, the Centers for Disease Control and Prevention (CDC), and the Office of the www.lww-medicalcare.com |
S91
Battles et al
Assistant Secretary of Health. AHRQ’s focus was on: prioritizing measures and 5-year national targets for HAI reduction and prevention; aligning and standardizing data definitions across agencies; and working with state and regional groups on program and project implementation. This leveraged previous HAI efforts by the Agency. The second version of the Action Plan, which included a broadened scope into other health settings, called the National Action Plan to Prevent Healthcare-associated Infections: Roadmap to Elimination (National Action Plan), was released in April 2012.11 AHRQ’s role was largely focused on research in terms of both supporting and conducting research on ways to prevent and reduce HAIs and on how to produce quality healthcare. In addition, AHRQ expanded the Comprehensive Unit-based Safety Program (CUSP) initiative nationwide, managed the Network of Patient Safety Databases, and oversaw the evaluation of the Action Plan.11 This paper provides insight to AHRQ’s Patient Safety Portfolio and, specifically, HAI prevention strategies by: first, discussing the structure of AHRQ’s HAI research portfolio; secondly, describing the process of HAI prevention practice implementation and lessons learned; and third, explaining outcomes and impacts of the AHRQ program. Researchers, policymakers, and healthcare professionals will gain a better understanding of the AHRQ HAI prevention research portfolio and national impact in relation to the National Action Plan.
STRUCTURE OF AHRQ’s HAI RESEARCH PORTFOLIO AHRQ’s Patient Safety Portfolio aims to prevent, mitigate, and decrease the number of medical errors, patient safety risks, and quality gaps associated with healthcare.1,3 AHRQ has invested in projects and programs to prevent HAIs, both internally and through its extramural funding vehicles. The HAI emphasis evolved through a growing national and congressional focus, as described in the introduction and background section of this paper. Funding has grown markedly, from
