National Quality Strategy Webinar

National Quality Strategy Webinar

Better Care, Healthier People and Communities, More Affordable Care: 5 Years of the National Quality Strategy May 17, 2016 Housekeeping Submit technical questions via chat If you lose your Internet connection, reconnect using the link emailed to you If you lose your phone connection, re-dial the phone number to rejoin ReadyTalk support: 800-843-9166 Closed captioning: http:// www.captionedtext.com/client/ event.aspx?CustomerID=1159

&EventID=2940004 2 Agenda History of the National Quality Strategy (NQS) Nancy Wilson, B.S.N., M.D., M.P.H., Executive Lead, National Quality Strategy National Quality Strategy Progress: Data from the 2015 National Healthcare Quality and Disparities Report Ernest Moy, M.D., M.P.H., Medical Officer, Center for Quality Improvement and Patient Safety, Agency for Healthcare Research and Quality The National Quality Strategy in Action: Lourie Center for Childrens Social and Emotional Wellness James Venza, Ph.D, Senior Director, Lourie Center for Childrens Social and Emotional Wellness

Discussion/Question and Answer 3 HISTORY OF THE NATIONAL QUALITY STRATEGY Nancy Wilson, B.S.N., M.D., M.P.H. 4 History of the National Quality Strategy Established by the Affordable Care Act to improve the delivery of health care services, patient health outcomes, and population health

More than 300 groups, organizations, and individuals, representing all sectors of the health care industry and the general public, provided input that shaped the Strategys aims, priorities, and levers The Strategy was first published in 2011 and serves as a nationwide effort to improve health and health care across America and align quality measures and quality improvement activities 5 Timeline of the National Quality Strategy 6 Aims, Priorities, and Levers Improving health and health care quality can occur only if all sectorsindividuals, family members, payers, providers, employers, and communitiesmake it their mission. Members of the health care community can align to the NQS by doing the following: Adopt the three aims to provide better, more affordable care

for the individual and the community Focus on the six priorities to guide efforts to improve health and health care quality Use one or more of the nine levers to identify core business functions, resources, and/or actions that may serve as means for achieving improved health and health care quality 7 The Relationship Between the Institute for Healthcare Improvements Triple Aim and NQS Three Aims 8 Priorities Patient Safety Improvement Initiatives Partnership for Patients, Hospital Readmission Reduction Program, Michigan Hospital Association Keystone Network Person- and Family-Centered Care

Consumer Assessment of Healthcare Providers and Systems, National Partnership for Women and Families, PatientsLikeMe Effective Communication and Care Coordination Argonaut Project, Lourie Center for Childrens Social and Emotional Wellness Prevention and Treatment of Leading Causes of Morbidity and Mortality Million Hearts, Better Health Partnership Health and Well-Being of Communities Lets Move!, Minnesota State Health Improvement Program Making Quality Care More Affordable

Medicare Shared Savings Program, Pioneer Accountable Care Organization Model, Camden Coalition of Healthcare Providers 9 Ongoing Federal Implementation Activities Annual meetings of the Interagency Working Group on Health Care Quality, including senior representatives from 24 Federal Agencies Annual updates to the Agency-Specific Plans developed by HHS operating divisions, which are available on the Working for Quality Web site 10 Ongoing Implementation Activities The Priorities in Focus series released in concert with the Agency for Healthcare Research and Quality (AHRQ) National Healthcare Quality and Disparities Report (QDR) Chartbooks spotlights current issues, recent Federal initiatives

to improve care quality, and recent data demonstrating relevant improvement in each of the six NQS priority areas The Priorities in Action series, which examine some of our Nations most promising and transformative Federal, State, and local quality improvement programs and describes their alignment to the NQS six priorities 11 5-Year Anniversary Stakeholder Toolkit

Organizations can now use a special toolkit to showcase their alignment to and support of the National Quality Strategy in recognition of its 5-year anniversary This toolkit offers new approved promotional materials, graphics, and Web content that organizations can tailor to their specific needs Organizations are encouraged to celebrate this anniversary and share their successes and progress throughout 2016 To download the Toolkit and other related materials, visit http:// www.ahrq.gov/workingforquality/toolkit.htm 12 Overview of the 5th Anniversary Update Key findings in the report include:

Dramatic improvement in access to health care, led by sustained reductions in the number of Americans without health insurance and increases in the number of Americans with a usual source of medical care Continued improvement in quality of health care, but wide variation exists across the National Quality Strategy priorities Persistent disparities related to race, ethnicity, and socioeconomic status among measures of access and all National Quality Strategy priorities, but some are getting smaller Features organizations putting the National Quality Strategy priorities into action to improve health and health care quality 13

NATIONAL QUALITY STRATEGY PROGRESS: DATA FROM THE 2015 NATIONAL HEALTHCARE QUALITY AND DISPARITIES REPORT Ernest Moy, M.D., M.P.H., Medical Officer, Center for Quality Improvement and Patient Safety Agency for Healthcare Research and Quality 14 National Healthcare Quality and Disparities Report Annual report to Congress mandated in the Healthcare Research and Quality Act of 1999 (P.L. 106-129) Provides a comprehensive overview of: Quality of health care received by the general U.S. population

Disparities in care experienced by different racial, ethnic, and socioeconomic groups Assesses the performance of our health system and identifies areas of strengths and weaknesses in: Access to health care Quality of health care Submitted on behalf of the Secretary of Health and Human Services 15 Brief QDR Timeline 16 QDR Role as a Resource in Improving Care NQS: Sets national priorities for health care quality improvement QDR: Tracks quality, access, and

disparities along NQS priorities at national & State levels Implementation Resources: Support work to improve quality and reduce disparities 17 Quality of health care improved through 2013, but the pace of measure improvement varied by NQS Priority Worsening Care Coordination (n=37) No Change Improving 18

Effective Treatment (n=37) 13 21 Healthy Living (n=58) 35 Patient Safety (n=31) 19 Person-Centered Care (n=20) 6 13 3 18 5

10 16 Total (n=191) 3 110 0% 20% 2 1 62 40% 60% 19

80% There are insufficient numbers of reliable measures of Care Affordability to summarize in this way. 100% 18 2015 QDR: Improvements in rates of uninsurance continue for all ages through 2015 Total 0-17 18-29 30-64 35 Percent

30 25 20 15 10 5 0 20 Q 10 1 Q2 Q3 Q4 1 Q1 1 20 Q2

Q3 Q 4 2 Q1 1 20 Q2 Q3 Q 4 3 Q1 1 20 Q2 Q3 Q4 4 Q1 1 20

Q2 Q3 Q4 5 Q1 1 20 Data Source: Centers for Disease Control and Prevention, National Center for Health Statistics, National Health Interview Survey, 2010 -2015, Family Core Component. 19 Note: For this measure, lower rates are better. Q2 Disparities remained prevalent across a broad spectrum of quality measures Worse AI/AN vs. White (n=142) 18

71 Black vs. White (n=248) 0% 44 116 44 7 46 102 30 Hispanic vs. White (n=210) Better

78 Asian vs. White (n=217) Poor vs. High Income (n=147) Same 102 89 77 52 20% 88 40% 60%

80% 100% 20 Significant numbers of disparities in quality of care are starting to narrow Worsening AI/AN vs. White (n=23) Asian vs. White (n=26) 5 8 1 18 37

Hispanic vs. White (n=64) 0% Improving 17 Black vs. White (n=80) Poor vs. High Income (n=87) No Change 37 28 6 33

29 3 53 20% 40% 60% 5 80% 100% 21 THE NATIONAL QUALITY STRATEGY IN ACTION: THE LOURIE CENTER FOR CHILDRENS SOCIAL AND EMOTIONAL WELLNESS Building a Sustainable Model of Early Childhood Mental

Health Intervention for Young Children & Their Families James Venza, Ph.D., Senior Director, Lourie Center for Childrens Social and Emotional Wellness 22 Lourie Center Legacy Birth of a center: mission-driven Leaders in child development: Reginald S. Lourie, T. Berry Brazelton, Stanley Greenspan Evidence based from the beginning: National Institute of Mental Health research study transitioned into direct service programs 23 Quality Care Lourie Center spotlighted in the 2011 as part of the National Quality Strategy Update (US Department of Health and Human Services).

The Center spreads evidence-based practices through education, research, and training. Recent research in the Parent-Child Clinic has shown that within 6 to 9 months of a family's enrollment in the program, treatment significantly increased parental emotional availability and insightfulness into the child's emotional cues, improved child and parent relationships, and strengthened the foundation of lifelong healthy development The Lourie Center provides technical training to Government Agencies, school systems, and national and international nonprofit organizations across the country and around the world Lourie Center spotlighted in the 2011 as part of the National Quality Strategy Update (US Department of Health and Human Services). 24 Integrating Theory-Practice-Training-Research Lourie Centers Attachment-centered Intervention Model (efficacy study) Practicing Attachment in the Real World: Improving maternal insightfulness and dyadic emotional availability at an outpatient community mental health clinic. Ziv, Kaplan & Venza (2016): Attachment and Human Development

Current studies also focus on efficacy from an attachment-based intervention lens Lourie Centers Special Education Elementary School: Academic achievement, social information processing, and classroom climate (initial results May 2016) Early Head Start: Partnership grant with University of Maryland: Buffering toxic stress in toddlers through attachment-based intervention (initial results summer 2016) Therapeutic Preschool Program: Relationship-based, trauma-informed intervention for families with preschool children (initial results 2017) 25 Layers of Challenge & Opportunities

Community-based services have limited funding (relative to hospital-based) Mental health has limited funding (insurance limits) Programs for young children have even less funding (narrow range, less awareness of need) Lourie Center operates from multiple-source funding: Federal; State; Montgomery and Prince Georges counties, MD; private foundations; individual donors NQS provides important recognition to funders that the Lourie Center is worth the investment 26 Increasing Coordination of Care Circle of Security Parenting Intervention: Attachment-Based Reflection Program Lourie Center sponsored Circle of Security Parenting Intervention training

for 110 professionals (2015); 60 additional (this week) Circle of Security Parenting Groups All Lourie Center programs: School, clinic, and home Serving families experiencing homelessness Supporting frontline staff in shelters 27 Expanding Coordinated Care Across the State, Nation, and Globe Key steps: 1) Federal Pre-K Expansion: Full-day therapeutic preschool program 2) Technical assistance support 3) International reach: Supporting childrens social and emotional development in the Kingdom of Lesotho in southern Africa

28 DISCUSSION/QUESTION AND ANSWER 29 Discussion/Question and Answer For users of the audio broadcast, submit questions via chat For those who dialed into the meeting, dial 14 to enter the question queue Graphic representing the ReadyTalk Webinar chat box screen with a red arrow pointing to the location where Webinar participants can input text to the chat box. 30 Discussion/Question and Answer

How has the National Quality Strategy impacted your organization in the 5 years since its publication? In what ways has your organization put the National Quality Strategy aims, priorities, and levers into action to improve health and health care quality? How has alignment to the National Quality Strategy shaped your organizations strategic efforts to work toward a delivery system that provides better, more affordable care to individuals and the community? How is your organization planning to celebrate the fifth anniversary of the National Quality Strategy? 31 Thank you for attending todays presentation! The presentation archive will be available on www.ahrq.gov/workingforquality To view the 5 Anniversary Update and other related materials, please go to http :// www.ahrq.gov/workingforquality/reports.

htm th For questions or high-resolution graphics, please email [email protected] Presenter Contact Information Nancy Wilson: [email protected] Quality and Disparities Report: [email protected] hhs.gov James Venza: [email protected] All QDR data are posted at http://nhqrnet.ahrq.gov 32

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