April 21, 2014

JHCPU Special Issue on Quality Improvement

Dr. Ahmed Calvo is Senior Medical Officer, Office of Health IT and Quality, Health Resources and Services Administration.

Evidence for Informing the Next Generation of Quality Improvement Initiatives: Models, Methods, Measures, and Outcomes, the August 2012 special supplement to the Journal of Health Care for the Poor and Underserved (JHCPU), includes quality improvement initiatives from across the safety net.  Among the topics addressed are promoting healthy weight, cancer screening and follow-up, HIV care, medication use, urban health, depression, early childhood caries, diabetes, asthma, and more.  View the full table of contents online.

The supplement was jointly sponsored by the Health Resources and Services Administration (HRSA), the National Institute on Minority Health and Health Disparities (NIMHD) of the National Institutes of Health (NIH), and JHCPU. Here, Ahmed Calvo, MD, MPH, senior guest editor for the special supplement, responds to questions about quality improvement in health care and lessons learned over the past decade.

Click the cover image to view the table of contents.

Q. The special supplement focuses on quality improvement lessons. In simple terms, what do you think are the important lessons of the past decade?

A. It is clear that the safety net has extensive experience and expertise about quality improvement of critical value to the discussions taking place in our nation regarding clinical and operational improvement and system transformation. Safety net providers are positioned to help lead in these arenas and to engage others in their communities and in the nation.

The journal provides stories and examples about how this could occur. For example, this could take place in the form of teaching other new safety net clinicians (i.e. those in the next generation of staff that has joined the safety net recently); or it could be in engaging the national dialogue about upcoming decisions about health information technology and quality measures – such as that taking place at the National Quality Forum (NQF) National Priorities Partnership (NPP) and the Measures Application Partnership (MAP); or participating in the National Quality Strategy (NQS) process. All of these activities have the potential to affect the nation and especially the safety net in many important ways.

Dr. Isham concludes his opening remarks to the journal on a similar note and frames the vision for learning from and by the safety net and for measuring our progress as a nation toward improving care overall.

Q. Many people are looking to health information technology (HIT) for the next generation of quality improvement initiatives. Do you agree that HIT offers the area of greatest promise?

A. The area of greatest promise is shifting to a person-centered methodology within a team-based approach to quality measures, transparency of data, and improved systems for exchanging the information of value to the person, to the clinicians, and to the public health providers. Technology plays a large role in this but it is really the value enabled by the technology and not the equipment itself that fosters  the human change and education – people (providers and patients) using the Health IT for their practice settings and for their personal needs to stay healthy.

The greatest promise is in teaching people how to use Health IT and to push to get information available for individuals to be able to use the data. To the extent that we can learn to use Health IT well and teach each other by taking the insights that are being gained at many local communities and sharing them in a national learning community—as a true national community of practice—then this probably has the greatest promise to make a difference in the next generation of quality improvement.

Q. What is the most important message to clinicians in safety net clinics from the work in the special supplement?

A. That the safety net is extremely sophisticated a) about the care that it delivers, b) about its quality measures, and c) about the ability to provide care to complex multi-condition patients that it serves.

Evidence of this can be found throughout the supplemental issue. Examples came from multiple types of HRSA programs, from multiple clinical settings, and addressing multiple types of conditions.  In the past the safety net did not always showcase itself nationally as a model and a key lesson going forward is to acknowledge all that’s been accomplished and create a vision for sharing and exploring it with the nation at large.

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