AHRQ celebrates 35 years of advancing healthcare through research and innovation.
By Pete Mercer
October 2024 – The Journal of Healthcare Contracting
The Agency for Health Research and Quality (AHRQ), the premier federal agency that works to improve the safety and quality of healthcare for all Americans, is celebrating its 35th anniversary this year. The operational theme for this anniversary is “Today’s Research, Tomorrow’s Healthcare,” positioning the agency’s history in providing a solid scientific evidence base for tomorrow’s healthcare delivery and policy.
Because improving healthcare is a communal effort, AHRQ will celebrate this anniversary by highlighting the successful partnerships and collaborations formed with co-founders, partners, grantees, stakeholders, staff members, and alumni that enhance the quality and safety of the healthcare industry.
Congress decided to elevate the National Center for Health Services Research and Health Care Technology Assessment to full agency status in 1989, creating the Agency for Health Care Policy and Research. “This pivotal moment recognized health services research (HSR) as a fundamental component of healthcare and a key to improving healthcare delivery. In 1999, Congress renamed the Agency as AHRQ, reaffirming and codifying our role not just as a funder of scientific research, but as the federal home of HSR,” Dr. Robert Otto Valez, Ph.D., MHSA, wrote in a blog post to commemorate the anniversary.
This is a notable benchmark for AHRQ and the industry at large because of how critical it is to protect the safety and quality of healthcare for every patient. AHRQ has proved over the last 35 years that research is instrumental to the future of healthcare and the overall wellness of American patients. As Dr. Valdez wrote in his blog, “AHRQ has established a tradition of supporting groundbreaking health services research to make healthcare more accessible, equitable, affordable, and safer.”
How the state of patient safety has changed in the last 35 years
While it’s hard to imagine with the many levels of compliance that are in place now, the safety of the patient wasn’t the highest priority 35 years ago. In fact, Craig A. Umscheid, MD, MS, Director, AHRQ’s Center for Quality Improvement and Patient Safety said that patient safety was a “fledgling field” at that time.
He said, “Medical errors such as healthcare associated infections were accepted as the cost of doing business. There was limited transparency about medical error, and individual clinicians were often blamed for medical errors, rather than addressing those systems facilitating errors in clinical practice. Such views made it difficult for providers and healthcare systems to learn from their own errors or learn from others facing similar patient safety challenges.”
Without the structure and framework that is necessary to track and prevent medical error, it creates an atmosphere without any transparency or accountability for the healthcare professionals who are, intentionally or not, hurting their patients.
Umscheid also pointed out that without that framework in place, it robs patients and their families of the power to voice their concerns and advocate for themselves. That lack of agency is not only dangerous to the health of the patients in the care of the provider, but it also harms the patient-doctor relationship by removing any sense of trust from the equation. That relationship is so critical to the health of the patient – when the patients don’t feel like they can trust their doctors, why would they put themselves at risk to receive care?
AHRQ accomplishments
Over the last 35 years, AHRQ has implemented several notable improvements and initiatives across the healthcare space. The Healthcare-Associated Infections Program has had a significant impact on preventing infections related to healthcare-related infections, one of the leading threats to patient safety in a healthcare space.
This program helps to prevent healthcare-associated infections by improving the provision of care to patients from frontline clinicians and other healthcare staff members. Through this program, AHRQ was able to develop tools to improve safety culture and develop better patient care processes like the Comprehensive Unit-based Safety Program. CUSP was developed by Peter Pronovost through an AHRQ-funded grant in the early 2000s, resulting in a 61% reduction of central line-associated bloodstream infections (CLABSI) in over 100 ICUs in Michigan.
After finding success there, AHRQ rolled out a national implementation project that resulted in a 41% reduction in more than 1,000 ICUs, showing that zero CLABSI was an attainable goal. The CUSP approach has since been applied to a number of healthcare-associated infections, including catheter-associated urinary tract infections in hospitals and nursing homes, surgical site infections in inpatient surgery, and the AHRQ Safety Program for Improving Antibiotic Use.
Other programs like the CAHPS Programs develop validated surveys that assess patient’s experiences with care in different healthcare settings and health plans, which has improved over time, according to research conducted by AHRQ. The Surveys on Patient Safety Culture Program surveys healthcare employees that assess patient culture in different care settings, while the Patient Safety Organization Program has been a significant contributor to patient safety across the healthcare continuum.
The state of patient safety today
While there have been significant changes and improvements to patient safety culture over the years, there is still work to be done. Umscheid said, “We need to continue to focus on how organizations can identify and address opportunities to strengthen the foundations of healthcare safety, including strengthening institutional culture of safety, amplifying the voice of patients and families in safety, supporting safety and well-being of the healthcare workforce, and supporting a learning healthcare system, which can learn from error and grow in response.”
Those “foundations” can be supported at any healthcare setting – acute care hospitals, ambulatory care, nursing homes, primary care, and home health settings. As the population continues to age, ambulatory care, nursing homes and home health settings are becoming increasingly important. Additionally, equitable care is a significant component to providing safe care. The goal is to create environments where everyone can receive the highest level of healthcare, regardless of things like race, ethnicity, disability, gender, sexual orientation, geography, language, and plenty of other factors.
Healthcare providers have an exciting opportunity regarding patient safety these days with a vast array of tools and technologies to improve care and optimize efficiency. From improving workflows to enhanced diagnostic testing, there are many new ways to ensure the patient receives the best care possible.
Umscheid said, “We continue to learn more about opportunities for improving diagnostic safety, which includes making the right diagnosis and effectively communicating that diagnosis to patients. AI may offer one approach to support diagnostic safety but may also present unintended consequences which need to be better understood so that they can be mitigated, particularly as this technology becomes more pervasive in healthcare delivery.”