■AHRQ Quality Indicators.Set of quality indi-
cators used by organizations to highlight
potential quality concerns, identify areas that
need further study and investigation, and track
changes over time
The U. S. Department of Defense (DoD) and the
Veterans Health Administration (VHA) have
taken leadership positions in developing tools,
resources, and programs aimed at improving safety,
promoting change, and promoting a culture of safety
within the DoD and VHA. The VHA National
Center for Patient Safety developed a toolkit for
fall prevention and management, tools for escape
and elopement management, and cognitive aids for
root cause analysis and health failure mode and
effect analysis.Health-Care Provider Professional
Organizations
Professional organizations directly address the mis-
sions and concerns regarding quality and safety of
the professionals they represent. Each organization
offers programs, access to evidence-based practices,
toolkits, and newsletters to aid their members in
driving quality within their own practice and
organization.
The vital quality and safety initiative of the
ANA is the National Database of Nursing Quality
Indicators (NDNQI), a database of unit-specific
nurse-sensitive information collected at hospitals.
Data are collected and evaluated to improve quality.
The indicators reflect the structure, process, and
outcomes of nursing care and lead to improved
quality and safety at the bedside. The ANA also
has a strong focus on safe nurse staffing levels to
promote safe, quality patient care.Nonprof it Organizations and Foundations
With few exceptions, nonprofit organizations and
foundations are generally focused on consumer
education, policy development, and research to
improve quality and safety within the health-care
system. Many organizations serve multiple mis-
sions. The Kaiser Family Foundation (2005) has a
strong emphasis on U.S. and international nonpar-
tisan health policy and health policy research. Self-
funded research and public opinion polling on
topics related to quality and safety in the health-
care system contribute to policy and legislation
development.chapter 10 | Quality and Safety 149encourage changes in processes, structures, and
behaviors within the health-care community.
■Post–Acute Care Reform Plan.CMS is exam-
ining post-acute transfers with the aim of reduc-
ing care fragmentation and unsafe transitions.
■Hospital Quality Initiative.This is a major ini-
tiative aimed at improving quality of care at the
provider and organization level. Organizations
provide data through public reporting of quality
measures that translate information to assist
consumers in health decisions. This initiative cre-
ates a uniform set of quality measurement by
which consumers can compare organizations and
by which organizations can benchmark progress
toward achieving goals in specified areas of care,
such as acute myocardial infarct, congestive heart
failure, pneumonia, and postsurgical infections.
These data feed the Hospital Compare Web site
(www.hospitalcompare.hhs.gov). Organizations
are incentivized to participate with an offering of
increased reimbursement.
Also under the HHS is the Agency for Healthcare
Research and Quality (AHRQ), which is the lead
federal agency charged with improving the quality,
safety, efficiency, and effectiveness of health care for
all Americans (HHS, 2008). Through multiple ini-
tiatives, the support of research, and evidence-
based decision-making, the AHRQ aims to fulfill
its mission:
■Health IT.A multifaceted initiative that includes
(a) research support of $260 million in grants and
contracts to support and stimulate investment
in health information technology (IT); (b) the
newly created AHRQ National Resource Center,
which provides technical assistance and research
funding to aid technology implementation within
communities; and (c) learning laboratories at
more than 100 hospitals nationwide to develop
and test health IT applications
■National Quality Measures Clearinghouse
(NQMC).Web-accessible database provides
access to evidence-based quality measures and
measure sets; NQMC provides access for
obtaining detailed information on quality
measures and to further their dissemination,
implementation, and use in order to inform
health-care decisions
■Medical Errors and Patient Safety.Web site
providing access to evidence-based tools and
resources for consumers and providers