Subtitle B-Health Care Quality Improvements

SEC. 211. HEALTH CARE DELIVERY SYSTEM RESEARCH;

QUALITY IMPROVEMENT TECHNICAL ASSIST

ANCE.

Part D of title IX of the Public Health Service Act,

as amended by section 201, is further amended by adding

at the end the following: "Subpart II-Health Care Quality Improvement Programs

"SEC. 933. HEALTH CARE DELIVERY SYSTEM RESEARCH. (a) PURPOSE.-The purposes of this section are

to- (1) enable the Director to identify, develop, evaluate, disseminate, and provide training in inno-vative methodologies and strategies for quality im-provement practices in the delivery of health care services that represent best practices (referred to as best practices) in health care quality, safety, and value; and

(2) ensure that the Director is accountable for implementing a model to pursue such research in a collaborative manner with other related Federal agencies. (b) ESTABLISHMENT OF CENTER.-There is estab-

lished within the Agency the Patient Safety Research Cen

ter (referred to in this section as the Center). (c) GENERAL FUNCTIONS OF CENTER.-The Center

shall- (1) carry out its functions using research from a variety of disciplines, which may include epidemi-ology, health services, sociology, psychology, human factors engineering, biostatistics, health economics, clinical research, and health informatics; (2) conduct or support activities for activities identified in subsection (a), and for- (A) best practices for quality improve-ment practices in the delivery of health care services; and (B) that include changes in processes of care and the redesign of systems used by pro-viders that will reliably result in intended health outcomes, improve patient safety, and reduce medical errors (such as skill development for health care practitioners in team-based health care delivery and rapid cycle process improve-

ment) and facilitate adoption of improved workflow; (3) identify providers, including health care

systems, single institutions, and individual providers, that-

(A) deliver consistently high-quality, efficient health care services (as determined by the Secretary); and

(B) employ best practices that are adapt-able and scalable to diverse health care settings or effective in improving care across diverse set-tings; (4) assess research, evidence, and knowledge

about what strategies and methodologies are most effective in improving health care delivery;

(5) find ways to translate such information rapidly and effectively into practice, and document the sustainability of those improvements;

(6) create strategies for quality improvement through the development of tools, methodologies, and interventions that can successfully reduce variations in the delivery of health care;

(7) identify, measure, and improve organizational, human, or other causative factors, including those related to the culture and system design of a health care organization, that contribute to the success and sustainability of specific quality improvement and patient safety strategies;

(8) provide for the development of best practices in the delivery of health care services that-

(A) have a high likelihood of success, based on structured review of empirical evidence;

(B) are specified with sufficient detail of the individual processes, steps, training, skills, and knowledge required for implementation and incorporation into workflow of health care practitioners in a variety of settings;

(C) are designed to be readily adapted by health care practitioners in a variety of settings; and

(D) where applicable, assist health care practitioners in working with other health care practitioners across the continuum of care and in engaging patients and their families in im-proving the care and patient health outcomes; (9) provide for the funding of the activities of

organizations with recognized expertise and excellence in improving the delivery of health care services, including childrens health care, by involving multiple disciplines, managers of health care entities, broad development and training, patients, caregivers and families, and frontline health care workers, in-cluding activities for the examination of strategies to share best quality improvement practices and to pro-mote excellence in the delivery of health care serv-ices; and

(10) build capacity at the State and commu-nity level to lead quality and safety efforts through education, training, and mentoring programs to carry out the activities under paragraphs (1) through (9). (d) RESEARCH FUNCTIONS OF CENTER.-

(1) IN GENERAL.-The Center shall support, such as through a contract or other mechanism, re-search on health care delivery system improvement and the development of tools to facilitate adoption of best practices that improve the quality, safety, and efficiency of health care delivery services. Such sup-port may include establishing a Quality Improve-ment Network Research Program for the purpose of testing, scaling, and disseminating of interventions to improve quality and efficiency in health care. Re-cipients of funding under the Program may include

national, State, multi-State, or multi-site quality im

provement networks. (2) RESEARCH REQUIREMENTS.-The re-

search conducted pursuant to paragraph (1) shall- (A) address the priorities identified by the Secretary in the national strategic plan es-tablished under section 399HH; (B) identify areas in which evidence is in-sufficient to identify strategies and methodolo-gies, taking into consideration areas of insuffi-cient evidence identified by a qualified con-sensus-based entity in the report required under section 399JJ; (C) address concerns identified by health care institutions and providers and commu-nicated through the Center pursuant to sub-section (e); (D) reduce preventable morbidity, mor-tality, and associated costs of morbidity and mortality by building capacity for patient safety research; (E) support the discovery of processes for the reliable, safe, efficient, and responsive deliv-ery of health care, taking into account discov-

eries from clinical research and comparative effectiveness research;

(F) be designed to help improve health care quality and is tested in practice-based settings;

(G) allow communication of research findings and translate evidence into practice recommendations that are adaptable to a variety of settings, and which, as soon as practicable after the establishment of the Center, shall include-

(i) the implementation of a national application of Intensive Care Unit improvement projects relating to the adult (including geriatric), pediatric, and neonatal patient populations;

(ii) practical methods for addressing health care associated infections, including Methicillin-Resistant Staphylococcus Aureus and Vancomycin-Resistant Entercoccus infections and other emerging infections; and

(iii) practical methods for reducing preventable hospital admissions and readmissions;

(H) expand demonstration projects for improving the quality of childrens health care and the use of health information technology, such as through Pediatric Quality Improvement Collaboratives and Learning Networks, con-sistent with provisions of section 1139A of the Social Security Act for assessing and improving quality, where applicable;

(I) identify and mitigate hazards by-

(i) analyzing events reported to patient safety reporting systems and patient safety organizations; and

(ii) using the results of such analyses to develop scientific methods of response to such events; (J) include the conduct of systematic re

views of existing practices that improve the quality, safety, and efficiency of health care de-livery, as well as new research on improving such practices; and

(K) include the examination of how to

measure and evaluate the progress of quality

and patient safety activities.

(e) DISSEMINATION OF RESEARCH FINDINGS.-

(1) PUBLIC AVAILABILITY.-The Director shall make the research findings of the Center avail-able to the public through multiple media and appro-priate formats to reflect the varying needs of con-sumers and diverse levels of health literacy.

(2) LINKAGE TO HEALTH INFORMATION TECH-NOLOGY.-The Secretary shall ensure that research findings and results generated by the Center are shared with the Office of the National Coordinator of Health Information Technology and used to in-form the activities of the health information tech-nology extension program under section 3012, as well as any relevant standards, certification criteria, or implementation specifications. (f) PRIORITIZATION.-The Director shall identify

and regularly update a list of processes or systems on

which to focus research and dissemination activities of the

Center, taking into account- (1) cost to Federal health programs; (2) consumer assessment of health care experi-ence; (3) provider assessment of such processes or systems and opportunities to minimize distress and injury to the health care workforce;

(4) potential impact of such processes or systems on health status and function of patients, including vulnerable populations including children;

(5) areas of insufficient evidence identified under subsection (d)(2)(B); and

(6) the evolution of meaningful use of health information technology, as defined in section 3000. (g) FUNDING.-There is authorized to be appro-

priated to carry out this section $20,000,000 for fiscal

years 2010 through 2014.

"SEC. 934. QUALITY IMPROVEMENT TECHNICAL ASSIST

ANCE AND IMPLEMENTATION.

(a) IN GENERAL.-The Director, through the Pa-

tient Safety Research Center established in section 933

(referred to in this section as the Center), shall award- (1) technical assistance grants or contracts to eligible entities to provide technical support to insti-tutions that deliver health care and health care pro-viders so that such institutions and providers under-stand, adapt, and implement the models and prac-tices identified in the research conducted by the Center, including the Quality Improvement Net-works Research Program; and

(2) implementation grants or contracts to eli-gible entities to implement the models and practices described under paragraph (1). (b) ELIGIBLE ENTITIES.-

(1) TECHNICAL ASSISTANCE AWARD.-To be eligible to receive a technical assistance grant or contract under subsection (a)(1), an entity-

(A) may be a provider, provider associa-tion, professional society, health care worker or-ganization, quality improvement organization, patient safety organization, local quality im-provement collaborative, the Joint Commission, academic health center, university, physician-based research network, primary care extension program established under section 399T, or any other entity identified by the Secretary; and

(B) shall have demonstrated expertise in providing information and technical support and assistance to health care providers regard-ing quality improvement. (2) IMPLEMENTATION AWARD.-To be eligible

to receive an implementation grant or contract under subsection (a)(2), an entity-

(A) may be a hospital or other provider or consortium or providers, as determined by the Secretary; and

(B) shall have demonstrated expertise in providing information and technical support and assistance to health care providers regarding quality improvement.

(c) APPLICATION.-

(1) TECHNICAL ASSISTANCE AWARD.-To re-ceive a technical assistance grant or contract under subsection (a)(1), an eligible entity shall submit an application to the Secretary at such time, in such manner, and containing-

(A) a plan for a sustainable business model that may include a system of-

(i) charging fees to institutions and providers that receive technical support from the entity; and

(ii) reducing or eliminating such fees for such institutions and providers that serve low-income populations; and (B) such other information as the Direc

tor may require. (2) IMPLEMENTATION AWARD.-To receive a grant or contract under subsection (a)(2), an eligible

entity shall submit an application to the Secretary at such time, in such manner, and containing-

(A) a plan for implementation of a model or practice identified in the research conducted by the Center including-

(i) financial cost, staffing requirements, and timeline for implementation; and

(ii) pre- and projected post imple-mentation quality measure performance data in targeted improvement areas identi-fied by the Secretary; and (B) such other information as the Direc-

tor may require.

(d) MATCHING FUNDS.-The Director may not award a grant or contract under this section to an entity unless the entity agrees that it will make available (di-rectly or through contributions from other public or pri-vate entities) non-Federal contributions toward the activi-ties to be carried out under the grant or contract in an amount equal to $1 for each $5 of Federal funds provided under the grant or contract. Such non-Federal matching funds may be provided directly or through donations from public or private entities and may be in cash or in-kind, fairly evaluated, including plant, equipment, or services.

258 (e) EVALUATION.- (1) IN GENERAL.-The Director shall evaluate the performance of each entity that receives a grant or contract under this section. The evaluation of an entity shall include a study of- (A) the success of such entity in achiev-ing the implementation, by the health care in-stitutions and providers assisted by such entity, of the models and practices identified in the re-search conducted by the Center under section 933; (B) the perception of the health care in-stitutions and providers assisted by such entity regarding the value of the entity; and (C) where practicable, better patient health outcomes and lower cost resulting from the assistance provided by such entity. (2) EFFECT OF EVALUATION.-Based on the outcome of the evaluation of the entity under para-graph (1), the Director shall determine whether to renew a grant or contract with such entity under this section. (f) COORDINATION.-The entities that receive a grant or contract under this section shall coordinate with health information technology regional extension centers

under section 3012(c) and the primary care extension program established under section 399T regarding the dissemination of quality improvement, system delivery reform, and best practices information..