Patient Protection and Affordable Care Act
Quality Improvement Initiatives: Establishment of Center to Research Health Care Quality Practices

Sec. 3501 Health Care Delivery System Research; Quality Improvement Technical Assistance

Health Care Delivery System Research

• Function. The Center for Health Care Quality Improvement and Patient Safety (“Center”) will facilitate the development and implementation of quality improvement practices.219 The Center must:

• Use “a variety of disciplines” to “carry out its functions;”
• Focus on improved delivery practices regarding “processes of care,” patient safety, reduction of medical errors, and workflow;
• Identify providers that delivery high quality care using “best practices that are adaptable” throughout the health care system;
• Evaluate research regarding most effective methods to improve the delivery of health care;
• Identify means to quickly and effectively implement methods into practice;
• Generate quality improvement strategies;
• “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;
• Facilitate development of best practices of the delivery of care that are, based on empirical evidence, likely to succeed, have sufficient detail regarding processes, training, and required knowledge for implementation into the health care system, can be readily adapted by providers, and help providers to work with other providers to engage patients and their families in an effort to improve outcomes;
• Allocate funding for organizations that have experience in improving the delivery of health care services, including children’s care, by utilizing numerous disciplines, health care manages, development and training, patients, etc.; and
• Build state and community level capacity to advance quality and safety efforts through means such as education and training.220

• Research. The Center must undertake specific research tasks and may establish a Quality Improvement Network Research Program in order to conduct testing and development of quality and efficiency interventions.221
  •  The Center must conduct research consistent with the National Strategic Action Plan, identify knowledge gaps, respond to concerns of health care institutions, and build the capacity of patient safety research in order to reduce associated deaths, injuries, and costs. The Center must develop practice recommendations for dissemination pertaining to the improvement of Intensive Care Units, antibiotic resistant infections, and hospital readmissions.222
  • The Center must expand children’s health and HIT demonstration projects. The Center must develop means to mitigate hazards by collecting and analyzing data from patient safety organizations and reporting systems. The Center must “conduct systematic reviews of existing practices that improve the quality, safety, and efficiency of health care delivery” and “include the examination of how to measure and evaluate the progress of quality and patient safety activities.”223
• Dissemination. The Director of the Center must make the research findings publicly available in a way that facilitates access by individuals with varying health literacy capacity. The director must also disseminate the Center’s research to the Office of the National Coordinator of Health Information Technology for the Office’s use in carrying out the tasks mandated by Section 3012.224
• Priorities. The Director must establish and continually update a lost of research priorities based on the following criteria: (1) “cost to Federal health programs;” (2) “consumer assessment of health care experience;” (3) provider assessment; (4) The impact of identified processes and systems on patient health; (5) knowledge gaps; (6) “the evolution of meaningful use of health information technology, as defined in section 3000.”225

Quality Improvement Technical Assistance and Implementation

• Grants. The Director has authority to award grants and contracts for technical support and implementation of quality improvement actions.226
  • Entities eligible for “technical assistance awards” are those that fall into a specified category (e.g. providers, patient safety organizations) and have knowledge and experience with providing technical support to providers regarding quality improvement. Hospitals and other providers, as determined by the Secretary, that have knowledge and experience with providing technical support to health care providers pertaining to quality improvement efforts may obtain “implementation awards.”227
  • Entities must apply to the director to receive either a technical assistance or implementation award. The application for a technical assistance award must include a “sustainable business mode” that has a system for charging provider and institutions for the receipt of technical assistance, a means of reducing such fees for providers with low-income clientele, and any other requirements that the Director specifies.228 The application for an implementation award must contain “a plan for implementation of a model or practice identified by the Center.”229 This plan must identify items such as cost, staffing needs, implementation timelines, estimated quality measure performance both before and after implementation, and any other requirements that the Director may specify.230

Entities that receive either technical assistance or implementation awards must agree to match every $5 of federal funding with $1 of non-federal funding.231 The Director will assess the progress of each grantee focusing, in particular, on the implementation success rate, perceived value of the grantee from the perspective of institutions and providers receiving assistance, and whether implementation generated cost savings or improved health outcomes. The Director will condition grant renewal upon the results of this evaluation.232 Grantees must coordinate their efforts with HIT regional extension centers and the primary care extension program.233