Working Together to Tackle Health Care’s “Voltage Drops”

Andy BindmanBy Andy Bindman, M.D., Director of AHRQ
Twitter: @AHRQNews

It has been nearly 16 years since the late John Eisenberg, M.D., AHRQ’s brilliant director from 1997 to 2002 and one of my early mentors, published an article in JAMA that remains a guidepost for me and others in the field even today.  The article deserves quoting for its enduring message:

Although the U.S. health system is often touted as one of the best in the world, disparities exist in quality of care received by different populations, in different regions, and across different institutions and clinicians.

John’s analysis, Transferring Insurance Coverage into Quality Health Care, is notable for its use of the analogy of “voltage drops.” It’s a clever turn of phrase that describes how high-quality care is too often out of reach for patients due to obstacles such as lack of insurance, limited access to health care services or institutions, or lack of a consistent relationship with a specific primary care provider.

Why think about this now?

While I’m still in my first month as AHRQ’s director, I’ve been reflecting on the enormous contributions of my predecessors. John, a beloved pioneer in health services research, was an international leader in quality improvement. Carolyn Clancy, M.D., admired as a clinician and educator, worked tirelessly to extend his legacy. Rick Kronick, Ph.D., passionately energized AHRQ’s expertise in health care data collection and analysis.

But it was Tim Ferris, M.D., senior vice president, population health management, Massachusetts General Hospital, who reminded me about “voltage drops” as part of his presentation last week at the Society of General Internal Medicine (SGIM) annual meeting.

I was wowed by the talent and enthusiasm of those who attended the conference. This was a large group—well over 2,000—whose members clearly share a commitment to creating a more efficient and effective health care system.

Tim’s reference to “voltage drops” was spot on. He reflected on the wealth of meeting presentations that described elements of a high-functioning health care system. One of the great challenges we face, he noted, is not simply collecting more information about how and why these elements work, but figuring out how to apply and expand them.

I’m feeling very optimistic about AHRQ’s potential to meet this challenge. The Agency’s staff is brimming with ideas and strategies for making health care better. Our EvidenceNOW, TeamSTEPPS, and Quality Indicators initiatives are terrific examples of AHRQ’s deep commitment to the implementation of effective improvement strategies. AHRQ is also beginning an exciting new initiative to characterize the progress health systems are making toward implementing the strategies, which can reduce their voltage drops, and the outcomes they achieve. I’ll use this space in the weeks and months ahead to share updates about our work.

But, of course, this is not a job only for AHRQ. And it’s not a job for any single sector of our health care community. The obligation is shared by all—front-line clinicians, policymakers, patients and caregivers, health economists, insurers, and health systems administrators. We’re in this together. I look forward to working with you to tackle these challenges and to continue the conversation through this forum and other interactive platforms.

This article was originally published on AHRQ Views Blog and is republished here with permission.