February 1, 2024
Patrick Romano, a professor of internal medicine and pediatrics, is a healthcare quality expert who has led the development and evaluation of metrics and resources to measure and publicly report patient safety and quality outcomes for a variety of healthcare settings. He serves on the leadership team at the Center for Healthcare Policy and Research (CHPR) and leads the Center’s quality and safety research. Romano and his CHPR team – coding lead John Kennedy, project manager Katrine Padilla, analytic lead Monika Ray, nursing quality improvement lead Irina Tokareva and surgeon lead Garth Utter – help lead the Agency for Healthcare Research and Quality's (AHRQ) Quality Indicators program. The award supporting this critical work was recently renewed for three additional years with nearly $1.4 million of funding.
In this Q&A, Romano discusses the importance of healthcare quality and safety research and his latest work.
What are quality indicators and why are they important?
Quality indicators are how we evaluate the performance of health care organizations, including hospitals, health plans and nursing homes. They are used by government agencies to monitor and publicly report on the quality of facilities and services, by payers to design their networks of provider organizations and negotiate contracts, by purchasers to reward high performers and penalize poor performers, and by consumers to make informed choices in the marketplace. Most importantly, quality indicators are used within health care organizations to identify quality gaps, to drive quality improvement efforts, to inform management decisions and to assess progress over time.
Quality indicators are how we evaluate the performance of health care organizations, including hospitals, health plans and nursing homes.
How does your research contribute to patient safety?
Our research focuses on improving current quality indicators and developing, testing and validating the next generation of quality measures. For example, we are developing and helping to implement electronic clinical quality measures that will use information in electronic health records to identify important complications of hospital care, including falls with injury, pressure sores, acute kidney injury, postoperative respiratory failure, postoperative venous thromboembolism and anticoagulant-related major bleeding. Over the past 20 years, the uptake and widespread use of quality measures developed by UC Davis, in partnership with research organizations like Mathematica and public agencies like AHRQ and the Centers for Medicare & Medicaid Services, has led to thousands fewer patients with blood clots in their leg veins, falls with injuries, and other complications of hospital care.
What are you working on now with AHRQ?
Under our new award from AHRQ, in partnership with Mathematica, we will continue to refine and update AHRQ’s Quality Indicators, which are the most widely use claims-based measures of quality-related hospital outcomes. We will also help to develop and test innovative new measures of diagnostic safety and maternal outcomes. These two domains have been identified as very high priorities for quality measurement and improvement over the next several years.
What are the most recent opportunities and challenges faced by quality and safety research?
The greatest opportunities in quality and safety research come from the nearly universal adoption of electronic health records (EHRs), and the rich data about medications, laboratory test results and vital signs now available from this source. However, these data have turned out to be far more difficult to use for quality measurement than experts anticipated, in part due to the non-standard ways in which many clinical findings are documented, the lack of any national “test bed” for testing potential measures, the operational difficulties in extracting and merging data across multiple systems, and the variation among EHR products on the market today. Many stakeholders complain about having too many quality measures, yet many important domains of quality, such as long-term health outcomes after elective operations, are still not consistently measured. Researchers in this field work in a challenging policy environment in which patients and purchasers demand more and better measures to inform their decision-making, while health care providers complain about the burden of measurement and increasing pressure to boost their productivity and reduce their costs.
The Center for Healthcare Policy and Research’s mission is to facilitate research, promote education, and inform policy about health and health care. The goal is to improve the health of the public by contributing new knowledge about access, delivery, cost, quality and outcomes related to health care and providing rigorous evidence to policymakers and other stakeholders. CHPR executes its mission through interdisciplinary and collaborative research; education and career development; and research synthesis and dissemination.