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Center for Organization and Delivery Studies
The Center for Organizational and Delivery Studies (CODS) of the Agency for Healthcare Research and Quality (AHRQ) actively pursues partnerships with the private sector to undertake research,
study value-based purchasing, and develop data.
Integrated Delivery System Research Network
CODS is home to the Integrated Delivery System Research Network (IDSRN)—a
model of field-based research developed under the leadership of CODS' Fred Hellinger. This initiative is now led by Cynthia
Palmer, IDSRN Project Officer. AHRQ has contracts with nine partners—consortia
of health care delivery systems and top researchers. The IDSRN was developed
explicitly to capitalize on the research capacity of, and research opportunities
occurring in, integrated delivery systems. The network provides a cadre of delivery-affiliated
researchers and sites to test ways to adapt and apply existing knowledge. Forty-four
awards, totaling approximately $11.5 million, have been made in the past 3 years.
The IDSRN projects are grouped into several categories, including patient safety,
bioterrorism, quality, disparities, information technology, and organization
and finance. For more information about the IDSRN, select the IDSRN Fact Sheet.
Chronic Care and Managed Care
CODS' Irene Fraser and Bernard Friedman
led a research partnership between AHRQ and the American Association of Health
Plans Foundation (AAHPF). The two organizations jointly issued a Request for
Applications (RFA) in 1998 to determine the impact of different features of
health plans on the quality of care provided to patients with chronic illnesses
and on outcomes. As a result, AHRQ and AAHPF, with AHRQ's sister agency, the
Health Resources and Services Administration (HRSA), awarded seven research
teams a total of more than $10 million over 5 years.
The research is determining how particular managed care policies and practices,
such as protocols governing the referral of patients to medical specialists
and arrangements for paying physicians, affect the quality of care for patients
living with chronic conditions. The seven teams, which were selected through
AHRQ's peer review process from a pool of over 30 applicants, were drawn from
scientists working at some of the top research institutions in the country.
For more details on this origin of the partnership and grants awarded, select
the 1998 press release, "AHCPR Teams with
AAHP Foundation to Improve Care for the Chronically Ill."
The findings of these studies are starting to appear in peer-reviewed journals
and have been presented at professional conferences. More will be published
in the near future. For interim results and discussion, contact either the principal
investigators listed in the press release or the Project Officer, Bernard Friedman
Child Health Insurance Research Initiative
AHRQ entered into a research partnership with the David and Lucile Packard
Foundation and HRSA to create the Child Health
Insurance Research Initiative (CHIRI™). CHIRI™ is an effort
to supply policymakers information to help them improve access to, and the quality
of, health care for low-income children. (See Request
for Proposals.) Overall funding totaled over $9 million over 3 years for
nine studies of public child health insurance programs and health care delivery
CHIRI™ studies seek to uncover which health insurance and delivery features
work best for low-income children, particularly minority children and those
with special health care needs. Seven of the projects focus exclusively on or
have separate analyses of children with special health care needs. Five projects
explore disparities between minority and white non-hispanic children.
A key feature of CHIRI™ is that the principal investigators participate
in a national Coordinating Committee. The Coordinating Committee, led by CODS'
Cindy Brach and her counterpart at the Packard
Foundation Gene Lewit, works to strengthen individual studies and to promote
collaboration among grantees to generate generalizable results.
CHIRI™ findings and further information about CHIRI™ can be obtained
from the Child Health Insurance Research
Initiative Web pages.
CODS formed a partnership with the Office
of Minority Health (OMH) to develop a research agenda for cultural competence
in health care. OMH and AHRQ co-funded a contract with Resources for Cross Cultural
Health Care (RCCHC), which conducted a literature review to identify research
that measured the impact of culturally competent interventions on health care
delivery and health outcomes. In April 2001 a Research Advisory Committee (RAC)
was convened for a two-and-a-half day meeting. The RAC reviewed an analysis
of the cultural competence literature and recommended questions for inclusion
in the research agenda. A draft research agenda was prepared and comments were
solicited from the RAC and the public. The final report containing the research
agenda, "Developing a Research Agenda for Cultural Competence in Health
Care" will be posted on OMH's and AHRQ's Web sites.
CODS' most recent research partnership is the Rewarding Results initiative
with the Robert Wood Johnson Foundation (RWJF). RWJF and the California HealthCare
Foundation awarded more than $4.9 million for six pilot projects to reward physicians
and hospitals for higher quality. As part of this national effort
to develop, evaluate, and share findings about innovations in the use of incentives
to encourage and reward high-quality care, AHRQ has awarded $1.5 million to
Boston University researchers to conduct a comprehensive national evaluation
of all six projects. The research project will examine the impact of financial
and non-financial incentives on the quality of health care services. (See Request
for Applications.) The goal of this research project is to find out which
incentives work best and to share that information with providers, health plans,
Partnerships to Support Value-based Purchasing
In our market-based health care system, employers have a significant lever
with which to affect the quality of care: they purchase health insurance for
their employees and their families, controlling a significant part of U.S. health
Despite the significant potential of this employer role, neither policymakers
nor employers have much empirical information about what purchasing strategies
to buy quality care—value—are effective in increasing employee and
community health. To help address this knowledge gap, CODS has been collaborating
with several employer groups.
CODS staff Irene Fraser and Peggy
McNamara collaborated with the National Business Coalition for Health (NBCH)
in analyzing its 1998 survey and 1999 case study interviews with select leaders
of local employer coalitions. The goal of the research project was to develop
a better understanding of the capacity of employer coalitions to incorporate
quality or value into their purchasing practices. The research found that most
coalitions have an infrastructure in place that could be tapped to advance quality
goals. Most coalitions:
- Collect or analyze information and data on quality.
- Group-purchase some or all of a benefits package on behalf of their members.
- Incorporate financial incentives for performance into purchase contracts.
- Collaborate on continuous quality improvement efforts.
Although the survey data could not tell us the extent to which coalitions
are tapping these strategies specifically to improve quality, interviews with
nine coalition leaders provided insights about how quality considerations can
factor into coalition strategies. For a more detailed discussion of the findings
from this research collaboration, see "The Pursuit of Quality by Business
Coalitions: A National Survey," by Fraser, McNamara, Lehman, Isaacson and
Moler, Health Affairs, November/December 1999. Select for summary and reprint ordering information.
Tools for Value-Based Purchasing and Quality Improvement
CODS' Jan De La Mare is
working with employer groups to disseminate a guide developed to assist purchasers
in assessing their value-based purchasing activities. "Evaluating the
Impact of Value-based Purchasing: A Guide for Purchasers" serves as a
tool for employers to help them track and assess the impact of their efforts
in "real time" so that they can determine quickly what works best
and how to fine-tune their strategies. Select to access an online version of
the guide, which was developed for an
CODS' Denise Remus and Stanford University are working
with provider, employer, and other stakeholder groups to explore the utility
and feasibility of adapting AHRQ tools, in particular the Quality Indicators
(QIs), for use in comparative quality reporting. The QI software contains 33
clinical performance measures that can be used with hospital discharge data.
The QIs span three dimensions of quality and identify:
- Potentially avoidable adverse hospital outcomes, such as in-hospital mortality following common elective procedures or complications, that occur in the hospital.
- Potentially inappropriate use of hospital procedures, such as cesarean sections.
- Potentially avoidable hospital admissions that indirectly point toward possible problems in access to, and appropriateness of, outpatient care.
CODS houses the Healthcare Cost and Utilization Project
(HCUP), a family of healthcare databases and related software tools and products
developed through a Federal-State-industry partnership and sponsored by AHRQ.
HCUP databases bring together the data collection efforts of State data organizations,
hospital associations, private data organizations, and the Federal government
to create a national information resource of patient-level health care data.
HCUP includes the largest collection of longitudinal hospital care data in
the United States, with all-payer, discharge information for the years 1988-2000. These databases enable research on a broad range of health policy issues,
including cost and quality of health services, medical practice patterns, access
to health care programs, and outcome of treatment at the national, State, and
local market levels.
HCUP's objectives are to:
- Obtain data from statewide information sources.
- Design and develop multi-State health care databases for health services
research and health policy analysis.
- Make these data available to a broad set of public and private users.
HCUP databases contain patient-level information compiled in a uniform format
with privacy protections in place.
The newest addition to the HCUP family is HCUPnet,
an interactive, online service that provides instant access to selected HCUP
statistics. HCUPnet is a tool for identifying, tracking, analyzing, and comparing
statistics on hospitals on the national, regional, and State level. HCUPnet
is free and ideal for developing national estimates, analyzing national trends,
and for research on hospital admissions that requires a large sample size.
HIV Research Network
The HIV Research Network (HIVRN), a CODS data partnership led by Fred
Hellinger, presently contains 18 medical institutions that treat more than
16,000 patients with HIV disease and are located across the United States. Each
institution assembles data on the clinical and demographic characteristics of
their patients with HIV infection, the frequency of each patient's outpatient
clinic visits, and the number of inpatient admissions. Participating institutions
then send the information to the data coordinating center located at the Johns
Hopkins School of Medicine. Information is consolidated into a single uniform
database at the data coordinating center.
The objective of the HIVRN is to acquire, investigate, and distribute information
collected from participating institutions on the delivery of services to people
with HIV infection. Treatment of HIV infection is complicated, and new drugs
are being developed rapidly. Moreover, treatment guidelines are modified frequently
in response to the swiftly growing body of knowledge about the effects of various
treatment regimens on the health of persons with HIV disease. Policymakers,
service providers, and patients need to know how often people with HIV infection
receive specific services, and what factors are related to receiving more or
One method for disseminating the information collected from 15 of the participating
institutions is HIVnet, a Web-based tool. HIVnet
provides instant access to selected information on inpatient and outpatient
utilization by persons with HIV disease. HIVnet does not contain information
on outcomes of treatment for HIV infection or on how to access HIV-related services
in your community.
The HIVRN is sponsored by several Federal agencies: the Agency for Healthcare
Research and Quality (AHRQ), the Center
for Substance Abuse Treatment in the Substance Abuse and Mental Health Services
Administration (SAMHSA), the HIV/AIDS Bureau
in the Health Resources and Services Administration (HRSA), and the Office of AIDS Research in the Office of the Director of the National Institutes of Health (OAR/NIH).
Select to access meetings held in conjunction with this project.
Current as of December 2002