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Evaluation of AHRQ's Partnerships for Quality Program

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Appendix A. Additional Tables (continued)

Table A.3. PFQ Project Evaluation Approaches and Measures

Grantee Organization and Principal Investigator (PI)

Evaluation Approach

Measures

1. Altarum Institute
PI: George J. Miller

Evaluation of the tool by partners via assessment of the face validity and utility of the model's structure, clinical protocols, and outputs.  Project was evaluating alternatives for responding to bioterrorist events by simulating these alternatives in the model.

 

2.  American Academy of Pediatrics (AAP)
PI: Carole M. Lannon, Center for Health Care Quality, Cincinnati Children's Hospital Medical Center

Quantitative measures of ADHD disease management processes, comparing  treatment group (eQIPP-enrolled and participating in AAP training/support) with controls (enrolled only in eQIPP) at baseline and follow-up points

Comparison of QI activities in treatment and control practices

Qualitative study of factors contributing to AAP chapters' ability to develop and sustain QI

% of charts demonstrating target level of care for 7 ADHD dx and rx components

Frequency and participation in QI activities for the two types of practices

3. American College of Physicians (ACP)
PI: Vincenza Snow

Pseudo-randomized trial comparing  pre-and post measures or indicators from experimental practices (those receiving practice-based, team-oriented CME training) to control practices (same training but at a later time)

Qualitative evaluation to elicit experiences of the practice teams and determine most useful aspects of the program.

Patient outcome and practice patterns:  process of care and clinical indicators from 15 enrolled diabetes patients in each practice at baseline, during intervention and post-intervention

Patient satisfaction, pre-post levels

Practice team experiences: pre-post levels of team collaboration

4. American Hospital Association (AHA), Health Research and Education Trust
PI: John R Combes

Compare baseline data from 3 initial learning labs to post-program data from 6 learning labs on length-of-stay, patient and family satsifaction, and financial measures

# of new hospital-based palliative care units created or enhancements to existing units as a result of visits to learning labs

Hospitals participating in visits to learning labs surveyed before and after their visits on the range of palliative care services offered, and on whether learning objectives for the visit were met.

Baseline clinical and financial information

Patient/family satisfaction measures with palliative care were not collected

6-month post visit reports of value of training, lessons learned, and new or enhanced services developed

5. American Medical Association (AMA)
PI: Karen S. Kmetik

Process evaluation to assess project progress, and impact, of the two models for electronic data transfer of physician  care practicese; success of the rollout and sustainability on a large scale over time; and generalizability of the models to other chronic conditions.

Changes in AMA-developed process of care performance measures for diabetes, CAD and major depressive disorder in participating physician practices

6. American Medical Directors Association (AMDA)
PI: David F. Polakoff

Compare process of care and clinical measures at baseline with those at 9 and 15 months post-intervention;  randomized each  participating NF to one of the two clincial practice guidelines to serve as cross-controls ("nested")

Clinical practice guideline implementation experiences of participants

Process of care and clinical outcomes for pain management and pressure ulcers in nursing facilities that participated

# of staff and amount of staff time spent on implementation, participation in each component of implementation process

7.  Association of California Nurse Leaders
PI: Nancy  Donaldson, CalNOC & UCSF School of Nursing

Compare baseline and post-intervention  patient outcome measures in participating med-surg units in the 35 intervention hospitals to non-participating units in the same hospitals.

Qualitative assessment of implementation progress.

Falls per 1000 patient days

Falls with injury/1000 patient days

Coaching processes milestones, linker and learner  feedback.

8. Catholic Healthcare Partners (CHP)
PI: Donald E. Casey

Quasi-experimental design: tracked pre- and post-intervention process of care measures for patients with heart failure, and compare these measures in participating and non-participating hospitals in 6 CHP regions.

Track intervention implementation progress in participating hospitals and assess effectiveness of HF GAP Clinical Advocates in influencing the measures.

Assess effectiveness of the CHP HF GAP Partnerships (system-wide and regional)—i.e., synergy, level of involvement, etc. using tool created by PFQ subcommittee on evaluation

4 HF inpatient performance measures: ACE inhibitor prescribed at discharge, LVEF assessment, smoking cessation counseling and appropriate discharge instructions

30 day "all cause" readmission rates for patients with an index admission for DRG 127

Appropriate use and dosage of beta-blockers & ACE inhibitors prescribed in outpatient settings

Appropriate identification & referral of chronic HF patients to palliative or hospice care at or near the end of life

Participation rates by cardiologists and primary care MDs in office-based QI activities

Successful negotiation of P4P incentives on above

9. Child Health Corporation of America (CHCA)
PI: Paul J. Sharek, Stanford University School of Medicine & L Packard Children's Hospital

Monitor process of care measures for targeted pediatric conditions in participating hospitals, and compare measures of compliance against AHRQ Hospital Patient Safety Best Practices

 

10. Connecticut Department of Public Health
PI: Louise Dembry, Yale-New Haven Health System & Yale School of Medicine

Quasi-experimental design comparing short and long-term knowledge of bioterrorism preparedness among physicians taking the course (N=41) and a control group (those eligible to take the course at a later time) (N=51)

Measures of knowledge of course content before the course, immediately after (only for those taking the course), and 6-months after  the course was administered.

11. HealthFront
PI: Michael Callahan

Assess the degree of "horizontal alignment" among purchasers, plans and government agencies within a region in their use of payment incentives, e.g. P4P, tiered networks to accelerate adoption of best practices

Proportion of total insured population that is subject to "aligned incentives" in the plans that use them.

12.  International Severity Info Systems, Inc.
PI: Susan Horn

Assessment of baseline and follow-up data on clinical, utilization and operational measures in participating nursing facilities, as well as staff-related measures

Qualitative assessment via focus groups and interviews of how the intervention supports use of best practice protocols in study units, integrates into daily workflow, achieves process efficiencies & gains user acceptance.

Pressure ulcer incidence acquired in and out of the facility;  hospital admissions, ER visits, # of forms used before and after intervention, annual turnover rates, staff satisfaction.

13. Joint Commission for Accreditation of Healthcare Organizations (JCAHO)
PI: Jerod M. Loeb

Project's outcomes were not the subject of its evaluation; it planned to evaluate the success of the project by comparing the goals and objectives accomplished against those outlined in the proposal.

 

14.  The Leapfrog Group
PI: Suzanne Delbanco

Measure the impact of payer use of incentives to promote the use of higher quality hospitals on employees' choice of hospitals and hospital adoption of recommended patient safety practices; one of the 6 sites measured employees use of hospitals pre and post incentive program, comparing employees subject to the incentives with those not affected

- Employee admissions to hospitals that do or do not meet Leapfrog patient safety standards.

- Hospitals applying for and meeting standards in the pilot communities

15. Lehigh Valley Hospital and Health Network
PI: Mark Young, later Kenneth D. Coburn

Monitor diabetes process-of-care measures and selected patients' clinical lab scores in participating physician practices at baseline, 6 months and 12 months post intervention.

Six-month reports to each practice  included their own process performance data and the latest ABC benchmarks for all practices.

Process: % of MDs screening for HbA1c, lipids and micro-albuminariuria

Clinical: blood pressure, lipid levels, cholesterol, triglycerides, hemoglobin

16. New York State Dept Of Health
PI: Suzanne Broderick/Beth Dichter

Quasi-experimental design with 2 intervention groups and 1 control group, comparing pre-post measures for all 3 groups.  One intervention group had only provider staff trained; the other had both provider staff and surveyors trained.

-Implementation: % of residents receiving the interventions; other measures of the degree to which facilities and staff implemented the interventions

-Clinical measures: falls, hospitalizations, weight loss and incontinence

17.  Physicians Micro Systems, Inc.
PI: Steven M Ornstein, Medical University of South Carolina

Monitor changes in physician adherence to clinical practice guidelines for 73 clinical indicators grouped into 8 areas among the 100 practices participating in the project, and track change in physician practices participating.  Will also conduct in-depth case studies of 10 practices

Summary Quality Index:  % of processes and outcomes that are up-to-date or under control for a given patient or practice; and a Diabetes Care Summary Quality Index

18. Research Triangle Institute
PI: Lucy A Savitz

Assess partnership strength and synergy created by the partnership in diffusing evidence-based practice

 

19. Texas A&M University Health Sciences Center, Rural and Community Health Institute (RCHI)
PI: Josie R Williams

Project outcomes were not evaluated, other than its progress in improving hospital and public health systems' ability to respond to bioterrorism events and disasters.

 

20. Visiting Nurse Service of New York, Center for Home Care Policy and Research
PI: Peny H Feldman

Process evaluation to assess the progress and success of initial collaborative and its feasibility as a vehicle for quality improvement.

CEO & staff surveys of implementation experiences, perceptions of value, etc.

Monthly chart review tracking of clinical measures for diabetes care and control and hospitalization rates for participants in the ReACH project.

CEO & team perceptions of value

Org. implementation measures

Indicators of spread beyond pilot group and sustainability

Clinical measures for glycemic control, foot care & medication management

Average agency-wide hospitalization rates

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