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Evaluation of AHRQ's Partnerships for Quality Program

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Appendix A. Additional Tables (continued)

Table A.5. PFQ Grant Outcomes

Grantee Organization and Principal Investigator (PI)

Reported Changes in Care Delivery Processes or Provider Practices

Reported Changes in Patient Outcomes (clinical indicators, functional status or health status)

Other Reported Outcomes

1. Altarum Institute
PI: George J. Miller

NA

NA

Provided information useful to public health officials in planning for, and reducing demand for medical care in the event of a smallpox outbreak. Also validated the use of a model for estimating casualties and disease spread during outbreaks.

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

Results not yet available as of 8/06 for the following measures:

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

Not measured; previous research established effectiveness of providing care in accordance with ADHD guidelines on better outcomes

Results not yet available as of 8/06 for the following measures

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

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

Results not yet available as of 8/06 for the following measures:

- process of care indicators, e.g. eye  and foot exams, flu vaccines,  from 15 enrolled diabetes patients in each practice at baseline, during intervention and post-intervention

Results not yet available as of 8/06 for the following measures:

- clinical indicators, e.g. blood pressure, % patients with LDL < 100 mg/dL,  etc. from 15 enrolled diabetes patients in each practice at baseline, during intervention and post-intervention

Early pilot program with 4 practices showed 75% of patients' blood pressure levels improved from baseline, and 50% achieved their target BP goal.

85% of experimental practices participated in entire training program

Training improved team collaboration by helping non-physician practice staff become more integrated in care process

Program spurred workflow changes (e.g. new forms and databases) to improve care of diabetes patients

Experience prompted AMA and ANA to award CME credit for participating in practice-based training

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

Results not yet available as of 8/06 for the following measures:

 - length-of-stay and financial/cost information for 3 initial learning labs' palliative care units

NA

60-70 hospitals visited learning labs over the course of the project—but not yet known how many established newpalliative care units or enhanced existing units.

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

NA

NA

Lessons on integrating perfomance measures into different types of electronic health record systems used in ambulatory care practices and data export issues/challenges

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

Results not yet available as of 8/06 for the following measures:

- Process of care indicators for pain management and pressure ulcers in nursing facilities that participated

Results not yet available as of 8/06 for the following measures:

 - clinical outcomes for pain management and pressure ulcers in nursing facilities that participated

Results not yet available as of 8/06 for the following measures

- # of staff and amount of 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

NA

Preliminary analysis indicates no significant change in mean falls and falls with injury/1000 patient days between the pre and post period for participating units, nor were the changes significantly different between participating and non-participating units. But  falls/1000 patient days in participating units were "trending" (downward).

3-year period needed to implement interventions may be too long in view of most hospitals' single-year budget horizon.

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

Preliminary data indicates that patients under care of HF Advocates have fewer hospital re-admissions,  lower 30-day all-cause readmission rate, and longer time between re-admissions than those not under care of HF Advocates.  Performance in 4 HF core measures have improved over the 4-year project period; CHP composite score = 95%.  Final data not yet available as of 8/06.

NA

Increased referrals to palliative care and hospice.

Improved document and coding by 20%.

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

Results from preliminary data analysis of the hospitals that participated in the project to reduce adverse drug events (ADE) related to narcotics showed a decrease from 39.1 to 17.1 ADEs per 1000 narcotic doses, a 49% reduction. 

12 sites that implemented measures to improve communication during transfers the ER and inpatient units improved pediatric patient safety as manifested by fewer duplicate or missed medications & lab tests, and incorrect or absent infection control information.

Preliminary data shows lower infection rates in several sites; overall bloodstream infection (BSI)  rate for all 29 participating hospitals decreased from 6.9 to 4.8 per 1000 line days, a 31% drop (statistically significant); 11 hospitals decreased catheter-associated bloodstream infection (CABSI) rates more than 50% and an estimated 112 CABSIs were avoided.

The CHCA pediatric trigger tool identified 22 times more adverse drug events than traditional reporting mechanisms (i.e. incident reports).

Savings from the ADE collaborative, in which 662 ADEs were prevented, was between $1.7 and $3.1 million depending on the whether these ADEs were "not preventable ($1.7 million) or "preventable" ($3.1 million) using the cost data provided by Bates et al. 1997.

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

NA

NA

Physicicans taking the bioterrorism preparedness course had a statistically significant increase in knowledge from pre-test to immediate post-test mean exam scores (67.4 to 77.2) , while those of the control group did not significantly change (56.6 to 55.6). However, long-term FU scores among MDs taking the course declined almost to the baseline score mean (64.4).

11. HealthFront
PI: Michael Callahan

NA

NA

Survey of medical groups and physician practices to understand their acceptance of and response to quality incentives showed that physicians are uncertain and wary of them.

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

Results not yet available as of 8/06 for the following measures:

 - hospital admission and ER visits

Preliminary findings showed reduction in pressure ulcer incidence for all patients and for high-risk patients in all participating facilities; six of 11 facilities were below the national average—which  did not decline over the project period.

# of forms used in each facility for documenting patient status has declined in all facilities; data for QI is now available in "real-time" and reviewed at least weekly.

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

NA

NA

Performance measurement: Hospitals' self-abstracted data on performance measures are statistically similar to third-party abstracts, rendering self-reports accurate enough for P4P purposes.  Preliminary results show statistically signficant correlation between perceptions of the value of core measures, QI actions taken and performance, but may not be clinically meaningful.

Bioterrorism preparedness: The majority of hospitals responding to the survey conduct "basic readiness" drills and planning, but are not well linked to public health and community health care entitites.

14.  The Leapfrog Group
PI: Suzanne Delbanco

NA

NA

In one pilot site (Boeing) rigorously evaluated, program did not have any significant effect on consumer choice of hospitals; physician referral proved to be a stronger determinant. Overall, project increased knowledge and tools for creating successful incentive and reward programs. 

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

Preliminary data showed increases in % of MDs screening for all appropriate tests and lower-performing MDs showed improved scores on ABCs

Patient lab scores showed statistically signficant improvement in all core clinical measures "corrected for regression to the mean"

Financial feasibility study of group visits found that 12-15 patients/group provides income comparable to routine office visits.

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

NA

Results not yet available as of 8/06 for the following measures: falls, hospitalizations, weight loss and incontinence

Preliminary data indicates that many of the experimental facilities did not implement the interventions, despite having received training to do so.

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

Preliminary mid-project results show the Summary Index Measure (% of eligible targets met for all 78 indicators, adjusted for patient complexity) rose from 33% at baseline (9/02) to 46% 3 and ½ yrs later (p<.0001); 6 condition-specific indices also had statistically significant improvements.

NA

Regression analysis suggests the practices attending a 2-day network meeting had greater improvements in the diabetes summary measures than those that did not.

18. Research Triangle Institute
PI: Lucy A Savitz

NA

NA

Lessons and findings for strategies to support knowledge transfer within and across health systems.

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

NA

NA

Findings from studies regarding: 1) use of bioterrorism funding on response readiness, 2) disease surveillance at the US-Mexican and US-Canadian borders and 3) rural hospitals' use of planning exercises and drills for emergencies.

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

Clinical measures for diabetes care and control:  chart review data showed improvement in the proportion of persons with diabetes receiving a comprehensive foot exam within 10 days of admission to home care, an increase of over 50 percentage points during the course of the project. Increases of over 30 percentage points, were also demonstrated for % of patients with an individualized glycemic control plan, % receiving education about foot care, and % whose medications reviewed for contraindications.

Preliminary data suggests acute care hospitalization reduction of 2.5 percentage points agency-wide (31.5% to 29%)

30 percentage point increase in % of patients with blood glucose in target range most or all of the time

40 percentage point increase in % of patients testing their blood glucose according to their care plan most or all of the time

Majority of CEOs & clinical managers said that their agency's participation led them to revise they way they approach QI initiatives, and helped to identify changes that they intended to spread across the entire organization.

Note:  Results that are expected, but not available as of 9/06 are in italics.

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