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IDSRN Project Awards

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Field Partnerships to Conduct and Use Research

Awards in Fiscal Year 2004

Bioterrorism Planning and Response
Improving Patient Safety
Organization and Coordination of Care
Improving Long-term Care
Quality Improvement
Health Information Technology
Other Topics

Bioterrorism Planning and Response

Expanding Surge Capacity through Use of Former (Shuttered or Converted) Hospitals
Partner: Abt Associates
Description: In a major man-made or natural disaster, it may be necessary to rapidly expand hospital capacity and care for large numbers of trauma victims or highly infectious patients. Most U.S. cities will lack the capacity to absorb a surge in demand for hospital care. One option would be to move low-acuity patients out of medical centers to temporary facilities such as closed or converted former hospitals. This task order assesses the required planning/preparedness needed for such hospital use in the Boston area. The priority areas identified for assessment are: identify ways to augment hospital bed capacity, assure sufficient numbers of trained medical personnel to support a crisis, ensure availability of pharmaceutical supplies, evaluate and expand National Disaster Medical Systems (NDMS) capabilities, and use models to set surge requirements.
Period: 6/04-6/05
Funding: $424,804

Health Care System Preparedness and Surge Capacity for Bioterrorism and Public Health Emergencies
Partner: Weill Medical College of Cornell University
Description: The purpose of the study is to produce a 40-60 page planning guide for hospital and health system administrators to help then understand and operationalize regional preparedness plans for emergencies that result in large numbers of casualties. The guide will provide information on: quantifying intra-institutional baseline and surge treatment capacity; defining the region and developing regional partnerships; qualifying regional surge capacity; defining triggers for plan activation; and addressing the roles and responsibilities of lead and support institutions. The task order will also be used to adapt and upgrade the Weill Discrete Event Simulation Model, using model outputs as examples in the planning guide. In addition, the Hospital Model will be upgraded and transferred to a Web-accessible platform to make it a stand-alone planning tool.
Period: 8/04-7/05
Funding: $482,081

Standardized 'Real Time' National Hospital Bed Availability and Patient Tracking System
Partner: Denver Health
Description: Denver Health investigators will develop, implement, and evaluate a "real-time" electronic hospital bed and patient tracking/monitoring system needed for surge events resulting from medical disasters. The system will permit Federal, regional, and State Command Centers to access standardized information across the entire Nation.
Period: 7/04-6/05
Funding: $692,585

Exploring the Special Needs and Potential Role of Nursing Homes in Surge Capacity for Bioterrorism and Other Public Health Emergencies
Partner: RTI
Description: This cross-sectional study uses mixed methods to address several research questions: Have nursing home (NH) administrators prepared and trained staff on disaster plans? Are NHs capable of accommodating patient flows resulting form acute care hospital needs to free beds for surge capacity in the event of bioterrorism or other public health emergencies? Are there NHs pivotally located in rural areas not served by hospital facilities that might offer strategic surge capacity? How do State regulations influence the ability of NHs to offer support or surge capacity? In addition to beds, what other resources could NHs offer?
Period: 7/04-7/05
Funding: $394,581

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Improving Patient Safety

Hospital Adoption of the National Quality Forum Safe Practices
Partner: Emory University
Description: The National Quality Forum (NQF) has published a consensus report titled "Safe Practices for Better Healthcare" identifying 30 health care safe practices that should be universally implemented to reduce the risk of harm to patients. A subset of these measures (i.e., use of computerized physician order entry, evidence-based hospital referral, and intensivists) has been adopted by Leapfrog in their survey of hospital safety practices. There is considerable public pressure on hospitals to comply with all thirty of these recommended practices. However, many questions remain about the utility and ease of implementing some of the practices, which practices should be implemented first to maximize a positive impact on patient safety, and what are the best strategies for implementation in order to achieve safer patient care. Using the NQF, Leapfrog, and AHRQ Safety Practices to implement up to 30 safe practices, the project objective is to examine safe practice implementation strategies in actual clinical environments. Sample questions include but are not limited to: How many safe practices have been adopted and it what clinical environment? Which safe practices are the easiest to implement and which present the most challenges to implementation and why? What is a realistic time frame for implementation? What are the costs and benefits of implementing safe practice(s)? What support, resources and tools are necessary for successful implementation? Should the list of safe practices be prioritized and what criteria should be developed and/or used for setting priorities? Are there economies associated with implementing "sets" of safe practices (e.g., should practices be implemented in tandem or sequentially for most effective impact)? What are the costs and benefits of implementing safe practices? Is there an association and/or correlation between the implementation of safe practices and improved clinical outcomes as measured by AHRQ's patient safety indicators (PSI) or other measures of safety and quality? How do types of settings influence the relationship between culture and outcomes (e.g., large v. small, urban v. rural, impatient v. outpatient)?
Period: 9/04-9/05
Funding: $259,435

Root Cause Analyses of Precursor Events Using an Electronic Reporting System
Partner: Weill Medical College of Cornell University
Description: The objective of this task order is to test existing assumptions that the underlying causes and contributing factors of three types of medical errors (defined below) are the same, similar, or have no relationship by examining their root cause(s), to further test whether this similarity is associated with the severity of potential or actual patient safety events, and to test whether these associations vary by clinical focus. For this study, patient safety events are defined as: (1) events that occur but do not reach the patient, (2) those that reach the patient but result in no measurable harm or injury, and (3) those that occur and cause harm, injury or death.
Period: 9/04-9/05
Funding: $249,158

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Organization and Coordination of Care

Methods for Developing Actionable Evidence for Consumers of Health Services Research (MATCH) Closing the Gap between Organizational Decisionmakers and Researchers
Partner: Kaiser Foundation Research Institute
Description: Well-intentioned efforts in recent years to improve the precision and usefulness of health services research have resulted in some constraints on the meaning of the word "evidence." For the purpose of health care research, the meaning of the word evidence does not necessarily encompass information that may be valuable at the system level in making decisions about the organization and design of health care delivery. The framework for the evidence that helps health system leaders make decisions is under-developed. Work is needed to help build such a framework by exploring the types of evidence that do and should inform decisions made in organizations that purchase, manage and provide health services. The first study objective is to develop a set of tools for use by system-level decisionmakers, such as general management and specialized senior executives, as they assess evidence needed for decision-making in health systems. Based on these tools, the second objective is to provide resource documents that will help researchers be more effective in collecting, arraying, validating and interpreting the kind of evidence that these decisionmakers want and need at the system level of health care.
Period: 9/04-3/06
Funding: $300,000

Cost of Poor Quality or Waste in IDS Settings
Partner: RTI
Description: An estimated 30 percent of health care costs are attributable to waste and the average cost of poor quality per patient per year is $1,500. Examples of poor quality and/or waste in health care are diverse and include such things as: clinician interruptions, duplicated or repeat testing/procedures, delays in care, inefficient use of clinician time, proper documentation/record keeping, iatrogenesis, and patient injuries among others. Participants in the RTI consortium in the IDSRN are conducting a study which should have high operational utility and impact. An initial literature review resulted in actual markers that signify the cost of poor quality. Previous work by members of the team suggests the need to address such problems in fully integrated systems settings in order to make a business case. By capturing the full complement of revenues and costs from insurers to providers and facilities enables viewing waste and poor quality effects across the entire value chain. Primary research objectives for this collaborative research activity are to: identify a typology of health care cost and inefficiency; build a financial system that identifies the costs of poor quality or waste and opportunities for improvement; and test the system in two IDSs.
Period: 8/04-1/06
Funding: $214,998
Final Report: Available at http://www.ahrq.gov/research//research/costpqids/.

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Improving Long-term Care

Development of E-Transition Tools for Home Health Care
Partner: Weill Medical College of Cornell University
Description: This task order follows up on findings from a recently finished IDSRN task order which analyzed ways to make communication and care monitoring between members of a hospital transition team at New York Presbyterian (NYP) and a home health agency, the Visiting Nurse Service of New York (VNSNY) better for patients with heart failure. That task order assessed ways to enhancing the content and format of a CMS form that is used at the time of hospital discharge (CMS 485—Home Health Certification and Plan of Care) so that clinicians could provide relevant clinical input into the care planning process and then to be able to improve the monitoring of the changing care after discharge. That project also piloted the new enhanced form and assessed the next steps for improving communication electronically. This project concluded that the next stage of development of a tool would need to involve clinicians in home care agencies as well as hospital and community physicians and additionally provide help to patients to improve self-care education. The project also concluded that a Web-based tool would be the best platform to give all parties access to the information, allow alerts to be designed when appropriate, and give access to and input from community based clinicians, who typically do not have access to electronic clinical records. The objectives are to: evaluate the impact of the redesigned Cornell/VNSNY CMS-485 on the transition process and outcomes of heart failure patients discharged from the hospital to home care; further develop and conduct a process evaluation of two-way electronic communication system between Weill Medical College of Cornell University and the Visiting Nurse Service of New York (an environment where the hospital and home care agency have electronic patient records); develop and pilot test a Web-based system for communication among hospital, home care and community providers without electronic record systems, as well as with patients and/or their families; and develop a presentation that demonstrates the Web-based system to other interested parties.
Period: 9/04-9/06
Funding: $644,937

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Quality Improvement

Translating Data to Information: Development of Reporting Template for the AHRQ Quality Indicators (QIs)
Partner: Weill Medical College of Cornell University
Description: There is much discussion regarding the lack of consumer interest in and use of public reports on providers' performance. This is not surprising given the fact that many performance reports are published without any audience testing as to their interests in the measures, comprehension of the information presented, or other report card attributes. The AHRQ Quality Indicators (QIs) are already being used for public reporting by two States using a template developed without the benefit of structured evaluation and testing of its effectiveness in translating data to information for use by a variety of stakeholders. There is considerable interest in using the QIs to both inform consumer decisions and pay for performance by purchasers of care. Hospitals and hospital associations are struggling with identifying effective formats for comparative reports and facilitating their use to identify opportunities for improvement. These organizations and other QI users are interested in identifying effective reporting formats and mechanisms to maximize the value and impact of these quality measurement efforts. Existing reporting programs, whether internet based or hard copy, have utilized a range of presentation formats. There is not yet overall consensus of which formats are likely to be most effective in conveying desired information to the intended stakeholder audience. This task order supports development and testing of reporting templates for all QIs (Prevention QIs [PQIs], Inpatient QIs [IQIs] and the Patient Safety Indicators [PSIs]) for four stakeholder audiences: (1) consumers, (2) purchasers, (3) policymakers and (4) health care providers. It will also evaluate an existing program that has used the AHRQ QIs for public reporting and pay for performance. Findings from this project will be incorporated into the QI software thus providing QI users with ready access to recommended reporting templates.
Period: 9/04-3/06
Funding: $245,000

Development of Curricula to Train Users in the Application of the Quality Indicators (QI) and the Interpretation of QI Output
Partner: RTI
Description: AHRQ has released several Quality Indicator (QI) software modules, including the Prevention QIs (PQIs), Inpatient QIs (IQIs), and the Patient Safety Indicators (PSIs). These modules and related documentation have been welcomed by many stakeholder audiences including Federal and State agencies, hospital associations, health care systems, purchasers, and payers interested in applying these standardized, scientifically based quality indicators to their data. However, even after the release of "user-friendly" software, users continue to request assistance with data preparation, software application and interpretation of QI output. To answer this need, RTI has developed training curricula tailored to three specific targeted user groups-purchasers, government agency staff, and health service organizations and/or association analysts. They have conducted user-specific training sessions on the application of AHRQ QIs and interpretation of the results of output produced in constructing the indicators.
Period: 10/03-4/05
Funding: $124,000

Train the Trainers in the Application of the AHRQ Quality Indicators
Partner: RTI
Description: AHRQ has released several Quality Indicator (QI) software modules, including the Prevention QIs (PQIs), Inpatient QIs (IQIs), and the Patient Safety Indicators (PSIs). These modules and related documentation have been welcomed by many stakeholder audiences including Federal and State agencies, hospital associations, health care systems, purchasers, and payers interested in applying these standardized, scientifically based quality indicators to their data. However, even after the release of "user-friendly" software, users continue to request assistance with data preparation, software application and interpretation of QI output. To answer this need, RTI was awarded an IDSRN task order in 2003 (290-00-0018 TO 8) titled "Development of curricula to train users in the application of Quality Indicators (QIs) and the interpretation of QI output." The principal investigators for this study have developed training curricula tailored to three specific targeted user groups-purchasers, government agency staff, and health service organizations and/or association analysts. They have conducted user-specific training sessions on the application of AHRQ QIs and interpretation of the results of output produced in constructing the indicators. In order to facilitate standardized training for groups of users in future, RTI is conducting a "train the trainer" session for staff in an organization with which AHRQ has an established contract to support use of the QIs and QI development and research. In addition to the training, RTI shall provide the appropriate background materials underlying the QI curricula in order to maintain the materials in the future. The objective of this Task Order is to train selected staff on the application and interpretation of the QIs so that these persons will be able to train other potential QI users and maintain the currency and relevancy of the QI curricula into the future.
Period: 9/04-6/05
Funding: $29,999

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Health Information Technology

Improving Diffusion of Effective Health Information Technology—A Study of the Effect of Technology on the Quality and Cost of Care
Partner: The Center for Health Care Policy and Evaluation
Description: This study analyzes the impact of implementing health information technology (Health IT) in medical practices. The investigators are identifying practices that have recently either implemented electronic health records (EHRs) or have been recognized by an established program for implementing other Health IT. Of particular interest are physician recognition programs sponsored by the National Committee on Quality Assurance (NCQA) (e.g., Physician Practice Connections Program, Diabetes Physician Recognition Program, Heart/Stroke Physician Recognition Program). The study is addressing the following questions: How much do Health IT tools improve physicians' performance on quality measures? Do physicians who use Health IT such as electronic health records (EHRs) provide more cost-efficient episodes of care than those who do not?
Period: 9/04-1/06
Funding: $235,213

A Feasibility Study of a National Ambulatory Care Database
Partner: The Center for Health Care Policy and Evaluation
Description: The purpose of this feasibility study is to provide an initial response to Congress' request to explore ways to improve management oversight, data, and modeling capacities related to Medicaid and SCHIP programs. Specifically, this study will: (1) identify key questions related to ambulatory care that a broad range of Federal, State, and local policymakers, purchasers, health plans, and researchers would seek to answer (identification of key questions); 2) assess the state-of-the-art activities on ambulatory care data collection and use (environmental scan); (3) examine the feasibility of developing a database(s) that could be used for quality improvement, planning and management of ambulatory care services (feasibility of ambulatory care data development); (4) to the extent feasible, develop possible strategies by which such a database(s) could be developed (strategies for ambulatory care data development); and (5) assess the feasibility of using ambulatory care data for modeling the impact of Federal or State program or policy changes (feasibility of modeling). This project shall result in (1) a summary of key questions that need to be answered through ambulatory care data; (2) a document summarizing the state-of-the-art national and State-wide activities related to ambulatory care data; (3) a final report on the feasibility of developing an ambulatory care database(s) and the strategies and costs of developing such database(s); (4) a final report on the feasibility of modeling the impact of Federal and State program and policy changes using ambulatory care data; and (5) a presentation of results of the feasibility study to AHRQ leadership.
Period: 9/04-6/05
Funding: $449,672

Improving Diffusion of Effective Health Information Technology—Best Practices and a "Toolkit" for Computer-based Clinical Decision Support Systems (CDSSs)
Partner: Denver Health
Description: This study is assessing best practices of current nationwide use of order sets, alerts and reminders as components of computer-based clinical decision support systems (CDSS) within computerized physician order entry (CPOE) applications. As part of the assessment, an implementation tool kit is being developed for use by health care institutions. The toolkit will provide guidance for development, implementation and evaluation of CDSSs in inpatient facilities that wish to decrease medical errors and adverse events using these technologies.
Period: 9/04-1/06
Funding: $247,462

Assessing Adoption of Effective Health Information Technology
Partner: University of Minnesota
Description: This project assesses the degree to which medical group practices have implemented or are in the process of implementing information technologies. It is also documenting barriers encountered in adopting these technologies and mechanisms to overcome such barriers. The study includes a survey of a national sample of medical practices stratified by size, ownership, location, and specialty mix to determine how adoption rates vary by these characteristics. The study will determine the degree to which barriers are overcome, the degree of utilization of technologies following adoption, key factors influencing practices to adopt technologies. It will also translate findings into educational programs and user-friendly publications for medical group practice administrators.
Period: 9/04-4/05
Funding: $248,349

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Other Topics

HIPAA Impact Study and Guidance Development
Partner: Abt Associates
Description: Implementation of the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule in 2003 has generated great concern over the privacy and confidentiality of health care data. Research has had a good track record over time in handling sensitive information, and initial review of the Privacy Rule led some researchers and organizations to assume that their work would not be affected because they were not "covered entities." However, new burdens of assurances and procedures are being required to gain access to sensitive health care data. The Privacy Rule is reaching far beyond the "covered entities" that the rule applies to and may have a profound impact on access to health care information that is the lifeblood of research. Changes in policies on the release of health care data for research purposes have been widespread, and little is known about how these changes will affect health services research. Review of the complex HIPAA regulations has involved legal representatives in health care organizations who guide policy decisions toward risk aversion. With risk management as the guiding principle, many organizations have been choosing policies more restrictive that those required by the Privacy Rule. These more restrictive policies, along with those already imposed by HIPAA, may have long term effects on health services research by limiting and/or delaying access to information and increasing costs for research. Furthermore, the burden of requirements that the Privacy Rule has placed on providers is likely to result in an uneven response to requests for research data. For example, a large hospital or medical practice may have programming support to create an electronic data file that only includes the "minimum necessary" data needed for a research study, while these resources will be difficult or impossible to utilize at smaller facilities. The tendency for smaller facilities to "opt out" of requests for research data could lend bias to research findings especially in the areas of outpatient care and rural health where information is already a challenge to locate.

  • Phase I: The responder will generate a report about the initial effects of the HIPAA Privacy Rule on health services research. Based on the report's findings, recommendations will be made as to how AHRQ could best assist health services researchers to work within the HIPAA Privacy regulations while maintaining access to data considered vital for research. The recommendations will include plans for development of guidance materials in Phase II.
  • Phase II: If appropriate, based on results of the Phase I report, the responder will develop guidance materials to assist health service researchers. Educational /guidance materials could address topics such as strategies to minimize delays in accessing information and options for controlling research costs related to these requirements.

Period: 5/04-8/05
Funding: $124,630

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