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The Effect of Health Care Working Conditions on Quality of Care

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Technical Assistance Workshop

Regarding RFA: HS-01-005, published March 26, 2001 in the NIH Guide to Grants and Contracts

Letter of Intent Receipt Date: April 20, 2001
Application Receipt Date: May 21, 2001

Many questions were posed at the technical assistance meeting held April 16, 2001, regarding RFA HS-01-005, "The Effect of Health Care Working Conditions on Quality of Care." These questions and the ensuing answers follow.

Question: When will the amendment (changing the institutional review board [IRB] approval requirement for this request for applications [RFA]) be published in the NIH Guide?
Answer: We are waiting for a publication date for the amendment to the RFA announcing the new receipt date for IRB approval. The new receipt date will likely proceed the date of review (August 23, 2001) by approximately 1 month.

Question: Can you focus on a single site (for example, home care) or do you need to include it as a set of sites?
Answer: A study focused on a single site, such as home care, would be responsive. However, hand-offs between sites of care may create quality issues. For example, transitions between hospital, home care, and primary provider may put patients at risk.

Question: Does Agency for Healthcare Research and Quality (AHRQ) plan to limit the number of awards by setting?
Answer: AHRQ does not plan to limit the number of awards by setting. However, we will try to have a balanced portfolio that covers a full range or working conditions with a full range of health care workers.

Question: Would a study that developed an instrument to identify working conditions risk factors be responsive to the RFA or would an applied study with the instrument be required?
Answer: If the instrument is used to measure working conditions, it would need to be applied to examine how working conditions impact on quality or safety.

Question: Are you using the PHS-398 application?
Answer: Yes.

Question: If you were doing a study with the primary outcome measures related to patient safety, could you also examine other quality measures as secondary outcomes?
Answer: Yes. However, if you're applying for the $2 million targeted set-aside for patient safety, you must focus exclusively on safety-related outcomes. For any other projects in response to the RFA, we would welcome projects that examined both safety and quality measures.

Question: Could you do a comparative study on the quality of a military hospital versus the quality in a civilian hospital?
Answer: Yes, but only if you are examining differences in working conditions and resultant differences in quality between the sites.

Question: We represent regulators and we have a unique relationship with working conditions because we do not have authority over a setting, just the health professional, though regulators are held accountable for the individual when errors are made. States are struggling to find a way to make sure practitioners are competent before errors happen—and spend a whole lot of money on continuing education (CE). We've got initial studies that show that it is really the work experience that makes the biggest difference. And we also know that discipline cases tend to be in the first 5 years of practice. We want to examine the effect of CE and mentoring on patient safety? Does that seem to fit this RFA?
Answer: If the measures of CE or mentorship are considered part of the organizational culture and the outcomes focus on safety or quality, it would be sufficient. However, these intermediate outcomes (i.e., mentoring and CE) and its effect on workers' understanding of how to prevent errors would not be responsive. These intermediate outcomes must be tied to safety or quality.

Question: Does quality have to be measured by safety measures?
Answer: No, safety is one element of quality. However, if you are interested in the $2 million set-aside for safety, your application would have to focus on safety.

Question: Do we agree on the definition for quality?
Answer: The definition of quality is left intentionally broad. However, there are some fairly accepted definitions of quality and quality improvement.

Question: Would a descriptive study that described quality measures be responsive?
Answer: No. The quality measures would need to be tied to working conditions.

Question: Does the principal investigator have to have a PhD?
Answer: No, a Ph.D. is not a requirement.

Slide Presentation

Select to access a presentation by Dr. Helen Burstin, Director of the Center for Primary Care Research, AHRQ:

Current as of April 2001


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