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ACTION Project Awards, Fiscal Year 2006

Field Partnerships for Applied Research

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Awards in Fiscal Year 2006

Developing Data and Measurement Capacity

Title: Ambulatory Care Quality Alliance Pilot Project
Partner: RTI International
ACTION Contact: Amy Roussel,
Description: The Ambulatory Care Quality Alliance (AQA), a broad-based national coalition of more than 125 member organizations representing physicians, consumers, employers, government, health insurance plans, and accrediting and quality improvement organizations, had the following objectives at the time this task order was launched: (1) to improve health care quality through a process in which key stakeholders agree on a strategy for measuring performance at the physician level; (2) to collect and aggregate data in the least burdensome way; and (3) to report meaningful information to consumers, physicians, and other stakeholders in order to inform choice and improve outcomes. RTI developed a quantitative analysis plan for the AQA Pilot Project, which the Agency for Healthcare Research and Quality and the Centers for Medicare & Medicaid Services were cosponsoring at six sites throughout the United States. The plan was developed to permit robust and maximally generalizable quantitative results and to accomplish efficient pooling of data across the sites.
Period: 04/06-11/06
Funding: $188,015
Deliverables: Quantitative analysis plan for internal use by the AQA Pilot Project.

Health Care Organization and Design

Title: Redesigning Delivery Processes for Efficiency and Value-Implementing, Assessing, and Spreading Redesign Methods and Techniques
Partner: RAND Corporation
ACTION Contact: Allen Fremont,
Description: This project implemented and tested interventions that had proven themselves useful in pilot sites in the United Kingdom's National Health Service (NHS). The interventions involved demand components (e.g., smoothing demand, buffering interruptions) and supply components (e.g., changing staff hours or assignments, changing day work routines) for improving quality and efficiency of night work in hospitals. The impact of the demand strategies was assessed separately from an intervention that used both supply and demand strategies, as did the NHS project. This project used a collaborative improvement framework that RAND's partner, the University Healthcare Consortium, had successfully applied to several projects over a 3-year period. RAND monitored clinical outcomes carefully. Qualitative data were used to provide feedback to improve implementation, as well as in evaluation of what worked well and why.
Period: 09/06-07/09
Funding: $399,639
Deliverables: Final report, including "Supply Recommendation" Packet, toolkit, data collection forms, interview guides, and cost data collection worksheet.

Title: Integrating Chronic Care and Business Strategies in the Safety Net
Partner: RAND Corporation
ACTION Contact: Allen Fremont,
Description: This project implemented and evaluated changes in safety net organizations that improve both care to individuals with multiple chronic conditions and organizational efficiency by: (1) developing a Chronic Care Model (CCM) and Business Change Package of modified or new implementation tools to assist safety net organizations in integrating the CCM with business strategies aimed at reducing waste and increasing productivity and revenue; (2) evaluating the CCM and Business Change Package and individual implementation tools; and (3) providing time-limited technical assistance to assist pilot sites in implementing the CCM and Business Change Package.
Period: 09/06-07/09
Funding: $498,759
Deliverables: Final report, CCM and Business Change Package, dissemination plan, evaluation report, practice coaching manual.

Title: Multi-Site Evaluation of Rapid HIV Testing in Emergency Departments
Partner: Health Research and Educational Trust
ACTION Contact: Maulik Joshi,
Description: The purpose of this study, funded by the Centers for Disease Control and Prevention (CDC), was to assess the ability of emergency departments (EDs) to identify undiagnosed HIV-positive individuals and link them into care. Operational information and outcome data were used in this assessment. Products that resulted from this study are intended to assist other hospitals in developing and implementing rapid HIV testing programs in the ED. Results and recommendations of the study may assist in programmatic decisionmaking and may improve CDC's ability to foster rapid HIV testing programs in EDs across the United States.
Period: 9/06-07/08
Funding: $239,989
Deliverables: Key Informant interview guide, site final reports, manuscript.

Patient Safety

Title: Testing Techniques To Radically Reduce Antibiotic-Resistant Bacteria (Methicillin-Resistant Staphyloccus aureus, or MRSA)
Partner: Indiana University
ACTION Contact: Bradley Doebbeling,
Description: The overall purpose of this task order was to measurably reduce hospital-acquired MRSA infections in selected acute care hospitals by at least 50 percent and document how this was done in order to help others achieve success in similar settings (i.e., how the barriers that delay reductions in MRSA rates can be overcome to achieve needed behavior changes). The study resulted in a 60 percent reduction in the implementation ICU sites and a 20 percent reduction in control ICUs in the same hospitals.
Period: 9/06-06/08
Funding: $432,932
Deliverables: Final Report, "Testing Techniques To Radically Reduce Antibiotic-Resistant Bacteria (Methicillin-Resistant Staphylococcus aureus, or MRSA)."

Title: Development and Testing of a Rapid Response Team Training Module Within TeamSTEPPS Curriculum
Partner: AIR
ACTION Contact: Kristin Carman,
Description: Rapid response teams are a subset of medical teams in general and should be built upon the knowledge, skills, and attitudes established by the evidence of good teamwork. The Department of Defense and AHRQ developed an evidence-based curriculum and toolkit for teamwork development, knowledge, and TeamSTEPPS (Strategies & Tools to Enhance Performance and Patient Safety). In this project, a training module for rapid response teams was designed, developed, implemented, assessed, and made ready for distribution as part of the TeamSTEPPS team training curriculum and support materials.
Period: 9/06-12/08
Funding: $497,654


Title: Assessing Hepatitis B Vaccination for Adults at Primary Care Settings
Partner: Denver Health
ACTION Contact: Susan Moore,
Description: This CDC-funded project measured the delivery of adult hepatitis B vaccination in primary care settings, which has been recommended for adults at risk since 1982. The main objectives were: (1) to estimate hepatitis B vaccination coverage among adults seen in primary care, and (2) to determine whether rates of hepatitis B vaccination are different among adults known to be at high risk compared to the rest of the adult population.
Period: 9/06-11/08
Funding: $199,956
Deliverables: Manuscript.

Title: Hepatitis B Surface Antigen Screening by Primary Care Providers
Partner: Denver Health
ACTION Contact: Susan Moore,
Description: This CDC-funded project determined: (1) physician practices with respect to screening for hepatitis B virus (HBV) infection (i.e., which patients were being tested); and (2) prevalence of chronic HBV infection among patients in primary care settings (i.e., which patients already had been identified) and how physicians evaluated and followed these patients. The purpose was to provide relevant baseline information for the development of new national recommendations for screening for HBV infection.
Period: 9/06-11/08
Funding: $300,000
Deliverables: Manuscript.

Payment and Finance

Title: Multi-Site Coordinated Evaluation of the Impact of Quality-Based Payment Strategies
Partner: Trustees of Boston University
ACTION Contact: Carol VanDeusen Lukas,
Description: This evaluation focused on the implementation and impact of pay for performance on physicians across three programs in diverse safety net settings, based on natural experiments. The project included a pre/posttest analysis of the impact of pay-for-performance programs on quality measures; assessment and comparison of providers' attitudes toward pay-for-performance programs with respect to such issues as the clinical relevance of the quality measures, adequacy of the financial incentives, and fairness of the payout formulas; and interviews with senior managers at each study setting who had firsthand knowledge of the clinical and financial details of the pay-for-performance programs.
Period: 08/06-02/08
Funding: $298,370
Deliverables: PowerPoint presentations of results at: World Congress Leadership Summit on Health Care Quality August 4-5, 2008, Boston, MA; Association of Community Affiliated Health Plans(ACAP) October 15, 2008, Cambridge, MA; National Healthcare Incentives Institute, October 19-21, 2008, Washington, DC.

Title: Assessing Physician Incentives for Pay for Performance
Partner: University of California at San Francisco
ACTION Contact: Claire Brindis,
Description: This project assessed a performance intervention that focused on the frequency of information feedback and size of incentive payment to health care providers at three sites. A randomized controlled trial feature, which was implemented at one site, was limited to the frequency of bonus allocation, with one group receiving an annual payment as a one-time bonus after the fact while a second group received a quarterly payment. Comparison of the effect of physician-level incentives was made across three sites in an observational study, assessing the impact of using incentive payments at the departmental level versus incentive payments across all physicians. Results indicate that physician-specific incentives, developed with input from the participating physician, appear associated with modest acceleration in improvement in some targeted measures, but not others. The frequency of payment itself, with no difference in the maximum bonus amount or in the frequency of reporting performance score, made no difference in performance in response to the pay-for-performance program. In the context of other ongoing organizational-level quality improvement efforts, the relatively small financial individual physician incentives we observed had limited incremental effects on well-established ambulatory care measures.
Period: 09/06-10/08
Funding: $335,589
Deliverables: Several presentations and articles:
Chung S, Palaniappan L, Rubin H, et al. Does the frequency of payment matter? - experience from a randomized physician-specific pay-for-performance experiment. Health Services Research 2009.
Chung S, Palaniappan L, Trujillo L, et al. Effect of physician-specific pay-for-performance incentives in a large group practice. American Journal of Managed Care, in press.

Emergency Preparedness

Title: Emergency Preparedness Resource Inventory and Surge Model Enhancements
Partner: Abt Associates
ACTION Contact: Terry Moore,
Description:The purpose of this project, funded by the Health Resources and Services Administration (HRSA), was to revise two recently developed AHRQ tools—the Emergency Preparedness Resource Inventory (EPRI) tool and the Surge Model—into alignment with the U.S. Department of Homeland Security's Universal Task List and to enhance Abt's previously developed Surge Model by adding a pandemic influenza scenario. The EPRI tool continues to be enhanced and this project has been extended to 2011. The tool allows local or regional planners to assemble an inventory of critical resources that would be useful in responding to a terrorist attack or natural disaster. It is Web based so that all selected organizations in an area can enter information about their resources. The Surge Model estimates the medical resources needed to treat casualties arising from biological, chemical, nuclear, and radiological attacks. Resources include hospital staff, medical equipment, and medical supplies.
Period: 09/06-09/11
Funding: $1,802,959
Deliverables: Emergency Preparedness Resource Inventory and Surge Model.

Title: HAvBED2 Delivery of a Sustainable Bed Availability Reporting System
Partner: Denver Health
ACTION Contact: Susan Moore,
Description: This HRSA-funded project refined the real-time hospital bed tracking system, "National Hospital Available Beds for Emergencies and Disasters (HAvBED) System," which was developed by Denver Health under a previous task order. This tracking/monitoring system serves as a potential management tool to assist in a State or region's ability to distribute and care for a surge of patients in the event of a large-scale mass casualty incident. This task order focuses on developing a maintainable working production system that will be deployed to communities that do not have a hospital bed tracking system. The system can be used for planning and response by the Department of Health and Human Services Office of the Assistant Secretary for Public Health Emergency Preparedness and other Federal, regional, State, or local command centers. A users' guide for hospitals or other users and a systems operations guide for administering the HAvBED2 system were developed.
Period: 09/06-11/07
Funding: $602,941
Deliverables: HAvBED 2: Hospital Available Beds for Emergencies and Disasters: A Sustainable Bed Availability Reporting System Final Report.

Long-Term Care

Title: Improving Quality of Care in Long-Term Care
Partner: RTI International
ACTION Contact: Amy Roussel,
The first aim of this project was to use a model of quality improvement to adapt evidence-based interventions that have been used in long-term care and community settings. RTI developed a multicomponent intervention program of medication review, assessment, environmental modification, and exercise to reduce risk factors for falls, as well as fall and fracture rates, among residents of assisted living facilities. The second aim was to assess the program within two matched pairs of assisted living facilities to determine the degree to which the facility implemented the intervention; the degree to which residents accepted and adhered to the intervention; facility- and resident-level facilitators for and obstacles to implementation and maintenance of the intervention; changes in modifiable resident risk factors and facility fall and fracture rates; and the relationship of implementation and adherence to change in risk factors and fall and fracture rates.
Period: 09/06-12/09
Funding: $449,098
Deliverables: Manuscripts, presentations, intervention manual, final report.

Page last reviewed October 2014
Internet Citation: ACTION Project Awards, Fiscal Year 2006: Field Partnerships for Applied Research. October 2014. Agency for Healthcare Research and Quality, Rockville, MD.