Ambulatory Safety and Quality:Ambulatory Safety and Quality: Improving Management of Individuals with Improving Management of Individuals with

Complex Healthcare Needs through Health ITComplex Healthcare Needs through Health IT

Funding Opportunity Announcement (FOA) Funding Opportunity Announcement (FOA)

Technical Assistance Conference CallTechnical Assistance Conference Call

January 10, 2008January 10, 2008

Conference Call AgendaConference Call Agenda

Overview of AHRQ Ambulatory Safety and Quality Program

Overview of the FOA Frequently asked questions Open forum

AHRQ Ambulatory Safety AHRQ Ambulatory Safety and Quality Programand Quality Program

Purpose: To improve the safety and quality of Purpose: To improve the safety and quality of ambulatoryambulatory health care in the United States health care in the United States– Patient safety and quality crises in hospitals are Patient safety and quality crises in hospitals are

only the “tip of the iceberg.” only the “tip of the iceberg.” – AHRQ recognizes the increasing scope, volume, AHRQ recognizes the increasing scope, volume,

and complexity of ambulatory careand complexity of ambulatory care The program contains an emphasis on the The program contains an emphasis on the

role of health information technology (health role of health information technology (health IT)IT)– Safe, high quality ambulatory care requires Safe, high quality ambulatory care requires

complex information management and complex information management and coordination across multiple settings, especially coordination across multiple settings, especially for patients with chronic illnesses.for patients with chronic illnesses.

ASQ: Five componentsASQ: Five components

1.1. Risk Assessment in Ambulatory CareRisk Assessment in Ambulatory Care2.2. Improving Quality through Clinician Improving Quality through Clinician

Use of Health ITUse of Health IT3.3. Enabling Patient-Centered Care Enabling Patient-Centered Care

through Health ITthrough Health IT4.4. Enabling Patient Safety and Quality Enabling Patient Safety and Quality

Measurement through Health ITMeasurement through Health IT5.5. Improving Management of Individuals Improving Management of Individuals

with Complex Healthcare Needs through with Complex Healthcare Needs through Health ITHealth IT

Definition of ambulatory Definition of ambulatory carecare

Ambulatory care refers to all types of Ambulatory care refers to all types of health services provided by health care health services provided by health care professionals on an outpatient basisprofessionals on an outpatient basis– in contrast to services provided to persons who are in contrast to services provided to persons who are

inpatientsinpatients– usually implies that the patient must travel to a location to usually implies that the patient must travel to a location to

receive services which do not require an overnight stayreceive services which do not require an overnight stay

Ambulatory settings include: health care Ambulatory settings include: health care clinician offices (large and small practices), clinician offices (large and small practices), outpatient clinics, community health centers, outpatient clinics, community health centers, emergency departments, urgent care centers, emergency departments, urgent care centers, and ambulatory surgery centers. and ambulatory surgery centers. – Home care entities are included Home care entities are included for the purpose of for the purpose of

this programthis program

Definition of complex Definition of complex health care needshealth care needs

An individual with complex healthcare An individual with complex healthcare needs requires on-going services from a needs requires on-going services from a variety of providers over a significant variety of providers over a significant period of time, e.g., multiple chronic period of time, e.g., multiple chronic diseasesdiseases

Definition of health care Definition of health care transitionstransitions

Health care transitionsHealth care transitions – Movement of patients between health care Movement of patients between health care

providers and settings as their conditions and care providers and settings as their conditions and care needs change during the course of a chronic or needs change during the course of a chronic or acute illnessacute illness

– The ASQ program includes a focus on transitions The ASQ program includes a focus on transitions between ambulatory care settings and hospitals, between ambulatory care settings and hospitals, home care, assisted living centers, and nursing home care, assisted living centers, and nursing homes homes critical to the success of ambulatory care for many critical to the success of ambulatory care for many

elderly and chronically ill populations. elderly and chronically ill populations.

– Non-ambulatory settings with a strong interest in Non-ambulatory settings with a strong interest in fostering safe, high quality ambulatory care and fostering safe, high quality ambulatory care and transitions are welcome to apply in partnership transitions are welcome to apply in partnership with an ambulatory organization with an ambulatory organization

RFA-HS-08-002RFA-HS-08-002

AHRQ is interested in supporting projects AHRQ is interested in supporting projects that investigate novel methods or evaluate that investigate novel methods or evaluate existing strategies for both clinician and existing strategies for both clinician and patient/family use of health IT in ambulatory patient/family use of health IT in ambulatory settings to improve outcomes through more settings to improve outcomes through more effective decision support or care delivery for effective decision support or care delivery for patients with complex healthcare needs and patients with complex healthcare needs and those in high risk care transitions those in high risk care transitions

AimsAims While health IT has demonstrated improvement in health While health IT has demonstrated improvement in health

care safety and quality in several large health care care safety and quality in several large health care delivery systems, the rate of health IT adoption in delivery systems, the rate of health IT adoption in ambulatory settings remains low. However, once ambulatory settings remains low. However, once implemented, health IT has the potential to facilitate new implemented, health IT has the potential to facilitate new models of care delivery, including management of patients models of care delivery, including management of patients by population, engaging with patients asynchronously, by population, engaging with patients asynchronously, and linking resources in the communityand linking resources in the community

Advancing knowledge in the following areas:Advancing knowledge in the following areas:– Providing high quality, appropriate care through the use of health ITProviding high quality, appropriate care through the use of health IT– Shared decision making and patient-clinician communicationShared decision making and patient-clinician communication– Integration of patient information across transitions in careIntegration of patient information across transitions in care– Strategies for successful health IT adoption in ambulatory settingsStrategies for successful health IT adoption in ambulatory settings– Impact of health IT on outcomes related to patients with complex health Impact of health IT on outcomes related to patients with complex health

care needs and across transitions in care in ambulatory settingscare needs and across transitions in care in ambulatory settings Span the spectrum from discovery, translation, Span the spectrum from discovery, translation,

measurement, and widespread dissemination of strategiesmeasurement, and widespread dissemination of strategies

RFA Objectives cont.RFA Objectives cont.

AHRQ is interested in advancing AHRQ is interested in advancing knowledge in the following areas:knowledge in the following areas:– Providing high quality, appropriate care through Providing high quality, appropriate care through

the use of health ITthe use of health IT– Shared decision making and patient-clinician Shared decision making and patient-clinician

communicationcommunication– Integration of patient information across transitions Integration of patient information across transitions

in carein care– Strategies for successful health IT adoption in Strategies for successful health IT adoption in

ambulatory settingsambulatory settings– Impact of health IT on outcomes related to Impact of health IT on outcomes related to

patients with complex health care needs and patients with complex health care needs and across transitions in care in ambulatory settingsacross transitions in care in ambulatory settings

Project RequirementsProject Requirements

Applicants are expected to:– describe the specific health IT application and intervention to be describe the specific health IT application and intervention to be

studied, and the expected effect on safety and other domains of studied, and the expected effect on safety and other domains of quality quality

– develop a project design and methodology plan which includes develop a project design and methodology plan which includes the research design, outcome measures and evaluation plan, the research design, outcome measures and evaluation plan, project milestones and timeline project milestones and timeline

– assess primary and secondary outcomes including clinical assess primary and secondary outcomes including clinical outcomes, system-level process and/or efficiency outcomes, outcomes, system-level process and/or efficiency outcomes, using measures suggested in this FOA where appropriate using measures suggested in this FOA where appropriate

– provide an evaluation and data analysis plan, including how the provide an evaluation and data analysis plan, including how the data will be collected at baseline and after intervention data will be collected at baseline and after intervention

– outline a plan for dissemination of results and adoption by other outline a plan for dissemination of results and adoption by other sites, including a proposal for widespread dissemination should sites, including a proposal for widespread dissemination should the project results meritthe project results merit

Highlights of theHighlights of theResearch Design and MethodsResearch Design and Methods

Describe the health IT intervention and should Describe the health IT intervention and should describe the development of the intervention and the describe the development of the intervention and the methodology for implementation.   methodology for implementation.   – When possible, the health IT intervention should conform to When possible, the health IT intervention should conform to

interoperability standards and use certified products (see interoperability standards and use certified products (see http://www.hitsp.org and http://www.cchit.org).  http://www.hitsp.org and http://www.cchit.org).  

Describe how the intervention could be integrated into Describe how the intervention could be integrated into the delivery of ambulatory care throughout the the delivery of ambulatory care throughout the applicant organization and potentially into sites across applicant organization and potentially into sites across the nation. the nation.

Discuss the future sustainability of the intervention by Discuss the future sustainability of the intervention by host organization after the grant has ended. host organization after the grant has ended.

Present a project dissemination plan Present a project dissemination plan – Dissemination plan must be incorporated into proposed Dissemination plan must be incorporated into proposed

budgetbudget– Additional dissemination grants may be available. Project Additional dissemination grants may be available. Project

plan and budget, however, must be complete without plan and budget, however, must be complete without additional funding.additional funding.

Outcomes measurementOutcomes measurement

Applicants must specify the project’s primary and Applicants must specify the project’s primary and secondary outcome measures and how these will be secondary outcome measures and how these will be evaluated.  evaluated. 

Required, when appropriate to the project aims:Required, when appropriate to the project aims:– the percent of adoption and use of health ITthe percent of adoption and use of health IT– the percent of patients who are receiving the appropriate the percent of patients who are receiving the appropriate

care for prevention, treatment and medication therapycare for prevention, treatment and medication therapy– the percent of eligible patients within the practices who have the percent of eligible patients within the practices who have

access to their personal health informationaccess to their personal health information– patients’ and providers' access to and utilization of quality patients’ and providers' access to and utilization of quality

measurement reports, especially if aggregated through a measurement reports, especially if aggregated through a health information exchange health information exchange

– the percent of ambulatory care clinicians within the practices the percent of ambulatory care clinicians within the practices that they partner with who routinely use measurement tools that they partner with who routinely use measurement tools to evaluate their patient’s experience, using CAHPS® to evaluate their patient’s experience, using CAHPS® Clinician & Group Survey (see Clinician & Group Survey (see http://www.cahps.ahrq.govhttp://www.cahps.ahrq.gov))

Privacy and SecurityPrivacy and Security

All applicants are required to describe how, in the All applicants are required to describe how, in the development and implementation of the intervention, development and implementation of the intervention, privacy and security issues related to the exchange of privacy and security issues related to the exchange of sensitive health information will be identified and sensitive health information will be identified and addressed.  addressed.  – Applicants should describe the resources and processes they will Applicants should describe the resources and processes they will

use to assure that these privacy and security concerns are being use to assure that these privacy and security concerns are being met throughout the project period.  These could include the met throughout the project period.  These could include the inclusion of participating patients in periodic reviews in order to inclusion of participating patients in periodic reviews in order to solicit their input and consultation with knowledgeable solicit their input and consultation with knowledgeable professionals over the course of the project, as well as a professionals over the course of the project, as well as a description of any existing privacy or security practices and description of any existing privacy or security practices and technology that will be incorporated into the project and reviewed technology that will be incorporated into the project and reviewed for compliance on a regular basis.for compliance on a regular basis.

– See the FOA for additional informationSee the FOA for additional information

Funding considerationsFunding considerations

Scientific merit of the proposed project as Scientific merit of the proposed project as determined by peer review determined by peer review

Availability of fundsAvailability of funds Responsiveness to goals and objectives of Responsiveness to goals and objectives of

the FOAthe FOA Relevance to program prioritiesRelevance to program priorities Programmatic balance among the ASQ Programmatic balance among the ASQ

initiative projectsinitiative projects Portfolio balance within AHRQ and DHHS Portfolio balance within AHRQ and DHHS

patient safety and health IT activitiespatient safety and health IT activities

Review CriteriaReview Criteria

Significance and impact Significance and impact Approach Approach InnovationInnovation Investigators and Partnerships Investigators and Partnerships Study setting(s) Study setting(s) Additional considerationsAdditional considerations

– Degree of responsivenessDegree of responsiveness– BudgetBudget– Privacy and Security Protections for PatientsPrivacy and Security Protections for Patients– Protection of Human Subjects from Research RiskProtection of Human Subjects from Research Risk– Inclusion of priority populationsInclusion of priority populations

Mechanism of Support & Mechanism of Support & Funds AvailableFunds Available

R 18 Research Demonstration and Dissemination Projects – To provide support designed to develop, test and To provide support designed to develop, test and

evaluate health service activities evaluate health service activities Up to $3 million available in FY 2008Up to $3 million available in FY 2008 Projects may be up to 3 years with $1.2 million Projects may be up to 3 years with $1.2 million

total cost ceiling and no more than $500,000 total cost ceiling and no more than $500,000 allowed in any single yearallowed in any single year

Anticipated 5 -7 awardsAnticipated 5 -7 awards Budget requests that exceed these limits will Budget requests that exceed these limits will

be returned without reviewbe returned without review

AHRQ does not accept AHRQ does not accept modular budgetsmodular budgets

AHRQ uses ONLY the detailed Research & AHRQ uses ONLY the detailed Research & Related Budget.  Related Budget.  

Do not use the PHS 398 Modular Budget.  Do not use the PHS 398 Modular Budget.  Applications submitted in modular budget Applications submitted in modular budget

format will be returned without review. format will be returned without review.

SF424(R&R)SF424(R&R)

All applications must be submitted All applications must be submitted electronicallyelectronically

Please see FOA for instructions on how Please see FOA for instructions on how to obtain electronic forms and register to obtain electronic forms and register your institution and PIyour institution and PI

Eligible InstitutionsEligible Institutions

You may submit an application if your organization is a:You may submit an application if your organization is a: – Public or non-profit private institution Public or non-profit private institution

including non-profit health care organizations, universities, colleges, and including non-profit health care organizations, universities, colleges, and faith-based or community-based organizations faith-based or community-based organizations

– Unit of local or State government or eligible agency of the Federal Unit of local or State government or eligible agency of the Federal government government

– Indian/Native American Tribal Government or Tribally Designated Indian/Native American Tribal Government or Tribally Designated Organization Organization

For profit organizations are not eligible to lead For profit organizations are not eligible to lead applicationsapplications– For-profit organizations may participate in projects as members of For-profit organizations may participate in projects as members of

consortia or as subcontractorsconsortia or as subcontractors– For-profit organizations that produce health IT systems are encouraged For-profit organizations that produce health IT systems are encouraged

to apply in partnership with a non-profit organizationto apply in partnership with a non-profit organization

Foreign institutions are not eligible to apply  Foreign institutions are not eligible to apply  – Foreign institutions may participate in projects as members of consortia Foreign institutions may participate in projects as members of consortia

or as subcontractorsor as subcontractors

Principal Investigator (PI)Principal Investigator (PI)

The PI should be an experienced senior level individual Because of the nature of the project, expertise in evaluation

is also a critical need that can be met through the requisite experience of the PI or another member of the project team.  

PI should devote a considerable portion of time to the project. If less than 20% time will be devoted, the application must include an explicit justification.

Individuals from underserved racial and ethnic groups and individuals with disabilities are encouraged to serve as PI.

Applications should describe PI responsibilities and background.

 

Key DatesKey Dates

Opening Date: January 21, 2008 Letter of Intent Receipt Date: January 18,

2008 Application Submission Date: February 21,

2008 Peer Review Date: May/June 2008 Earliest Anticipated Start Date: July 2008

Frequently Asked QuestionsFrequently Asked Questions

Does AHRQ accept modular Does AHRQ accept modular budgets?budgets?

No.No.– AHRQ uses ONLY the detailed Research AHRQ uses ONLY the detailed Research

& Related Budget.  & Related Budget.  

– Do not use a Modular Budget.  Do not use a Modular Budget. 

– Applications submitted in modular budget Applications submitted in modular budget format will be returned without review. format will be returned without review.

Are Emergency Rooms Are Emergency Rooms ambulatory care sites?ambulatory care sites?

For the purpose of this FOA, Yes.For the purpose of this FOA, Yes.– AAmbulatory settings include: health care clinician mbulatory settings include: health care clinician

offices (large and small practices), outpatient offices (large and small practices), outpatient clinics, community health centers, emergency clinics, community health centers, emergency departments, urgent care centers, and ambulatory departments, urgent care centers, and ambulatory surgery centers. surgery centers. 

– For the purpose of this programFor the purpose of this program: : home care home care entities are included as well.entities are included as well.

Can there be Co-PIs?Can there be Co-PIs?

No.No.– AHRQ requires that the lead institution AHRQ requires that the lead institution

designate one and only one individual as designate one and only one individual as the project’s principal investigator. the project’s principal investigator.

How much detail should the How much detail should the letter of intent (LOI) include?letter of intent (LOI) include?

The LOI is to allow AHRQ staff to estimate the The LOI is to allow AHRQ staff to estimate the potential peer review workload and plan the reviewpotential peer review workload and plan the review

AHRQ will not provide feedback on the LOI.AHRQ will not provide feedback on the LOI. Content should include:Content should include:

– an acknowledgement of interest in this funding opportunityan acknowledgement of interest in this funding opportunity– a few comments on the subject of the proposed researcha few comments on the subject of the proposed research– background expertise of key personnelbackground expertise of key personnel

– the nature and role of participating institutions the nature and role of participating institutions  This letter of intent is not required, is not binding, and This letter of intent is not required, is not binding, and

is not considered in the review of a subsequent is not considered in the review of a subsequent application.application.

Ground Rules for Open Ground Rules for Open ForumForum

The conference call operator will put you in a queue based on call order.

Please keep your questions brief. We will try to keep responses brief. Questions that are very specific to a particular institution

or situation will not be addressed – these can be discussed individually with a Project Officer from AHRQ at a later time.

If you do not get an opportunity to ask a question, please e-mail your question to ComplexPatients@ahrq.hhs.gov

AHRQ contactsAHRQ contacts

For additional technical assistance, please contact an AHRQ staff person who will be glad to provide technical assistance:

– Scientific/Research Issues: Robert Mayes: ComplexPatients@ahrq.hhs.gov

– Peer Review Issues: Kish Wadhwani: Kishena.Wadhwani@ahrq.hhs.gov

– Financial/Grant Management Issues: Michelle Burr: Michelle.Burr@ahrq.hhs.gov