Field Partnerships for Applied Research
ACTION (Accelerating Change and Transformation in Organizations and Networks) is a model of field-based research designed to promote innovation in health care delivery by accelerating the diffusion of research into practice. The ACTION network includes 15 large partnerships and collaborating organizations that provide health care to more than 100 million Americans.
Select for the ACTION Fact Sheet.
Select for Awards in Fiscal Year 2006.
Contents
Health Care Organization and Payment
Patient Safety
Health Information Technology (IT)
Prevention
Emergency Preparedness
Health Care Organization and
Payment
Title: Reducing Waste and Providing More Efficient Care Through Redesign
of Delivery Processes
Partner: American Institutes for Research (AIR)
Description: The AIR team is developing, refining, implementing,
and evaluating a new rheumatology ambulatory care model (Patient Centric Electronic
Redesign for Rheumatology [PACER-Rheum]) in two rheumatology practice
settings, using two redesign approaches (Lean and Plan-Do-Study-Act [PDSA]).
The aims include evaluating whether PACER-Rheum improves efficiency, productivity,
quality and safety, adherence, and patient-centeredness; evaluating whether
there is a business case for the model; determining which redesign
elements explain observed effects; and disseminating findings in ways that
promote adoption of PACER-Rheum elsewhere.
Period: 08/07-07/09
Funding: $399,999
Title: Decision Guide for Employers, Public Purchasers, and Health
Plans Interested in Designing a Consumer (Financial) Incentive Strategy
Partner: University of California at San Francisco (UCSF)
Description: UCSF is identifying and synthesizing evidence,
theory, and implementation examples that directly address purchasers' design-related
decisions regarding financial schemes directed at consumers. The Agency for
Healthcare Research and Quality (AHRQ) will publish and disseminate the findings
in the form of a guide for purchasers.
Period: 12/06-11/08
Funding: $200,000
Title: Health Literacy and Informed Consent and Authorization for
Research Testing AHRQ's Toolkit
Partner: Trustees of Boston University
Description: AHRQ's Informed Consent and Authorization
Toolkit is specifically designed to provide guidance to both health services
researchers and Institutional Review Board (IRB) officials about how to obtain
informed consent in a manner such that low-literate populations are truly
informed and give their consent to participate in research. The toolkit includes
a step-by-step description of the informed consent and authorization process,
sample forms, a sample test to verify understanding, vignettes illustrating
when oral consent and authorization would be appropriate, and a list of other
Department of Health and Human Services (DHHS) resources. This project seeks
to 1) improve upon the toolkit through the expert review, 2) validate it,
and 3) promote it to key constituencies.
Period: 07/07-06/08
Funding: $149,571
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Patient Safety
Title: Implementing TeamSTEPPS™: A Train-The-Trainer Project
Partner: American Institutes of Research
Description: AHRQ and the Department of Defense (DOD) cofunded
TeamSTEPPS™ (Team Strategies & Tools to Enhance Performance and Patient
Safety) as an evidence-based curriculum and toolkit for teamwork development.
TeamSTEPPS™ is available to all and being distributed nationally. It
is a train-the-trainer curriculum to introduce team training in civilian health
care organizations. The task order objectives are to develop, deploy, and implement
a program to support the adoption and use of TeamSTEPPS™ by health systems,
provider institutions, and health profession education institutions nationwide.
The implementation includes master training, technical assistance and consultation,
and development of various channels of learning for continued support and improvement.
Period: 09/07-08/09
Funding: $2,581,903
Title: Dissemination of TeamSTEPPS™ Adoption
Partners: Three ACTION partnerships—RTI, the University
of Iowa, and Yale University—were awarded task orders to work on this
topic.
Description: The primary objective is to facilitate adoption
of TeamSTEPPS™ using the curriculum provided by AHRQ and the DOD (see
project "Implementing TeamSTEPPS™: A Train-The-Trainer
Project"). The ACTION partnerships involved are observing,
measuring, evaluating, and documenting findings regarding the implementation
and adoption process in systems of their choosing. The evaluation is examining
1) how trainees learn and retain techniques/behaviors, 2) if TeamSTEPPS™ is
used appropriately in "real world" settings, and 3) if outcomes
and improvement are sustained.
Period: 09/07-09/09
Funding: Each of the three task orders does not exceed $250,000
Title: Reducing Hospital-Associated Infections (HAI):
Improving Patient Safety Through Implementing Multi-Disciplinary Interventions
Partners: Five ACTION partnerships—AIR, Denver Health,
Health Research and Educational Trust (HRET), University of Iowa, and Yale
University—were awarded task orders to work collaboratively on this
topic.
Description: The five awardees constitute the AHRQ HAI Initiative,
whose goal is to identify factors associated with the implementation of tools
and interventions meant to assist hospitals in successfully reducing and
sustaining the reduction of infections associated with the process of care
at 34 hospitals. Multi-disciplinary teams at each participating hospital
will use several different tools and interventions designed to change human
behaviors, habits, and the safety culture within the health care organizations.
The interventions apply evidence-based tools to reduce bloodstream infections
(BSIs) and infections related to ventilator-associated pneumonia (VAP), central
venous catheters (CVC), and chest tube insertion. The HAI Initiative is determining
how well the tools work, the challenges and barriers that need to be overcome,
how successes can be sustained over time, and how the culture of the health
care organization may contribute to, or impede, improvements in infection
safety.
Period: 09/07-07/09
Funding: None of the five task orders exceeds $400,000
Title: Development and Use of Ambulatory Adverse Event Trigger Tools
Partner: Trustees of Boston University
Description: Ideally, this task order will lead to the development
of a low-cost and labor-efficient targeted injury detection system (TIDS),
usable across multiple settings, with diverse electronic health record (EHR)
systems as well as paper-based systems. The objectives are to 1) broaden
trigger tools for use in detecting adverse events in the ambulatory setting;
2) assess the baseline level of ambulatory adverse events within a sample
of institutions in the ACTION network using these tools; and 3) identify
which triggers would be most amenable to TIDS development, based upon frequency
and impact of the adverse events, provider acceptance, integration into work
flow, ability to affect outcome, expertise and human capital required for
implementation, and low risk for provider alert fatigue.
Period: 10/07-04/09
Funding: $399,993
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Health Information Technology (IT)
Title: Improving Asthma Care in an Integrated Safety Net Through a
Commercially Available Electronic Medical Record
Partner: Denver Health
Description: The overarching goals for the project are to
improve the quality and patient-centeredness of asthma ambulatory care for
children and adults. Two existing and widely used HIT applications that currently
do not "talk" to each other are being linked by developing software
to achieve this: a clear, easy to use, publicly available no-line interactive
asthma action plan (IAAP) and a commercially available electronic health record
(Epic). With a mouse click, a provider will be able to call up the IAAP from
the setting of care to determine asthma severity, the best treatment plan,
and a one-page, color asthma action plan for the patient to take home. The
intervention is being evaluated for its impact on quality improvement.
Period: 09/07-07/09
Funding: $393,575
Title: Assessing the Impact of a Dynamic Chronic Care Registry on
the Quality of Care
Partner: Denver Health
Description: The objectives of the project are to improve
the quality of care provided to adult diabetic patients currently receiving
care within an urban safety net system through use of information from an
integrated diabetes registry. The registry is used to distribute quarterly
patient report cards to patients' homes; distribute standard and enhanced
quarterly provider report cards reflecting their quality of care to diabetic
patients in eight community health centers; develop and use a point-of-care
interface to improve adherence to guideline-based care; evaluate the effects
of these interventions on process, quality, cost, and satisfaction with care;
and use the findings to generalize this approach for other chronic diseases
and health care systems.
Period: 09/07-05/09
Funding: $357,343
Title:Improving Quality Through Health IT: Testing
the Feasibility and Assessing the Impact of Using Existing Health IT Infrastructure
for Better Care Delivery
Partner: HRET
Description: HRET and the Alliance of Chicago Community
Health Services aim to understand how health IT can improve access to, and
management of, laboratory information for patients with HIV and patients
in need of cervical cancer screening. The study goal is to illustrate how
health IT tools can improve 1) compliance with evidence-based lab test guidelines
and 2) the efficiency and quality of care by reducing duplicate tests, lost
results, and results lacking followup. The project aims to develop a set
of best practices to disseminate to other community health centers and physician
practices.
Period: 09/07-07/09
Funding: $393,457
Title: Improving Lab Followup by Delivering an Enhanced Medication
List to Outpatient Physician Practices
Partner: Indiana University
Description: In this project, outpatient primary care clinicians
are provided, just prior to a patient's office visit, with a medication
list based on pharmacy-dispensed medications to that patient. The list provides
a prompt for discussion between the clinician and patient of the medications
the patient should be taking. In addition, decision support provides prompts
for routine lab monitoring, drug-drug interactions, drug-lab interactions,
and drugs to be avoided in the elderly. Distillation and grouping of medication
messages is used to produce a comprehensible medication list. The intervention
is being piloted, implemented more fully, and evaluated as to its impact
on quality and safety.
Period: 09/07-07/09
Funding: $400,000
Title: Implementing and Improving the Integration of Decision Support
Into Outpatient Clinical Workflow
Partner: Indiana University
Description: This project incorporates field study and controlled
simulation to integrate colorectal cancer screening clinical decision support
(CDS) into workflow. The study includes 1) key informant interviews of site-specific
best practices; 2) direct observation of colorectal cancer screening CDS
to identify barriers and facilitators to workflow integration; 3) rapid prototyping
of design alternatives based on findings; 4) simulation to test the impact
of design on efficiency, usability, and workload; and 5) implementation of
the refined CDS in local clinics to assess usability and impact. The implementation
plan involves institutions that have demonstrated improved quality and efficiency
using CDS: the Regenstrief Institute, the Department of Veterans Affairs
(VA), and Partners Healthcare System.
Period: 09/07-09/09
Funding: $394,662
Title: Use of an Electronic Referral System to Improve the Outpatient
Primary Care–Specialty Care Interface
Partner: RAND
Description: RAND and UCSF–San Francisco General Hospital,
the city's main safety net provider of specialty care, are using a
Web-based eReferral system to improve the integration of primary and specialty
care through a common interface. This project extends use of the Web-based
implementation beyond five clinics in which promising results have been achieved
in reducing waste and improving quality of care to a new specialty clinic
and affiliated federally qualified health centers. The study is evaluating
quality, efficiency, accessibility, and patient-centeredness of care, and
will yield an implementation handbook, cost tool, and summaries of findings
for dissemination to other care settings.
Period: 09/07-09/09
Funding: $396,536
Title: Improving Quality Through Health IT: Testing the Feasibility
and Assessing the Impact of Using Existing Health IT Infrastructure for Better
Care Delivery
Partner: Yale University
Description: The overarching goals for the project are to
implement and evaluate the impact of a new secure messaging system called
ClinicalMessenger™ in the Yale–New Haven Children's Hospital
Respiratory Medicine Clinic. The first study aim is to understand the content
of what children, adolescents, and their parents send as secure messages
to providers. The second aim is to evaluate the impact of secure messaging
with regard to provider time spent, emergency department utilization for
medication refills, and qualitative satisfaction with the system for all
users.
Period: 09/07-09/09
Funding: $399,970
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Prevention
Title: Case Study for the Centers for Disease Control and Prevention's
(CDC's) Diabetes Primary Prevention Initiative 4
Partner: RTI
Description: This CDC-funded project assesses the CDC's
Diabetes Primary Prevention Initiative 4 (DPPI 4). The goals are to 1) describe
in a case study the intervention pilots in the States of California, Massachusetts,
Michigan, Minnesota, and Washington, focusing on generalizable concepts, tools,
and key observations in the development, planning, and testing of interventions
as well as early results from the pilots that have potential for use in other
States; 2) assess to what extent the support provided to the States and the
intervention work group contribute to their implementation capacity; 3) assess
to what extent diabetes prevention activities are sustainable and what resources,
tools, and capacity are needed for sustainability; and 4) determine the key
elements for further dissemination.
Period: 04/07-03/08
Funding: $249,631
Title: Healthcare Systems for Tracking Abnormal Colorectal Cancer
Results
Partner: The CNA Corporation
Description: In this CDC-funded project, two interventions
that proved to be successful in 120 primary care practices are being extended
to a set of primary care practices in Lehigh Valley, Pennsylvania. One intervention
targets patients and the other targets physicians. The interventions will
be assessed using an evaluation to determine the factors that positively
and negatively affect implementation and impact of the intervention, including
the business case.
Period: 9/06-02/08
Funding: $250,000
Title: Implementing Evidence-Based Strategies to Improve Asthma Care
for Children
Partner: HRET
Description: HRET's partner, the University of Washington,
is testing a novel practice-based approach to knowledge uptake at the point
of care. The intervention has two phases: 1) training in administering and
interpreting spirometry to increase identification of severity of asthma
cases; and 2) training providers to use monitoring and a written asthma action
plan with patients for patient self-management. This multi-component, distance
learning model involves 16 pediatric practices in New York State (8 per study
arm). Spirometers are used in conjunction with software for Health Insurance
Portability and Accountability Act (HIPAA)-compliant centralized data collection
of flow volume curves and a Spirometry Fundamentals CD-ROM. Practices are
matched and randomized into intervention and control groups; control practices
receive the sequenced program 5 months later than intervention practices.
Period: 07/07-01/09
Funding: $299,501
Title: Program Evaluation to Improve Hepatitis C Virus (HCV) Screening
Practices and Testing Uptake in Select Primary Care Provider Settings
Partner: Trustees of Boston University
Description: This CDC-funded project is conducting a cross-sectional
program evaluation of HCV screening and testing in partnership with four
primary care sites. The team is reviewing current practices and baseline
data at the clinics; developing improved HCV risk assessment instruments;
obtaining/developing training materials to train key individuals at each
site; implementing new procedures and evaluating the effectiveness of risk-based
screening; adding and evaluating routine screening for a 1945-1964 birth
cohort; and ensuring sustainability and dissemination of the findings.
Period: 9/07-09/09
Funding: $550,000
Title: Improving Implementation of the U.S. Preventive Services Task
Force Recommendation for Prophylactic Aspirin Use Among Adults at Risk for
Cardiovascular Disease
Partner: Abt Associates
Description: The project goal is to improve measurably the
implementation and uptake of a specific evidence-based clinical preventive
service—the U.S. Preventive Services Task Force recommendation for
counseling for aspirin prophylaxis among adults at risk for cardiovascular
events—at Geisinger Health System. A risk management model is being
developed and tested using Geisinger's EHR to identify and improve
aspirin prophylaxis in at-risk patients. Three interventions are being used
and compared: one patient-based, one nurse-based, and one physician-based.
The study is documenting the plans, activities, and systems changes by which
improved care delivery is achieved.
Period: 9/07-04/09
Funding: $300,000
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Emergency Preparedness
Title: Disaster Alternative Care Facilities
Partner: Denver Health
Description: The goal of this Health Resources and Services
Administration (HRSA)-funded task order is to review and revise an Alternative
Care Site Selection Tool that was developed under AHRQ Contract No. 290-00-0014
Task Order No. 5, titled "The Rocky Mountain Regional Model for Bioterrorist
Events." This user-friendly tool aids in pre-selecting and staffing
alternative care sites in the event of a disaster. A site selection matrix
provides a quantitative, customized, and simple methodology to identify the "best" alternative
site, using lessons learned from 1) Hurricanes Katrina and Rita (at the Superdome
and Convention Center, respectively), 2) the use of Federal Medical Shelters
and other mobile assets, and 3) States actively engaging in the work of site
selection and setup activities.
Period: 6/07-05/08
Funding: $150,000
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Current as of November 2007
Publication No. AHRQ 08-0023-EF
Internet Citation:
ACTION Project Awards, Fiscal Year 2007: Field Partnerships for Applied Research. November 2007. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/research/action07.htm
540 Gaither Road Rockville, MD 20850