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Ambulatory Safety and Quality Program

Health IT Portfolio

To improve the safety and quality of ambulatory health care in the United States, the Agency for Healthcare Research and Quality (AHRQ) awarded 53 grants in 2007. The Ambulatory Safety and Quality program accentuates the role of health information technology (IT) through awards in three areas: quality measurement, quality improvement, and patient-centered care through health IT.

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Introduction
Enabling Quality Measurement Through Health IT
Improving Quality Through Clinician Use of Health IT
Enabling Patient-Centered Care Through Health IT
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Introduction

In 2007, AHRQ awarded 53 health IT grants totaling about $21 million as part of the its Ambulatory Safety and Quality (ASQ) program. The program's goal is to improve the safety and quality of ambulatory health care in the United States. For the purpose of this program, AHRQ defines ambulatory care as health services provided by health care professionals in outpatient settings. These settings include practitioner offices, clinics, outpatient departments of hospitals, large or small group practices, community health centers, emergency departments, diagnostic imaging centers, dialysis centers, home care, mental health centers, occupational health centers, and school health facilities.

The program accentuates the role of health IT through three funding opportunity announcements (FOAs):

Enabling Quality Measurement Through Health IT.
Improving Quality Through Clinician Use of Health IT.
Enabling Patient-Centered Care Through Health IT.

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Enabling Quality Measurement (EQM) Through Health IT

The purpose of this FOA is to:

Develop safety and quality measures in ambulatory care settings.
Automate quality measurement.
Demonstrate the ability of electronic data systems (EDS) (such as electronic health records [EHRs] or claims data merged with EHR data) to expand potential safety and quality measures.
Demonstrate improved ability to export data for reporting performance on measures and improvement.

In total, 17 health IT grants were awarded under this FOA. Four more grants were funded through patient safety set-asides. The projects focus on common chronic illnesses and prevention. National organizations and initiatives are prominently involved, such as:

The American Medical Association.
The National Committee for Quality Assurance (NCQA).
The American Gastroenterological Association.
The Ambulatory Care Quality Alliance (AQA).

A variety of ambulatory settings and organizations are addressed, from large integrated delivery systems to small provider practices and from urban settings to small rural communities.

Closing the Feedback Loop To Improve Diagnostic Quality
Description: Develops ways to close the loop of outpatient diagnosis in an effort to improve the quality of diagnostic and therapeutic decisionmaking in ambulatory settings.
Estimated Total Funding: $998,509
Focus Area(s): Quantitative scale to determine quality of diagnosis in the clinical setting.
Type of Health IT: Clinical decision support
Principal Investigator: Eta Berner
Grant No.: 1R18HS017060
Applicant Institution: University of Alabama at Birmingham, Birmingham, AL
Estimated Dates: 9/14/2007 – 9/29/2009

Colorado Associated Community Health Information Exchange (CACHIE)
Description: Designs, develops, implements, and evaluates an interoperable quality information system (QIS) for a collaborative network of community health centers (CHC) that permits real-time and synchronous quality reporting to inform patient care, quality interventions, and health policy and advocacy efforts.
Estimated Total Funding: $986,302
Focus Area(s): Specific measures to be determined
Type of Health IT: Health information exchange, quality of care decision support
Principal Investigator: Arthur Davidson
Grant No.: 1R18HS017205
Applicant Institution: Denver Health and Hospital Authority, Denver, CO
Estimated Dates: 9/30/2007 – 9/29/2009

Automating Assessment of Asthma Care Quality
Description: Develops, validates, applies, and evaluates a scalable method for routine and comprehensive measurement of outpatient asthma care quality.
Estimated Total Funding: $871,711
Focus Area(s): 19 asthma care quality measures from the RAND Quality Assessment Tools
Type of Health IT: Quality of care decision support, data electronic transform & load
Principal Investigator: Brian Hazlehurst
Grant No.: 1R18HS017022
Applicant Institution: Kaiser Foundation Research Institute, Portland, OR
Estimated Dates: 9/30/2007 – 9/29/2009

Developing and Using Valid Clinical Quality Metrics for Health IT With HIE
Description: Proposes to derive a set of quality metrics that can capture the effects of health IT with health information exchange (HIE) and that can be retrieved electronically through the contributions of the Health Information Technology Evaluation Collaborative, the New York State Department of Health, and four regional health information organizations (RHIOs) that are implementing health IT with HIE and focusing on the ambulatory setting.
Estimated Total Funding: $974,545
Focus Area(s): Ambulatory quality metrics responsive to the effects of health IT and HIE
Type of Health IT: Health information exchange
Principal Investigator: Rainu Kaushal
Grant No.: 1R18HS017067
Applicant Institution: Weill Medical College of Cornell University, New York, NY
Estimated Dates: 9/30/2007 – 9/29/2009

Surveillance for Adverse Drug Events in Ambulatory Pediatrics
Description: Uses a computerized system to detect and report ADEs that occur in the outpatient setting, in the emergency department, and during the transitions of hospital admission and discharge.
Estimated Total Funding: $992,699
Focus Area(s): Adverse drug events for pediatric patients in ambulatory settings, emergency departments, and transitions of care
Type of Health IT: Operational decision support – quality of care
Principal Investigator: Peter Kilbridge
Grant No.: 1R18HS017010
Applicant Institution: Washington University, St. Louis, MO
Estimated Dates: 9/01/2007 – 8/31/2009

Cardio-HIT Phase II
Description: Studies exception reporting to: (1) document the prevalence and patterns of exception reporting for performance measures for coronary artery disease and heart failure; (2) assess the feasibility and accuracy of exception reporting; and (3) analyze and address stakeholder concerns regarding exception reporting.
Estimated Total Funding: $996,166
Focus Area(s): Coronary artery disease and heart failure measures
Type of Health IT: Operational decision support – quality of care
Principal Investigator: Karen Kmetik
Grant No.: R18HS017160
Applicant Institution: American Medical Association, Chicago, IL
Estimated Dates: 9/30/2007 – 9/29/2009

Electronic Support for Public Health - Vaccine Adverse Event Reporting System
Description: Seeks to improve the quality of vaccination programs by improving the quality of physician adverse vaccine event detection and reporting to the national Vaccine Adverse Event Reporting System (VAERS).
Estimated Total Funding: $999,995
Focus Area(s): Vaccine adverse effects
Type of Health IT: Registry (vaccination), clinical/medication reminders (provider-focused)
Principal Investigator: Ross Lazarus
Grant No.: 1R18HS017045
Applicant Institution: Harvard Pilgrim Health Care, Inc., Boston, MA
Estimated Dates: 9/30/2007 – 9/29/2009

Medication Monitoring for Vulnerable Populations via IT
Description: Demonstrates the ability of health information interoperable exchange and electronic health records (EHR) to provide useful quality and safety measures for the vulnerable populations served by a community health center (CHC).
Estimated Total Funding: $994,325
Focus Area(s): Medication safety monitoring for ACEI/ARB, Digoxin, diuretics and statins
Type of Health IT: System integration, quality of care decision support
Principal Investigator: Christopher Lehmann
Grant No.: 1R18HS017018
Applicant Institution: Johns Hopkins University, Baltimore, MD
Estimated Dates: 9/21/2007 – 8/31/2009

Improving Quality in Cancer Screening: The Excellence Report for Colonoscopy
Description: Seeks to evaluate and improve the quality of screening and diagnostic colonoscopies in ambulatory care settings.
Estimated Total Funding: $616,207
Focus Area(s): Colonoscopy pre-procedure, procedure and post-procedure measures
Type of Health IT: Operational decision support – quality of care
Principal Investigator: Judith R. Logan
Grant No.: 1R18HS017017
Applicant Institution: Oregon Health & Science University, Portland, OR
Estimated Dates: 9/01/2007 – 8/31/2009

Standardization and Automatic Extraction of Quality Measures in an Ambulatory EMR
Description: Establishes the standardization efforts necessary for data capture of quality measures in an ambulatory EMR system and demonstrate the efficiency and accuracy of using a data extraction and reporting expert to perform quality measurement in the ambulatory care setting.
Estimated Total Funding: $889,681
Focus Area(s): Physician quality reporting initiative
Type of Health IT: Standards (semantic), data electronic transform & load
Principal Investigator: Denni McColm
Grant No.: 1R18HS017094
Applicant Institution: Citizens Memorial Hospital District, Bolivar, MO
Estimated Dates: 9/07/2007 – 8/31/2009

Bringing Measurement to the Point of Care
Description: Enables measurement of the quality of care, with a focus on public health priority issues, disadvantaged populations, and small office practices. This project will design and test a "quality dashboard" suitable for small office practices that will integrate quality measurement and clinical decision support at the point of care.
Estimated Total Funding: $694,961
Focus Area(s): Ambulatory care screening measures
Type of Health IT: Health information exchange, Quality of care decision support
Principal Investigator: Farzad Mostashari
Grant No.: 1R18HS017059
Applicant Institution: New York City Health/Mental Hygiene, New York, NY
Estimated Dates: 9/30/2007 – 9/29/2009

Massachusetts Quality E-Measure Validation Study
Description: Evaluates the readiness of structured EHR data to support ambulatory clinical quality measurement by using the AQA ambulatory care measurement set to compare quality measurement based on a structured EHR data measurement method to two standard measurement methods.
Estimated Total Funding: $995,575
Focus Area(s): AQA starter set for primary care (26 measures)
Type of Health IT: System integration, quality of care decision support
Principal Investigator: Eric Schneider
Grant No.: 1R18HS017048
Applicant Institution: Harvard University (School of Public Health), Boston, MA
Estimated Dates: 9/12/2007 – 8/31/2009

Feedback of Treatment Intensification Data To Reduce Cardiovascular Disease Risk
Description: Kaiser Permanente Northern California proposes to develop and evaluate a treatment intensification protocol based upon a system-level innovation using an electronic health record to identify patients in need of treatment intensification for systolic blood pressure.
Estimated Total Funding: $997,069
Focus Area(s): Cardiovascular disease process and outcome measures
Type of Health IT: Clinical decision support (provider focused)
Principal Investigator: Joe Selby
Grant No.: 1R18HS017031
Applicant Institution: Kaiser Foundation Research Institute, Oakland, CA
Estimated Dates: 9/01/2007 – 8/31/2009

Using Electronic Records To Detect and Learn From Ambulatory Diagnostic Errors
Description: Uses data from electronic health records (EHR) to detect diagnostic errors in primary care, understand their causes, and lay groundwork for formulating future prevention strategies.
Estimated Total Funding: $873,108
Focus Area(s): Measuring potential diagnostic errors in primary care
Type of Health IT: Operational decision support (quality of care)
Principal Investigator: Eric Thomas
Grant No.: 1R18HS017244
Applicant Institution: University of Texas Health Science Center at Houston, Houston, TX
Estimated Dates: 9/30/2007 – 9/29/2009

Monitoring Intensification of Treatment for Hyperglycemia and Hyperlipidemia
Description: Develops and validates a new diabetes quality-of-care process measure and the technology for monitoring that measure using analysis of the text of physician notes in the EMR.
Estimated Total Funding: $533,431
Focus Area(s): Development of new diabetes quality-of-care process measures
Type of Health IT: Quality of care decision support, data electronic transform & load
Principal Investigator: Alexander Turchin
Grant No.: R18HS017030
Applicant Institution: Brigham and Women's Hospital, Boston, MA
Estimated Dates: 9/30/2007 – 9/29/2009

Using [Health] IT To Improve the Quality of CVD Prevention & Management
Description: Uses electronic medical records (EMRs) in a large health care system to: (1) identify practice variations in delivery of key cardiovascular disease (CVD) preventive and disease management services; (2) relate practice variation to outcomes among patients in the clinical practices; and (3) provide feedback to managers on how guidelines adherence relates to morbid and mortal events, and to costs of care.
Estimated Total Funding: $605,862
Focus Area(s): Prevention index and disease management index
Type of Health IT: Quality of care decision support
Principal Investigator: Thomas Vogt
Grant No.: 1R18HS017016
Applicant Institution: Kaiser Foundation Research Institute, Honolulu, HI
Estimated Dates: 9/05/2007 – 8/31/2009

Crossing the Quality Assessment Chasm: Aligning Measured and True Quality of Care
Description: Identifies and quantifies the impact on quality assessment of real-world circumstances where the current cross-sectional measures of quality do not reflect the true quality of care being rendered. The result of the analysis will help to create a new set of quality measures that is more consistent with actual clinical care.
Estimated Total Funding: $812,237
Focus Area(s): Diabetes care measurement techniques accounting for differences in patient populations
Type of Health IT: Quality of care decision support
Principal Investigator: Mark Weiner
Grant No.: 1R18HS017099
Applicant Institution: University of Pennsylvania, Philadelphia, PA
Estimated Dates: 9/30/2007 – 9/29/2009

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