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 Years 2006 and 2007.
Health Care Organization and Payment
Title: Reducing Waste and Inefficiency through
Process Redesign
Partner: American Institutes for Research
Description: This project furthers AHRQ's commitment to the
redesign of health care processes to reduce waste and enhance efficiency. The
task order objectives are to assess and disseminate promising techniques and
methodologies in health care redesign. AIR is investigating the contribution of
Lean/Toyota Production Systems (TPS) to reducing waste in health care delivery
systems.
Period: 7/08-6/10
Funding: $399,813
Deliverables:A final report that
includes: environmental scan summary, case study report, analysis of the business
case, recommendations for implementing Lean/TPS, dissemination activities (past
and planned), and publications and presentations.
Title: Improving
Patient Flow and Reducing Emergency Department Crowding
Partner:
Health Education and Research Trust
Description: Urgent Matters, a Robert Wood Johnson Foundation (RWJF)-funded
program based at The George Washington University School of Public Health and
Health Services, has spent the last 6 years identifying patient flow quality
innovations implemented by hospitals across the Nation. This RWJF-funded ACTION
task order is designed to test and evaluate these innovations through ACTION partnerships.
More specifically, this project creates a unique opportunity for hospitals to
implement and evaluate patient flow improvement strategies with the support of
a collaborative structure and technical assistance. The project goals are to: (1)
rigorously evaluate the implementation of strategies for improving patient flow
and reducing emergency department crowding within the context of a hospital
collaborative; (2) promote the spread of promising practices to a wider
audience and variety of hospitals; and (3) advance the development of quality
measurement in the emergency department.
Period: 9/08-3/10
Funding: $399,948
Deliverables: Evaluation report
and dissemination plan.
Patient Safety
Title: National Implementation of the
Comprehensive Unit-Based Safety Program (CUSP) To Reduce Central-Line
Associated Blood Stream Infections (CLABSI) in the ICU
Partner: Health Education and Research
Trust
Description: The project
goals are to implement
and beta test a Comprehensive Unit-Based Safety Program (CUSP) as a strategy
for reducing central line-associated bloodstream infections (CLABSI) in the
intensive care units (ICUs) of 100 hospitals from 10 States over a period of 3 years.
Specifically, new partners or existing statewide cooperatives of stakeholders,
including State hospital associations (SHAs), quality improvement
organizations, public health agencies, and health care purchasers, will reduce
CLABSI in ICUs. HRET will evaluate (1) the adoption of the CUSP intervention
strategy/tools and (2) the effect of these strategy/tools on CLABSI rates
within each participating State cooperative.
Period: 9/08-9/11
Funding: $2,999,963
Deliverables: Deliverables
include recruitment, operational, and sustainability plans for statewide consortia and a Children's
Hospital Network; a CUSP Course Design Guide and other CUSP
materials; data collection protocols; a final report; and materials for
publication.
Title: Testing Spread and Implementation of
Novel MRSA-Reducing Practices
Partner: Indiana University
Description: This task order aims to broaden spread of an already-tested "Methicillin-resistant
Staphylococcus aureus (MRSA) intervention bundle" from ICUs to
additional units in hospitals participating in an existing Indiana University
ACTION project on MRSA. It also is designed to spread successful MRSA
reduction interventions to additional hospitals in the Indianapolis region and
beyond. The participating health care settings are also to identify and monitor
health care-associated community onset (HACO) MRSA cases and controls who
receive care in participating hospitals and affiliated settings, identify
strategies to reduce HACO MRSA, and demonstrate reduction of HACO MRSA. The
Indiana University-led team is to evaluate the
effectiveness of tested implementation strategies and innovations by applying
information technology to enable consistent collection, sharing, analysis, and
reporting of data; capture the hospital cost savings through participation in
the project; and disseminate findings and promote outreach to target audiences
and other stakeholders.
Period: 9/08-9/11
Funding: $1,800,000
Deliverables: A final report
summarizing findings and lessons learned. The report is to include
tools to help others implement the MRSA Intervention Bundle, a social network
analysis, findings on cost savings; and a dissemination and outreach plan.
Title: Healthcare Associated Infections (HAI)
Initiative Assessment Program
Partners: Indiana University
Description: Indiana University is fulfilling a
coordination, analytical, technical assistance, and evaluative function for
ACTION's HAI Initiative, which includes five partnerships led
by American Institutes for Research, Denver Health, Health Education and
Research Trust, University of Iowa, and Yale New Haven Health Services
Corporation. These partnerships were awarded task orders to work
collaboratively on this topic in 2007. The goal of this exploratory
qualitative initiative is to identify factors associated with the
implementation of tools and interventions that can assist hospitals in
successfully reducing and sustaining the reduction of infections associated
with the process of care. The teams will use several different tools and
interventions designed to change human behaviors, habits, and safety culture
within health care organizations. The HAI initiative is determining whether the
tools used are successful in reducing infection rates, while identifying both
the challenges and barriers encountered during implementation. In addition,
the HAI initiative is focusing on how these successes can be sustained over
time and how the organization's culture may contribute to, or impede,
improvements in infection safety.
Period: 3/08-1/10
Funding: $400,000
Deliverables: Synthesis of HAI
implementation assessment reports, implementation toolkit, final report,
dissemination and outreach plan, and manuscripts.
Title: Evaluation of Phase I Demonstrations of
the Pharmacy Quality Alliance
Partner: CNA
Description: CNA is evaluating Phase I demonstration projects, supported by
the Pharmacy Quality Alliance (PQA). The projects are designed to test pharmacy
performance reports that incorporate PQA-endorsed measures of pharmacy
performance (including 15 claims-based measures and a consumer questionnaire of
their experience with pharmacy services). The demonstration sites are testing
the feasibility of using PQA-developed report templates and are examining the
utility of these reports in various practice environments. The evaluation
focuses on implementation issues. It will measure the impact and cost of
collecting and reporting pharmacy performance data, including claims-based
performance data and aggregate consumer survey data. In addition, CNA is to develop
evaluation design plans for Phase II demonstrations, which are to test quality
improvement efforts on pharmacy performance. The Phase I demonstrations
launched in 2008 seek to establish the most efficacious methods of collecting,
analyzing, and reporting the 15 pharmacy quality measures and consumer
questionnaire data. In mid-2009, PQA plans to implement Phase II projects to
demonstrate the impact of collecting and reporting data on pharmacy quality
measures, as well as the impact of quality improvement efforts on pharmacy
performance. CNA is performing a comprehensive evaluation of Phase I
demonstration projects and assisting in the development of an evaluation design
plan for Phase II demonstration projects.
Period: 9/08-3/10
Funding: $506,015
Deliverables: Project and
evaluation design plans and reports, interview protocols, and a final report.
Title: Designing Consumer Reporting Systems for
Patient Safety Events
Partner: RTI
Description: RTI plans to: (1) develop ideas and recommendations
for ideal consumer reporting systems for patient safety events; (2) identify
the types of data elements (e.g., reports, information) that would be collected
from consumers; and (3) determine the different types of mechanisms in which
consumer reporting can best be captured. RTI will explore various options for
the possible design, development, and implementation of a patient safety event
reporting system for consumers. This project features a variety of activities
needed to design and develop recommendations on an effective, practical
consumer reporting system for patient safety events. These include establishing
a technical expert panel (TEP), conducting an environmental scan and literature
review of existing reporting systems and mechanisms that would be applicable to
a consumer reporting system, and conducting focus groups and key stakeholder
interviews. The focus groups and interviews will provide feedback on the TEP's
recommendations. The information will also be incorporated with feedback on
consumer experiences with patient safety events to inform the design and
content of a consumer reporting system for patient safety events.
Period: 9/08-5/10
Funding: $417,799
Deliverables: Environmental scan
and literature review, final report and recommendations, peer-reviewed journal
manuscript, and dissemination plan.
Title: Promoting Safety and Quality Through Human Resource
Practices
Partner: Health Research and Educational Trust (HRET)
Description: Remarkably, many health care providers still make limited use
of human resource (HR) practices recognized as beneficial in other industries.
Moreover, there has been limited investigation of the applicability of such
practices to health care. This project seeks to address these needs. HRET is to
conduct a broad scan of innovative HR practices within health care and identify
one HR practice that holds promise for improving working conditions, enhancing
staff performance, reducing turnover, or otherwise contributing to safety and
quality. (HRET will not examine teamwork and magnet hospital certification,
which have already been studied extensively.) Of particular interest are
effective practices from other industries that may be appropriate for health
care and are currently being tried by innovative health systems. HRET is to then
scan for more detailed information on the selected practice within health care
and in other industries and conduct case studies of successful applications of
the practice within health care. The scan and the cases will include analysis
of the business case for the practice. Then HRET will develop and disseminate
recommendations for implementing promising forms of this HR practice within
interested health care organizations.
Period: 8/08-1/10
Funding: $349,878
Deliverables: Scan summary, case
study report, business case analysis, implementation report, dissemination
plan, final report, and manuscripts.
Title: Preventing Pressure Ulcers in Hospitals
Partner: Boston University
Description: Boston University is to review successful approaches to
preventing pressure ulcers in hospitals, including both clinical and managerial
factors; lead a workgroup from participating hospitals to develop and test
tools to improve pressure ulcer prevention practices in hospitals; develop a
quality improvement manual for hospitals that provides a step-by-step approach
for hospitals using these new tools to prevent pressure ulcers, and lead
multidisciplinary teams from each participating hospital in a pilot quality
improvement (QI) project that uses these tools to help refine the QI manual.
Pressure ulcer prevention tools may differ depending on the hospital
department that is the focus of the prevention efforts. A pilot QI program
will provide further insight into the effectiveness of the tools when used in a
QI project. The program will also help further refine how to use the tools and develop
a manual to be developed on pressure ulcer prevention. Boston University will gather information about the important experiences and challenges of the
participating facilities, account for all important changes that participating
facilities make in both processes and structures to improve pressure ulcer
reduction practices, and monitor the changing rate of hospital-acquired
pressure ulcers that occur in each hospital.
Period: 9/08-9/10
Funding: $499,930
Deliverables: Manual to guide
hospitals in how to prevent pressure ulcers, prevention tools, and final report.
Title: Assessing Organizational Responses to
AHRQ's Health Literacy Pharmacy Tools
Partner: Abt Associates
Description: In 2005, AHRQ and the Robert Wood Johnson Foundation funded the
PILL study (Pharmacy Intervention for Limited Literacy) to develop and test
pharmacy interventions. Four health literacy pharmacy tools have resulted.
AHRQ now seeks to learn how pharmacies respond to these tools and about the
conditions that may encourage or discourage adoption of the tools. In addition
to learning specifically about the effectiveness of distributing these tools,
AHRQ wants to increase understanding of how to promote quality improvement in
pharmacy settings more generally.
Period: 8/08-2/11
Funding: $400,000
Deliverables: Case study
reports, Promoting Pharmacy Health Literacy
Guides, final report, manuscripts, and dissemination plan.
Title: Risk Informed Assessment of Teamwork and
Clinical Outcomes
Partner: American Institutes for Research
Description: AHRQ
has supported risk assessment projects using sociotechnical probabilistic risk
assessments (ST-PRAs) to develop a risk-informed approach to the design and
implementation of patient safety practices, particularly in the area of
ambulatory care. This project will take the lessons learned in the development
and use of risk models to create a risk-informed approach to evaluation of
safety and quality improvement efforts. Creating risk models that identify the
risks associated with adverse outcomes can be used to focus attention on which
processes are related to the elimination or mitigation of the risks associated
with the adverse or undesirable outcomes. This task order will develop a
risk-informed evaluation approach to teamwork by conducting formalized ST-PRAs
in labor and delivery, surgery, and treatment for acute myocardial infarction;
using the risk models to identify which specific risks lead to the adverse
outcome; and identifying the process measures related to the risk reduction as
intermediate variables.
Period: 8/08-1/10
Funding:
$349,955
Deliverables: Fault tree for
ST-PRA models, report of prioritized risk profiles for each primary condition,
report on prototype testing in the field, manuscripts, and final report.
Health Information Technology
Title: Building an Implementation Toolset for
E-Prescribing
Partner: RAND
Description: The
overarching goals of this project are to develop and test an e-prescribing toolset that provides
information and tools in sufficient detail to act as a "how-to guide" for
implementing e-prescribing across various organizational settings. The project
includes: (1) environmental scan of current e-prescribing implementations, both
nationally and internationally; (2) analysis of successful implementations in
several organizational configurations, such as integrated delivery systems,
community ambulatory networks, and small practice/independent pharmacies; (3) implementation
toolset; and (4) pilot e-prescribing implementation using the toolset. The
toolset will include applicable standards with implementation guides,
technology requirements, workflow analysis tools, governance agreement
templates, and other relevant materials. The focus of the pilot implementation
is not on the implementation itself, but rather, on the completeness and
usability of the toolset. A final report detailing the results and ways in
which the toolset may be enhanced for broad use is also required. Based on the
success of this initial work, further implementation pilots reflecting various
organizational configurations are possible.
Period: 8/08-1/10
Funding: $999,825
Deliverables: Assessment report,
implementation toolset, final report, and dissemination activities.
Prevention
Title: Coordinating Care Across Primary Care
Practices and Specialty Care Practices: Developing and Testing a Feed Forward
and Feedback Strategy
Partner: Boston University
Description: The purpose of this task order is to provide a network to
design, implement, and evaluate a process for the timely feed-forward of
information between primary care practices and specialty care practices. The
network should consider the full loop of information sharing that will help
guide care, including feedback from specialty practices to primary care
practices, but must pay particular attention to the feed-forward strategy.
Specifically, Boston University will: (1) develop a process to feed information
forward, i.e., to have primary care providers' specific questions and reasons
for referral, applicable test results from the primary care workup, and
relevant patient history go with the patient to the specialist; (2) test and
evaluate the feed-forward process; and (3) develop and pilot test a process to
secure timely and appropriate feedback to the primary care practice from the
specialist as a companion to the process developed under item 1. The process
for feeding information forward will have the broadest application possible, be
appropriate for use with multiple specialties, and cover a range of clinical
conditions. Tools developed to feed information forward can be paper based but
must be easily convertible for electronic systems.
Period: 9/08-9/10
Funding: $399,736
Deliverables: Educational/promotional materials,
documentation of the implementation process, evaluation of outcomes, final
report, and dissemination activities.
Emergency Preparedness
Title: Mass
Casualty Events Models and Tools To Support Planning and Response for Pandemic
and All Hazards Preparedness
Partner:
Abt Associates
Description: This task order is cosponsored by several agencies and offices within
the U.S. Department of Health and Human Services: the Health Resources and
Services Administration, the Assistant Secretary for Preparedness and Response
(ASPR), and the Office of Public Health Emergency
Preparedness. Due to the unique surge capacity requirements posed
by several at-risk populations, this project will quantify and categorize these
patients to estimate their incremental potential burden to initial mass
casualty care efforts. The product of this work will be a model for estimating
this population in any community, their attendant medical and service needs,
and the tolerable/intolerable thresholds below which access cannot be reduced
without jeopardizing their medical stability. The model includes specific mass
casualty scenarios and the consequences each will have on a municipality's
high-intensity home care population, as well as the added community and home
care burden of discharged hospitalized patients. Planners will be able to use
this model to proceed with emergency response in an informed manner, including
this patient population in the initial surge planning and avoiding an unexpected
wave of acute patients. The project will contribute to the planning for health
care sector infrastructure considerations and recovery after a devastating mass
casualty event. This model of early-discharged hospital-based at-risk patients
and community-based at-risk patients may be integrated into the other surge models
being developed with Abt for ASPR under an ongoing statement of work with AHRQ.
In addition, this work will develop both a decision support algorithm for
evacuation decisions and a tool that can be used "on the ground" in the
aftermath of a disaster to assess damaged hospitals and determine whether they
can reopen and what they will need to reopen quickly and safely. Such a tool
will be useful after an event such as a severe hurricane or flood. This work
builds on the previous AHRQ-funded task order that resulted in the shuttered hospital
"inspection tool" and "Facility Checklist and Guide."
Period: 9/08-9/10
Funding: $449,995
Deliverables: A model for estimating early-discharged
hospital-based at-risk patient and community-based at-risk patient population
in a given community; an Evacuation Decision Guide, or decision algorithm,
based on type of disaster, to help emergency management decide whether and when
to evacuate a hospital; and a Revised Facility Checklist and Guide, or
inspection guide, tailored to different types of disasters (hurricanes, floods,
explosions, etc.), to help inspectors assess damaged and evacuated hospitals
and determine how best to prepare them to reopen.
Title: National
Disaster Medical System—Katrina Research Project Phase I
Partner:
Abt Associates
Description: During the massive hurricane destruction along the U.S. Gulf Coast
in 2005, a number of National
Disaster Medical System (NDMS) clinics were set up in nine large shelters
to meet the immediate nonemergency medical needs of displaced persons.
"Visits" generated records that were scanned into electronic (pdf) format. Early
records in the 12-week period are likely to be somewhat incomplete and
unformatted, and the records will need systematic coding to determine what
information can be gleaned to inform emergency planners as they prepare to
respond to future major disasters. In addition, the potential use of the data
in rigorous analyses has to be determined. This project addresses an
exploratory Phase I of a potentially multiphase project. In Phase I, a sampling
frame will be developed, a small sample of records will be coded, and the
sampled records will be analyzed to determine whether the records are likely to
yield analyzable (and worthwhile) information. Findings from Phase I will
inform the potential research feasibility for other phases, including more
indepth analyses of the NDMS Katrina-Rita disaster period client records.
Period: 9/08-9/09
Funding: $229,898
Deliverables: Sampling
frame, final
report, journal article, and presentation.
Title: Hospital Preparedness
Exercise Evaluation Resource Guidebook
Partner:
Weill Medical College of Cornell University
Description: This ASPR-funded task order addresses the need to develop a set
of overarching guidance principles that will allow hospitals to communicate
effectively with community partners, meet Federal exercise requirements, and
meet accreditation standards required for emergency preparedness Using an
existing environmental scan as a starting point, Weill will convene a series of
meetings to identify resources and best practices for conducting and evaluating
hospital emergency preparedness exercises. They will identify a consolidated
list of guidance tools, which will form the basis for a resource/reference
manual for hospitals' use in preparedness exercises. The resource/reference
manual will, at a minimum, include the exercise/emergency preparedness
standards recommended by the Homeland Security Exercise and Evaluation Program,
the Joint Commission, and the Centers for Medicare & Medicaid Services
(CMS). A manual will be developed to provide specifics on the planning,
conduct, evaluation, and after-action processes health care organizations need to
meet the intent of exercise program requirements for Federal funding programs, as
well as accreditation and regulatory agencies.
Period: 9/08-9/09
Funding: $443,685
Deliverables: Resource
manual, final report and supporting materials, and presentation of results.
Title: Supporting
the Development of Regional Planning Coalitions
Partner:
Abt Associates
Description: This CMS/HRSA-funded task order is studying two existing
regional planning coalitions, Midwest Alliance and UPC, which
encompass U.S. Department of Health and Human Services (HHS) Region 7/8 and
Region 4, respectively. The project is designed to identify potential promising
practices that may be applicable, replicable, or usable in other regions and
regional coalitions and to identify tools for planning, disaster health/medical
assessments, and response. The focus of all activities is to support regional
planning and the role of the Regional Emergency Coordinator.
Period: 4/08-8/09
Funding: $994,647
Deliverables: Assistance
to identified coalitions in hosting regional conference; template for convening
future regional meetings; interim report; Web page template; recommendations on
strengthening planning coalitions and improving potential for replication of
the planning coalition process in other regions; tool for development of a
concise State profile, including an inventory of preparedness-related State
health and medical assets; toolkit of preparedness, disaster health/medical
assessment, and response tools that are primarily in the public domain;
resource manual for use by other HHS regions in their planning efforts; final
report; and presentation of findings.
Long-Term Care
Title: Early Screening and Exercise Prevention
of Disability and Falls in Persons Residing in Continuing Care Retirement Communities
(CCRCs)
Partner:
American Association of Homes & Services for the Aging (AAHSA)
Description: There is evidence to show that an exercise program matched to a
person's needs, along with counseling to integrate the exercise into their day-to-day
activities, can decrease the risk of disability among high-risk individuals.
However, most of the existing data have been generated from studies conducted
in highly controlled clinical trial settings, not in "real world" settings in
which older adults live and function. Thus, it is not known if existing tools
for identifying and intervening with adults at high risk of disability can be
effectively implemented in real-world residential settings in a manner that
promotes health, prevents disability, and fits into typical staffing patterns.
The main components of this project are screening with a short physical
performance battery (training and implementation); implementation of an
evidence-based exercise and counseling program among persons at high risk of
disability in CCRCs; analysis of the impact of the intervention on disability
risk for CCRC residents; and demonstration of the feasibility of conducting
such a program in CCRCs.
Period: 7/08-6/10
Funding: $499,714
Deliverables: Literature review, implementation
guide, data collection plan and instruments, analytic plan, slide presentations
for meetings, and manuscript.
Title:
Development of an Assisted Living Consensus Instrument (Phase I)
Partner: Abt Associates
Description: This task order supports the development of an instrument
designed to obtain provider-reported information on the services and
characteristics of individual assisted living residences. Project efforts
include providing technical and logistical support for consensus development activities
to develop uniform data items and definitions; development of a draft self
administered questionnaire for providers (based on the consensus materials
developed); development of draft instrument-associated data collection
materials; and project documentation activities. Phase II of the project
(planned for fiscal year 2009 funding) will include small-scale testing with
consumers and providers and medium and large scale testing with providers.
Based on the testing results, the instrument and associated materials developed
in Phase I will be finalized. Phase III of the project (planned for fiscal
year 2010 funding) will include dissemination activities for the materials
developed. Current plans are to compete these phases separately, as two
additional task orders, through ACTION.
Period: 5/08-4/10
Funding: $207,939
Deliverables: Template for consensus
reporting, self-administered questionnaire, instrument-associated data
collection materials, and final report.
Current as of December 2008
AHRQ Publication No. AHRQ 09-0027-EF
Internet Citation:
ACTION Project Awards, Fiscal Year 2008: Field Partnerships for Applied Research. AHRQ Publication No. AHRQ 09-0027-EF, December 2008. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/research/action08.htm