Appendix B: Summaries
of PFQ Grantee Activities (continued)
PFQ Grant Summary: Striving Together, Improving
Healthcare
Lead Organization: Texas A&M University System (TAMUS), Health Science Center
Partner Team: Texas A&M Rural and Community Health Institute, Texas A&M Health
Science Center Office of Homeland Security, Altarum Research Institute,
Inc., Air Force Texas Center for Medical Strategy Training and
Readiness (first year only)
Title: Striving Together, Improving
Healthcare
Topic Area: Bioterrorism/Emergency
Preparedness
Principal Investigators: Josie R. Williams, director of Rural and Community Health Institute,
Texas A&M University System Health Science Center; co-principal
investigator Janine C. Edwards, research professor, TAMUS
AHRQ Project Officer: Sally Phillips
Total Cumulative Award: $399,816
Funding Period: 9/2002–9/2006
Project Status: Completed 9/29/06
1. Project
Description
Goals. The project had two original aims: (1) to improve type 2 diabetes care in
partner hospitals, clinics, and other organizations by implementing a care
management intervention and (2) to conduct a case study of the management of
bioterrorism (BT) funding on the readiness of public health and acute care
systems in selected Texas Department of Health regions to respond effectively
to BT threats. When the first component on diabetes care was not funded, the
grantee changed its project to focus solely on the bioterrorism component. It
revised its goal as "the formation of partnerships that will facilitate the
study of important factors related to preparedness for bioterrorism and natural
disaster."
Activities
and Progress. During the first year, the project formed an Advisory Council
to guide the study of selected regions' use of U.S. Centers for Disease Control
bioterrorism preparedness funding and conducted and completed case studies of
Public Health Region 8 (the San Antonio metropolitan area and 21 surrounding
counties) and Region 2/3 (Dallas/Fort Worth metropolitan area). It found that
(1) a regional strategy for resource allocation can be more effective in
providing essential epidemiology services to small rural counties than a strict
per capita allocation to each county; (2) regular disease surveillance systems
can be used for bioterrorism incidents; (3) clear lines of authority and
cooperation across those lines of authority are needed; (4) personal
relationships and trust are critical to building relationships for
preparedness, with such relationships developed through regular communication
and the fulfillment of promises in allocating funds; and (5) continual and
clear communication is necessary to achieve bioterrorism preparedness among an
established network of people. The study found that Region 8 had one of the
best emergency preparedness plans in the country, as confirmed by its
subsequent response to Hurricanes Katrina and Rita.
The case study
also found that public health officials experienced difficulty in obtaining the
cooperation of physicians in all public health matters, even in state-required
reporting of infectious disease cases. Therefore, the research team developed a
learning exercise about Avian flu for medical students, which it taught to
second-year students at the Texas A&M College of Medicine. The exercise
emphasized the importance of reporting requirements and cooperation among all
sectors for both emergency preparedness and day-to-day use.
Given
that disease surveillance is such an important component of an effective
disaster preparedness system, the project decided in its second year to study
how disease surveillance methods in Texas and Mexico could affect the delivery
of health care services in the event of bioterrorism or natural disaster along
the U.S.-Mexico border. The project team conducted interviews with public health
officers, emergency managers, the director of the U.S. Air Force surveillance
agency, two health officers for the Mexican border town of Acuna, and the Texas state epidemiologist. The study found that information flows rely on a mix of statutory
and informal networks; that public health officers working in the field often
have no formal training in public health; that many doctors and hospitals do
not routinely report on reportable diseases; and that obstacles prevent
information sharing about disease surveillance on the Texas-Mexico border. It
recommended improved information infrastructure at the local public health
level and between U.S. and Mexican public health officials.
In
the third year, the project team used the findings from the study of
U.S.-Mexico border disease surveillance issues to help the Altarum Research
Institute, another grantee and partner in the program, develop a causality
prediction model to estimate the effects of early detection strategies for smallpox
and influenza. It found, for example, that the effect of restricting casual
contacts by infected individuals was greatest for the first couple of contacts,
suggesting that absolute quarantines would not be necessary or cost-effective.
This finding prompted the project team to expand its study of disease
surveillance at international borders to the U.S.-Canada border.
Through
Altarum's contacts, the study team formed an informal partnership with Michigan public health officials to undertake research on areas of similar and dissimilar
concern about infectious disease surveillance at both the northern and southern
U.S. borders. The research identified four issues that should receive
priority: (1) robust bi-national health organizations that overcome
jurisdictional obstacles to public health; (2) funding for border health
security; (3) local-regional public health agencies able to function relatively
independently during disaster; and (4) mechanisms to identify and properly manage
emerging health disparities at both borders. At the state and federal levels in
the United States, Canada, and Mexico, the findings recommended efforts to
develop formal communication channels at the federal level among all three
governments and to resolve differences in diagnostic standards and reporting
requirements for communicable diseases. It also recommended creating and
funding a bi-national border organization between the United States and Canada and providing adequate funding for existing U.S.Mexico bi-national
organizations. Finally, the research recommended planning and exercising
effective preparedness for all types of disasters across the international
borders.
In
the final year of the project, the team had two goals. It planned to complete
its analysis of disease surveillance communication patterns and problems on
both U.S. borders and to conduct disaster-training exercises in small rural hospitals
that belong to a network of Texas A&M's Rural and Community Health
Institute. The training exercises or drills focus on Avian flu to enable small,
rural hospitals to approximate the preparedness achieved by urban hospitals
with more extensive resources and training opportunities. The exercise used an
AHRQ-developed tool called Evaluation of Hospital Disaster Drills: A
Module-Based Approach.
2. Partnership
Structure/Function
The project
investigators created an Advisory Council that met on a quarterly basis to
provide input into and feedback on the project and its findings. In addition to
staff at Texas A&M Health Sciences Center, the Advisory Council included
the director of Texas Public Health Region 8, the School of Rural Public Health, and the head of the Texas Department of Health's State Epidemiology
Office. The Texas Department of Public Health's Region 8 was more the subject
of the project's first case study than a partner in carrying out the research.
The lead organization, TAMUS, also developed a partnership with the Altarum
Research Institute during the first six months of the project after learning
that both it and Altarum had a mutual interest in disaster preparedness.
Table 1. Major Partner Organizations and Roles in the Project
Partner Organizations |
Organization |
Role in Project |
Lead Organization (grant recipient) |
Texas A&M University Systems (TAMUS)
Health Science Center,
Rural & Community
Health Institute (RCHI)
|
Co-principal investigator responsible for communicating
with partners; deciding on research design, regions to be
studied, staff Advisory Council; leads and directs all data
collection and analyses and reports.
Directed by principal investigator, provides platform for
disseminating lessons learned to hospitals in RCHI
network
|
Key
Collaborators |
Altarum Research
Institute, Inc. |
Collaborator in conducting studies of disease surveillance
using its electronic model for healthcare |
Target Organizations |
|
Medical students to test training program involving an
Avian flu exercise
Conducted Avian flu disaster drills in 15 rural hospitals
|
3. Project Evaluation and Outcomes/Results
The project engaged an independent qualitative
evaluator who reviewed the case study and wrote a report of the first year's
work. Project outcomes consisted of (1) reports (see below) and publications
whose findings have lessons and potential applicability elsewhere and (2)
disaster preparedness training exercises for medical students and rural
hospitals. Medical students provided feedback on the Avian flu training
exercise, and independent public health officials observed and wrote reports
for each participating hospital on the rural hospital training exercise.
The case studies produced several important
recommendations for policy and practice. One recommendation is for state and
national public health officials to develop policies that target funds to
disease surveillance methods that produce the greatest impact in mitigating
disease burden in BT and natural disasters, particularly in U.S. border areas, which are widely acknowledged to pose risks to homeland security. However, the
existence of 50 state systems impedes rapid communication with Canadian and
Mexican authorities, which operate centralized disease surveillance reporting
systems. Additional policy recommendations include the need for robust
bi-national health organizations to overcome jurisdictional obstacles to public
health; the need for local-regional public health agencies that function
relatively independently during disasters; and the need to understand and
properly manage emerging health disparities at both borders.
4. Major Products
- Akins, R. et al.
"The Role of Public Health Nurses in Bioterrorism Preparedness." Disaster
Management and Response Journal. Disaster Management & Response: DMR
Vol. 3, No. 4, pp. 98-105.
- Edwards, J. et
al. "Lessons Learned from a Regional Strategy for Resource Allocation." Biosecurity
and Bioterrorism: Biodefense Strategy, Practice, and Science 2005. Vol. 3,
No. 2, pp. 113-118.
- Silenas, R. et
al. "Influenza Pandemic: A Disaster Preparedness Exercise for Medical
Students." Submitted to Teaching and Learning in Medicine, March 2006.
- Silenas, R. et
al. Presentation at Academy Health Conference in Boston, June 2005, on "Closing
the Gap between Biological Agent Detection and Response."
- Silenas, R. et
al. Presentation at TRIP Conference in Washington, DC, July 2005 on "Improving
Disparities in Healthcare through Disease Surveillance at the Field Level."
- Silenas, R. et
al. "Syndromic Surveillance: Potential Meets Reality." Proceedings of the
National BTR 2005 Conference. University of New Mexico.
- Williams, J. et
al. "A Case Study of Surveillance in Texas Department of State Health
Services, Region 8." Technical Report. Rural and Community Health Institute,
Health Science Center, Texas A&M University System, October 2004.
- Williams, J. et
al. "Study of Disease Surveillance Policy Issues across the International
Borders of the United States." Technical Report. Rural and Community Health
Institute, Health Science Center, The Texas A&M University System, April
2006.
5. Potential for Sustainability/Expansion after PFQ
Grant Ends
The hospital exercises conducted in March 2006 merged
the Rural and Community Health Institute (RCHI) network with the work of this
project, which holds potential for sustainability of disaster preparedness work
in small, rural Texas hospitals. For example, three hospitals that did not
participate in the March training program have asked the team to conduct the
exercise again. The RCHI network offers the potential for sustaining disaster
preparedness activities. The team also plans to pursue funding for continued
work with Altarum, the delivery of training exercises for rural hospitals, and
additional studies of U.S. border disease surveillance systems.
Return to Appendix B Contents
PFQ Grant Summary: Partnership for Achieving Quality Homecare
Lead Organization:Visiting Nurse Service of New York (VNSNY)
Partner Team: VNSNY with 8 home health agencies, and starting in year 3, Delmarva
and other QIOs
Title: Partnership for Achieving Quality Homecare (PAQH)
Topic Area: Better use of evidence-based quality improvement approaches by home
care agencies serving the elderly
Principal Investigators: Penny Hollander Feldman, Director, Center for Home Care Policy and
Research, VNSNY
AHRQ Project Officer: Judy Sangl
Total Cumulative Award: $913,667
Funding Period: 10/2002–9/2006
Project Status: Received a no cost extension through September 2007
1. Project
Description
Goals. This project sought to improve home care for elderly individuals by
creating a learning collaborative—the Partnership for Achieving Quality
Homecare (PAQH)—through which selected home care agencies throughout the nation
could (1) identify and prioritize improvement goals and (2) gain access to
methods, tools, and materials that would enable them to conduct more
sophisticated, evidence-based quality improvement activities than they could
individually. The project originally planned to focus on one clinical condition
prevalent in the home care population. Over the four-year project period,
however, it considered the possibility of expanding either by adding partners
and/or target conditions. The project also planned to develop a "toolkit" of
materials and techniques that could be disseminated to home care agencies for
use in translating research findings into daily practice.
Activities
and Progress. The first year was devoted primarily to planning and setting
the foundation for the project. The lead agency, VNSNY, established a
partnership steering committee, which selected diabetes as the clinical focus
for the project. The project invited home health agencies to join the
improvement initiative if they had a reputation for innovation and the capacity
to participate, i.e., interested staff, information systems, ability to pay for
participants' trips, etc.
The
eight agencies selected were dispersed geographically, were a mixture of
nonprofit and for-profit entities, and varied in size. The agencies formed three-person
QI teams, collected baseline performance data according to the instruments
developed by VNSNY, and participated in a collaborative learning model, which
was based on the Institute for Healthcare Improvement (IHI) Breakthrough
Series. Agencies participated in three face-to-face meetings, with the first
meeting highlighting the Model for Improvement. The collaborative adopted the
rapid cycle "Plan-Do-Study-Act" (PDSA) approach to quality improvement in order
to test and implement clinical practice guidelines developed by the American
Diabetes Association.
During
the second year, collaborative agencies worked on three common targets for
diabetes quality improvement—glycemic control, foot care, and medication
management—and on two other areas of their choosing (e.g. hypertension, lipid
control, lifestyle changes). Each agency assessed the gap between current and
desired performance targets and worked to achieve the targets with support via
phone (coaching) calls with the VNSNY staff and consultants, and from each
other at two subsequent meetings. Using chart review data submitted by each
agency on diabetes patients, VNSNY prepared monthly feedback reports containing
data on outcomes and processes of care, including data from the supplemental
Outcome and Assessment Information Set (OASIS) collected at two points in time.
VNSNY also established a listserv for informal communication among
collaborative members.
In
the third year, VNSNY evaluated the results and lessons from the diabetes
learning collaborative and created a strategic expansion plan, which involved
not only adding new partners to extend the reach of QI activities, but also a
new clinical focus—reduction of acute care hospitalization among home health
recipients. Seven of the eight PAQH home health agency members agreed to
participate in the second collaborative. With help from the project's AHRQ
program officer, VNSNY secured a commitment from the Delmarva Foundation, the
QIO for Maryland and DC and the QIO Support Center for home health improvement
for all QIOs at the time, to help recruit several QIOs from around the country,
and a few additional home health agencies, to participate in the new
collaborative. VNSNY planned to use a different learning collaborative model,
relying on web-based technology to hold training and on seminars to hold down
costs while sustaining the core elements of the learning collaborative. VNSNY
developed pilot training materials and outcome measures for this acute care
hospitalization collaborative.
In
the fourth year, to extend the reach of home health QI initiatives, VNSNY began
working with 10 QIO representatives from around the country on a strategy to
develop a "wholesale" model for disseminating evidence-based strategies for
home care practice tailored to the needs and issues unique to home health care
agencies working with decentralized staff and led by nurses. The focus is on
Reducing Acute Care Hospitalization, hence the name "ReACH." The lead QIO
changed to Quality Insights of PA, which helps recruit and support
communication with participating QIOs. VNSNY also developed a system for
collecting measures on acute care hospitalization, which is in the OASIS data
set submitted to CMS. The ReACH Collaborative was implemented in two
overlapping waves over two years. The 1st wave ends in December
2006, while the second wave began in September 2006 and will end in August
2007. Participating home health care agency teams attended three Learning
Sessions hosted by their respective QIOs to hear and share best practices for
improvements in the multiple content areas. At each session, teams reported on
the activities, methods, and results surrounding their improvement efforts.
With the expansion of the partnership, VNSNY utilized distance-learning
technology (WebEX, teleconference) to allow simultaneous learning and sharing
while minimizing project costs to expand access to a wide audience of
participating home health agencies.
2. Partnership
Structure/Function
The
Diabetes Collaborative had a partnership steering committee made up of CEOs and
other management-level representatives from the participating organizations who
were a critical part of the planning process. They provided the human and
financial resources needed to implement the project and supported the
cross-agency learning process and evaluation.
The ReACH
Collaborative also has an advisory group, which was more involved than the
first collaborative's steering committee in project design. Those on the
advisory group include QIO representatives, the QIOSC, Quality Insights of PA,
and ReACH Collaborative faculty. In the early part of this initiative, VNSNY
had weekly or biweekly calls with the QIOs to support project design and
initiation. Currently, the advisory group conducts monthly conference calls
with QIOs. In addition, the ReACH Collaborative has engaged a partners group
that includes key stakeholders such as CMS, Visiting Nurse Associations of
America, and other leaders from the home care industry and professional
organizations. This group is convened quarterly to assess the project design,
implementation, and opportunities for expansion and additional support.
Table 1. Major Partner Organizations and Roles in the Project
|
Organization |
Role in Project |
Lead Organization (grant recipient) |
VNSNY
PI: Penny Hollander
Feldman, PhD
|
Provide overall leadership and direction to the
Collaboratives; create and staff expert panels and steering
committees to guide project development and content;
develop and implement evaluation plans and activities on
project impact; provide training and technical assistance to
participating home health agencies and QIOs; assess
opportunities for expansion and sustainability of project
outcomes
|
Key
Collaborators |
Delmarva Foundation
(the QIO for MD &
DC). In year 3,
switched to Quality
Insights of PA—the
QIO support center
for HH quality
improvement
10 QIOs, beginning in
year 3
|
To recruit QIOs and home health agencies from the acute
hospitalization pilot test as participants for the second
ReACH Collaborative QIOs recruit and work with participating agencies to
actively support the implementation and spread of the
initiative throughout the project period; QIOs host
participating agencies for each learning session and provide
direct coaching and technical assistance to the teams to
support their improvement efforts during the action periods
|
Target Organizations |
8 home health
agencies located
throughout the
country
|
Commitment to achieving explicit goals in selected common
areas of collaborative; involvement of three team members
in both collaborative learning sessions and bi-monthly
conference calls; willingness to share outcomes and
assessment information set and other data on achievement of
process and outcomes goals; commitment to providing their
change results in a timely manner; willingness to have a site
visit
|
69 home health
agencies participating
in REACH National
Demonstration
Collaborative
|
Home health agencies designate a senior leader, or "spread
sponsor," for the initiative to support the necessary systems
redesign, staff training, and practice improvements across
the agency to reduce avoidable hospitalizations; agency
participants designate a 3- to 5-member team to participate
in the full implementation of the collaborative; agency teams
test and implement key changes to meet the Collaborative
aims, report monthly data on process measures, and share
key lessons learned within and across Collaborative teams;
agencies are expected to participate in each wave of the
Collaborative to support spread of successful changes
throughout the agency
|
3. Project Evaluation and Outcomes/Results
The evaluation of the first learning collaborative
found that all eight teams integrated change into systems or standard operative
procedures. Many accomplished this by redesigning agency-wide forms and
documentation, while some worked more closely with their diabetes nurse
specialists or revamped the orientation for new staff. All of the teams also
codified change into their training manuals and other systems by, for example,
adding new competencies around the core topics for their nursing staff or
creating standards of care for diabetes patients to be used throughout the
agency. Five of the eight teams had used or were planning to use the PDSA
model for other quality improvement initiatives, and six teams had integrated
or intended to integrate the improvement process into their other improvement
initiatives.
The main domains and measures/research questions used
for the evaluation of the first diabetes learning collaborative, which were
very comprehensive, included (1) collaborative reach in numbers of patients
affected; (2) leadership experience, engagement, and satisfaction, including
perceived value of participation in the Collaborative and its impact on each
organization's strategic objectives, (3) team/staff experience, expectations,
engagement, and satisfaction, (4) success in implementing the improvement model,
and in collecting and submitting data; team use of data to make changes in
clinical care practices, (5) spread beyond pilot group and use for other
quality initiatives, and sustainability of change via integration into existing
systems and processes, training manuals, and other systems or through
commitment from leadership for continuation and integration of the QI process
with other initiatives; (6) clinical improvement (discussed below); and (7)
cost of the Collaborative's direct costs.
A complete review of the outcomes is beyond the scope
of this summary, but some examples suggest that the outcomes were very
positive. In terms of leadership's perceived value of the project, a majority
of home health agency CEOs and clinical managers surveyed after the diabetes
collaborative ended agreed or strongly agreed that their agency's participation
led them to revise their approach QI initiatives and helped to identify changes
that they intended to spread to the entire organization. Over 70 percent of the
CEO/managers strongly agreed that their agency's participation in the
Collaborative was likely to lead to lasting improvement in care provided to
patients with diabetes.
Agencies were required to submit monthly data on the
following clinical measures:
Glycemic
Control
-
Patients with an
individualized glycemic control plan ("target" blood sugar range).
-
Patients testing
their blood glucose according to their plan most or all of the time (among
patients with a control plan).
-
Patients whose
blood glucose is in their target range most or all of the time.
Foot
Care
-
Patients who
received a comprehensive foot exam (visual inspection, vascular assessment and
testing for sensation ) within 10 days of home care admission.
-
Patients (and/or
their caregivers) who received education about foot care.
-
Patients who did
not develop a new foot ulcer during home care.
Medication
Management
- Patients (or
their caregiver) who can return-demonstrate administration of their insulin
(among patients who are taking insulin).
- Patients taking
their diabetes medications as prescribed most or all of the time (among
patients taking one or more diabetes medications).
- Patients whose
prescribed medications have been reviewed for possible drug interactions or
contraindicated medications.
In terms of clinical outcomes, chart review data from
monthly reports submitted by participating agencies showed that the greatest
improvement, Collaborative-wide, was in the proportion of persons with diabetes
who received a comprehensive foot exam within 10 days of their admission to
home care, with an increase of over 50 percentage points during the course of
the Collaborative. Increases of over 30 percentage points, Collaborative-wide,
were also demonstrate for 1) percent of patients with an individualized
glycemic control plan, 2) percent of patients testing their blood glucose
according to plan most or all of the time, 3) percent receiving education about
foot care, and 4) percent whose medications were reviewed for contraindications.
These results should be interpreted with caution because there was no control
group, but the clinical change data suggest that performance on eight of the
nine clinical measures increased over the course of the collaborative and for
three months after it ended. The one exception was in "no new foot ulcer,"
which did not change substantially, as it was already quite good at the
start.
VNSNY developed an evaluation plan to assess the
implementation and impact of the ReACH National Demonstration Collaborative.
The primary objective is to evaluate the effectiveness of the Collaborative in
reducing acute care hospitalization rates among participating home care
agencies. The four key components of the evaluation plan include: 1) assess the
improvement work of participating home care agencies (monthly performance
data); 2) document the strategies employed to reduce acute care
hospitalizations at participating home care agencies; 3) assess QIO supports to
facilitate the improvement work of participating home care agencies; and 4)
determine the effectiveness of the virtual Collaborative Learning Model
approach to reduce avoidable hospitalizations. Data will be collected in
interviews with key home health agency staff from a random sample of
participating home care agencies, surveys of participating QIO staff, online
evaluations of learning sessions, and monthly performance data of key clinical
indicators. Project staff will assess the change in performance on each of 5
clinical indicators, comparing results from a baseline study period with
results from a post-implementation study period. These data will be assessed
for each Wave of the Collaborative (Jan-Dec 2006; Nov-Aug 2007).
4. Major Products
- Acute Care
Hospitalization Toolkit.
- Diabetes Toolkit
and Dissemination Document (for each collaborative).
- ReACH Project
Website (paqh.org/ReACH). PAQH engaged IANet technology partners to support
development of a project Web site to serve as the core infrastructure for the
national virtual Learning Collaborative. The ReACH project Web site is a
resource for participating agencies to submit data, view agency-specific and
national performance, and download or link to valuable tools and resources to
support improvement efforts aimed at reducing acute care hospitalizations. All
registered users are automatically enrolled on the agency listserv to support
communication and sharing of information with peers across the country.
- Presentations:
(1) October 2002, Deans from the Rutgers, Yale, U Penn, NYU, Columbia, Hunter,
and Pace nursing schools; (2) January 2003, New England Health Care Summit in
Boston; (3) September 2003, "A National Quality Agenda and Experiences from the
Field" at the National Association for Healthcare Quality's Annual Education
Conference; and (4) July 2006, Translating Research Into Practice Meeting in
Washington, DC. Collaborative participants also presented about the project
to state departments of health and agency boards.
- Organized a
national meeting in July 2003, "Charting the Course for Home Health Quality:
Action Steps for Achieving Sustainable Improvement," New York City, June
30-July 1, 2003. The proceedings were published in Home Healthcare Nurse
December 2004. An interview with the PI (and the commissioned papers from this
meeting) was published in the May/June 2004 edition of the Journal for
Healthcare Quality (JHQ).
- Organized the
national meeting, "Advancing the Agenda for Home Healthcare Quality," held on
March 31-April 1, 2005. Proceedings were published in Home Healthcare Nurse
May 2006, and the commissioned papers were published in JHQ, Jan/Feb 2006.
- "The Importance
of Screening for Depression in Home Care Patients," Caring, November
2003.
- "Improving the
Delivery of Care for Diabetes Patients with a Collaborative Model," Home
Healthcare Nurse 23(3): 177-182, March 2005.
5. Potential for Sustainability/Expansion After PFQ
Grant Ends
As noted, the Diabetes Collaborative appeared to have
long-lasting effects on quality improvement initiatives within the eight
participating home health agencies. Seven of the eight that decided to
continue with the ReACH collaborative have demonstrated their interest in and
commitment to continuing QI activities, at least in an advisory capacity.
The Reducing Acute Care Hospitalization Collaborative
will continue until August 2007 with additional funding obtained from the
Robert Wood Johnson Foundation. Additionally, the project received a no cost
extension until September 2007. VNSNY hired a business consultant to help them
develop a strategic sustainability plan. The plan included research and
interviews with current and prospective partners, clients and key
stakeholders. Initial findings of the plan have revealed opportunities to
extend the Partnership and serve a key role with a variety of local and
national stakeholders to support translation of evidence-based strategies to
frontline home care practice. The plan will be finalized by the end of Project
Year 5.
Return to Appendix B Contents
Return to Contents
AHRQ Publication No. 08-M010-EF
Current as of December 20, 2006
Internet Citation:
Evaluation of AHRQ's Partnerships for Quality Program. Program Evaluation. AHRQ Publication No. 08-M010-EF, December 20, 2006. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/about/evaluations/partnerships/