Ambulatory Safety and Quality:Ambulatory Safety and Quality:Enabling Patient-Centered Care through Health ITEnabling Patient-Centered Care through Health IT

Funding Opportunity Announcement (FOA) Funding Opportunity Announcement (FOA) Technical AssistanceTechnical Assistance Conference CallConference Call

January 4, 2007January 4, 2007

Conference Call AgendaConference Call Agenda

Overview of AHRQ Ambulatory Safety and Quality Program

Overview of the FOA

Frequently asked questions

Open forum

Eligible InstitutionsEligible Institutions

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

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

– Unit of local or State government or eligible agency of the Federal government Unit of local or State government or eligible agency of the Federal government – Indian/Native American Tribal Government or Tribally Designated Organization Indian/Native American Tribal Government or Tribally Designated Organization

For profit organizations are not eligible to lead applicationsFor profit organizations are not eligible to lead applications– For-profit organizations may participate in projects as members of consortia or as For-profit organizations may participate in projects as members of consortia or as

subcontractorssubcontractors– For-profit organizations that produce health IT systems are encouraged to apply For-profit organizations that produce health IT systems are encouraged to apply

in partnership with a non-profit organizationin partnership with a non-profit organization

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

subcontractorssubcontractors

AHRQ Ambulatory Safety AHRQ Ambulatory Safety and Quality Programand Quality Program

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

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

complexity of ambulatory carecomplexity of ambulatory care

The program contains an emphasis on the role of The program contains an emphasis on the role of health information technology (health IT)health information technology (health IT)– Safe, high quality ambulatory care requires complex Safe, high quality ambulatory care requires complex

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

ASQ: Four componentsASQ: Four components

1.1. Risk Assessment in Ambulatory CareRisk Assessment in Ambulatory Care

2.2. Improving Quality through Clinician Improving Quality through Clinician Use of Health ITUse of Health IT

3.3. Enabling Patient-Centered Care Enabling Patient-Centered Care through Health ITthrough Health IT

4.4. Enabling Patient Safety and Quality Enabling Patient Safety and Quality Measurement through Health ITMeasurement through Health IT

Definition of ambulatory careDefinition of ambulatory care

Ambulatory care refers to all types of health Ambulatory care refers to all types of health services provided by health care professionals services provided by health care professionals on an outpatient basison an outpatient basis– in contrast to services provided to persons who are inpatientsin contrast to services provided to persons who are inpatients– usually implies that the patient must travel to a location to receive usually implies that the patient must travel to a location to receive

services which do not require an overnight stayservices which do not require an overnight stay

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

programprogram

RFA-HS-07-007RFA-HS-07-007   

This FOA solicits applications to explore the use of health information technology (IT) and related policies and practices to establish and enhance patient-centered care in ambulatory settings.  

Goals and AimsGoals and Aims The purpose of this FOA is to investigate novel methods or The purpose of this FOA is to investigate novel methods or

evaluate existing strategies for using health IT to create or evaluate existing strategies for using health IT to create or enhance patient-centered models of care in the ambulatory enhance patient-centered models of care in the ambulatory setting. setting.

The goal of this FOA is to identify, promote, and disseminate The goal of this FOA is to identify, promote, and disseminate models of patient-centered care that include the use of personal models of patient-centered care that include the use of personal health data and evidence-based information to support patients in health data and evidence-based information to support patients in managing their health and illnesses and improve health outcomes managing their health and illnesses and improve health outcomes in ambulatory care and across health care transitions.in ambulatory care and across health care transitions.

Demonstrate how patient-centered care can improve health Demonstrate how patient-centered care can improve health outcomes, patient safety, and patients' reported experience with outcomes, patient safety, and patients' reported experience with care. care. – Focus on shared decision-making and patient-clinician communication, Focus on shared decision-making and patient-clinician communication,

personal health records, integration of patient information across personal health records, integration of patient information across transitions in care, and patient self-management of chronic conditions. transitions in care, and patient self-management of chronic conditions. 

Patient-Centered CarePatient-Centered Care

Patient-centered care is responsive to the needs and preferences of individual patients, provides patients with access to their medical information, and empowers patients to be active participants in care decisions and in the daily management of their health and illnesses.

Areas of InterestAreas of Interest While there are many ways health IT may be used to While there are many ways health IT may be used to

provide patient-centered ambulatory care, AHRQ has provide patient-centered ambulatory care, AHRQ has identified the following four areas of particular interest:identified the following four areas of particular interest:– Shared decision-making and patient-clinician Shared decision-making and patient-clinician

communicationcommunication – Personal health records (PHRs)Personal health records (PHRs) – Integration of patient information across Integration of patient information across

transitions in caretransitions in care – Patient self-management of chronic conditionsPatient self-management of chronic conditions

Project OverviewProject Overview

Applicants are expected to:– describe an intervention to be studied, describe an intervention to be studied, – place the intervention in context and discuss how it is place the intervention in context and discuss how it is

expected or known to affect patient-centered care,  expected or known to affect patient-centered care,  – provide a detailed implementation plan with provide a detailed implementation plan with

appropriate methods, appropriate methods, – describe a robust analysis and evaluation plan with describe a robust analysis and evaluation plan with

measures for assessing patient-, office-, and health measures for assessing patient-, office-, and health system-level outcomes, system-level outcomes,

– and include a dissemination plan.and include a dissemination plan.

Highlights of the Research Design Highlights of the Research Design and Methods Sectionand Methods Section

Describe the selected research design and methodsDescribe the selected research design and methods– Explain why given the project objectives, and taking into account Explain why given the project objectives, and taking into account

practical constraints, the research design will best enable the specific practical constraints, the research design will best enable the specific aims to be realized.  aims to be realized. 

The applicant should describe the health IT component of the The applicant should describe the health IT component of the intervention.  intervention.  – When possible, the health IT intervention should conform to When possible, the health IT intervention should conform to

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

The design must include a timeline with specific The design must include a timeline with specific milestones, covering all major phases of the project. milestones, covering all major phases of the project.

Specify the project’s primary and secondary outcome Specify the project’s primary and secondary outcome measures.  measures.  – These may include health outcome, patient satisfaction, process These may include health outcome, patient satisfaction, process

measures, costs, and measures of patient safety. measures, costs, and measures of patient safety. 

Assessing Patient Experience Assessing Patient Experience

Applicants are strongly encouraged to use AHRQ- Applicants are strongly encouraged to use AHRQ- funded CAHPS® Clinician & Group Survey as an funded CAHPS® Clinician & Group Survey as an outcome measure outcome measure – Domains include: access (getting needed care and Domains include: access (getting needed care and

getting care quickly), clinician communication, office staff getting care quickly), clinician communication, office staff courtesy, helpfulness and respect, and an overall rating.  courtesy, helpfulness and respect, and an overall rating. 

– Optional supplements: shared decision making and cost Optional supplements: shared decision making and cost of care. of care.

Please consider sharing data with National CAHPS Please consider sharing data with National CAHPS Benchmarking Database (NCBD)Benchmarking Database (NCBD)

For more information: For more information: www.cahps.ahrq.govwww.cahps.ahrq.gov

Required MeasurementsRequired Measurements

Applicants are required to measure and report on the percent Applicants are required to measure and report on the percent of eligible patients who have access to their personal health of eligible patients who have access to their personal health information, including medication therapy, and/or customized information, including medication therapy, and/or customized decision support.  decision support. 

When appropriate, applicants are required to measure and When appropriate, applicants are required to measure and report patients’ access to and utilization of quality report patients’ access to and utilization of quality measurement reports of their providers.measurement reports of their providers.

AHRQ strongly encourages applicants to measure and report AHRQ strongly encourages applicants to measure and report the percent of ambulatory clinicians who routinely use the percent of ambulatory clinicians who routinely use measurement tools to evaluate their patient’s experience.measurement tools to evaluate their patient’s experience.

More HighlightsMore Highlights

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

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

Must present a project dissemination planMust present a project dissemination plan– Dissemination plan must be incorporated into proposed budgetDissemination plan must be incorporated into proposed budget– Additional dissemination grants may be available. Project plan and Additional dissemination grants may be available. Project plan and

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

Privacy and SecurityPrivacy and Security

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

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

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

Three Special Funding PreferencesThree Special Funding Preferences

Projects conducted in primary care Practice-Based Research Networks Projects conducted in primary care Practice-Based Research Networks ($1.5 million)($1.5 million)

Projects focusing on practices that serve vulnerable populations ($1.5 Projects focusing on practices that serve vulnerable populations ($1.5 million) million)

Projects that focus on medication management Projects that focus on medication management ($2.0 million)($2.0 million)

Many projects will be included in more than one of these priority areas Many projects will be included in more than one of these priority areas and awards in these areas are contingent upon the submission of a and awards in these areas are contingent upon the submission of a sufficient number of meritorious applications. sufficient number of meritorious applications.

All applications should include Appendix 1All applications should include Appendix 1– State which of the funding preferences for which the application State which of the funding preferences for which the application

should be considered or “No funding preference requested.”should be considered or “No funding preference requested.” Section III.3 details requirements for funding preferencesSection III.3 details requirements for funding preferences

Funding considerationsFunding considerations

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

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

FOAFOA Relevance to program prioritiesRelevance to program priorities Programmatic balance among the ASQ initiative Programmatic balance among the ASQ initiative

projectsprojects Portfolio balance within AHRQ and DHHS patient Portfolio balance within AHRQ and DHHS patient

safety and health IT activitiessafety and health IT activities

Review CriteriaReview Criteria

Significance and impact Significance and impact Usefulness and generalizability Usefulness and generalizability Approach Approach Investigators and Partnerships Investigators and Partnerships Study setting(s) Study setting(s) Budget Budget

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

Mechanism of Support & Mechanism of Support & Funds AvailableFunds Available

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

evaluate health service activities evaluate health service activities One-time solicitation Projected $6 million in total costs in FY 07 ~15-20 grants Up to 36 months in duration Budget supported by AHRQ not to exceed $1.2 million in

total costs (Note: total costs = direct and indirect) Budget also may not exceed $500,000 in total costs in any

single project year Anticipated that size and duration will vary

AHRQ does not accept modular AHRQ does not accept modular budgetsbudgets

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

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

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

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

All applications must be submitted All applications must be submitted electronicallyelectronically

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

Eligible InstitutionsEligible Institutions

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

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

– Unit of local or State government or eligible agency of the Federal government Unit of local or State government or eligible agency of the Federal government – Indian/Native American Tribal Government or Tribally Designated Organization Indian/Native American Tribal Government or Tribally Designated Organization

For profit organizations are not eligible to lead applicationsFor profit organizations are not eligible to lead applications– For-profit organizations may participate in projects as members of consortia or as For-profit organizations may participate in projects as members of consortia or as

subcontractorssubcontractors– For-profit organizations that produce health IT systems are encouraged to apply For-profit organizations that produce health IT systems are encouraged to apply

in partnership with a non-profit organizationin partnership with a non-profit organization

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

subcontractorssubcontractors

Principal Investigator (PI)Principal Investigator (PI)

The PI should be an experienced senior level individual

Because of the nature of the project, expertise in evaluation is also a critical need that can be met through the requisite experience of the PI or another member of the project team.  

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

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

Applications should describe PI responsibilities and background.  

Key DatesKey Dates

Opening Date: January 15, 2007 Letter of Intent Receipt Date: January 19, 2007 Application Submission Date: February 15, 2007 Peer Review Date: April/May 2007 Earliest Anticipated Start Date: July 2007

Frequently Asked QuestionsFrequently Asked Questions

Are hospitals allowed to apply?Are hospitals allowed to apply?

Public and non-profit health care institutions, Public and non-profit health care institutions, including hospitals, are eligible to apply.including hospitals, are eligible to apply.

For-profit organizations, including for-profit For-profit organizations, including for-profit health care organizations and health IT health care organizations and health IT vendors, may be included as consortia vendors, may be included as consortia members or subcontractors in an application members or subcontractors in an application submitted by an eligible lead organization.submitted by an eligible lead organization.

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

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

Related Budget.  Related Budget.  – Do not use a Modular Budget.  Do not use a Modular Budget.  – Applications submitted in modular budget format Applications submitted in modular budget format

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

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

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

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

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

What if we want to focus on the transition What if we want to focus on the transition between settingsbetween settings??

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

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

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

chronically ill populations. chronically ill populations. – Non-ambulatory settings with a strong interest in fostering Non-ambulatory settings with a strong interest in fostering

safe, high quality ambulatory care and transitions are safe, high quality ambulatory care and transitions are welcome to apply in partnership with an ambulatory welcome to apply in partnership with an ambulatory organization organization

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

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

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

Ground Rules for Open ForumGround Rules for Open Forum The conference call operator will put you in a queue based on

call order.

Please keep your questions brief.

We will try to keep responses brief.

Questions that are very specific to a particular institution or situation will not be addressed – these can be discussed individually with a Project Officer from AHRQ at a later time.

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

AHRQ contactsAHRQ contacts For additional technical assistance, please contact an AHRQ

staff person who will be glad to provide technical assistance:

– Scientific/Research Issues: David Meyers: David.Meyers@ahrq.hhs.gov Ronda Hughes: Ronda.Hughes@ahrq.hhs.gov

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

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