Ambulatory Safety and Quality: Improving Management of Individuals with Complex Healthcare Needs through Health IT Funding Opportunity Announcement (FOA) Technical Assistance Conference Call January 10, 2008

Conference Call Agenda Overview of AHRQ Ambulatory Safety and Quality Program Overview of the FOA Frequently asked questions Open forum

AHRQ Ambulatory Safety and Quality Program Purpose: To improve the safety and quality of ambulatory health care in the United States Purpose: To improve the safety and quality of ambulatory health care in the United States – Patient safety and quality crises in hospitals are only the “tip of the iceberg.” – AHRQ recognizes the increasing scope, volume, and complexity of ambulatory care The program contains an emphasis on the role of health information technology (health IT) The program contains an emphasis on the role of health information technology (health IT) – Safe, high quality ambulatory care requires complex information management and coordination across multiple settings, especially for patients with chronic illnesses.

ASQ: Five components 1. Risk Assessment in Ambulatory Care 2. Improving Quality through Clinician Use of Health IT 3. Enabling Patient-Centered Care through Health IT 4. Enabling Patient Safety and Quality Measurement through Health IT 5. Improving Management of Individuals with Complex Healthcare Needs through Health IT

Definition of ambulatory care Ambulatory care refers to all types of health services provided by health care professionals on an outpatient basis Ambulatory care refers to all types of health services provided by health care professionals on an outpatient basis – in contrast to services provided to persons who are inpatients – usually implies that the patient must travel to a location to receive services which do not require an overnight stay Ambulatory settings include: health care clinician offices (large and small practices), outpatient clinics, community health centers, emergency departments, urgent care centers, and ambulatory surgery centers. Ambulatory settings include: health care clinician offices (large and small practices), outpatient clinics, community health centers, emergency departments, urgent care centers, and ambulatory surgery centers. – Home care entities are included for the purpose of this program

Definition of complex health care needs An individual with complex healthcare needs requires on-going services from a variety of providers over a significant period of time, e.g., multiple chronic diseases An individual with complex healthcare needs requires on-going services from a variety of providers over a significant period of time, e.g., multiple chronic diseases

Definition of health care transitions Health care transitions Health care transitions – Movement of patients between health care providers and settings as their conditions and care needs change during the course of a chronic or acute illness – The ASQ program includes a focus on transitions between ambulatory care settings and hospitals, home care, assisted living centers, and nursing homes critical to the success of ambulatory care for many elderly and chronically ill populations. critical to the success of ambulatory care for many elderly and chronically ill populations. – Non-ambulatory settings with a strong interest in fostering safe, high quality ambulatory care and transitions are welcome to apply in partnership with an ambulatory organization

RFA-HS AHRQ is interested in supporting projects that investigate novel methods or evaluate existing strategies for both clinician and patient/family use of health IT in ambulatory settings to improve outcomes through more effective decision support or care delivery for patients with complex healthcare needs and those in high risk care transitions AHRQ is interested in supporting projects that investigate novel methods or evaluate existing strategies for both clinician and patient/family use of health IT in ambulatory settings to improve outcomes through more effective decision support or care delivery for patients with complex healthcare needs and those in high risk care transitions

Aims While health IT has demonstrated improvement in health care safety and quality in several large health care delivery systems, the rate of health IT adoption in ambulatory settings remains low. However, once implemented, health IT has the potential to facilitate new models of care delivery, including management of patients by population, engaging with patients asynchronously, and linking resources in the community While health IT has demonstrated improvement in health care safety and quality in several large health care delivery systems, the rate of health IT adoption in ambulatory settings remains low. However, once implemented, health IT has the potential to facilitate new models of care delivery, including management of patients by population, engaging with patients asynchronously, and linking resources in the community Advancing knowledge in the following areas: Advancing knowledge in the following areas: – Providing high quality, appropriate care through the use of health IT – Shared decision making and patient-clinician communication – Integration of patient information across transitions in care – Strategies for successful health IT adoption in ambulatory settings – Impact of health IT on outcomes related to patients with complex health care needs and across transitions in care in ambulatory settings Span the spectrum from discovery, translation, measurement, and widespread dissemination of strategies Span the spectrum from discovery, translation, measurement, and widespread dissemination of strategies

RFA Objectives cont. AHRQ is interested in advancing knowledge in the following areas: AHRQ is interested in advancing knowledge in the following areas: – Providing high quality, appropriate care through the use of health IT – Shared decision making and patient-clinician communication – Integration of patient information across transitions in care – Strategies for successful health IT adoption in ambulatory settings – Impact of health IT on outcomes related to patients with complex health care needs and across transitions in care in ambulatory settings

Project Requirements Applicants are expected to: – describe the specific health IT application and intervention to be studied, and the expected effect on safety and other domains of quality – develop a project design and methodology plan which includes the research design, outcome measures and evaluation plan, project milestones and timeline – assess primary and secondary outcomes including clinical outcomes, system-level process and/or efficiency outcomes, using measures suggested in this FOA where appropriate – provide an evaluation and data analysis plan, including how the data will be collected at baseline and after intervention – outline a plan for dissemination of results and adoption by other sites, including a proposal for widespread dissemination should the project results merit

Highlights of the Research Design and Methods Describe the health IT intervention and should describe the development of the intervention and the methodology for implementation. Describe the health IT intervention and should describe the development of the intervention and the methodology for implementation. – When possible, the health IT intervention should conform to interoperability standards and use certified products (see and – When possible, the health IT intervention should conform to interoperability standards and use certified products (see and Describe how the intervention could be integrated into the delivery of ambulatory care throughout the applicant organization and potentially into sites across the nation. Describe how the intervention could be integrated into the delivery of ambulatory care throughout the applicant organization and potentially into sites across the nation. Discuss the future sustainability of the intervention by host organization after the grant has ended. Discuss the future sustainability of the intervention by host organization after the grant has ended. Present a project dissemination plan Present a project dissemination plan – Dissemination plan must be incorporated into proposed budget – Additional dissemination grants may be available. Project plan and budget, however, must be complete without additional funding.

Outcomes measurement Applicants must specify the project’s primary and secondary outcome measures and how these will be evaluated. Applicants must specify the project’s primary and secondary outcome measures and how these will be evaluated. Required, when appropriate to the project aims: Required, when appropriate to the project aims: – the percent of adoption and use of health IT – the percent of patients who are receiving the appropriate care for prevention, treatment and medication therapy – the percent of eligible patients within the practices who have access to their personal health information – patients’ and providers' access to and utilization of quality measurement reports, especially if aggregated through a health information exchange – the percent of ambulatory care clinicians within the practices that they partner with who routinely use measurement tools to evaluate their patient’s experience, using CAHPS® Clinician & Group Survey (see

Privacy and Security All applicants are required to describe how, in the development and implementation of the intervention, privacy and security issues related to the exchange of sensitive health information will be identified and addressed. All applicants are required to describe how, in the development and implementation of the intervention, privacy and security issues related to the exchange of sensitive health information will be identified and addressed. – Applicants should describe the resources and processes they will use to assure that these privacy and security concerns are being met throughout the project period. These could include the inclusion of participating patients in periodic reviews in order to solicit their input and consultation with knowledgeable professionals over the course of the project, as well as a description of any existing privacy or security practices and technology that will be incorporated into the project and reviewed for compliance on a regular basis. – See the FOA for additional information

Funding considerations Scientific merit of the proposed project as determined by peer review Scientific merit of the proposed project as determined by peer review Availability of funds Availability of funds Responsiveness to goals and objectives of the FOA Responsiveness to goals and objectives of the FOA Relevance to program priorities Relevance to program priorities Programmatic balance among the ASQ initiative projects Programmatic balance among the ASQ initiative projects Portfolio balance within AHRQ and DHHS patient safety and health IT activities Portfolio balance within AHRQ and DHHS patient safety and health IT activities

Review Criteria Significance and impact Significance and impact Approach Approach Innovation Innovation Investigators and Partnerships Investigators and Partnerships Study setting(s) Study setting(s) Additional considerations Additional considerations – Degree of responsiveness – Budget – Privacy and Security Protections for Patients – Protection of Human Subjects from Research Risk – Inclusion of priority populations

Mechanism of Support & Funds Available R 18 Research Demonstration and Dissemination Projects – To provide support designed to develop, test and evaluate health service activities Up to $3 million available in FY 2008 Up to $3 million available in FY 2008 Projects may be up to 3 years with $1.2 million total cost ceiling and no more than $500,000 allowed in any single year Projects may be up to 3 years with $1.2 million total cost ceiling and no more than $500,000 allowed in any single year Anticipated 5 -7 awards Anticipated 5 -7 awards Budget requests that exceed these limits will be returned without review Budget requests that exceed these limits will be returned without review

AHRQ does not accept modular budgets AHRQ uses ONLY the detailed Research & Related Budget. AHRQ uses ONLY the detailed Research & Related Budget. Do not use the PHS 398 Modular Budget. Do not use the PHS 398 Modular Budget. Applications submitted in modular budget format will be returned without review. Applications submitted in modular budget format will be returned without review.

SF424(R&R) All applications must be submitted electronically All applications must be submitted electronically Please see FOA for instructions on how to obtain electronic forms and register your institution and PI Please see FOA for instructions on how to obtain electronic forms and register your institution and PI

Eligible 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 including non-profit health care organizations, universities, colleges, and faith-based or community-based organizations including non-profit health care organizations, universities, colleges, and faith-based or community-based organizations – Unit of local or State government or eligible agency of the Federal government – Indian/Native American Tribal Government or Tribally Designated Organization For profit organizations are not eligible to lead applications For profit organizations are not eligible to lead applications – For-profit organizations may participate in projects as members of consortia or as subcontractors – For-profit organizations that produce health IT systems are encouraged to apply in 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 subcontractors

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 Dates Opening Date: January 21, 2008 Letter of Intent Receipt Date: January 18, 2008 Application Submission Date: February 21, 2008 Peer Review Date: May/June 2008 Earliest Anticipated Start Date: July 2008

Frequently Asked Questions

Does AHRQ accept modular budgets? No. No. – AHRQ uses ONLY the detailed Research & Related Budget. – AHRQ uses ONLY the detailed Research & Related Budget. – Do not use a Modular Budget. – Do not use a Modular Budget. – Applications submitted in modular budget format will be returned without review.

Are Emergency Rooms ambulatory care sites? For the purpose of this FOA, Yes. For the purpose of this FOA, Yes. – Ambulatory settings include: health care clinician offices (large and small practices), outpatient clinics, community health centers, emergency departments, urgent care centers, and ambulatory surgery centers. – Ambulatory settings include: health care clinician offices (large and small practices), outpatient clinics, community health centers, emergency departments, urgent care centers, and ambulatory surgery centers. – For the purpose of this program: home care entities are included as well.

Can there be Co-PIs? No. No. – AHRQ requires that the lead institution designate one and only one individual as the project’s principal investigator.

How much detail should the letter of intent (LOI) include? The LOI is to allow AHRQ staff to estimate the potential peer review workload and plan the review The LOI is to allow AHRQ staff to estimate the potential peer review workload and plan the review AHRQ will not provide feedback on the LOI. AHRQ will not provide feedback on the LOI. Content should include: Content should include: – an acknowledgement of interest in this funding opportunity – a few comments on the subject of the proposed research – background expertise of key personnel – the nature and role of participating institutions – the nature and role of participating institutions This letter of intent is not required, is not binding, and is not considered in the review of a subsequent application. This letter of intent is not required, is not binding, and is not considered in the review of a subsequent application.

Ground 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 your question to

AHRQ contacts For additional technical assistance, please contact an AHRQ staff person who will be glad to provide technical assistance: – – Scientific/Research Issues: Robert Mayes: – – Peer Review Issues: Kish Wadhwani: – – Financial/Grant Management Issues: Michelle Burr: