Ambulatory Safety and Quality: Enabling Patient-Centered Care through Health IT Funding Opportunity Announcement (FOA) Technical Assistance Conference Call January 4, 2007

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

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

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: Four 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

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

RFA-HS RFA-HS 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 Aims The purpose of this FOA is to investigate novel methods or evaluate existing strategies for using health IT to create or enhance patient-centered models of care in the ambulatory setting. The purpose of this FOA is to investigate novel methods or evaluate existing strategies for using health IT to create or enhance patient-centered models of care in the ambulatory setting. The goal of this FOA is to identify, promote, and disseminate models of patient-centered care that include the use of personal health data and evidence-based information to support patients in managing their health and illnesses and improve health outcomes in ambulatory care and across health care transitions. The goal of this FOA is to identify, promote, and disseminate models of patient-centered care that include the use of personal health data and evidence-based information to support patients in managing their health and illnesses and improve health outcomes in ambulatory care and across health care transitions. Demonstrate how patient-centered care can improve health outcomes, patient safety, and patients' reported experience with care. Demonstrate how patient-centered care can improve health outcomes, patient safety, and patients' reported experience with care. – Focus on shared decision-making and patient-clinician communication, personal health records, integration of patient information across transitions in care, and patient self-management of chronic conditions. – Focus on shared decision-making and patient-clinician communication, personal health records, integration of patient information across transitions in care, and patient self-management of chronic conditions.

Patient-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 Interest While there are many ways health IT may be used to provide patient-centered ambulatory care, AHRQ has identified the following four areas of particular interest: While there are many ways health IT may be used to provide patient-centered ambulatory care, AHRQ has identified the following four areas of particular interest: – Shared decision-making and patient-clinician communication – Personal health records (PHRs) – Integration of patient information across transitions in care – Patient self-management of chronic conditions

Project Overview Applicants are expected to: – describe an intervention to be studied, – place the intervention in context and discuss how it is expected or known to affect patient-centered care, – place the intervention in context and discuss how it is expected or known to affect patient-centered care, – provide a detailed implementation plan with appropriate methods, – describe a robust analysis and evaluation plan with measures for assessing patient-, office-, and health system-level outcomes, – and include a dissemination plan.

Highlights of the Research Design and Methods Section Describe the selected research design and methods Describe the selected research design and methods – Explain why given the project objectives, and taking into account practical constraints, the research design will best enable the specific aims to be realized. – Explain why given the project objectives, and taking into account practical constraints, the research design will best enable the specific aims to be realized. The applicant should describe the health IT component of the intervention. The applicant should describe the health IT component of the intervention. – When possible, the health IT intervention should conform to interoperability standards and use certified products (see – When possible, the health IT intervention should conform to interoperability standards and use certified products (see The design must include a timeline with specific milestones, covering all major phases of the project. The design must include a timeline with specific milestones, covering all major phases of the project. Specify the project’s primary and secondary outcome measures. Specify the project’s primary and secondary outcome measures. – These may include health outcome, patient satisfaction, process measures, costs, and measures of patient safety. – These may include health outcome, patient satisfaction, process measures, costs, and measures of patient safety.

Assessing Patient Experience Applicants are strongly encouraged to use AHRQ- funded CAHPS® Clinician & Group Survey as an outcome measure Applicants are strongly encouraged to use AHRQ- funded CAHPS® Clinician & Group Survey as an outcome measure – Domains include: access (getting needed care and getting care quickly), clinician communication, office staff courtesy, helpfulness and respect, and an overall rating. – Domains include: access (getting needed care and getting care quickly), clinician communication, office staff courtesy, helpfulness and respect, and an overall rating. – Optional supplements: shared decision making and cost of care. Please consider sharing data with National CAHPS Benchmarking Database (NCBD) Please consider sharing data with National CAHPS Benchmarking Database (NCBD) For more information: For more information:

Required Measurements Applicants are required to measure and report on the percent of eligible patients who have access to their personal health information, including medication therapy, and/or customized decision support. Applicants are required to measure and report on the percent of eligible patients who have access to their personal health information, including medication therapy, and/or customized decision support. When appropriate, applicants are required to measure and report patients’ access to and utilization of quality measurement reports of their providers. When appropriate, applicants are required to measure and report patients’ access to and utilization of quality measurement reports of their providers. AHRQ strongly encourages applicants to measure and report the percent of ambulatory clinicians who routinely use measurement tools to evaluate their patient’s experience. AHRQ strongly encourages applicants to measure and report the percent of ambulatory clinicians who routinely use measurement tools to evaluate their patient’s experience.

More Highlights 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. Must present a project dissemination plan Must 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.

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

Three Special Funding Preferences Projects conducted in primary care Practice-Based Research Networks ($1.5 million) Projects conducted in primary care Practice-Based Research Networks ($1.5 million) Projects focusing on practices that serve vulnerable populations ($1.5 million) Projects focusing on practices that serve vulnerable populations ($1.5 million) Projects that focus on medication management ($2.0 million) Projects that focus on medication management ($2.0 million) 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 sufficient number of meritorious applications. 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 sufficient number of meritorious applications. All applications should include Appendix 1 All applications should include Appendix 1 – State which of the funding preferences for which the application should be considered or “No funding preference requested.” Section III.3 details requirements for funding preferences Section III.3 details requirements for funding preferences

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 Usefulness and generalizability Usefulness and generalizability Approach Approach Investigators and Partnerships Investigators and Partnerships Study setting(s) Study setting(s) Budget Budget Additional considerations Additional considerations – Degree of responsiveness – 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 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 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 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 Questions

Are hospitals allowed to apply? Public and non-profit health care institutions, including hospitals, are eligible to apply. Public and non-profit health care institutions, including hospitals, are eligible to apply. For-profit organizations, including for-profit health care organizations and health IT vendors, may be included as consortia members or subcontractors in an application submitted by an eligible lead organization. For-profit organizations, including for-profit health care organizations and health IT vendors, may be included as consortia members or subcontractors in an application submitted by an eligible lead organization.

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.

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

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.

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: David Meyers: Ronda Hughes: – – Peer Review Issues: Kishena Wadhwani: – – Financial/Grant Management Issues: Michelle Burr: