The Agency for Healthcare Research and Quality (AHRQ) has a long record of conducting and supporting research that contributes to the knowledge base on quality improvement and patient safety. This report presents, alphabetically and by State, selected ongoing or recently completed AHRQ programs and other activities related to the quality of the Nation's health care and its improvement.
Introduction: AHRQ and Quality
How This List Is Organized
Programs and Projects
Additional Information
Online AHRQ Quality-Related Resources
State-Based Health Policy/Research Centers
Quality health care means doing the right thing at the right time in the right way for the right people—and having the best possible results.* As the lead Federal agency concerned with improving quality of care, AHRQ's mission is to improve the quality, safety, efficiency, and effectiveness of health care for all Americans. The Agency's research and other programs provide information that helps people make more informed health care decisions and improve the Nation's health care system.
AHRQ's recently completed and ongoing initiatives related to improving the quality and safety of health care, listed by State, are categorized as follows:
Centers for Education and Research on Therapeutics (CERTs)
The CERTs program is a national initiative to increase awareness of the benefits and risks of new, existing, or combined uses of therapeutics through education and research. Seven Centers, each with a specific area of research emphasis, comprise the program. The Centers work with public and private collaborators on projects, thus allowing each Center to expand the number of its research projects and extend their potential impact. More information is available at www.ahrq.gov/clinic/certsovr.htm.
HCUP State Partners
The Healthcare Cost and Utilization Project (HCUP) is a family of health care databases and related software tools and products developed through a Federal-State-Industry partnership sponsored by AHRQ. The HCUP databases are based on the data collection efforts of State and private data organizations and hospital organizations in participating States that maintain statewide data systems and contribute their data to HCUP. Currently, 38 State data organizations partner with AHRQ in the Healthcare Cost and Utilization Project. Contact information for HCUP State partners is available on the HCUP User Support Web site at www.hcup-us.ahrq.gov/partners.jsp.
Health Information Technology (IT) Projects
The health IT initiative aims to promote the use of information technology through developing networks for sharing clinical data in order to improve the Nation's health care system. The initiative includes support for over 100 grants and contracts to communities, hospitals, providers, and health care systems in 40 States, including small and rural hospitals, to help in all phases of developing and using IT to improve health care. The IT effort includes State-based development of statewide networks for health information sharing and creation of a national health IT resource center. Other recent IT-related projects in addition to those in AHRQ's health IT initiative are also listed here.
IDSRN Partners
The Integrated Delivery System Research Network (IDSRN) was developed explicitly to capitalize on the research capacity of, and research opportunities occurring within, integrated delivery systems. The network of nine partners and their health system collaborators develops and disseminates scientific evidence about what works and what does not work in terms of organizational "best practices" related to care delivery and research diffusion. This model of field-based research links the Nation's top researchers with some of the largest health care systems to conduct research on critical health care issues on an accelerated timetable. Some recent projects from the IDSRN partners are listed here; a complete listing is at www.ahrq.gov/research/idsrnproj.htm.
Partnerships for Quality
The purpose of the Partnerships for Quality initiative is development of partnerships among researchers, health plans, medical and nursing facilities and services, employers, consumer groups, and professional societies to test prototype activities aimed at accelerating the health system's adoption of research findings that have been shown to improve quality of care for patients. Initiated in 2002, the 22 projects span much of the Nation and involve more than 88,000 medical providers; 5,800 hospitals, nursing homes and other health care facilities; and 180 health plans.
Partnerships in Implementing Patient Safety
These 17 projects are assisting health care institutions to implement safe practice interventions that show evidence of eliminating or reducing risks, hazards, and harms associated with the process of care. A key component is the development of a set of free, publicly available toolkits for health care providers and others that will share lessons learned on how to best implement patient safety practices. Because some of the projects involve health systems with locations in several States, the research projects will, in effect, span nearly half of the States.
Patient Safety Improvement Corps
A collaboration between AHRQ and the Department of Veterans Affairs National Center for Patient Safety, the Patient Safety Improvement Corps is a training program for State health officials and their selected hospital partners to improve safety nationwide by developing and evaluating sustainable interventions. Fifteen States in 2003-04 and 20 States and the District of Columbia in 2004-05 have completed the training program. The program—three 1-week sessions and a patient safety project to be completed over the year—lets participants analyze adverse medical events and "near misses" with the aim of identifying the root causes of the events so as to correct or prevent them. Additional information is available at http://www.patientsafety.gov/psic/.
Other Patient Safety/Quality Improvement Projects
In addition to the specific programs and initiatives categorized separately, these Other Patient Safety/Quality Improvement Projects aim to build research capacity around quality of care and safety issues, identify root causes of threats to patient safety, test reporting strategies and interventions to improve quality and safety, and translate research findings into practice. Beginning in fiscal year 2001, this far-reaching initiative includes support for patient safety centers of excellence, as well as research and demonstration projects for identifying and implementing processes and systems of care that improve safety. A variety of administrative mechanisms—including research grants, contracts, task orders, and career development awards—are being utilized to support these far-reaching quality and patient safety efforts.
Practice-Based Research Networks (PBRNs)
In 2002 AHRQ awarded developmental grants to 36 primary care practice-based research networks. Each PBRN is a group of ambulatory practices, devoted principally to the primary care of patients and affiliated with each other and with an academic institution or professional organization. AHRQ provides support to these institutions to enhance the capacity of the PBRNs and to better address questions related to community-based health care and the translation of research findings into practice.
Select link to go to programs and projects in each State.
UAB CERTs of Musculoskeletal Disorders (U18 HS10389)
Institution: University of Alabama (Birmingham)
Investigator: Kenneth G. Saag
Emphasis: Therapies for musculoskeletal disorders
Improving Primary Care Patient Safety With Handheld DSS (R18 HS11820)
Institution: University of Alabama (Birmingham)
Investigator: Eta Berner
Objective: Develop, implement, and evaluate computer-based decision support systems (DSSs) in ambulatory care settings by examining barriers to clinician use of these handheld devices and assessing their impact on patient safety, specifically on prevention of inappropriate prescribing of medications.
PDA-CT: Informatics for Community Treatment Teams (290-01-0024)
Institution: Simulation Technologies, Inc. (Huntsville)
Investigator: Annie Saylor
Objective: Develop, implement, and evaluate a decision support system intervention focused on minimizing the barriers to use of these systems to impact patient safety.
Alabama Practice-Based Research Network (R21 HS12529)
Institution: University of Alabama (Birmingham)
Investigator: T. Michael Harrington
Objective: Enhance the capacity of the network's clinicians, most of whom are in medically underserved areas, to improve practice using personal digital assistants (PDAs) and conduct studies on the use of PDA-managed protocols to promote smoking cessation and reduce obesity-related morbidity and mortality.
Return to Programs and Projects
Central Kenai Peninsula Health Collaborative Technology (P20 HS14902)
Institution: Central Peninsula General Hospital, Inc. (Soldotna)
Investigator: Edward Burke
Objective: Assess current technology resources and plan implementation of area-wide electronic communications and connectivity to electronic health records and a patient-support Web-based data system.
Division of Alaska Longevity Programs (Juneau)
Partner: Yukon-Kuskokwim Health Corporation (Bethel)
Project: Analyzing the Process of Transferring a Patient from Facility to Facility
Objective: Use health care failure mode effects analysis to assess the process of transferring a patient out of a facility, focusing on the major steps from the time the decision is made to transfer a patient until the patient leaves the facility.
Rheumatoid Arthritis Quality of Care in Alaska Natives (R03 HS15625)
Institution: Alaska Native Tribal Health Consortium (Anchorage)
Investigator: Elizabeth Ferucci
Objective: Identify deficiencies present in rheumatoid arthritis care and factors contributing to them and develop quality improvement initiatives to be implemented statewide to improve the care of Alaska Natives with rheumatoid arthritis.
Return to Programs and Projects
University of Arizona CERTs (U18 HS10385)
Institution: University of Arizona (Tucson)
Investigator: Raymond Woosley
Emphasis: Reduction of drug interactions that result in harm to women
Arizona Department of Health Services (Phoenix)
Banner Health/ASU Partnership for ED Patient Safety (U18 HS15921)
Institution: Banner Health (Phoenix)
Investigator: Twila Burdick
Objective: Implement a patient flow process called "Door-to-Doc," which reduces the time patients wait to see an emergency department (ED) physician, and facilitate the moving of ED patients who need to be admitted to the most appropriate inpatient nursing unit.
Return to Programs and Projects
Arkansas Delta Inpatient/Outpatient Quality Improvement (UC1 HS15059)
Institution: St. Bernards Medical Center (Jonesboro)
Investigator: Cinda Bates
Objective: Implement a computer decision-support system in inpatient and outpatient settings, including several rural clinics, in a 23-county area. The system includes a health care provider training component a hospital pharmacy component for adverse drug event management and prevention strategies.
Arkansas Research Collaborative (ARC) (R21 HS13580)
Institution: University of Arkansas for Medical Sciences (Little Rock)
Investigator: Geoffrey Goldsmith
Objective: Study the care provided to the State's large rural population, specifically by developing an information management system to use in assessing and improving the quality of care and disseminating research findings statewide.
Return to Programs and Projects
Office of Statewide Health Planning and Development (Sacramento)
Health Information Technology Systems (290-02-0003)
Institution: Southern California Evidence-based Practice Center—RAND (Santa Monica)
EPC Director: Paul Shekelle
Objective: Examine the evidence on the costs/benefits of interoperable electronic health IT data exchange for providers and payers/purchasers, identify barriers to implementation of electronic health IT systems, and determine the cost/benefit information needed by decisionmakers to give a clearer understanding of the health IT "value proposition" particular to a specific situation.
Crossing the Quality Chasm in Eastern Rural Kern County (P20 HS15342)
Institution: Tehachapi Hospital (Tehachapi)
Investigator: Kiki Nocella
Objective: Develop a regional collaborative and business plan for implementing health IT in a rural region and conduct a telemedicine demonstration project to assess the barriers and issues of broad health IT intervention including scan/store medical record, chronic disease registry and personal health record; telemedicine and teleradiology; and linking the region's partners.
El Dorado County Safety Net Technology Project (P20 HS14908)
Institution: Marshall Medical (Placerville)
Investigator: Neda West
Objective: Develop a comprehensive plan for health IT implementation and integration by 1) assessing specific clinical and organizational needs and feasibility of health IT implementation, 2) defining project parameters and developing the implementation plan, and 3) specifying procedures for ongoing evaluation and feedback.
IT Systems for Rural Indian Clinic Health Care (UC1 HS15339)
Institution: California Rural Indian Health Board (Sacramento)
Investigator: Susan Dahl
Objective: Integrate health services research, clinic redesign, and electronic practice management through a partnership with three rural Tribal Health Programs to implement electronic health records and clinical decision-support systems.
Tulare District Hospital Rural Health EMR Consortium (UC1 HS15096)
Institution: Healthcare Management Systems (Tulare)
Investigator: Paul Galloway
Objective: Use an existing infrastructure to construct a fully integrated electronic medical record (EMR) to give clinicians real-time access to patient data through pharmacy and laboratory management, patient scheduling, barcoding, physician order entry, electronic signature, insurance eligibility, and medication-dispensing units at nursing stations.
Santa Cruz County, CA Diabetes Mellitus Registry (UC1 HS15362)
Institution: Pajaro Valley Community Health (Watsonville)
Investigator: F. Wells Shoemaker
Objective: Expand a Web-based diabetes registry that provides patient histories and needed tests at the point of care among public, private, and not-for-profit health care providers and track the diabetes population to identify trends in key indicators.
Impact of Health Information Technology on Clinical Care (R01 HS15280)
Institution: Kaiser Foundation Research Institute (Oakland)
Investigator: John Hsu
Objective: Evaluate the effects of staggered installation of a health IT system that includes an electronic medical record with provider order entry and clinical decision support in primary care settings on quality, safety, and resource use within a large integrated delivery system that includes 780,000 members with chronic illnesses.
Kaiser Foundation Research Institute, Kaiser Permanente of Northern California (Oakland) (290-00-0015)
Collaborators: Kaiser Permanente—Northwest, Southern California, Colorado, Georgia, Hawaii, Group Health Cooperative of Puget Sound; Harvard Pilgrim Health Care; HealthPartners Research Foundation; Henry Ford Health System; Lovelace Health Systems; Fallon Health Care System
Projects:
Relationship of Provider Group Characteristics to Quality of Care and Medication Errors in Ambulatory Care Settings (290-00-0015-4)
Investigator: Leif Solberg/Floyd Frost
Objective: Study the effect of selected medical group practice characteristics on quality of care and patient safety, targeting two medication safety issues: drug-drug interactions and recommended laboratory monitoring of drug therapy.
Electronic Communication in Integrated Delivery Systems (290-00-0015-8)
Investigator: John Hsu
Objective: Assess how electronic communication, which includes E-mail and other Internet-based methods of communication, can improve communication, knowledge, access, effectiveness, timeliness, patient safety, and other aspects of health care.
Patient Characteristics, Adverse Drug Reactions, Best Practices, and Patient Safety: A Study of HIV Care in San Francisco (290-00-0015-9)
Investigator: Gerald DeLorenze/Stephen Follansbee
Objective: Evaluate practices undertaken to reduce adverse drug reactions and other untoward consequences of treatment for persons who are HIV positive.
Prevalence and Strategies for Appropriate Prescription Medication Dosing for Children (290-00-0015-10)
Investigator: Robert Davis
Objective: Examine the impact of a computerized physician order entry system and other interventions that address medication error to broaden knowledge on the types of children's prescription errors that occur and how to most effectively reduce them.
Antidepressant Medications and Suicidal Behavior in Children and Adolescents (290-00-0015-14)
Investigator: Enid Hunkeler
Objective: Use existing large databases to examine associations, if any, between various suicidal behaviors (i.e., suicide attempts, emergency room visits, and/or hospitalization for suicidal behavior) and antidepressant use by patients under 19 years of age.
CalNOC Partners To Reduce Patient Falls Project (U18 HS13704)
Institution: Association of California Nurse Leaders (Sacramento)
Investigator: Nancy Donaldson
Objective: Use evidence from the scientific literature and data from the California Nursing Outcomes Coalition's statewide repository to reduce the incidence of patient falls and fall-related injuries in California hospitals.
Consumer-Driven Model for Improving Health Care Quality (U18 HS13684)
Institution: Pacific Business Group on Health (San Francisco)
Investigator: David Hopkins
Objective: Stimulate market demand for high-quality physicians (i.e., physicians who scored highly on a set of quality measures) by identifying information on the quality and efficiency performance of physicians that could be provided to consumers.
Optimal Prevention of Hospital Acquired Venous Thromboembolism (U18 HS015826)
Institution: University of California (San Diego)
Investigator: Greg Maynard
Objective: Implement a protocol focusing on eliminating preventable hospital-acquired venous thromboembolism (VTE) and produce a modifiable toolkit that can be disseminated to other health care systems caring for patients at risk for VTE.
California Department of Health Services, Licensing and Certification Program Partners:
Huntington Hospital; Kaiser Permanente; Los Angeles County; USC Healthcare Network, Los Angeles, Oakland, Pasadena
Project: Patient Safety Improvement Resource Manual
Objective: Develop a resource manual that identifies and defines critical elements, activities, components, and functions of an effective patient safety program.
Center for Patient Safety at the End of Life (P20 HS11558)
Institution: RAND (Santa Monica)
Investigator: Dorcas Lynn
Objective: Improve the safety of end-of-life care for patients with serious chronic illness who are disproportionately affected by medical errors and other safety lapses.
Closing the Quality Gap: A Critical Analysis of Quality Improvement Strategies (290-02-0017)
Institution: Stanford-UC San Francisco Evidence-based Practice Center
EPC Director: Douglas Owens
Objective: Produce a systematic review and analysis of the evidence that discusses issues and methods on assessing whether the available evidence suggests that a setting- or population-specific quality improvement strategy would work (www.ahrq.gov/clinic/tp/qgap1tp.htm); and produce separate systematic reviews and analyses of the evidence for quality improvement in care for diabetes mellitus (www.ahrq.gov/clinic/tp/dbgap2tp.htm), asthma, hypertension (www.ahrq.gov/clinic/tp/hypergap3tp.htm), medication management, treatment of nosocomial infections, and care coordination.
End-of-Life Care and Outcomes (290-02-0003)
Institution: Southern California Evidence-based Practice Center—RAND (Santa Monica)
Objective: Produce a systematic review and analysis of the evidence (http://www.ahrq.gov/clinic/tp/eoltp.htm) on outcome variables, processes, and interventions that are associated with better or worse outcomes and that serve as valid indicators of the quality of end-of-life care for terminally ill patients and families.
Impacts of Unit-Level Nurse Workload on Patient Safety (R01 HS11954-01)
Institution: University of California (San Francisco)
Investigator: Nancy E. Donaldson
Objective: Assess the relationship between daily changes in hospital working conditions—including nurse staffing ratios, workload, and skill mix—and medical errors or adverse events.
Improving Drug Safety: Linking Lab and Pharmacy Data (UC1 HS14249)
Institution: Kaiser Foundation Research Institute (Oakland)
Investigator: David J. Magid
Objective: Conduct randomized controlled trials of an electronic alert system designed to detect prescription drug errors at the point of distribution in order to evaluate the usefulness of a device that intercepts medication errors after a prescription has been written but before a pharmacist can dispense the drug.
Medical-Surgical Co-Management Evaluating a New Paradigm (K08 HS11416)
Institution: University of California (San Francisco)
Investigator: Andrew Auerbach
Objective: Derive a medical complication risk index to identify high-risk patients and conduct a randomized trial of co-management of at-risk patients (as identified by the index) that examines co-management's impact on medical complication rates, utilization, and patient satisfaction.
Real-time Assessment of Risk Factors—Medication Errors (UC1 HS14283)
Institution: Veterans Medical Research Foundation (San Diego)
Investigator: Timothy Dresselhaus
Objective: Assess medication risk factors (wrong-patient, wrong-medication, or wrong-dosage) as they occur while sampling the types of medication errors involving different individuals in different hospital settings by using a handheld electronic device in order ot identify recurring and preventable medication errors that will serve as the foundation of institution-specific intervention plans.
Regionalization of Bioterrorism Preparedness and Response (290-02-0017)
Institution: Stanford-UC San Francisco Evidence-based Practice Center
EPC Director: Douglas Owens
Objective: Produce a systematic review and analysis of the evidence (http://www.ahrq.gov/clinic/tp/bioregtp.htm) identifying key tasks of responders and resources required to perform them in case of a bioterrorism event and the potential effectiveness of existing regional preparedness and response systems for accomplishing these key tasks.
Develop, Implement, Maintain, and Assess a National Electronic Web-based Morbidity and Mortality Conference Site (290-01-0011)
Institution: University of California, San Francisco
Investigator: Robert Wachter
Objective: Develop, test, and evaluate a national, Web-based, blame-free learning program for providers of health care that relies on reports of "near-misses" and is modeled after and functions like hospital morbidity and mortality conferences.
DCERPS: Standardized Encounters to Study Patient Safety (P20 HS11521)
Institution: University of California (San Diego)
Investigator: Joseph Scherger
Objective: Use realistic simulation techniques to analyze clinician-patient interactions in the hospital setting and create patient safety training materials based on the information from these simulated encounters.
Safety and Financial Ramifications of ED Copayments (R01 HS11434)
Institution: Kaiser Foundation Research Institute (Oakland)
Investigator: John Hsu
Objective: Evaluate the effects of the size of a copayment for emergency department use on mean treatment costs and rates of hospital admissions, intensive care unit admissions, and mortality for both the total population and selected vulnerable populations.
Strategic Alliance for Error Reduction: California Healthcare (P20 HS11512)
Institution: University of California (Los Angeles)
Investigator: Lee Hilborne
Objective: Establish coordinated, systems-level approaches and programs to better understand, identify, and prevent errors throughout the health care delivery system by involving key stakeholders to address issues of patient empowerment, data systems development, and provider culture change.
Telemedicine for Children in Rural Emergency Departments (K08 HS13179)
Institution: University of California (Davis)
Investigator: James Marcin
Objective: Determine the impact of telemedicine consultations on medication error rates, patient transfer rates, and implicit quality assessments, as well as on satisfaction with care that critically ill and injured children receive in rural emergency departments.
Transfer of a Novel Pediatric Simulation Program (U18 HS12022)
Investigator: Louis P. Halamek
Institution: Stanford University
Objective: Assess the impact of NeoSim, a simulator-based training program for neonatal resuscitation, to determine whether the skills acquired within a simulated delivery room environment result in improved human performance and enhanced patient safety in the actual delivery room.
Compendium of Patient Safety Practices (290-97-0013-6)
Institution: University of California (San Francisco)
Investigator: Robert Wachter
Objective: Produce a systematic review and analysis of the evidentiary base for practices to improve patient safety (http://www.ahrq.gov/clinic/tp/ptsaftp.htm).
Unexpected Clinical Events: Impact on Patient Safety (R01 HS11375)
Institution: Veterans Medical Research Foundation (San Diego)
Investigator: Matthew Weinger
Objective: Investigate non-routine events during patient care related to anesthesiology by collecting prospective and retrospective data on unusual/extraordinary events in the preoperative period, developing a useful classification of such occurrences, and relating them to clinical outcomes to provide insights into potential system faults.
Informatics Tools to Reduce Warfarin Errors (R18 HS11804)
Institution: University of California (Davis)
Investigator: Richard White
Objective: Reduce the incidence of serious warfarin dosing errors in hospitalized patients being started on warfarin for the first time by developing clinical informatics tools for computer systems specifically designed to find errors in warfarin use.
PDA-Based Drug Dosage Optimization (290-01-0018)
Institution: Prediction Sciences (San Diego)
Investigator: Arouh, Scott
Objective: Use neural nets to develop a personal digital assistant-based algorithm to predict optimum medication dosages for treating patients with bipolar disorder.
Community Health Center Network (R21 HS13543)
Institution: Community Health Center Network (Oakland)
Investigator: Neil Maizlish
Objective: Develop a system for integrating computerized clinical data from various sources to create disease registries in seven community health centers in Alameda County which serve as safety-net providers for over 60,000 uninsured and Medicaid managed care patients, largely low-income Latinos, Asians, and African Americans.
UCLA Primary Care Network (R21 HS13572)
Institution: University of California (Los Angeles)
Investigator: Robert Oye
Objective: Enhance information system capability to collect self-reported race/ethnicity data from patients and relevant clinical questions from clinicians in the network, which serves a diverse patient population, half of whom are in managed care plans.
UCSF/Stanford Collaborative Research Network (R21 HS13544)
Institution: University of California (San Francisco)
Investigator: Andrew Bindman
Objective: Conduct a study entitled IDEALL (Improving Diabetes Efforts Across Literacy and Language) to test two forms of disease management aimed at overcoming communication barriers and promoting self-management in diabetic patients with low language and literacy levels.
USC-LA Network (R21 HS13531)
Institution: University of Southern California (Los Angeles)
Investigator: Lynda Knox
Objective: Identify and test an information system for use by members of the network, which serves predominately Latino and African American patients, that will enhance communication and increase the capacity to translate research into practice.
* Your Guide to Choosing Quality Health Care. AHCPR Publication. No. 99-0012, July 2001. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/consumer/qnt/