Ambulatory Safety and Quality Program: Health IT Portfolio (continued)

Enabling Patient-Centered Care Through Health IT

The purpose of this funding opportunity announcement (FOA) is to investigate novel methods or evaluate existing strategies for using health information technology (health IT or HIT) to create or enhance patient-centered models of care in the ambulatory setting. Applicants were expected to demonstrate how patient-centered care can improve health outcomes, patient safety, and patients' reported experience with care. Applicants were encouraged to consider projects that focus on:

• Shared decisionmaking.
• Patient-clinician communication.
• Access to medical information.
• Patient self-management of chronic conditions.

The long-term goal of this effort is to improve the delivery of patient-centered care in ambulatory settings.

Patient-Centered Care Grants

Sixteen grants were awarded under this FOA. The projects have a diverse range of interventions, using different health IT applications. Most applications target the primary care office as the setting of care while others address the home environment. Two projects address subspecialty care and one specifically focuses on transitions between the inpatient and ambulatory setting. While all areas of patient-centered care are addressed across the grants, most of the projects focus on patient self-management.

Conversational IT for Better, Safer Pediatric Primary Care
Estimated Total Funding: $1,159,609
Description: Develops and evaluates an integrated patient-centered health information system, the Personal Health Partner (PHP) that will use fully automated, interactive, conversations to gather personal health data and counsel parents before scheduled visits, exchange that data with the child's primary care clinician via the electronic health record (EHR), and offer personalized followup assessment and counseling after visits.
Focus Area(s): Patient self-management; access to medical information (clinicians)
Type of Health IT: Telehealth (patient-focused), PHR, human/machine interface
Principal Investigator: William G. Adams
Grant No.: 1R18HS017248
Applicant Institution: Boston Medical Center, Boston, MA
Estimated dates: 9/30/2007—9/29/2010

Using a Telemedicine System To Promote Patient Care Among Underserved Individuals
Estimated Total Funding: $1,198,371
Description: Seeks to advance care for hypertension for African Americans in North Philadelphia by enhancing an existing telemedicine system that supports the chronic care model by increasing access, incorporating hypertension treatment guidelines, quality measures, automating reminders and feedback for both patients and health care providers, and enabling the PHR to exchange data between other Health Level 7 (HL7)-compliant electronic medical record (EMR) systems.
Focus Area(s): Patient self-management of chronic illness; access to medical information (patients and clinicians); shared decisionmaking; patient-clinician communication
Type of Health IT: Telehealth (patient-focused), data electronic transform and load, clinical/medication reminders (patient and provider-focused)
Principal Investigator: Alfred Bove
Grant No.: 1R18HS017202
Applicant Institution: Temple University, Philadelphia, PA
Estimated dates: 9/30/2007—9/29/2010

Enhancing Self-Management of T2DM With an Automated Reminder and Feedback System
Estimated Total Funding: $1,166,243
Description: Tests an Automated Self-Management Monitor (ASMM) with low-income housing sites and through primary care clinics to determine whether ASMM can improve self-monitoring of blood glucose and glycemic control in patients with type II diabetes mellitus.
Focus Area(s): Patient self-management of chronic illness
Type of Health IT: clinical/medication reminders (patient-focused), human/machine interface
Principal Investigator: Edith Burns
Grant No.: R18HS017276
Applicant Institution: Medical College of Wisconsin, Milwaukee, WI
Estimated dates: 9/01/2007—8/31/2010

Personal Health Records and Elder Medication Use Quality
Estimated Total Funding: $1,199,999
Description: Investigates the effect of a current PHR system among older adults on patient-reported medication therapy management behaviors, beliefs about medications, medication-use quality indicators, and on medication adherence.
Focus Area(s): Patient self-management; access to medical information (patients)
Type of Health IT: Human/machine interface, PHR, clinical/medication reminders (patient-focused)
Principal Investigator: Elizabeth Chrischilles
Grant No.: 1R18HS017034
Applicant Institution: University of Iowa, Iowa City, IA
Estimated dates: 9/30/2007—9/29/2010

Ambulatory Care Compact To Organize Risk and Decisionmaking (ACCORD)
Estimated Total Funding: $923,783
Description: Designs, develops, implements, and evaluates a model of care delivery that enables patients and primary care providers to agree upon shared, followup care plans that incorporate patient and provider preferences.
Focus Area(s): Patient self-management; shared decisionmaking
Type of Health IT: System architecture, PHR
Principal Investigator: Henry Chueh
Grant No.: 1R18HS017190
Applicant Institution: Massachusetts General Hospital (MGH), Boston, MA
Estimated dates: 9/30/2007—9/29/2010

Implementing a Low-Literacy, Multimedia IT System To Enhance Patient-Centered Cancer Care
Estimated Total Funding: $1,198,839
Description: Tests whether a low-literacy-friendly, multimedia information and assessment system used in daily clinical practice enhances patient-centered care and improves patient outcomes for vulnerable populations.
Focus Area(s): Patient self-management of chronic illness; patient-clinician communication
Type of Health IT: Human/machine interface, clinical/medication reminders (patient focused)
Principal Investigator: Elizabeth Hahn
Grant No.: 1R18HS017300
Applicant Institution: Evanston Northwestern Healthcare, Chicago, IL
Estimated dates: 9/30/2007—9/29/2010

Virtual Patient Advocate To Reduce Ambulatory Adverse Drug Events
Estimated Total Funding: $1,180,772
Description: Focuses on the transition between hospitalization and the first ambulatory visit; also tests a Virtual Patient Advocate to prepare patients for discharge and determines their degree of understanding of self-care, medications, and followup.
Focus Area(s): Patient self-management; access to medical information (patients and clinicians)
Type of Health IT: Clinical/medication reminders (patient-focused), human/ machine interface
Principal Investigator: Brian Jack
Grant No.: 1R18HS017196
Applicant Institution: Boston Medical Center, Boston, MA
Estimated dates: 9/01/2007—8/31/2010

An Interactive Preventive Health Record To Promote Patient-Centered Care
Estimated Total Funding: $1,198,677
Description: Investigates whether an interactive preventive health record (IPHR), called My Preventive Care, increases the delivery of recommended preventive services and whether the IPHR increases shared decisionmaking and improves clinician-patient communication.
Focus Area(s): Shared decisionmaking; patient-clinician communication
Type of Health IT: PHR, clinical/medication reminders (patient-and provider-focused)
Principal Investigator: Alexander Krist
Grant No.: 1R18HS017046
Applicant Institution: Virginia Commonwealth University, Richmond, VA
Estimated dates: 9/01/2007—8/31/2010

Tailored DVD To Improve Medication Management for Low Literate Elderly Patients
Estimated Total Funding: $1,199,014
Description: Uses an electronic medication history to develop tailored patient education DVDs and print materials for low-literate audiences to empower geriatric patients and their caregivers to participate in treatment decisions and negotiate acceptable medication regimens that are more amenable to followthrough.
Focus Area(s): Patient self-management; shared decisionmaking; patient-clinician communication
Type of Health IT: clinical/medication reminders (patient-focused), human/machine interface
Principal Investigator: Kate Lapane
Grant No.: 1R18HS017281
Applicant Institution: Brown University, Providence, RI
Estimated dates: 9/30/2007—9/29/2010

Impact of a Wellness Portal on the Delivery of Patient-Centered Prospective Care
Estimated Total Funding: $902,411
Description: Develops, tests, and refines an Internet-based patient wellness portal linked to the previously developed Preventive Services Reminder System (PSRS), to will facilitate preventive care in primary care practices.
Focus Area(s): Patient self-management; shared decisionmaking
Type of Health IT: Telehealth (patient-focused)
Principal Investigator: James Mold
Grant No.: 1R18HS017188
Applicant Institution: University of Oklahoma Health Sciences Center, Oklahoma City, OK
Estimated dates: 9/01/2007—8/31/2010

Patient-Centered Informatics System To Enhance Health Care in Rural Communities
Estimated Total Funding: $1,199,999
Description: Evaluates whether integrating the functions of an EMR, PHR, and communication system leads to more patient-centered care in rural communities in the Intermountain West.
Focus Area(s): Patient self-management; access to medical information (patients and clinicians); patient-clinician communication
Type of Health IT: CHN (rural), clinical/medication reminders (provider-and patient-focused)
Principal Investigator: Matthew Samore
Grant No.: 1R18HS017308
Applicant Institution: University of Utah, Salt Lake City, UT
Estimated dates: 9/30/2007—9/29/2010

Harnessing Health IT for Self-Management Support and Medication Activation in a Medicaid Health Plan
Estimated Total Funding: $1,130,769
Description: Tests the impact of the automated telephone self-management support on diabetes management and combine it with a medication activation communication strategy.
Focus Area(s): Patient self-management of chronic illness
Type of Health IT: Telehealth (patient-focused), human/machine interface, clinical/medication reminders (patient-focused)
Principal Investigator: Dean Schillinger
Grant No.: 1R18HS017261
Applicant Institution: University of California; San Francisco, San Francisco, CA
Estimated dates: 9/01/2007—8/31/2010

Enabling Sleep Apnea Patient-Centered Care Via an Internet Intervention
Estimated Total Funding: $1,155,062
Description: Examines the effect of a Web-based intervention designed for patients with obstructive sleep apnea syndrome that integrates a telemetry treatment device and an internet-based portal that tracks management of continuous positive airway pressure.
Focus Area(s): Patient self-management of chronic illness
Type of Health IT: Telehealth (patient-focused), PHR
Principal Investigator: Carl Stepnowsky
Grant No.: 1R18HS017246
Applicant Institution: Veterans Medical Research Foundation, San Diego, CA
Estimated dates: 9/30/2007-9/29/2010

Patient-Centered Online Disease Management Using a Personal Health Record System
Estimated Total Funding: $1,158,401
Description: Evaluates a Customized, Continuous Care Management (CCCM) program for diabetes care and examines the CCCM's impact on HgA1C as well as self-management practices, better processes of care, lower cardiovascular risk, enhanced patient experience and satisfaction, and improved patient psychosocial well-being.
Focus Area(s): Patient self-management of chronic illness; access to medical information (patients and clinicians)
Type of Health IT: PHR, clinical/medication reminders (patient-focused)
Principal Investigator: Paul Tang
Grant No.: 1R18HS017179
Applicant Institution: Palo Alto Medical Foundation Research Institute, Palo Alto, CA
Estimated dates: 9/01/2007—8/31/2011

Using an Electronic Personal Health Record To Empower Patients With Hypertension
Estimated Total Funding: $1,181,369
Description: Examines the feasibility, acceptability, and impact of a health IT intervention (the ePHR) that has been modified to incorporate the experiences, perspectives, and insights of patients and family members actually using the system.
Focus Area(s): Patient self-management of chronic illness; access to medical information (patients); patient-clinician communication
Type of Health IT: PHR
Principal Investigator: Peggy Wagner
Grant No.: 1R18HS017234-01
Applicant Institution: Medical College of Georgia, Augusta, GA
Estimated dates: 9/01/2007—8/31/2010

Using IT for Patient-Centered Communication and Decisionmaking About Medications
Estimated Total Funding: $1,199,997
Description: Develops and tests a multimedia program to help patients understand the importance of both giving and receiving accurate information about medications.
Focus Area(s): Patient self-management; shared decisionmaking; patient-clinician communication
Type of Health IT: Clinical decision support (CDS), medication management (patient-focused)
Principal Investigator: Michael Wolff
Grant No.: 1R18HS017220
Applicant Institution: Northwestern University, Chicago, IL
Estimated dates: 9/30/2007—9/29/2010

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Improving Management of Individuals With Complex Health Care Needs Through Health IT

The primary goal of this FOA is to identify, promote, and disseminate models of patient-centered care. This includes the use of personal health data and evidence-based information to support both providers and patients in managing health and illnesses and improve health outcomes in ambulatory care for patients with complex health care needs and across high-risk health care transitions.

Applicants were encouraged to demonstrate the ability of EHRs and/or PHRs to effectively move evidence-based information to the point of care, including the development and utilization of machine-actionable, evidence-based clinical information, and participation of both providers and patients/families in health information exchanges. In particular, examination of the role of workflow and effective use of clinical alerts and reminders, with an emphasis on prevention and chronic illness management was encouraged.

Management of Individuals With Complex Health Care Needs Grants

Twelve projects were funded under this FOA. The projects described use innovative methods including interactive voice systems and other information systems as well as randomized trials to determine how health IT can improve patient self-management.

Chronic Mental Health: Improving Outcomes Through Ambulatory Care Coordination
Estimated Total Funding: $1,199,871
Description: Develops and implements a health information exchange (HIE) network focused on coordination of care for individuals with chronic mental illness.
Focus Area(s): Behavioral health
Type of Health IT: HIE
Principal Investigator: Wende Baker
Grant No.: R18HS017838-01
Applicant Institution: Southeast Nebraska Behavioral Health Information Network, Inc., Lincoln, NE
Estimated dates: 9/30/2008-9/29/2011

Evaluation of Effectiveness of an HIT-based Care Transition Information Transfer System
Estimated Total Funding: $1,155,371
Description: Develops and evaluates a care transition information transfer system that provides high-risk rural patients and their primary care providers with discharge information, particularly focused on medication management
Focus Area(s): Impact of health IT on outcomes in a rural ambulatory clinic
Type of Health IT: EHR, HIE
Principal Investigator: Elizabeth Ciemens
Grant No.: R18HS017864-01
Applicant Institution: Billings Clinic Foundation, Billings, MT
Estimated dates: 9/30/2008-9/29/2011

Enhancing Complex Care Through an Integrated Care Coordination Information System
Estimated Total Funding: $1,155,147
Description: Creates, implements, and evaluates an integrated care coordination information system in a diverse set of clinics using certified EHRs and existing standards.
Focus Area(s): Impact of health IT on chronic illness outcomes in a rural ambulatory clinic
Type of Health IT: EHRs
Principal Investigator: David Dorr
Grant No.: R18HS017832-01
Applicant Institution: Oregon Health & Science University, Portland, OR
Estimated dates: 9/30/2008-9/29/2011

An Electronic Personal Health Record for Mental Health Consumers
Estimated Total Funding: $1,199,379
Description: Adapts an existing PHR to fit the needs of persons with a serious mental disorder and one or more chronic medical conditions.
Focus Area(s): Mental health
Type of Health IT: Web-based PHR
Principal Investigator: Benjamin Druss
Grant No.: R18HS017829-01
Applicant Institution: Emory University, Atlanta, GA
Estimated dates: 9/30/2008-9/29/2011

Improving Medication Management Practices and Care Transitions Through Technology
Estimated Total Funding: $1,199,998
Description: Conducts a randomized trial to assess the effectiveness and cost effectiveness of two CDS interventions aimed at improving medication management in home health care.
Focus Area(s): Home health patients at risk of medication problems due to the drugs they are taking and/or the complexity of their medication regimens
Type of Health IT: CDS
Principal Investigator: Penny Feldman
Grant No.: R18HS017837-01
Applicant Institution: Visiting Nurse Service of New York, New York, NY
Estimated dates: 9/30/2008-9/29/2011

Using HIT To Improve Transitions of Complex Elderly Patients from SNF to Home
Estimated Total Funding: $1,188,157
Description: Develops and evaluates an EMR-based medication reconciliation system for medication monitoring and followup of elderly patients discharged from a skilled nursing facility (SNF) to ambulatory settings.
Focus Area(s): Drug-induced injury in the ambulatory geriatric population
Type of Health IT: EMR
Principal Investigator: Terry Field
Grant No.: R18HS017817-01
Applicant Institution: University of Massachusetts Medical School, Worcester, MA
Estimated dates: 9/30/2008-9/29/2011

A Longitudinal Telephone and Multiple Disease Management System To Improve Ambulatory Care
Estimated Total Funding: $1,199,934
Description: Assesses the effectiveness of an interactive voice response system for providing hospital discharge followup of patients with complex health care needs.
Focus Area(s): Patients with multiple chronic diseases
Type of Health IT: Interactive voice response
Principal Investigator: Robert Friedman
Grant No.: R18HS017855-01
Applicant Institution: Boston Medical Center, Boston, MA
Estimated dates: 9/30/2008-9/29/2011

Randomized Controlled Trial Embedded in an Electronic Health Record Ambulatory Care
Estimated Total Funding: $1,199,928
Description: Assesses the effective of an electronic PHR for improved self-management and clinical outcomes in HIV/AIDS positive individuals.
Focus Area(s): HIV/AIDS
Type of Health IT: Web-based PHR
Principal Investigator: James Kahn
Grant No.: R18HS017784-01
Applicant Institution: University of California San Francisco, San Francisco, CA
Estimated dates: 9/30/2008-9/29/2011

Improving Care Transitions for Complex Patients Through Decision Support Ambulatory Care
Estimated Total Funding: $1,198,254
Description: Develops and evaluates a decision support system that will augment the availability of information at ambulatory practices following three types of care transitions; hospital discharges, emergency department encounters, and specialty clinic evaluations.
Focus Area(s): Ambulatory clinics
Type of Health IT: HIE, CDS
Principal Investigator: David Lobach
Grant No.: R18HS017795-01
Applicant Institution: Duke University, Durham, NC
Estimated dates: 9/30/2008-9/29/2011

Improving Pediatric Cancer Survivorship Care Through SurvivorLink
Estimated Total Funding: $1,199,998
Description: Develops, implements, and evaluates an electronic PHR to support improved self-management and clinical outcomes in pediatric cancer survivors.
Focus Area(s): Patient self-management
Type of Health IT: Web-based PHR
Principal Investigator: Ann Mertens
Grant No.: R18HS017831-01
Applicant Institution: Emory University, Atlanta, GA
Estimated dates: 9/30/2008-9/29/2011

E-Coaching: IVR-Enhanced Care Transition Support for Complex Patients
Estimated Total Funding: $1,199,999
Description: A randomized trial of the use of an interactive voice response system to facilitate post-hospital discharge transitions for patients with congestive heart failure or chronic obstructive pulmonary disease into the community.
Focus Area(s): Home health
Type of Health IT: Interactive voice response
Principal Investigator: Christine Ritchie
Grant No.: R18HS017786-01
Applicant Institution: University of Alabama at Birmingham, Birmingham, AL
Estimated dates: 9/30/2008-9/29/2011

Using Electronic Data To Improve Care of Patients With Known or Suspected Cancer
Estimated Total Funding: $1,199,531
Description: Tests the use of health IT to identify patients experiencing delays in diagnosis and/or treatment of some types of cancer and to facilitate their movement through the health care system.
Focus Area(s): Integrated care network
Type of Health IT: EMRs
Principal Investigator: Hardeep Singh
Grant No.: R18HS017820-01
Applicant Institution: Baylor College of Medicine, Houston, TX
Estimated dates: 9/30/2008-9/29/2011

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For More Information

For additional information on AHRQ projects on health information technology, please visit http://www.healthit.ahrq.gov or contact the health IT staff at healthit@ahrq.gov.