Ambulatory Safety and Quality Program

Health IT Portfolio: Program Brief

Introduction

The purpose of the Agency for Healthcare Research and Quality's (AHRQ) Ambulatory Safety and Quality (ASQ) program is to improve the safety and quality of ambulatory health care in the United States. For the purpose of this program, AHRQ defines ambulatory care as health services provided by health care professionals in outpatient settings. These settings include practitioner offices, clinics, outpatient departments of hospitals, large or small group practices, community health centers (CHCs), emergency departments, diagnostic imaging centers, dialysis centers, home care, mental health centers, occupational health centers, and school health facilities.

The scope of ambulatory care has increased over the past decade, as the volume and complexity of interventions have expanded. Safe, high-quality ambulatory care requires complex information management and coordination across multiple settings, especially for patients with chronic illnesses. The opportunity to turn the potential of health information technology (health IT or HIT) toward improving safety and quality in the ambulatory care setting, especially within care transitions, forms the cornerstone of the ASQ program. The program accentuates the role of health IT through the following funding opportunity announcements (FOAs):

• Enabling Quality Measurement Through Health IT (also includes a patient safety focus).
• Improving Quality Through Clinician Use of Health IT.
• Enabling Patient-Centered Care Through Health IT.
• Improving Management of Individuals With Complex Health Care Needs Through Health IT.

Overall, 65 health IT grants have been awarded, totaling approximately $35 million.

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Enabling Quality Measurement Through Health IT

The purpose of this FOA is to develop safety and quality measures in ambulatory care settings, automate quality measurement, demonstrate the ability of electronic data systems (such as electronic health records [EHRs] or claims data merged with EHR data) to expand potential safety and quality measures, and demonstrate improved ability to export data for reporting performance on measures and improvement.

Applicants were encouraged to consider projects that focus on a variety of aspects of quality measurement. Some aspects of interest include process, data elements, value and accuracy, creation of meaningful information, and timeliness of data integration.

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Enabling Quality Measurement Grants

In total, 17 health IT grants were awarded under this FOA. Of these, four grants were funded through a patient safety set-aside. The projects described focus on common chronic illnesses and prevention. There is prominent involvement of national organizations and initiatives such as the American Medical Association, the National Committee for Quality Assurance, the American Gastroenterological Association, and the Ambulatory Care Quality Alliance (AQA). A variety of ambulatory settings and organizations are addressed, from large integrated delivery systems to small provider practices and from urban settings to small rural communities.

Closing the Feedback Loop To Improve Diagnostic Quality
Estimated Total Funding: $998,509
Description: Develops ways to close the loop of outpatient diagnosis in an effort to improve the quality of diagnostic and therapeutic decisionmaking in ambulatory settings.
Focus Area(s): Quantitative scale to determine quality of diagnosis in the clinical setting
Type of Health IT: Clinical decision support (CDS)
Principal Investigator: Eta Berner
Grant No.: 1R18HS017060
Applicant Institution: University of Alabama at Birmingham, Birmingham, AL
Estimated dates: 9/14/2007—8/31/2010

Colorado Associated Community Health Information Exchange (CACHIE)
Estimated Total Funding: $986,302
Description: Designs, develops, implements, and evaluates an interoperable quality information system for a collaborative network of CHCs that permits real-time and synchronous quality reporting to inform patient care, quality interventions, and health policy and advocacy efforts.
Focus Area(s): Specific measures to be determined
Type of Health IT: Health information exchange (HIE), quality of care decision support
Principal Investigator: Arthur Davidson
Grant No.: 1R18HS017205
Applicant Institution: Denver Health and Hospital Authority, Denver, CO
Estimated dates: 9/30/2007—6/30/2010

Automating Assessment of Asthma Care Quality
Estimated Total Funding: $871,711
Description: Develops, validates, applies, and evaluates a scalable method for routine and comprehensive measurement of outpatient asthma care quality.
Focus Area(s): 19 asthma care quality measures from the RAND Quality Assessment Tools
Type of Health IT: Quality of care decision support, data electronic transform and load
Principal Investigator: Brian Hazlehurst
Grant No.: 1R18HS017022
Applicant Institution: Kaiser Foundation Research Institute, Portland, OR
Estimated dates: 9/30/2007—9/29/2010

Developing and Using Valid Clinical Quality Metrics for Health IT With HIE
Estimated Total Funding: $974,545
Description: Proposes to derive a set of quality metrics that can capture the effects of health IT with HIE and be retrieved electronically through the contributions of the Health Information Technology Evaluation Collaborative, the New York State Department of Health, and four regional health information organizations that are implementing health IT with HIE and focusing on the ambulatory setting.
Focus Area(s): Ambulatory quality metrics responsive to the effects of health IT and HIE
Type of Health IT: HIE
Principal Investigator: Rainu Kaushal
Grant No.: 1R18HS017067
Applicant Institution: Weill Medical College of Cornell University, New York, NY
Estimated dates: 9/30/2007—6/29/2010

Surveillance for Adverse Drug Events in Ambulatory Pediatrics
Estimated Total Funding: $992,699
Description: Uses a computerized system to detect and report adverse drug events (ADEs) that occur in the outpatient setting, in the emergency department, and during the transitions of hospital admission and discharge.
Focus Area(s): ADEs for pediatric patients in ambulatory settings, emergency departments, and transitions of care
Type of Health IT: Operational decision support—quality of care
Principal Investigator: Peter Kilbridge
Grant No.: 1R18HS017010
Applicant Institution: Washington University, St. Louis, MO
Estimated dates: 9/01/2007—8/31/2010

Cardio-HIT Phase II
Estimated Total Funding: $996,166
Description: Studies exception reporting to: (1) document the prevalence and patterns of exception reporting for performance measures for coronary artery disease and heart failure, (2) assess the feasibility and accuracy of exception reporting, and (3) analyze and address stakeholder concerns regarding exception reporting.
Focus Area(s): Coronary artery disease and heart failure measures
Type of Health IT: Operational decision support—quality of care
Principal Investigator: Karen Kmetik
Grant No.: R18HS017160
Applicant Institution: American Medical Association, Chicago, IL
Estimated dates: 9/30/2007—12/31/2009

Electronic Support for Public Health - Vaccine Adverse Event Reporting System
Estimated Total Funding: $999,995
Description: Seeks to improve the quality of vaccination programs by improving the quality of physician adverse vaccine event detection and reporting to the national Vaccine Adverse Event Reporting System.
Focus Area(s): Vaccine adverse effects
Type of Health IT: Registry (vaccination), clinical/medication reminders (provider-focused)
Principal Investigator: Ross Lazarus
Grant No.: 1R18HS017045
Applicant Institution: Harvard Pilgrim Health Care, Inc., Boston, MA
Estimated dates: 9/30/2007—9/29/2010

Medication Monitoring for Vulnerable Populations via IT
Estimated Total Funding: $994,325
Description: Demonstrates the ability of health information interoperable exchange and EHRs to provide useful quality and safety measures for the vulnerable populations served by a CHC.
Focus Area(s): Medication safety monitoring for angiotensin converting enzyme inhibitors/angiotensin receptor blockers (ACEI/ARB), Digoxin, diuretics, and statins
Type of Health IT: System integration, quality of care decision support
Principal Investigator: Christopher Lehmann
Grant No.: 1R18HS017018
Applicant Institution: Johns Hopkins University, Baltimore, MD
Estimated dates: 9/21/2007—5/31/2010

Improving Quality in Cancer Screening: The Excellence Report for Colonoscopy
Estimated Total Funding: $616,207
Description: Seeks to evaluate and improve the quality of screening and diagnostic colonoscopies in ambulatory care settings.
Focus Area(s): Colonoscopy pre-procedure, procedure, and post-procedure measures
Type of Health IT: Operational decision support—quality of care
Principal Investigator: Judith R. Logan
Grant No.: 1R18HS017017
Applicant Institution: Oregon Health & Science University, Portland, OR
Estimated dates: 9/30/2007—8/31/2010

Standardization and Automatic Extraction of Quality Measures in an Ambulatory EMR
Estimated Total Funding: $889,681
Description: Establishes the standardization efforts necessary for data capture of quality measures in an ambulatory electronic medical record (EMR) system and demonstrates the efficiency and accuracy of using a data extraction and reporting expert to perform quality measurement in the ambulatory care setting.
Focus Area(s): Physician quality reporting initiative
Type of Health IT: Standards (semantic), data electronic transform and load
Principal Investigator: Denni McColm
Grant No.: 1R18HS017094
Applicant Institution: Citizens Memorial Hospital District, Bolivar, MO
Estimated dates: 9/07/2007—8/31/2009

Massachusetts Quality E-Measure Validation Study
Estimated Total Funding: $995,575
Description: Evaluates the readiness of structured EHR data to support ambulatory clinical quality measurement by using the AQA ambulatory care measurement set to compare quality measurement based on a structured EHR data measurement method to two standard measurement methods.
Focus Areas: AQA starter set for primary care (26 measures)
Type of Health IT: System integration, quality of care decision support
Principal Investigator: Eric Schneider
Grant No.: 1R18HS017048
Applicant Institution: Harvard University (School of Public Health), Boston, MA
Estimated dates: 9/12/2007—8/31/2010

Feedback of Treatment Intensification Data To Reduce Cardiovascular Disease Risk
Estimated Total Funding: $997,069
Description: Proposes to develop and evaluate a treatment intensification protocol using an EHR to identify patients in need of treatment intensification for systolic blood pressure.
Focus Area(s): Cardiovascular disease process and outcome measures
Type of Health IT: CDS (provider-focused)
Principal Investigator: Joe Selby
Grant No.: 1R18HS017031
Applicant Institution: Kaiser Foundation Research Institute, Oakland, CA
Estimated dates: 9/01/2007—8/31/2010

Using Electronic Records To Detect and Learn From Ambulatory Diagnostic Errors
Estimated Total Funding: $873,108
Description: Uses data from EHRs to detect diagnostic errors in primary care, understand their causes, and lay groundwork for formulating future prevention strategies.
Focus Area(s): Measuring potential diagnostic errors in primary care
Type of Health IT: Operational decision support (quality of care)
Principal Investigator: Eric Thomas
Grant No.: 1R18HS017244
Applicant Institution: University of Texas Health Science Center at Houston, Houston, TX
Estimated dates: 9/30/2007—9/29/2010

Monitoring Intensification of Treatment for Hyperglycemia and Hyperlipidemia
Estimated Total Funding: $533,431
Description: Develops and validates a new diabetes quality-of-care process measure and the technology for monitoring that measure using analysis of the text of physician notes in the EMR.
Focus Area(s): Development of new diabetes quality-of-care process measures
Type of Health IT: Quality of care decision support, data electronic transform and load
Principal Investigator: Alexander Turchin
Grant No.: R18HS017030
Applicant Institution: Brigham and Women's Hospital, Boston, MA
Estimated dates: 9/30/2007—9/29/2010

Using IT To Improve the Quality of CVD Prevention & Management
Estimated Total Funding: $605,862
Description: Uses EMRs in a large health care system to: (1) identify practice variations in delivery of key cardiovascular disease preventive and disease management services, (2) relate practice variation to outcomes among patients in the clinical practices, and (3) provide feedback to managers on how guidelines adherence relates to morbid and mortal events, and to costs of care.
Focus Area(s): Prevention index and disease management index
Type of Health IT: Quality of care decision support
Principal Investigator: Thomas Vogt
Grant No.: 1R18HS017016
Applicant Institution: Kaiser Foundation Research Institute, Honolulu, HI
Estimated dates: 9/05/2007—2/28/2010

Crossing the Quality Assessment Chasm: Aligning Measured and True Quality of Care
Estimated Total Funding: $812,237
Description: Identifies and quantifies the impact on quality assessment of real-world circumstances where the current cross-sectional measures of quality do not reflect the true quality of care being rendered. The result of the analysis will help to create a new set of quality measures that is more consistent with actual clinical care.
Focus Area(s): Diabetes care measurement techniques accounting for differences in patient populations
Type of Health IT: Quality of care decision support
Principal Investigator: Mark Weiner
Grant No.: 1R18HS017099
Applicant Institution: University of Pennsylvania, Philadelphia, PA
Estimated dates: 9/30/2007—9/29/2010

Bringing Measurement to the Point of Care
Estimated Total Funding: $694,961
Description: Enables measurement of the quality of care, with a focus on public health priority issues, disadvantaged populations, and small office practices. This project will design and test a "quality dashboard" suitable for small office practices that will integrate quality measurement and CDS at the point of care.
Focus Area(s): Ambulatory care screening measures
Type of Health IT: HIE, quality of care decision support
Principal Investigator: Winifred Wu
Grant No.: 1R18HS017059
Applicant Institution: New York City Health/Mental Hygiene, New York, NY
Estimated dates: 9/30/2007—9/29/2010