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ACTION Project Awards, Fiscal Year 2007

Field Partnerships for Applied Research

ACTION (Accelerating Change and Transformation in Organizations and Networks) is a model of field-based research designed to promote innovation in health care delivery by accelerating the diffusion of research into practice. The ACTION network includes 15 large partnerships and collaborating organizations that provide health care to more than 100 million Americans.

Select for the ACTION Fact Sheet.
Select for Awards in Fiscal Year 2006.

Contents

Health Care Organization and Payment
Patient Safety
Health Information Technology (IT)
Prevention
Emergency Preparedness

Health Care Organization and Payment

Title: Reducing Waste and Providing More Efficient Care Through Redesign of Delivery Processes
Partner: American Institutes for Research (AIR)
ACTION Contact: Kristin Carman, AIR, kcarman@air.org
Description: The AIR team is developing, refining, implementing, and evaluating a new rheumatology ambulatory care model (Patient Centric Electronic Redesign for Rheumatology [PACER-Rheum]) in two rheumatology practice settings, using two redesign approaches (Lean and Plan-Do-Study-Act [PDSA]). The aims include evaluating whether PACER-Rheum improves efficiency, productivity, quality and safety, adherence, and patient-centeredness; evaluating whether there is a business case for the model; determining which redesign elements explain observed effects; and disseminating findings in ways that promote adoption of PACER-Rheum elsewhere.
Period: 08/07-07/10
Funding: $399,999
Deliverables: TBD.

Title: Decision Guide for Employers, Public Purchasers, and Health Plans Interested in Designing a Consumer (Financial) Incentive Strategy
Partner: University of California at San Francisco (UCSF)
ACTION Contact: Claire Brindis, Claire.Brindis@ucsf.edu
Description: UCSF identified and synthesized evidence, theory, and implementation examples that directly address purchasers' design-related decisions regarding financial schemes directed at consumers. AHRQ published and disseminated the findings in the form of a purchaser's guide.
Period: 12/06-11/08
Funding: $200,000
Deliverables: Consumer Financial Incentives: A Decision Guide for Purchasers Final Contract Report.

Title: Health Literacy and Informed Consent and Authorization for Research Testing AHRQ's Toolkit
Partner: Trustees of Boston University
ACTION Contact: Carol VanDeusen Lukas, carol.vandeusenlukas@med.va.gov
Description: AHRQ's Informed Consent and Authorization Toolkit is specifically designed to provide guidance to both health services researchers and Institutional Review Board (IRB) officials about how to obtain informed consent in a manner such that low-literate populations are truly informed and give their consent to participate in research. The toolkit includes a step-by-step description of the informed consent and authorization process, sample forms, a sample test to verify understanding, vignettes illustrating when oral consent and authorization would be appropriate, and a list of other Department of Health and Human Services (DHHS) resources. This project improved upon the toolkit through an expert review, validated it, and promoted it to key constituencies.
Period: 07/07-10/08
Funding: $149,571
Deliverables: AHRQ Informed Consent and Authorization Toolkit for Minimal Risk Research.

Patient Safety

Title: Implementing TeamSTEPPS™: A Train-The-Trainer Project
Partner: American Institutes of Research
ACTION Contact: Kristin Carman, AIR, kcarman@air.org
Description: AHRQ and the Department of Defense (DOD) cofunded TeamSTEPPS™ (Team Strategies & Tools to Enhance Performance and Patient Safety) as an evidence-based curriculum and toolkit for teamwork development. TeamSTEPPS™ is available to all and is distributed nationally. It is a train-the-trainer curriculum to introduce team training in civilian health care organizations. The task order objectives are to develop, deploy, and implement a program to support the adoption and use of TeamSTEPPS™ by health systems, provider institutions, and health profession educational institutions nationwide. The implementation includes master training, technical assistance and consultation, and development of various channels of learning for continued support and improvement.
Period: 09/07-09/11
Funding: $4,581,903

Title: Dissemination of TeamSTEPPS™ Adoption
Partners: Three ACTION partnerships—RTI, the University of Iowa, and Yale University—were awarded task orders to work on this topic.
ACTION Contacts: Amy Roussel, roussel@rti.org; Marcia Ward, Marcia-m-ward@uiowa.edu; Beverly Belton, Beverly.belton@ynhh.org
Description: The primary objective was to facilitate adoption of TeamSTEPPS™ using the curriculum provided by AHRQ and the DOD (go to project "Implementing TeamSTEPPS™: A Train-The-Trainer Project"). The ACTION partnerships involved observed, measured, evaluated, and documented findings regarding the implementation and adoption process in systems of their choosing. The evaluation examined (1) how trainees learn and retain techniques/behaviors, (2) if TeamSTEPPS™ was used appropriately in "real world" settings, and (3) if outcomes and improvement were sustained.
Period: 09/07-09/09 (one extended to 03/10)
Funding: $750,000

Title: Reducing Hospital-Associated Infections (HAI): Improving Patient Safety Through Implementing Multi-Disciplinary Interventions
Partners: Five ACTION partnerships—AIR, Denver Health, Health Research and Educational Trust (HRET), University of Iowa, and Yale University—were awarded task orders to work collaboratively on this topic.
ACTION Contacts: Kristin Carman, AIR, kcarman@air.org; Susan Moore, susan_moore@dhha.org; Maulik Joshi, mjoshi@aha.org; Marcia Ward, Marcia-m-ward@uiowa.edu; Beverly Belton, Beverly.belton@ynhh.org
Description: Multidisciplinary teams at 34 participating hospitals used AHRQ-supported evidence-based tools for improving infection safety to facilitate changes in clinician behaviors and habits, care processes, and safety culture. The goal of this project was to identify challenges to successfully preventing HAIs at the point of care. Five partners prepared case studies that examined how their hospitals addressed infection prevention. These case studies analyze hospital staff opinions about the viability and success of activities; methods, interventions, and training that hospitals use to combat HAIs; and hospitals' successes at keeping patients infection free at the point of care. Responses from three common data collection forms (Patient Safety and Infection Catalog, Patient Safety and Infection Prevention Assessment, and HAI Information Collection and Reporting Summary) provide the basis for analysis across the partnerships about staff perceptions of safety activities and infection prevention, including facilitators, barriers, and challenges to reducing HAIs.
Period: 09/07-10/09
Funding: $2,000,000
Deliverables: Five case studies.

Title: Development and Use of Ambulatory Adverse Event Trigger Tools
Partner: Trustees of Boston University
ACTION Contact: Carol VanDeusen Lukas, carol.vandeusenlukas@med.va.gov
Description: This task order intends to lead to the development of a low-cost and labor-efficient targeted injury detection system (TIDS), usable across multiple settings, with diverse electronic health record (EHR) systems as well as paper-based systems. The objectives are to (1) broaden trigger tools for use in detecting adverse events in the ambulatory setting; (2) assess the baseline level of ambulatory adverse events within a sample of institutions in the ACTION network using these tools; and (3) identify which triggers would be most amenable to TIDS development, based on frequency and impact of adverse events, provider acceptance, integration into workflow, ability to affect outcome, expertise and human capital required for implementation, and low risk for provider alert fatigue.
Period: 10/07-12/09
Funding: $399,993
Deliverables: Chart classification tools, final report, several presentations completed, and several manuscripts in development. "Development of Trigger Tools for Surveillance of Adverse Events in Ambulatory Surgery" accepted for publication in Quality and Safety in Health Care.

Health Information Technology (IT)

Title: Improving Asthma Care in an Integrated Safety Net Through a Commercially Available Electronic Medical Record
Partner: Denver Health
ACTION Contact: Susan Moore, susan_moore@dhha.org
Description: Hennepin County Medical Center (HCMC), a quasi-public safety net located in Minneapolis, MN, developed and implemented an electronic decision support tool for asthma care at eight primary care clinics. The application, written in Java and running on all standard Web browsers, was designed so that it could easily be invoked by a clinician whose workflow is guided by a commercially available electronic health record (EHR) system. It can also be invoked as a standalone desktop application, but the novelty of the proposal was creating a simple, low-cost, easy-to-maintain link between the EHR system and the application. Health care delivery sites around the United States, who have heard about it primarily through Epic-sponsored channels of communication, are interested in using the application. Technological enhancements to the application are being developed that would greatly reduce the future effort required to maintain it and to disseminate it.
Period: 09/07-12/09
Funding: $697,134
Deliverables: Administrator tools for maintaining the application's knowledge content; software bundling to facilitate installation into the most common enterprise environments; an administrator tool that facilitates the installation of the link between the EHR system and the software; and a set of user enhancements identified during user testing.

Title: Assessing the Impact of a Dynamic Chronic Care Registry on the Quality of Care
Partner: Denver Health
ACTION Contact: Susan Moore, susan_moore@dhha.org
Description: The objectives of the project were to improve the quality of care provided to adult diabetic patients currently receiving care within an urban safety net system through use of information from an integrated diabetes registry. The registry was used to distribute quarterly patient report cards to patients' homes; distribute standard and enhanced quarterly provider report cards reflecting their quality of care to diabetic patients in eight community health centers; develop and use a point-of-care interface to improve adherence to guideline-based care; evaluate the effects of these interventions on process, quality, cost, and satisfaction with care; and use the findings to generalize this approach to other chronic diseases and health care systems.
Period: 09/07-05/09
Funding: $357,343
Deliverables: Poster presented at 2009 meeting of Society of General Internal Medicine, presentation at Academy Health 2009, implementation handbook, manuscript, final report.

Title: Improving Quality Through Health IT: Testing the Feasibility and Assessing the Impact of Using Existing Health IT Infrastructure for Better Care Delivery
Partner: HRET
ACTION Contact: Maulik Joshi, mjoshi@aha.org
Description: HRET and the Alliance of Chicago Community Health Services studied how health IT could improve access to, and management of, laboratory information for patients with HIV and patients in need of cervical cancer screening. The study goal was to illustrate how health IT tools could improve (1) compliance with evidence-based lab test guidelines and (2) efficiency and quality of care by reducing duplicate tests, lost results, and results lacking followup. The project was to develop a set of best practices to disseminate to other community health centers and physician practices.
Period: 09/07-09/09
Funding: $393,457
Deliverables: Implementation Handbook or "lessons learned," manuscript, dissemination plan, final report.

Title: Improving Lab Followup by Delivering an Enhanced Medication List to Outpatient Physician Practices
Partner: Indiana University
ACTION Contact: Bradley Doebbeling, bdoebbel@iupui.edu
Description: In this project, outpatient primary care clinicians were provided, just prior to a patient's office visit, with a medication list based on pharmacy-dispensed medications to that patient. The list provided a prompt for discussion between the clinician and patient of the medications the patient should be taking. In addition, decision support provided prompts for routine lab monitoring, drug-drug interactions, drug-lab interactions, and drugs to be avoided in older adults. Distillation and grouping of medication messages were used to produce a comprehensible medication list. The intervention was piloted, implemented more fully, and evaluated as to its impact on quality and safety.
Period: 09/07-07/10
Funding: $400,000
Deliverables: American Medical Informatics Association 2009 poster presentation, final report, manuscript.

Title: Implementing and Improving the Integration of Decision Support Into Outpatient Clinical Workflow
Partner: Indiana University
Description: This project incorporated field study and controlled simulation to integrate colorectal cancer screening clinical decision support (CDS) into workflow. The study included (1) key informant interviews of site-specific best practices; (2) direct observation of colorectal cancer screening CDS to identify barriers and facilitators to workflow integration; (3) rapid prototyping of design alternatives based on findings; (4) simulation to test the impact of design on efficiency, usability, and workload; and (5) implementation of the refined CDS in local clinics to assess usability and impact. The implementation plan involved institutions that had demonstrated improved quality and efficiency using CDS: the Regenstrief Institute, the Department of Veterans Affairs (VA), and Partners Healthcare System.
Period: 09/07-09/09
Funding: $394,662
Deliverables: Manuscripts, final report.

Title: Use of an Electronic Referral System to Improve the Outpatient Primary Care–Specialty Care Interface
Partner: RAND
ACTION Contact: Allen Fremont, allen_fremont@rand.org
Description: RAND and UCSF-San Francisco General Hospital, the city's main safety net provider of specialty care, used a Web-based eReferral system to improve the integration of primary and specialty care through a common interface. This project extended use of the Web-based implementation beyond five clinics in which promising results had been achieved in reducing waste and improving quality of care to a new specialty clinic and affiliated federally qualified health centers. The study evaluated quality, efficiency, accessibility, and patient-centeredness of care. The deliverables included an implementation handbook, cost tool, and summaries of findings for dissemination to other care settings.
Period: 09/07-10/09
Funding: $396,536
Deliverables: Three manuscripts (qualitative analysis of implementation factors, quantitative outcomes, cost model), implementation handbook, final report.

Title: Improving Quality Through Health IT: Testing the Feasibility and Assessing the Impact of Using Existing Health IT Infrastructure for Better Care Delivery
Partner: Yale University
ACTION Contact: Beverly Belton, Beverly.belton@ynhh.org
Description: The overarching goals for the project were to implement and evaluate the impact of a new secure messaging system called ClinicalMessenger™ in the Yale—New Haven Children's Hospital Respiratory Medicine Clinic. The first study aim was to understand the content of what children, adolescents, and their parents send as secure messages to providers. The second aim was to evaluate the impact of secure messaging with regard to provider time spent, emergency department utilization for medication refills, and qualitative satisfaction with the system for all users.
Period: 09/07-10/09
Funding: $399,970
Deliverables: Electronic Messaging Implementation Handbook; poster at 2009 Institute for Healthcare Improvement Conference, December 2009; manuscript; final report.

Prevention

Title: Case Study for the Centers for Disease Control and Prevention's (CDC's) Diabetes Primary Prevention Initiative 4
Partner: RTI
ACTION Contact: Amy Roussel, roussel@rti.org
Description: This CDC-funded project assessed the CDC's Diabetes Primary Prevention Initiative 4 (DPPI 4). The goals were to (1) describe in a case study the intervention pilots in California, Massachusetts, Michigan, Minnesota, and Washington, focusing on generalizable concepts, tools, and key observations in developing, planning, and testing interventions, as well as early results from the pilots that would have potential for use in other States; (2) assess to what extent the support provided to the States and the intervention workgroup contributed to their implementation capacity; (3) assess to what extent diabetes prevention activities were sustainable and what resources, tools, and capacity were needed for sustainability; and (4) determine the key elements for further dissemination.
Period: 04/07-08/08
Funding: $283,341
Deliverables: Case study, final report for CDC planning purposes.

Title: Healthcare Systems for Tracking Abnormal Colorectal Cancer Results
Partner: The CNA Corporation
ACTION Contact: Daniel Harris, harrisd@cna.org
Description: In this CDC-funded project, two interventions that proved to be successful in 120 primary care practices are being extended to a set of primary care practices in Lehigh Valley, Pennsylvania. One intervention targets patients and the other targets physicians. The interventions are evaluated to determine the factors that positively and negatively affect implementation and impact of the intervention, including the business case.
Period: 9/06-05/10
Funding: $543,671
Deliverables: Final report, toolkit, manuscripts, dissemination plan, North American Primary Care Research Group presentation.

Title: Implementing Evidence-Based Strategies to Improve Asthma Care for Children
Partner: HRET
ACTION Contact: Maulik Joshi, mjoshi@aha.org
Description: HRET's partner, the University of Washington, tested a novel practice-based approach to knowledge uptake at the point of care. The intervention had two phases: (1) training in administering and interpreting spirometry to increase identification of asthma severity; and (2) training providers to use monitoring and a written asthma action plan with patients for patient self-management. This multicomponent, distance learning model involved 16 pediatric practices in New York State (8 per study arm). Spirometers were used in conjunction with software for Health Insurance Portability and Accountability Act (HIPAA)-compliant centralized data collection of flow volume curves and a Spirometry Fundamentals CD-ROM. Practices were matched and randomized into intervention and control groups; control practices received the sequenced program 5 months later than intervention practices.
Period: 07/07-04/09
Funding: $299,501
Deliverables: Final report, including final versions of manuscripts, products and tools, and evaluation results.

Title: Program Evaluation To Improve Hepatitis C Virus (HCV) Screening Practices and Testing Uptake in Select Primary Care Provider Settings
Partner: Trustees of Boston University
ACTION Contact: Carol VanDeusen Lukas, carol.vandeusenlukas@med.va.gov
Description: This CDC-funded project conducted a cross-sectional program evaluation of HCV screening and testing in partnership with four primary care sites. The team reviewed current practices and baseline data at the clinics; developed improved HCV risk assessment instruments; obtained/developed materials to train key individuals at each site; implemented new procedures and evaluated the effectiveness of risk-based screening; added and evaluated routine screening for a 1945-1964 birth cohort; and assessed sustainability and dissemination of the findings.
Period: 9/07-09/10
Funding: $550,000
Deliverables: Final report and manuscripts.

Title: Improving Implementation of the U.S. Preventive Services Task Force Recommendation for Prophylactic Aspirin Use Among Adults at Risk for Cardiovascular Disease
Partner: Abt Associates
ACTION Contact: Terry Moore, BDU@abtassoc.com
Description: The project goal is to improve measurably the implementation and uptake of a specific evidence-based clinical preventive service—the U.S. Preventive Services Task Force recommendation for counseling for aspirin prophylaxis among adults at risk for cardiovascular events—at Geisinger Health System. A risk management model is being developed and tested using Geisinger's EHR to identify and improve aspirin prophylaxis in at-risk patients. Three interventions are being used and compared: one patient based, one nurse based, and one physician based. The study is documenting the plans, activities, and systems changes by which improved care delivery is achieved.
Period: 9/07-04/10
Funding: $300,000
Deliverables: Clinical decision support tool, final report, dissemination plan, manuscript.

Emergency Preparedness

Title: Disaster Alternative Care Facilities
Partner: Denver Health
ACTION Contact: Susan Moore, susan_moore@dhha.org
Description: The goal of this Health Resources and Services Administration (HRSA)-funded task order was to review and revise an Alternative Care Site Selection Tool that was developed under AHRQ Contract No. 290-00-0014 Task Order No. 5, titled "The Rocky Mountain Regional Model for Bioterrorist Events." This user-friendly tool aids in preselecting and staffing alternative care sites in case of a disaster. A site selection matrix provides a quantitative, customized, and simple methodology to identify the "best" alternative site, using lessons learned from (1) Hurricanes Katrina and Rita (at the Superdome and Convention Center, respectively), (2) use of Federal Medical Shelters and other mobile assets, and (3) States actively engaging in site selection and setup activities.
Period: 6/07-11/08
Funding: $234,779
Deliverables: Revised Alternative Care Site Selection Tool

Current as of November 2009
Internet Citation: ACTION Project Awards, Fiscal Year 2007: Field Partnerships for Applied Research. November 2009. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/research/findings/factsheets/translating/action07/index.html