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ACTION Project Awards, Fiscal Year 2008

Field Partnerships for Applied Research

Select for the ACTION Fact Sheet.
Select for Awards in Fiscal Years 2006 and 2007.

Health Care Organization and Payment

Title: Reducing Waste and Inefficiency Through Process Redesign
Partner: American Institutes for Research
ACTION Contact: Kristin Carman, AIR, kcarman@air.org
Description: This project furthers AHRQ's commitment to the redesign of health care processes to reduce waste and enhance efficiency. The task order objectives are to assess and disseminate promising techniques and methodologies in health care redesign. AIR is investigating the contribution of Lean/Toyota Production Systems (TPS) to reducing waste in health care delivery systems.
Period: 7/08-6/11
Funding: $629,805
Deliverables:A final report that includes: environmental scan summary, case study report, analysis of the business case, recommendations for implementing Lean/TPS, dissemination activities (past and planned), and publications and presentations.

Title: Improving Patient Flow and Reducing Emergency Department Crowding
Partner:Health Research and Educational Trust
ACTION Contact: Maulik Joshi, mjoshi@aha.org
Description: Urgent Matters, a Robert Wood Johnson Foundation (RWJF)-funded program based at The George Washington University School of Public Health and Health Services, has spent the last 6 years identifying patient flow quality innovations implemented by hospitals across the Nation. This RWJF-funded ACTION task order is designed to test and evaluate emergency department innovations through ACTION partnerships. More specifically, this project creates a unique opportunity for hospitals to implement and evaluate patient flow improvement strategies with the support of a collaborative structure and technical assistance. The project goals are to: (1) rigorously evaluate the implementation of strategies for improving patient flow and reducing emergency department crowding within the context of a hospital collaborative; (2) promote the spread of promising practices to a wider audience and variety of hospitals; and (3) advance the development of quality measurement in the emergency department.
Period: 9/08-3/10
Funding: $399,948
Deliverables: Evaluation report and dissemination plan

Patient Safety

Title: National Implementation of the Comprehensive Unit-based Safety Program (CUSP) To Reduce Central-Line Associated Blood Stream Infections (CLABSI) in the ICU
Partner: Health Research and Educational Trust
ACTION Contact: Maulik Joshi, mjoshi@aha.org
Description: Often referred to as a central venous catheter, a central line is a tube placed in a large vein in a patient's neck, chest, or groin to administer medication or fluids or to collect blood samples. According to the Centers for Disease Control and Prevention (CDC), each year, an estimated 250,000 cases of CLABSI occur in U.S. hospitals, and an estimated 30,000 to 62,000 infected patients die. This project was expanded in 2009 to include additional activities, building on the national implementation of the 3-year Comprehensive Unit-based Safety Program (CUSP) to reduce CLABSIs in intensive care units (ICUs) that began in 100 hospitals from 10 States. The program includes tools to help health care professionals identify opportunities to reduce potential health care-associated infections (HAIs) and implement policies to make care safer in the ICU. Since the initial implementation of the CUSP-CLABSI initiative in 10 States, additional hospitals in those States have expressed interest in participating in the program. This project expands the CUSP-CLABSI initiative to 22 States, the District of Columbia, and Puerto Rico. As a result of additional funding from AHRQ and a private foundation, all 50 States, Puerto Rico, and the District of Columbia are now participating in a similar initiative called the Keystone Project. In an 18-month period, the Keystone Project reduced the rate of BSIs from intravenous lines by two-thirds within 3 months in more than 100 ICUs in Michigan and helped the average ICU decrease its infection rate to 0. Because CLABSI is a significant problem in hospitals and in settings other than the ICU, this project also expands the CUSP-CLABSI initiative to general medical and surgical hospital units. Current CUSP resources will be modified so that they are applicable to a non-ICU environment .
Period: 9/08-9/12
Funding: $8,999,963
Deliverables: Deliverables include recruitment, operational, and sustainability plans for statewide consortia and a Children's Hospital Network; a CUSP Course Design Guide and other CUSP materials; data collection protocols; a final report; and materials for publication.

Title: Testing Spread and Implementation of Novel MRSA-Reducing Practices
Partner: Indiana University
Description: This task order aims to broaden the spread of an already-tested "Methicillin-resistant Staphylococcus aureus (MRSA) intervention bundle" from ICUs to additional units in hospitals participating in an existing Indiana University ACTION project on MRSA. It also is designed to spread successful MRSA reduction interventions to additional hospitals in the Indianapolis region and beyond. The participating health care settings are also to identify and monitor health care-associated community onset (HACO) MRSA cases and controls who receive care in participating hospitals and affiliated settings, identify strategies to reduce HACO MRSA, and demonstrate reduction of HACO MRSA. The Indiana University-led team is to evaluate the effectiveness of tested implementation strategies and innovations by applying information technology to enable consistent collection, sharing, analysis, and reporting of data; capture the hospital cost savings through participation in the project; and disseminate findings and promote outreach to target audiences and other stakeholders.
Period: 9/08-9/11
Funding: $1,800,000
Deliverables: A final report summarizing findings and lessons learned. The report is to include tools to help others implement the MRSA intervention bundle, a social network analysis, findings on cost savings and a dissemination and outreach plan.

Title: Healthcare Associated Infections (HAI) Initiative Assessment Program
Partners: Indiana University
ACTION Contact: Bradley Doebbeling, bdoebbel@iupui.edu
Description: Indiana University is fulfilling a coordination, analytical, technical assistance, and evaluative function for ACTION's HAI Initiative, which includes five partnerships led by American Institutes for Research, Denver Health, Health Education and Research Trust, University of Iowa, and Yale New Haven Health Services Corporation. These partnerships were awarded task orders in 2007 to work collaboratively on this topic. The goal of this exploratory qualitative initiative is to identify factors associated with the implementation of tools and interventions that can assist hospitals in successfully reducing and sustaining the reduction of infections associated with the process of care. The teams will use several different tools and interventions designed to change human behaviors, habits, and safety culture within health care organizations. The HAI initiative is determining whether the tools used are successful in reducing infection rates, while identifying both the challenges and barriers encountered during implementation.The assessment program is preparing manuscripts that synthesize and analyze findings across the case studies of the five partners to determine common barriers, challenges, and facilitators and to identify topics for further research.
Period: 3/08-1/10
Funding: $400,000
Deliverables: Synthesis of HAI implementation assessment reports, implementation toolkit, final report, dissemination and outreach plan, and manuscripts.

Title: Evaluation of Phase I Demonstrations of the Pharmacy Quality Alliance
Partner: CNA
ACTION Contact: Dan Harris, harrisd@cna.org
Description: CNA is evaluating Phase I demonstration projects, supported by the Pharmacy Quality Alliance (PQA). The projects are designed to test pharmacy performance reports that incorporate PQA-endorsed measures of pharmacy performance (including 15 claims-based measures and a consumer questionnaire of their experience with pharmacy services). The demonstration sites are testing the feasibility of using PQA-developed report templates and are examining the utility of these reports in various practice environments. The evaluation focuses on implementation issues. It will measure the impact and cost of collecting and reporting pharmacy performance data, including claims-based performance data and aggregate consumer survey data. In addition, CNA is to develop evaluation design plans for Phase II demonstrations, which are to test quality improvement efforts on pharmacy performance. The Phase I demonstrations launched in 2008 seek to establish the most effective methods of collecting, analyzing, and reporting the 15 pharmacy quality measures and consumer questionnaire data. In mid-2009, PQA planned to implement Phase II projects to demonstrate the impact of collecting and reporting data on pharmacy quality measures, as well as the impact of quality improvement efforts on pharmacy performance. CNA is performing a comprehensive evaluation of Phase I demonstration projects and assisting in the development of an evaluation design plan for Phase II demonstration projects.
Period: 9/08-3/10
Funding: $506,015
Deliverables: Project and evaluation design plans and reports, interview protocols, and a final report.

Title: Designing Consumer Reporting Systems for Patient Safety Events
Partner: RTI
ACTION Contact: Amy Roussel, roussel@rti.org
Description: RTI plans to: (1) develop ideas and recommendations for ideal consumer reporting systems for patient safety events; (2) identify the types of data elements (e.g., reports, information) that would be collected from consumers; and (3) determine the different types of mechanisms in which consumer reporting can best be captured. RTI will explore various options for the possible design, development, and implementation of a patient safety event reporting system for consumers.This project features a variety of activities needed to design and develop recommendations on an effective, practicalconsumer reporting system for patient safety events. These include establishing a technical expert panel (TEP), conducting an environmental scan and literature review of existing reporting systems and mechanisms that would be applicable to a consumer reporting system, and conducting focus groups and key stakeholder interviews. The focus groups and interviews will provide feedback on the TEP's recommendations. The information will also be incorporated with feedback on consumer experiences with patient safety events to inform the design and content of a consumer reporting system for patient safety events.
Period: 9/08-9/10
Funding: $617,799
Deliverables: Environmental scan and literature review, final report and recommendations, peer-reviewed journal manuscript, and dissemination plan.

Title: Promoting Safety and Quality Through Human Resource Practices
Partner: Health Research and Educational Trust (HRET)
ACTION Contact: Maulik Joshi, mjoshi@aha.org
Description: Remarkably, many health care providers still make limited use of human resource (HR) practices recognized as beneficial in other industries.Moreover, there has been limited investigation of the applicability of such practices to health care. This project seeks to address these needs. HRET is to conduct a broad scan of innovative HR practices within health care and identify one HR practice that holds promise for improving working conditions, enhancing staff performance, reducing turnover, or otherwise contributing to safety and quality. (HRET will not examine teamwork and magnet hospital certification, which have already been studied extensively.) Of particular interest are effective practices from other industries that may be appropriate for health care and are currently being tried by innovative health systems. HRET is to then scan for more detailed information on the selected practice within health care and in other industries and conduct case studies of successful applications of the practice within health care. The scan and the cases will include analysis of the business case for the practice. Then HRET will develop and disseminate recommendations for implementing promising forms of this HR practice within interested health care organizations.
Period: 8/08-1/10
Funding: $349,878
Deliverables: Scan summary, case study report, business case analysis, implementation report, dissemination plan, final report, and manuscripts.

Title: Preventing Pressure Ulcers in Hospitals
Partner: Boston University
ACTION Contact: Carol VanDeusen Lukas, carol.vandeusenlukas@med.va.gov
Description: Boston University is reviewing successful approaches to preventing pressure ulcers in hospitals, including both clinical and managerial factors; leading a workgroup from participating hospitals to develop and test tools to improve pressure ulcer prevention practices in hospitals; developing a quality improvement manual for hospitals that provides a step-by-step approach for hospitals using these new tools to prevent pressure ulcers; and leading multidisciplinary teams from each participating hospital in a pilot quality improvement (QI) project that uses these tools to help refine the QI manual. Pressure ulcer prevention tools may differ depending on the hospital department that is the focus of the prevention efforts. A pilot QI program will provide further insight into the effectiveness of the tools when used in a QI project. The program is also helping further refine how to use the tools and developing a manual on pressure ulcer prevention. Boston University is gathering information about the important experiences and challenges of the participating facilities, accounting for all important changes that participating facilities make in both processes and structures to improve pressure ulcer reduction practices, and monitoring the changing rate of hospital-acquired pressure ulcers that occur in each hospital.
Period: 9/08-9/10
Funding: $499,930
Deliverables: Manual to guide hospitals in how to prevent pressure ulcers, prevention tools, and final report.

Title: Assessing Organizational Responses to AHRQ's Health Literacy Pharmacy Tools
Partner: Abt Associates
ACTION Contact: Terry Moore, BDU@abtassoc.com
Description: In 2005, AHRQ and the Robert Wood Johnson Foundation funded the PILL study (Pharmacy Intervention for Limited Literacy) to develop and test pharmacy interventions. Four health literacy pharmacy tools have resulted. AHRQ now seeks to learn how pharmacies respond to these tools and about the conditions that may encourage or discourage adoption of the tools. In addition to learning specifically about the effectiveness of distributing these tools, AHRQ wants to increase understanding of how to promote quality improvement in pharmacy settings more generally.
Period: 8/08-2/11
Funding: $400,000
Deliverables: Case study reports, Promoting Pharmacy Health Literacy Guides, final report, manuscripts, and dissemination plan. Poster: “Disseminating Health Literacy Tools for Pharmacies: The Utility of Rogers' Diffusion of Innovations Theory” at the Medical Care section of the American Public Health Association (APHA) meeting in November 2008.

Title: Risk Informed Assessment of Teamwork and Clinical Outcomes
Partner: American Institutes for Research
ACTION Contact: Kristin Carman, AIR, kcarman@air.org
Description: AHRQ has supported risk assessment projects using sociotechnical probabilistic risk assessments (ST-PRAs) to develop a risk-informed approach to the design and implementation of patient safety practices, particularly in the area of ambulatory care. This project takes the lessons learned in the development and use of risk models to create a risk-informed approach to evaluation of safety and quality improvement efforts. Creating risk models that identify the risks associated with adverse outcomes can be used to focus attention on which processes are related to the elimination or mitigation of the risks associated with the adverse or undesirable outcomes. This task order is developing a risk-informed evaluation approach to teamwork by conducting formalized ST-PRAs in labor and delivery, surgery, and treatment of acute myocardial infarction; using the risk models to identify which specific risks lead to the adverse outcome; and identifying the process measures related to risk reduction as intermediate variables.
Period: 8/08-1/10
Funding: $349,955
Deliverables: Fault tree for ST-PRA models, report of prioritized risk profiles for each primary condition, report on prototype testing in the field, manuscripts, and final report.

Health Information Technology

Title: Building an Implementation Toolset for E-Prescribing
Partner: RAND
ACTION Contact: Allen Fremont, allen_fremont@rand.org
Description: The overarching goals of this project are to develop and test an e-prescribing toolset that provides information and tools in sufficient detail to act as a "how-to guide" for implementing e-prescribing across various organizational settings. The project includes: (1) environmental scan of current e-prescribing implementations, both nationally and internationally; (2) analysis of successful implementations in several organizational configurations, such as integrated delivery systems, community ambulatory networks, and small practice/independent pharmacies; (3) implementation toolset; and (4) pilot e-prescribing implementation using the toolset. The toolset will include applicable standards with implementation guides, technology requirements, workflow analysis tools, governance agreement templates, and other relevant materials. The focus of the pilot implementation is not on the implementation itself, but rather, on the completeness and usability of the toolset. A final report detailing the results and ways in which the toolset may be enhanced for broad use is also required. Based on the success of this initial work, further implementation pilots reflecting various organizational configurations are possible.
Period: 8/08-1/10
Funding: $1,999,825
Deliverables: Assessment report, implementation toolset, final report, and dissemination activities.

Prevention

Title: Coordinating Care Across Primary Care Practices and Specialty Care Practices: Developing and Testing a Feed Forward and Feedback Strategy
Partner: Boston University
ACTION Contact: Carol VanDeusen Lukas, carol.vandeusenlukas@med.va.gov
Description: The purpose of this task order is to provide a network to design, implement, and evaluate a process for the timely feed-forward of information between primary care practices and specialty care practices. The network is considering the full loop of information sharing that will help guide care, including feedback from specialty practices to primary care practices, paying particular attention to the feed-forward strategy. Specifically, Boston University is: (1) developing a process to feed information forward, i.e., to have primary care providers' specific questions and reasons for referral, applicable test results from the primary care workup, and relevant patient history go with the patient to the specialist; (2) testing and evaluating the feed-forward process; and (3) developing and pilot testing a process to secure timely and appropriate feedback to the primary care practice from the specialist as a companion to the process developed under item 1. The process for feeding information forward is intended to have the broadest application possible, be appropriate for use with multiple specialties, and cover a range of clinical conditions. Tools developed to feed information forward can be paper based but must be easily convertible for electronic systems.
Period: 9/08-9/10
Funding: $399,736
Deliverables: Educational/promotional materials, documentation of the implementation process, evaluation of outcomes, final report, and dissemination activities.

Emergency Preparedness

Title: Mass Casualty Events Models and Tools To Support Planning and Response for Pandemic and All Hazards Preparedness
Partner: Abt Associates
ACTION Contact: Terry Moore, BDU@abtassoc.com
Description: This task order is cosponsored by several agencies and offices within the U.S. Department of Health and Human Services: the Health Resources and Services Administration, the Assistant Secretary for Preparedness and Response (ASPR), and the Office of Public Health Emergency Preparedness. Due to the unique surge capacity requirements posed by several at-risk populations, this project quantifies and categorizes these patients to estimate their incremental potential burden to initial mass casualty care efforts. The product of this work will be a model for estimating this population in any community, their attendant medical and service needs, and the tolerable/intolerable thresholds below which access cannot be reduced without jeopardizing their medical stability. The model includes specific mass casualty scenarios and the consequences each will have on a municipality's high-intensity home care population, as well as the added community and home care burden of discharged hospitalized patients. Planners will be able to use this model to proceed with emergency response in an informed manner, including this patient population in the initial surge planning and avoiding an unexpected wave of acute patients. The project will contribute to health care sector infrastructure planning and recovery after a devastating mass casualty event. This model of early-discharged hospital-based at-risk patients and community-based at-risk patients may be integrated into the other surge models being developed with Abt for ASPR under an ongoing statement of work with AHRQ. In addition, this project is developing both a decision support algorithm for evacuation decisions and a tool that can be used "on the ground" in the aftermath of a disaster to assess damaged hospitals and determine whether they can reopen and what they will need to reopen quickly and safely. Such a tool will be useful after an event such as a severe hurricane or flood. This work builds on the previous AHRQ-funded task order that resulted in the shuttered hospital "inspection tool" and "Facility Checklist and Guide."
Period: 9/08-9/10
Funding: $449,995
Deliverables: A model for estimating early-discharged hospital-based at-risk patient and community-based at-risk patient population in a given community; an Evacuation Decision Guide, or decision algorithm, based on type of disaster, to help emergency management decide whether and when to evacuate a hospital; and a Revised Facility Checklist and Guide, or inspection guide, tailored to different types of disasters (hurricanes, floods, explosions, etc.), to help inspectors assess damaged and evacuated hospitals and determine how best to prepare them to reopen.

Title: National Disaster Medical System—Katrina Research Project Phase I
Partner: Abt Associates
ACTION Contact: Terry Moore, BDU@abtassoc.com
Description: During the massive hurricane destruction along the U.S. Gulf Coast in 2005, a number of National Disaster Medical System (NDMS) clinics were set up in nine large shelters to meet the immediate nonemergency medical needs of displaced persons. "Visits" generated records that were scanned into electronic (pdf) format. Early records in the 12-week period are likely to be somewhat incomplete and unformatted, and the records need systematic coding to determine what information can be gleaned to inform emergency planners as they prepare to respond to future major disasters. In addition, the potential use of the data in rigorous analyses is being determined. This project addresses an exploratory Phase I of a potentially multiphase project. In Phase I, a sampling frame is being developed, a small sample of records is being coded, and the sampled records are being analyzed to determine whether the records are likely to yield analyzable (and worthwhile) information. Findings from Phase I will inform the potential research feasibility for other phases, including more indepth analyses of the NDMS Katrina-Rita disaster period client records.
Period: 9/08-12/10
Funding: $229,898
Deliverables: Sampling frame, final report, journal article, and presentation.

Title: Hospital Preparedness Exercise Evaluation Resource Guidebook
Partner: Weill Medical College of Cornell University
ACTION Contact: Ann Matier, ammatier@med.cornell.edu
Description:This ASPR-funded task order addresses the need to develop a set of overarching guidance principles that will allow hospitals to communicate effectively with community partners, meet Federal exercise requirements, and meet accreditation standards required for emergency preparedness Using an existing environmental scan as a starting point, Weill is convening a series of meetings to identify resources and best practices for conducting and evaluating hospital emergency preparedness exercises. They are to identify a consolidated list of guidance tools to form the basis for a resource/reference manual for hospitals' use in preparedness exercises. The resource/reference manual will, at a minimum, include the exercise/emergency preparedness standards recommended by the Homeland Security Exercise and Evaluation Program, the Joint Commission, and the Centers for Medicare & Medicaid Services (CMS). A manual is being developed to provide specifics on the planning, conduct, evaluation, and after-action processes health care organizations need to meet the intent of exercise program requirements for Federal funding programs, as well as accreditation and regulatory agencies.
Period: 9/08-12/09
Funding: $443,685
Deliverables: Hospital Preparedness Exercises: Atlas of Resources and Tools; Hospital Preparedness Exercises: Guidebook; Hospital Preparedness Exercises: Pocket Guide; final report; other dissemination materials.

Title: Supporting the Development of Regional Planning Coalitions
Partner: Abt Associates
ACTION Contact: Terry Moore, BDU@abtassoc.com
Description: This task order funded by the Centers for Medicare & Medicaid Services and the Health Resources and Services Administration is studying two existing regional planning coalitions, Midwest Alliance and UPC,which encompass U.S. Department of Health and Human Services (HHS) Region 7/8 and Region 4, respectively. The project is designed to identify potential promising practices that may be applicable, replicable, or usable in other regions and regional coalitions and to identify tools for planning, disaster health/medical assessments, and response. The focus of all activities is to support regional planning and the role of the Regional Emergency Coordinator.
Period: 4/08-2/10
Funding: $994,647
Deliverables: Assistance to identified coalitions in hosting regional conference; template for convening future regional meetings; interim report; Web page template; recommendations on strengthening planning coalitions and improving potential for replication of the planning coalition process in other regions; tool for development of a concise State profile, including an inventory of preparedness-related State health and medical assets; toolkit of preparedness, disaster health/medical assessment, and response tools that are primarily in the public domain; resource manual for use by other HHS regions in their planning efforts; final report; and presentation of findings.

Long-Term Care

Title: Early Screening and Exercise Prevention of Disability and Falls in Persons Residing in Continuing Care Retirement Communities (CCRCs)
Partner: American Association of Homes & Services for the Aging (AAHSA)
ACTION Contact: Helaine Resnick, hresnick@aahsa.org
Description: There is evidence to show that an exercise program matched to a person's needs, along with counseling to integrate the exercise into their day-to-day activities, can decrease the risk of disability among high-risk individuals. However, most of the existing data have been generated from studies conducted in highly controlled clinical trial settings, not in "real world" settings in which older adults live and function. Thus, it is not known if existing tools for identifying and intervening with adults at high risk of disability can be effectively implemented in real-world residential settings in a manner that promotes health, prevents disability, and fits into typical staffing patterns. The main components of this project are screening with a short physical performance battery (training and implementation); implementation of an evidence-based exercise and counseling program among persons at high risk of disability in CCRCs; analysis of the impact of the intervention on disability risk for CCRC residents; and demonstration of the feasibility of conducting such a program in CCRCs.
Period: 7/08-12/10
Funding: $547,714
Deliverables: Literature review, implementation guide, data collection plan and instruments, analytic plan, slide presentations for meetings, and manuscript.

Title: Development of an Assisted Living Consensus Instrument (Phases I and II)
Partner: Abt Associates
ACTION Contact: Terry Moore, BDU@abtassoc.com
Description: This task order supports the development of an instrument designed to obtain provider-reported information on the services and characteristics of individual assisted living residences. Project efforts include providing technical and logistical support for consensus development activities to develop uniform data items and definitions; development of a draft self-administered questionnaire for providers (based on the consensus materials developed); development of draft instrument-associated data collection materials; and project documentation activities. Phase II of the project (fiscal year 2009 funding) includes small-scale testing with consumers and providers and medium- and large-scale testing with providers. Based on the testing results, the instrument and associated materials developed in Phase I are being finalized. Phase III of the project (planned for fiscal year 2010 funding) will include dissemination activities for the materials developed.
Period: 5/08-5/11
Funding: $427,936
Deliverables: Template for consensus reporting, self-administered questionnaire, instrument-associated data collection materials, and final report.

Current as of November 2009
Internet Citation: ACTION Project Awards, Fiscal Year 2008: Field Partnerships for Applied Research. November 2009. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/research/findings/factsheets/translating/action08/index.html