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ACTION Project Awards, Fiscal Year 2009

Field Partnerships for Applied Research

Select for the ACTION Fact Sheet.
Select for Awards in Fiscal Years 2006, 2007, 2008, and 2010.

Health Care Organization and Payment

Title: Incorporating AHRQ's QIs in Hospital Quality Improvement Practices
Partner: RAND
ACTION Contact: Allen Fremont, allen_fremont@rand.org
Description: RAND is developing a toolkit that will facilitate hospitals' application of the AHRQ Quality Indicators (QIs) in improving quality and patient safety. The toolkit will provide instruction on how to apply the QIs to the hospitals' data; methods on how to evaluate the data to identify opportunities for improvement; strategies for implementing interventions (or evidence-based best practices); methods to measure progress; tools for evaluating the cost-effectiveness of these changes; and discussion of the value of using the QIs for quality improvement, as well as potential challenges and barriers to quality improvement efforts that incorporate the AHRQ QIs and how to help overcome them. RAND will help disseminate tools developed through this project and will present evidence of the value of using the AHRQ QIs in quality improvement.
Period: 4/10-11/11
Funding: $599,737
Deliverables: A final report that includes toolkit, implementation plan, dissemination plan, manuscripts, and presentation materials.

Title: Developing the CAHPS Survey for Cancer Care
Partner: American Institutes for Research
ACTION Contact: Kristin Carman, AIR, kcarman@air.org
Description: AIR is developing and testing a survey based on CAHPS® (Consumer Assessment of Healthcare Providers and Systems) design principles through which cancer patients can report on the quality of care they receive in different treatment settings; developing and testing formats for reporting data from this survey to cancer patients and other audiences; preparing and submitting a package to obtain use of the CAHPS trademark; working with AHRQ and the National Cancer Institute to develop and implement a dissemination plan; and submitting the completed survey to the National Quality Forum (NQF) for review and approval.
Period: 9/09-9/10
Funding: $599,978
Deliverables: CAHPS Survey and Reporting Kit for Cancer Care, trademark and NQF endorsement, presentation to User Network, manuscripts, and additional presentations.

Title: Avoiding Readmissions in Hospitals Serving Diverse Patients
Partner: Boston University
ACTION Contact: Carol VanDeusen Lukas, carol.vandeusenlukas@med.va.gov
Description: Boston University is revising the Project Reengineered Discharge (Project RED) Toolkit to facilitate hospitalwide implementation in hospitals that serve culturally and linguistically diverse patients, Implementing the Project RED Toolkit in a set of diverse hospitals in an effort to reduce 30-day readmission and emergency department revisit rates at implementing hospitals, and learning about implementation of the Project RED Toolkit to support dissemination.
Period: 8/09-3/12
Funding: $499,977
Deliverables: Revised Project RED toolkit, implementation evaluation report, impact evaluation report, dissemination plan, peer-reviewed and trade journal manuscripts, and final report.

Patient Safety

Title: Demonstration of a Comprehensive Unit-based Safety Program (CUSP) To Reduce Catheter-Associated Urinary Tract Infection (CAUTI)
Partner: Health Research and Educational Trust
ACTION Contact: Maulik Joshi, mjoshi@aha.org
Description: HERT is initiating a demonstration of the concept of a tested and proven Comprehensive Unit-based Safety Program (CUSP) that can be applied to catheter-associated urinary tract Infection (CAUTI) by developing a modification to existing CUSP protocol and supporting materials. The current CUSP protocol and materials will be provided to the offerors at http://www.aone.org/hret/programs/cusp.html and https://www.patientsafetygroup.org/program/index. HERT is recruiting 10 hospitals within each of 10 States to demonstrate the utility of applying CUSP to CAUTI and expanding or enhancing existing statewide consortia efforts to reduce health care-associated infections (HAIs) to include CAUTI. The initial Keystone Project of the Michigan Hospital Association focused the CUSP approach on reducing central-line bloodstream infections (CLABSI) in intensive care units (ICUs). The project demonstrated that the CUSP approach significantly sustained the reduction of CLABSI rates in hospital ICUs throughout Michigan. Following the success with CLABSI, the Keystone Project expanded the CUSP approach to address CAUTI. The reduction of CAUTI rates using the CUSP approach proved to be equally successful. Both successes increased interest in demonstrating that the CUSP approach can be a vital tool to help other hospitals reduce HAIs.
Period: 9/09-9/11
Funding: $997,857
Deliverables: Sustainability plan for statewide consortia and Children's Hospital network, CUSP course design guide, final CUSP package, data collection protocols, final report.

Title: Standardizing Antibiotic Use in Long-Term Care Settings (SAUL)
Partners: Abt Associates and American Institutes for Research
ACTION Contacts: Terry Moore, BDU@abtassoc.com; Kristin Carman, AIR, kcarman@air.org
Description: Antibiotics are commonly prescribed in long-term care facilities, and the proportion of inappropriate antibiotic prescriptions can be as high as 75 percent in this setting. Optimizing use of antibiotics in long-term care facilities will reduce the incidence of Clostridium difficile colitis and the emergence of multidrug-resistant organisms that pose major morbidity and mortality risks for residents. This effort includes two projects that will first assess current antibiotic utilization practices in a group of long-term care facilities using the Loeb "minimum criteria" as a standard and then develop new approaches to optimize antibiotic prescribing practices in a subset of facilities.
Period: 9/09-3/12
Funding: $1,999,532
Deliverables: Dissemination plan, dissemination activities, final report, manuscript(s).

Title: Reducing Clostridium Difficile Infections in a Regional Collaborative of Inpatient Health Care Providers
Partner: Boston University
ACTION Contact: Carol VanDeusen Lukas, carol.vandeusenlukas@med.va.gov
Description: This project aims to reduce Clostridium dfficile infections (CDIs) along with their associated morbidity, mortality, and costs in a cohort of regional inpatient facilities. Participating facilities have patients with frequent health care contacts before and after hospitalization, such as acute care facilities, associated nursing homes, long-term care facilities, and ambulatory care settings, including emergency departments. Interventions for reducing CDI rates will include decreasing unnecessary antimicrobial prescribing and improving infection control. Prevention measures will be bundled according to the clinical processes and personnel most affected by their implementation (e.g., measures affecting environmental services or facilities maintenance versus nursing care or other clinical care). Investigators will conduct both quantitative and qualitative research, including interviews, focus groups, and periodic surveys to identify barriers that either impede prevention measure implementation or make it expensive. As a result of this project, researchers will develop an implementation toolkit and manual to assist other regional prevention collaboratives in reducing CDI rates.
Period: 9/09-9/11
Funding: $999,984
Deliverables: Implementation toolkit and manual, final report; materials for publication.

Title: Improving Measurement of Surgical Site Infection (SSI) Risk Stratification and Outcome Detection
Partner: Denver Health
ACTION Contact: Susan Moore, susan_moore@dhha.org
Description: SSIs are a substantial cause of morbidity and mortality among hospitalized patients. Based on survey data from 2002, SSIs accounted for approximately 16 percent of an estimated 1.7 million HAIs and 8,205 of the 98,987 HAI-associated deaths, for a mortality rate of 3 percent. The financial burden attributable to these largely preventable infections is also significant, with an estimated hospital cost of $25,546 per infection and approximately $7 billion annually nationwide. Feedback on surgeon-specific SSI rates is considered to be the cornerstone for preventing these infections. For feedback to be effective, however, surgeons must believe that the rates are reliable for comparing their performance to that of their peers. Unfortunately, many surgeons believe that current surveillance methods are unreliable because of limitations in patient risk adjustment and event detection. This multihospital study will use sensitive electronic detection algorithms to determine SSI rates in a large number of specific high-risk procedures and will design and test methods to risk stratify on data elements that can be optimized for electronic collection. Investigators will propose a risk-adjusted model in a set of procedures and then verify the model's predictive value in a second patient pool. Finally, investigators will assess surgeon acceptance of the surveillance methodology using the risk-adjusted models with sensitive event-detection methods.
Period: 9/09-3/11
Funding: $413,172
Deliverables: Final report.

Title: Reducing Infections Caused by Carbapenem-Resistant Enterobacteriaceae Through Application of Recently Developed Recommendations
Partner: Boston University
ACTION Contact: Carol VanDeusen Lukas, carol.vandeusenlukas@med.va.gov
Description: Carbapenem-resistant Enterobacteriaceae (CRE) is a bacterial agent that is emerging as a challenge in health care settings. One type of CRE-Klebsiella pneumoniae carbapenemase (KPC)-producing organisms, also known as carbapenem-resistant Klebsiella pneumoniae-poses significant treatment challenges because it is resistant to almost all available antimicrobial agents. As a result, these infections have been associated with higher mortality, longer hospital stays, and increased health care costs. The emergence and spread of KPC-producing organisms and other types of CRE are worrisome public health developments and underscore the immediate need for aggressive detection and control strategies. The goal of this project is to demonstrate the efficacy of aggressive infection control interventions recommended by the Centers for Disease Control and Prevention to halt the emergence of KPC-producing organisms. A second goal is to develop an implementation toolkit and manual to assist facilities in implementing aggressive infection control approaches to reduce the spread of KPC-producing organisms.
Period: 9/09-9/11
Funding: $499,998
Deliverables: Implementation toolkit, dissemination plan, dissemination activities, final report, manuscript(s).

Title: Catheter-Associated Urinary Tract Infection Demonstration Project Using the Comprehensive Unit-Based Patient Safety Program
Partner: Health Research and Educational Trust (HRET)
ACTION Contact: Maulik Joshi, mjoshi@aha.org
Description: The urinary tract is the most common site of HAIs, accounting for more than 30 percent of infections reported by acute care hospitals. Complications associated with catheter-associated urinary tract infections (CAUTIs) cause patient discomfort, prolonged hospital stays, and increased cost and mortality. Each year, more than 13,000 deaths are associated with urinary tract infections. The success of the Comprehensive Unit-based Safety Program (CUSP) in reducing CLABSIs (see HRET task order above) has increased pressure to apply the program to other HAIs, including CAUTIs; thus, this project initiates a demonstration of the CUSP concept as applied to CAUTIs. Investigators will first modify CUSP materials so that they apply to CAUTIs and then use the materials in 10 hospitals in each of 10 States, for a total of 100 hospitals, to demonstrate CUSP's utility in reducing CAUTIs.�
Period: 9/09-9/11
Funding: $997,857
Deliverables: Sustainment plan for statewide consortia and hospital network, CUSP Course Design guide ; final CUSP package, data collection protocols, final report.

Title: Prevention of Blood Stream Infections for Outpatients Undergoing Hemodialysis
Partner: Yale University
ACTION Contact: Beverly Belton, Beverly.Belton@ynhh.org
Description: According to CDC, in 2006 approximately 330,000 patients were maintained on hemodialysis in the United States. Infection, most often of the bloodstream, is the second leading cause of death for hemodialysis patients. Bloodstream infections (BSIs) are most frequently experienced by patients with indwelling vascular catheters. As in several other ACTION studies, this study will use the Comprehensive Unit-based Safety Program (CUSP) to examine the comparative effectiveness of standard recommended practices with antibiotic catheter locks and antiseptic catheter locks for preventing BSIs in hemodialysis patients. Secondary evaluations will include screening assessments for changes in antimicrobial resistance and evaluating the development of toxicities related to the use of catheter locks.
Period: 9/09-3/12
Funding: $999,993
Deliverables: Expert meeting report, study protocol for pilot, final report.

Title: Refine, Develop, and Conduct Formative Evaluation of High-Impact Training Modules for Frontline Nursing Home Personnel To Improve Patient Safety
Partner: RAND
ACTION Contact: Allen Fremont, Allen_fremont@rand.org
Description: A comprehensive range of extant patient safety educational modules and materials that were designed and developed to have relevance for frontline provider personnel are being gathered, examined, and assessed for relevance for frontline nursing home provider and caregiver personnel. Three high-impact patient safety areas in the nursing home setting will be selected and modules/materials will be adapted, refined, or otherwise developed as new educational content to support the training needs of provider and caregiver workers. Three exemplar modules will be developed that focus on the high-impact areas and that incorporate relevant patient safety principles. The exemplar modules will be pilot tested with representative providers and caregivers in the nursing home setting as part of the formative evaluation process. The modules will be revised as needed based on pilot test results to improve their effectiveness and will be finalized in a format that is easy to access and suitable for use by nursing home participants and their instructors.
Period: 9/09-3/11
Funding: $374,884
Deliverables: Final report, patient safety educational modules for frontline nursing home providers and other relevant personnel.

Title: Improving Patient Safety System Implementation for Limited-English-Proficiency Patients
Partner: Abt Associates
ACTION Contact: Terry Moore, BDU@abtassoc.com
Description: To decrease harm due to language barriers and cross-cultural communication problems, this project is developing and field testing a TeamSTEPPS training module to educate hospital staff about language barriers, cultural diversity, and interventions to reduce errors; developing a guide for hospitals on preventing medical errors due to language barriers and cross-cultural communication problems; and promoting implementation of these tools.
Period: 9/09-4/12
Funding: $499,978
Deliverables: Environmental scan, field test report, finalized TeamSTEPPS training module, hospital guide, implementation promotion plan, final report.

Title: Guide to Patient and Family Engagement in Health Care Quality and Safety in the Hospital Setting: Development, Implementation, and Evaluation
Partner: American Institutes for Research
ACTION Contact: Kristin Carman, AIR, kcarman@air.org
Description: AIR is promoting patient and family engagement in hospital settings by: (1) developing, piloting, and revising a Guide to Patient and Family Engagement in Hospital Quality and Safety, which may require adapting existing tools/materials and developing new tools/materials where they are needed but do not yet exist; (2) implementing and evaluating the guide in a limited number of settings; and (3) broadly disseminating the guide and providing technical assistance to implementers.
Period: 9/09-9/10
Funding: $899,996
Deliverables: Environmental scan results, pilot test results for implementation of the Guide to Patient and Family Engagement in Hospital Quality and Safety, revised guide, dissemination and technical assistance plan, dissemination report, final report.

Title: Evaluation of AHRQ's On-Time Pressure Ulcer Program (non-hospital-based adverse event systems)
Partner: Abt Associates
ACTION Contact: Terry Moore, BDU@abtassoc.com
Description: The first objective of this task order is to evaluate AHRQ's On-Time Pressure Ulcer Prevention Program by measuring and assessing to what extent the program improved pressure ulcer rates in facilities that have implemented the program compared to a set of control facilities. The second objective is to develop an injurious falls prevention module with pilot nursing homes, similar to the On-Time Pressure Ulcer Prevention module, with a focus on the following: standardizing assessment information; identifying high-risk residents; tracking changing risks; developing reports that help assess accuracy of assessments; track referrals, treatments, and therapies; help clinical decisionmaking; and develop and test the specifications for software development. The module will be integrated with the On-Time Pressure Ulcer Prevention module when possible and will explore efficiencies from integration with the existing pressure ulcer risk management module.
Period: 6/09-5/10
Funding: $480,790 (with option to extend and expand project)
Deliverables: Final falls prevention tools and health information technology specifications; advisory panel recommendations; summary of implementation variation in plans, barriers, and lessons learned; final educational and training materials; publications and presentations.

Title: Using Evidence-Based Nursing Practices and EHR Decision Support To Reduce Fall-Related Patient Injuries in Acute Care
Partner: Aurora
ACTION Contact: Gina Graham, gina.graham@aurora.org
Description: This project is designed to develop, test, and disseminate evidence-based nursing practice decision support care planning within the electronic health record (EHR), improve care planning, reduce fall-related incidence and injury in acute care patients, and estimate or track costs and financial benefits of a nursing decision support tool. The content of the decision support tool will be interoperable across EHRs when possible. Over time, this tool may contribute to improvements in safety and quality of health information technology (HIT)-supported nursing care and may help systems reduce HIT implementation costs.
Period: 6/09-1/11
Funding: $387,369
Deliverables: Patient and family education materials for fall prevention; online staff education materials to reduce risk of patient falls; assessment of costs and financial benefits of electronic decision support and care planning for nurses; dissemination plan; final report.

Health Information Technology

Title: Communication-Focused Technologies
Partner: American Association of Homes & Services for the Aging, Boston University, RTI International
ACTION Contact: Helaine Resnick, hresnick@aahsa.org; Carol VanDeusen Lukas, carol.vandeusenlukas@med.va.gov; Amy Roussel, roussel@rti.org
Description: Three task orders were awarded to develop and test proof-of-concept projects that leverage innovative communication-focused technologies (e.g., cell phones, social networking sites, telehealth) to improve access to care, service quality, or patient safety in ambulatory settings. Each project makes innovative use of communication-based technologies, is person focused, targets hard-to-reach populations (based on geography, socioeconomic status, race/ethnicity, etc.), and addresses ambulatory care issues. Based on the success of this initial work, further implementation pilots are possible if funding is available.
Period: 5/09-10/10; 7/09-4/11
Funding: $1,200,000
Deliverables: Interim and final implementation and assessment reports, final report, and dissemination activities.

Title: Guide to Identifying and Remediating Unintended Consequences of Implementing Health IT
Partner: RAND
ACTION Contact: Allen Fremont, allen_fremont@rand.org
Description: RAND is to develop, pilot, and disseminate a guide to avoiding unintended and undesired consequences of implementing HIT or identifying and addressing undesired consequences that emerge during implementation. Use of the guide should promote more effective HIT implementation and greater user satisfaction. In the long run, the guide may contribute to improvements in safety and quality of HIT-supported care and may help systems reduce HIT implementation costs.
Period: 5/09-6/11
Funding: $399,894
Deliverables: Environmental scan, guide, dissemination plan, final report, dissemination activities.

Prevention

Title: Linking Clinical Practices and Community/Public Health Resources for Prevention
Partner: RTI International
ACTION Contact: Amy Roussel, roussel@rti.org
Description: The project goal is to facilitate linkages, communication, and coordination between clinical practices and public health/community-based organizations to increase health promotion. RTI is to perform an environmental scan and develop case studies on successful clinical-community linkages; convene a large meeting on this topic; and analyze findings from these activities. RTI will determine common processes, infrastructure, organizational requirements, and policies that facilitate factors, remove barriers, and promote solutions, and identify any other elements related to accomplishing sustainable linkages between clinical practices and community-based/public health interventions. In addition, RTI will develop a report on the current state of knowledge, models, project findings, and recommendations related to clinical-community linkages to support health promotion and will assist with dissemination and use of findings.
Period: 4/09-10/10
Funding: $299,936
Deliverables: Environmental scan, case studies on successful clinical-community linkages; report on the current state of knowledge and recommendations related to clinical-community linkages to support health promotion; dissemination of findings.

Emergency Preparedness

Title: Research, Report Writing, Event Management, and Meeting Facilitation Support for the National Commission on Children and Disasters
Partner: Abt Associates
ACTION Contact: Terry Moore, BDU@abtassoc.com
Description: The goals of this project are twofold: (1) to synthesize existing research, findings, and recommendations of the Commission into a final report to advise President Obama and Congress on children's needs as they relate to preparation for, response to, and recovery from all hazards; and (2) to provide administrative and meeting facilitation support to the Commission's stakeholder outreach initiatives, field hearings, and public meetings.
Period: 9/09-10/10
Funding: $425,000
Deliverables: Facilitation of and reporting on Commission meetings and other communications; creation, hosting, and management of an online registration Web site for all the Commission's public meetings; final report.

Current as of November 2009
Internet Citation: ACTION Project Awards, Fiscal Year 2009: Field Partnerships for Applied Research. November 2009. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/research/findings/factsheets/translating/action09/index.html