Harnessing Data Visualization to Advance Equity in Clinical Services

About the Challenge

Background

The Agency for Healthcare Research and Quality (AHRQ) is announcing a competition to accelerate the identification and elimination of inequities in the receipt of preventive services. Preventive services include but are not limited to immunizations, screening tests, and counseling on healthy behaviors. Receiving preventive services can reduce the incidence of serious health conditions and save lives.

Despite the potential benefits, data suggest that there are significant and widespread disparities in the receipt of preventive services. Currently, less than 4% of Black non-Hispanic adults and Hispanic adults received all age-appropriate preventive health services recommended by the United States Preventive Services Task Force.² Furthermore, the literature on certain health conditions targeted by preventive services shows higher prevalence or worse outcomes for persons of certain races and ethnicities and for persons of low socioeconomic status. Examples include breast cancer, cervical cancer, colorectal cancer, diabetes, cardiovascular disease (CVD), human immunodeficiency virus (HIV), hypertension, lung cancer, obesity, smoking, unhealthy alcohol use, and unhealthy drug use. Some health conditions show disparities by sex, age (e.g., higher adjusted mortality rates in persons aged 65 years or older), sexual behaviors (e.g., higher prevalence of HIV in men who have sex with men), or socioeconomic factors (e.g., higher blood pressure control rates for college graduates and those with greater income; higher prevalence of tobacco use among adults who completed less education, have lower household incomes, are uninsured, or live with a disability). For other clinical preventive services, the disparities are less clear (for example, screening for depression).³

While data on the receipt of preventive services are routinely collected, there is a further need to focus on within-health system use of data to better understand factors underlying disparities and to ultimately drive more equitable care.  

Challenge Goal

AHRQ’s Center for Evidence and Practice Improvement (CEPI) announces a Challenge to create data visualizations to identify disparities in the receipt of clinical preventive services and use these visualizations to create or adapt interventions to address these disparities.

In phase 1 of the Challenge, participants will create a proposal which includes descriptions of the research team, data visualization(s), possible drivers of disparities, and potential interventions to address care gaps. Proposals should leverage published work in this area and are encouraged to build on existing healthcare system data analytics infrastructure. In phase 2, participating organizations will develop the visualization and deploy it across a participating health system; for example, by using standard data elements available in most EHRs and commonly used dashboard software. Participants will further define and implement interventions to address the drivers of the identified disparities. The winning teams will be selected based on the potential impact of the proposal.

AHRQ encourages proposals from teams partnering with health systems in shortage areas or in medically underserved areas/populations as defined by the Health Resources & Services Administration (HRSA). 

AHRQ encourages projects concerning the delivery of healthcare for priority populations. More information can be found on the AHRQ website.

The Challenge consists of two phases:

Phase 1 overview:

Participants will submit a project proposal on the development of a populational-level data visualization tool for one or more USPSTF recommended clinical preventive services that enables stratification by priority populations. Data visualizations must be electronic health record (EHR)-compatible to allow for seamless integration into existing workflow or low-burden adaptation of workflow; they must furthermore be EHR-interoperable to allow for use of visualization across EHRs and health systems. Priority populations must be clearly defined and a rationale for including specific groups must be provided. Proposals must describe an approach to understand disparities and at least one intervention to address the care gaps identified using the data visualization tool. The patient perspective must be an integral part of the proposed process, for example, by including patient representatives on the research or data visualization design team, or by incorporating user experience in testing the data visualization and/or intervention(s). Applicants are encouraged to include potential interventions to address care gaps at more than one level (patient-provider, community, system, etc.).

Phase 2 overview:

The winner(s) of Phase 1 will deploy the proposed data visualization tool and implement and evaluate the corresponding intervention. A final report must be provided to AHRQ that includes data on the tool development and use, intervention implementation measures, proven or potential clinical impact, and recommendations for future researchers and implementation at other sites. Both the winners of Phase 1 and the winners of Phase 2 will receive cash prizes at the end of Phase 2.

Challenge Design

Requirements

Participating teams must consist of or partner with health systems and have access to necessary data and data analytics infrastructure. Teams must have expertise in the clinical topic, evidence-based practice, data analytics, implementation science, and quality improvement.

This Challenge consists of two phases:

Phase 1: Proposal

During Phase 1, teams submit a proposal to develop a visualization tool to identify care gaps in the receipt of clinical preventive services and develop or adapt interventions to address these care gaps.

Phase 1 requirements include:

1. Specifications for a population-level data visualization tool for clinical preventive services, including:
   • Proposed populations to stratify.
   • Measures to include.
   • Plan for access to and use of healthcare system electronic medical record and integration of the tool.
2. Description of potential findings and approach to addressing any revealed inequities, including potential intervention(s). The data visualization tool is not the intervention itself but must be an integral part of the intervention and guide its implementation.
3. Plan for incorporating the patient perspective.
4. Implementation and evaluation plan, including plan for sustainability or further research after the project period.
5. List of team members, their role, area of expertise, and hours on project.

Each proposal will be considered and evaluated on its own merit rather than in comparison to other submissions. Strongest consideration will be given to proposals that directly link the data visualization component with the intervention(s) to analyze and act on the new information.

Up to 5 proposals will be selected as winners for Phase 1.

Phase 2: Implementation of Intervention

Winners in Phase 1 will be invited to develop and implement the data visualization tool, describe the use of visualized data to understand and respond to inequities in preventive care, and provide a final report to AHRQ.

Phase 2 requirements include:

1. Operationalize the steps outlined in the Phase 1 proposal, including development, implementation, and evaluation of the data visualization tool and intervention(s).
2. Generate a 508-compliant final report based on the approach and measures proposed in Phase 1. This must include:
   • How the tool and intervention were developed and implemented, including how the visualized data were analyzed and acted upon, and lessons learned.
   • Proven or expected clinical impact, sustainability plan, and recommendations for how the data visualization can be implemented at other sites.

Timeline and Prize Amounts

AHRQ is hosting this challenge as a two-phase competition. All costs associated with developing and submitting proposals as well as implementing the data visualization tool will be the responsibility of the Challenge participant. Cash prizes will be awarded only after the projects are evaluated and determined acceptable at the end of Phase 2.

Timeline

• September 21, 2023—Challenge launch. For AHRQ requirements on accessibility and compliance with Section 508, please refer to the AHRQ Publishing and Communications Guidelines. For questions regarding the Challenge, please email ahrqchallenge@ahrq.hhs.gov.
• January 5, 2024—Submissions for Phase 1 (written proposals) are due. 
• February 14, 2024—AHRQ will complete the review of the proposals and announce the Phase 1 winners. Phase 2 of the Challenge will commence once the Phase 1 winners are announced and notified.
• February 16, 2024 (approximate)—AHRQ will schedule a virtual technical assistance webinar with all winners of Phase 1 to discuss scope of content, accessibility/compliance with Section 508, and address questions that the winners may have. Questions will be submitted in advance.
• August 16, 2024—Phase 2 participants Final Reports are due.
• September 27, 2024—Winners of Phase 2 are announced.
• October 2024—Final reports are published on the AHRQ website and prizes are distributed.

Prize Amounts

Up to five entries in Phase 1 will be will be selected as winners of Phase 1. Only the entries selected as winners of Phase 1 will be eligible to enter Phase 2. AHRQ will award up to five Phase 1 winners cash prizes of $50,000 each. These prizes will be distributed at the end of Phase 2 of the Challenge.

At the end of Phase 2, the first-place winner of Phase 2 will be awarded $100,000 (plus $50,000 from Phase 1) and the second-place winner will be awarded $50,000 (plus $50,000 from Phase 1). The third-place winner will be awarded $20,000 (plus $50,000 from Phase 1), and fourth and fifth place holders will be awarded $10,000 each (plus $50,000 from Phase 1 each). All final reports will be posted on the AHRQ website.

Participants in Phase 2 may be disqualified if their submitted project deviate from their winning Phase 1 proposals.

Rules

Eligibility Rules for Participating in the Challenge

To be eligible under this Challenge, an individual (whether participating singly or in a group) or entity:

1. Must have registered (Challenge.gov) to participate in the Challenge.
2. Must have complied with the rules set forth in this announcement for participation in this Challenge.
3. Must be incorporated and maintain a primary place of business in the United States (in the case of a private entity), and in the case of an individual, whether participating singly or in a group, must be a citizen or permanent resident of the United States.
4. May not be a Federal entity or Federal employee acting within the scope of their employment. (All Federal employees should consult with their agency Ethics Official to determine whether the Federal ethics rules will limit or prohibit the acceptance of a prize).
5. May not be an employee of AHRQ or any other company, organization, or individual involved with the design, production, execution, judging, or distribution of the Challenge, or their immediate family (spouse, parents and stepparents, siblings and stepsiblings, and children and stepchildren), or household members (people who share the same residence at least 3 months out of the year).
6. May not use Federal funds from a grant to develop Challenge applications unless consistent with the purpose of the grant award.
7. May not use Federal funds from a contract to develop Challenge applications or to fund efforts in support of a Challenge submission.
8. Shall not be deemed ineligible because the individual or entity used Federal facilities or consulted with Federal employees during a competition if the facilities and employees are made equitably available to all individuals and entities participating in the competition.
9. Shall not be required to purchase liability insurance as a condition of participation in this competition.

Additional Rules of Participation

By participating in this Challenge, everyone (whether participating singly or in a group) or entity:

1. Agrees to follow all applicable Federal, State, and local laws, regulations, and policies.
2. Agrees to comply with all terms and conditions of participation in this Challenge.
3. Agrees that the submission will not use HHS or AHRQ logos or official seals, except as authorized by HHS or AHRQ. Notwithstanding this authorized use of AHRQ/HHS branding, participants will not claim endorsement by AHRQ/HHS.
4. Understands that all materials submitted to AHRQ as part of a submission become AHRQ records. Any confidential commercial or financial information contained in a submission must be clearly designated as such at the time of submission.
5. Agrees that the submission must not infringe upon copyright or any other rights of any third party. 
6. Agrees to assume any and all risks and waive claims against the Federal Government and its related entities, except in the case of willful misconduct, for any injury, death, damage, or loss of property, revenue, or profits, whether direct, indirect, or consequential, arising from participation in this prize contest, whether the injury, death, damage, or loss arises through negligence or otherwise.
7. Agrees to indemnify the Federal Government against third-party claims for damages arising from or related to Challenge activities.
8. Understands that AHRQ reserves the right to cancel, suspend, and/or modify this prize contest, or any part of it, for any reason, at AHRQ’s sole discretion. AHRQ also reserves the right not to award any prizes if no entries are deemed worthy.
9. Understands that AHRQ will not select a winner that is named on the Excluded Parties List System (EPLS).

Intellectual Property (IP) Rights

1. Each participant retains title and full ownership in and to their submission. Participants expressly reserve all intellectual property rights not expressly granted.
2. By participating in the Challenge, each participant (whether participating singly or in a group) acknowledges that he or she is the sole author or owner of, or has a right to use, any copyrightable works that the submission comprises, that the works are wholly original with the participant (or is an improved version of an existing work that the participant has sufficient rights to use and improve), and that the submission does not infringe any copyright or any other rights of any third party of which participant is aware.
3. In addition, each participant (whether participating singly or in a group) grants to the U.S. Government a paid-up, nonexclusive, royalty-free, irrevocable worldwide license in perpetuity, and the right to reproduce, publish, post, link to, share, display publicly (on the web or elsewhere) and prepare derivative works, including the right to authorize others to do so on behalf of the U.S. Government.
4. Each participant must clearly delineate any intellectual property and/or confidential commercial information contained in a submission that the participant wishes to protect as proprietary data, in accordance with Additional Rules of Participation No. 4.
5. If the submission includes any third-party works (such as third-party content or open-source code), the participant must be able to provide, upon request, documentation of all appropriate licenses and releases for use of such third-party works. If the participant cannot provide documentation of all required licenses and releases, AHRQ reserves the right, in its sole discretion, to disqualify the submission.

References

1. Borsky, A., et al., Few Americans Receive All High-Priority, Appropriate Clinical Preventive Services. Health Affairs, 2018. 37(6): p. 925-928.

2. Borsky AE, Z.M., Wolff T, Ngo-Metzger Q, Mueller N, Bierman AS, Disparities in Receipt of High-Priority Clinical Preventive Services Under Review, 2023.

3. Jonas DE, Riley S, Barclay C, Voisin C, Chirumamilla V. Preventive Healthcare: Gathering Stakeholder Input on Evidence and Implementation Review and Update the List of High-Priority Clinical Preventive Services for Adults Age 35 or Older.

For Further Information, contact: ahrqchallenge@ahrq.hhs.gov