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Turning Research to ACTION through Delivery-Based Networks

Turning Research to ACTION through Delivery-Based Networks. Cynthia Palmer, MSc, Program Officer, CDOM, AHRQ. Goals for Today. Share our experience using a delivery-based research network, the IDSRN

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Turning Research to ACTION through Delivery-Based Networks

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  1. Turning Research to ACTION through Delivery-Based Networks Cynthia Palmer, MSc, Program Officer, CDOM, AHRQ

  2. Goals for Today • Share our experience using a delivery-based research network, the IDSRN • Describe what’s changing with the transition to the IDSRN’s successor: Accelerating Change and Transformation in Organizations and Networks (ACTION) • Explore potential collaboration through ACTION

  3. Original research 18% variable Negative results Dickersin, 1987 Submission 46% 0.5 year Kumar, 1992 Koren, 1989 Acceptance Negative results 0.6 year Kumar, 1992 Publication 17:14 Expert opinion 35% 0.3 year Poyer, 1982 Balas, 1995 Lack of numbers Bibliographic databases 50% 6. 0 - 13.0 years Antman, 1992 Poynard, 1985 Reviews, guidelines, textbook 9.3 years Inconsistent indexing Implementation 17 yrs to turn 14% of original research to the benefit of patient care (Andrew Balas)

  4. To Improve Health Care, Need to Move from Supply-Driven Model RESEARCHERS DECISION-MAKERS • Questions • Hypotheses • Funding Applications • Study • Writing • Revising • Submitting/resubmitting PUBLICATIONS Leadership Politics Evidence Culture

  5. …to Demand-Driven Model DECISION-MAKERS RESEARCHERS Info + Tools Info + Tools PUBLICATIONS

  6. Demand-driven Models: IDSRN and ACTION • Network of healthcare delivery-based partnerships • Hospitals, ambulatory care, LTC facilities, health plans • HS researchers and consultants • Work through pre-competed 5-year master contracts • Contractors (partners) compete for task orders • Focus on rapid-cycle, applied research of interest to AHRQ, partnerships’ own operational leaders and others

  7. How Does Contract Process Work? • Rolling topic selection throughout fiscal year • Topic ideas welcomed from all sources • Choose topics critical to DHHS, health systems, sponsors • Competitive (or justified sole-source) solicitation • Partnerships submit proposals within 4-5 weeks • Each partnership may submit >1 proposal • Review by small, informal committee • Awards made within 2 days to 3 weeks • Fixed cost contracts • Typically 12-18 month project timelines

  8. How Does Funding Work? • Historically, ~$1 million/yr in dedicated funds, plus some AHRQ portfolio funding (e.g. pt safety, LTC, HIT) • 2000-2005: >$26 million awarded to 93 projects in IDSRN • In 2005: 67% of the $6.6 million awarded with external funds (through IAAs or gifting mechanisms: ASPE, CDC, CMS, DHS, DoD, NCI, NIMH, OMH, OASPHEP, RWJF) • Match topics with AHRQ-targeted Congressional appropriations, earmarks, interests of external funders

  9. ACTION: Growing Capacity • Build on IDSRN’s capacity, track record for impact, our 5-yr experience with the program • ACTION RFP emphasized: • Focus on demand-driven, practical, applied, rapid-cycle work across 10 portfolio topics • taking implementation and uptake of innovation to scale • Leadership commitment to turn research to practice (e.g., in-kind resources, readiness to leverage additional funding)

  10. ACTION: Growing Capacity (2) • Inclusion of firm(s) in the partnerships with expertise in communication, dissemination, tracking sustainability • More breadth and depth in partnerships (e.g., include QIOs? VA?) • Assistance in seeking co-sponsorship opportunities, commitment of in-kind resources • Understanding of anticipated deliverables (tools, products, strategies for successful implementation) • Understanding of ACTION contract requirements

  11. Critical Criteria for ACTION Contracts • Proposal review assured: • Responsiveness to these RFP goals and objectives • Consideration of past performance regarding rapid-cycle implementation, dissemination, uptake of demand-driven and evidence-based products, tools, strategies

  12. Who Will Participate in ACTION? • Awarding of 15 contracts to large, top-ranking partnerships is underway • ACTION will have volume and diversity in settings, providers, payors, populations, topics • ACTION partnerships offer several strategic advantages that include the following…

  13. Strategic Advantage 1:Size and Breadth • > 100 million recipients of care • Majority of physicians • > 50% of acute care hospitals • >60,000 outpatient practices • >3,000 LTC facilities • >900 rehabilitation facilities • >1,000 home health agencies • >500 dental clinics • Plus safety nets, school health clinics, etc

  14. Strategic Advantage 2: Diversity • Payer mix: privately insured, Medicare (19 million), Medicaid (~12 million), uninsured (~6 million) • Geographic mix: all states; urban, inner-city, suburban and rural (>7 million) residents • Demographic mix: ethnic and racial minorities (>12 million), children and adolescents (>10 million), persons aged 65+ (>17 million)

  15. Strategic Advantage 3: Data, Research, Implementation Capacity • Large, robust databases (e.g., administrative, clinical, registries) many are electronic, increasingly linkable • Many nationally-recognized academic & field-based researchers with expertise in data manipulation, methods, emerging organizational and management issues • Operational leadership committed to setting agenda, using findings, in-kind contributions

  16. Strategic Advantage 4: Speed • From request for proposals to award : ~9 weeks • Average project completed in 15 months • Mechanism for short add-on work • Can also do short e-mail queries • Do you have an interest in X? • Have you ever tried Y?

  17. Strategic Advantage 5: Impact • ACTION will require products and tools as contract deliverables, such as: • Presentations to healthcare operational leadership • Presentations at live/web-assisted conferences • Scalable, scenario-appropriate models • Training curricula, workshops, workshop tools • “How to” guides, workbooks, DVDs, videos, webcasts • Publications in peer-reviewed and trade journals • Dozens of local to international examples of uptake of such tools developed/tested in IDSRN projects

  18. Impact: Emergency Preparedness Tools Ready for Katrina Disaster Relief • Expand Surge Capacity with Former ("Shuttered") Hospitals: tohelp officials select and mobilize formerly closed health facilities in a public disaster • Alternate Site Locator: to help State and local officials quickly locate appropriate alternate health care sites if existing ones are overwhelmed • Health Emergency Assistance Line and Triage Hub (HEALTH) Model: todevelop health emergency contact centers

  19. Impact: Emergency Preparedness Tools Ready for Katrina Disaster Relief • Emergency Preparedness Resource Inventory: tohelp local/regional planners inventory critical resources such as equipment, personnel, and supplies • Staffing for Disaster Preparedness Response Model: to plan antibiotic dispensing and vaccination campaigns to respond to large-scale natural disease outbreaks and localized episodes

  20. Impact: New York Creates Seamless Hospital to- Home Transition for Cardiac Patients • Problem - Poor communication between New York hospital and home health care at patient discharge • Product • Phase I: electronic tool for rapid, accurate, complete information flow between care settings and providers • Phase II: web-based system will include several large cardiology practices affiliated with Cornell – link hospital, home health providers, GPs, patients • Impact • NYPHS geriatrics, HIV and general medicine clinics using Phase I tool for patients discharged to care with ANY home health agency. CIO for Cornell Physician’s Organization wants to adapt the e-485 for inclusion in their EPIC EHR currently used by > 150 providers.

  21. Impact: Plans Use Guides to Increase Cultural/Linguistic Competency • Problem • CMS mandated either culturally and linguistically appropriate service (CLAS) or clinical improvement efforts in M+COs, but M+COs uncertain how to proceed • Product • Lovelace developed CLAS guides to help M+COs • Guides posted on CMS and AHRQ websites; mailed to all M+COs; used as training tools in 5 CLAS workshops • Impact • Users report that guides provide valuable tools and information, are easy to reference, have increase plan awareness of gaps in services for limited English proficiency and ethnically diverse members

  22. Impact: Health Plans Use Tool to Identify and Track HEDIS Measure Disparities • Problem • Lack of race/ethnicity data in various health plans to assess impact on access to care, resource use, outcomes of care • Product • Spreadsheet tool to identify HEDIS measure disparities in performance for race/ethnicity, SES, gender by patient subgroups, measures, and/or business lines. • Impact • Tool + technical assistance (RAND) being used by 9 large health plans in a Collaborative co-sponsored by AHRQ and RWJF to reduce disparities in diabetes care.

  23. Impact: Safety Net Hospital Transformation Prompts Rapid Improvements in Care • Problem How to redesign a hospital system • Product Toolkit developed to assist Denver Health and others considering hospital system transformation • Impact Using lessons learned in first 13 months, >12 examples of system improvements have already been enthusiastically adopted at Denver Health

  24. 2006 ACTION Timeline: Next Steps 02/06 04/06 06/06 08/06 … Finalize contracts Solicit TO topics from AHRQ and external sources (ongoing) Seek internal & external commitments to fund TOs (ongoing) Send out RFTOs through July Award TOs through fiscal year end Plan and hold Annual Meeting (04/06?) Select & convene Advisory Panel (2 x /year)

  25. Collaboration Through ACTION • Nominate concepts for projects you'd like to see funded: • Send 1-2 page concepts to: CPalmer2@ahrq.gov • In clude: brief study rationale, suggested methods if known, description of how findings may improve health care delivery/health outcomes, timeframe (12-18 months maximum) and a rough, estimated total budget amount.

  26. Collaboration Through ACTION • Sponsor one or more projects (or suggest potentially interested sponsors or co-sponsors).

  27. Collaboration Through ACTION 3. Other Ideas? Questions? Comments? For more information contact: Program Officer: CPalmer2@AHRQ.gov CDOM Director: IFraser@ahrq.gov ACTION RFP at: www.ahrq.gov/fund/contraix.htm

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