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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 Cynthia Palmer, MSc, Program Officer, CDOM, AHRQ
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
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)
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
…to Demand-Driven Model DECISION-MAKERS RESEARCHERS Info + Tools Info + Tools PUBLICATIONS
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
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
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
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)
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
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
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…
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
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)
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
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?
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
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
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
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.
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
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.
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
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)
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.
Collaboration Through ACTION • Sponsor one or more projects (or suggest potentially interested sponsors or co-sponsors).
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