This Funding Opportunity Announcement (FOA) invites R18 grant applications for research that demonstrates how health information technology (IT) can improve patient-centered health outcomes and quality of care in primary care and other ambulatory settings through the scale and spread of successful, existing health IT-enabled practice models that use Patient-Reported Outcome (PRO) measures to achieve these objectives. For the purposes of this FOA, successful models are defined as models that demonstrate measurable impact on factors such as patient and clinician adoption, patient health outcomes, or quality of care.
The patient’s perspective is central to healthcare decisions affecting prevention, diagnosis, treatment and long-term care. PROs offer an essential perspective that complements clinician assessments, and may provide greater insights into health status, function, symptom burden, adherence, health behaviors, and quality of life. For the purposes of this FOA, PROs are data provided by patients regarding their health and functional status, including quality of life, symptoms, and activities of daily living. PROs can inform the clinical management of individuals, shared decision-making, patient self-management support, care planning, and goal setting in addition to supporting goal attainment. Furthermore, PROs provide important data for research and quality improvement efforts.
Several validated PRO measures are publically available and used to gather PRO data. For example, specialty practices can utilize condition-specific PRO measures such as the Knee injury and Osteoarthritis Outcome Score (KOOS) and the Hip disability and Osteoarthritis Outcome Score (HOOS) to systematically monitor an individual’s progress following knee and hip interventions, respectively. The Function and Outcomes Research for Comparative Effectiveness in Total Joint Replacement (FORCE-TJR) registry effort is a successful health IT-enabled model for collecting KOOS and HOOS measure data. The FORCE-TJR system collects and shares with participating surgeons real-time patient-reported outcomes to improve patient care following joint replacement surgery.
Examples of successful health IT-enabled approaches for PRO measure implementations exist for other conditions as well. The Distributed Ambulatory Research in Therapeutics Network (DARTNet), a collaboration of practice-based research networks, completed a comparative effectiveness research project on major depression that built an informatics infrastructure to collect patient-reported data on a large scale via the PHQ-9. Also, the Comparative Effectiveness Research Translation Network (CERTAIN), a network of healthcare provider organizations in Washington State, works in collaboration with the Surgical Care and Outcomes Assessment Program (Spine SCOAP), to conduct a program focused on spine surgery performance. Spine SCOAP provides data collected from patients undergoing lumbar or cervical spine surgery utilizing measures such as the Numeric Pain Rating Scale, a general measure of pain, and spine-specific measures of function, including the Oswestry Disability Index, and the Neck Disability Index (Hartzler, Chaudhuri, Fey, Flum, & Lavallee, 2015).
AHRQ is interested in understanding how heath IT can further extend (“scale and spread”) successful PRO measure implementations beyond the initial clinical setting or institution in which the health IT-enabled PRO implementation was originally developed and applied, thereby increasing the impact on practice. There is a need to scale and spread the successful use of PROs in a manner that is efficient, actionable by the physician, supports patients’ engagement with their health and care, and improves clinical processes and outcomes.
The overarching objective of this FOA is to demonstrate how health IT can improve patient-centered health outcomes and quality of care in primary care and other ambulatory settings through the scale and spread of successful, health IT-enabled practice models that use PRO measures to achieve these objectives. Since health IT is a demonstrated enabler of the use of PROs in certain care settings with certain populations and disease types, AHRQ is interested in further studying the use of health IT for the scale and spread of existing, successful PRO measure implementations in primary care and other ambulatory settings.
This FOA intends to support projects that scale and spread existing, successful PRO implementation approaches to additional sites, new settings, or new populations.
Examples of research projects responsive to AHRQ Health IT Priorities under this FOA include but are not limited to, the following:
- Implementation and evaluation of the use of health IT to facilitate the scale and spread of an existing PRO measure implementation to a larger or different population compared to the population involved in the original implementation (e.g., scale a local implementation to a regional, state, or national level).
- Implementation and evaluation of the use of health IT to facilitate the scale and spread of an existing PRO measure implementation into settings (e.g., primary care vs sub-specialty care) or disease conditions different from those in the original implementation.
- Implementation and evaluation of an innovative and scalable interface design to provide enhanced features to scale and spread the use of PRO measures by clinical providers, patients, health center staff, and other populations in ambulatory care settings.
- Adaptation, implementation, and evaluation of the effectiveness of a health IT implementation strategy to scale and spread PRO measures into rural, minority, low literacy and numeracy, and other underserved populations to reduce health disparities and improve quality of care.
All projects must:
- Describe the target population of the scaling effort;
- Describe a quantifiable impact of the scaling effort (e.g., number of additional patients and or clinicians affected);
- Describe the scaling effort, including the scaling methodology and the plan to evaluate the actual impact on patient health outcomes and quality of care due to the effort. Effects on the quality of care may include effects on patient and provider satisfaction, impacts on clinical workflow or other relevant indicators;
- Contain a discussion about the original PRO implementation, including the PRO measure(s) used, the setting and populations involved as well as the patient health and quality of care outcomes achieved; and
- Incorporate the use of existing PRO measures. Development of new PRO measures is beyond the scope of this effort.
Applications that propose to develop new PRO measures will not be accepted for peer review. Applicants proposing to develop new PRO measures in their initial application will not be allowed to revise or send in additional information after submission.
In addition, applicants are strongly encouraged to address, in their evaluation plans, how they will identify implementation facilitators and barriers and note strategies that will be used to overcome any encountered barriers.
Successful scale and spread efforts must deal with many challenges beyond the actual technology innovation (Mittman, 2014) and AHRQ is interested in understanding best practices for dealing with these challenges.
Applicants interested in learning more about conceptualizing a ‘scale and spread’ project are encouraged to refer to two white papers published by the Institute for Healthcare Improvement (IHI) on the Framework for Spread (Massoud, Nielsen, Nolan, Schall, & Sevin, 2006) and a guide for designing large-scale improvement initiatives (McCannon, Schall, & Perla, 2008).
Deadlines: standard dates apply
Filed Under: Funding Opportunities