Improving safety in all healthcare settings is a priority for AHRQ, and a comprehensive strategy is in place to reduce adverse events in all settings so that people can expect safe care whenever and wherever they receive it, including health care that occurs between and across settings. As the most significant investments in improving patient safety had originally been made in the inpatient and emergency room settings, AHRQ launched a multi-year initiative to expand the scientific evidence, strategies, and tools that are available for improving patient safety in all health care settings. Specifically, in 2015 AHRQ published two Funding Opportunity Announcements that were focused on improving patient safety in ambulatory care settings and long term care facilities. These settings have unique challenges and barriers inherent in improving safety including the assurance of coordination, continuity, communication, and follow-up of care that is often spread among a number of providers. In subsequent years, progress was made in the development, improvement and use of evidence-based measures, metrics, tools and practices to overcome such challenges and improve patient safety in the ambulatory and long term care settings. Measures, metrics, tools, and practices have been derived from new and existing data sources, and have been validated and are practicable for broader implementation in other ambulatory or long term care sites. Research about implementation strategies and the impact on patient safety in ambulatory and long term care settings will provide information for decision-makers and ensure effective delivery of safe care in these settings.
In cases where a measure, metric, tool, or practice has been found to improve patient safety, has been validated, and tested locally, little may be known about the best means of implementation, the challenges and barriers associated with implementation, or the factors that contribute to effective implementation. A need exists for new and improved strategies for implementation of measures, metrics, tools and practices to be developed and evaluated in ambulatory and long term care settings to achieve the maximum impact on patient safety and public health.
Healthcare organizations use different ways to define the nature of care provided as ambulatory versus long term care or other types of care. For the purposes of this FOA:
- Ambulatory Care is defined by the site where most primary and specialty medical care is delivered and is synonymous with outpatient care; it includes all non-inpatient settings, with the following exceptions: for the purposes of this announcement, projects in ambulatory surgery centers, dialysis centers, and emergency rooms are not eligible for consideration.
- Long Term Care Facilities include skilled nursing facilities, residential care homes, assisted living, nursing homes and other long term care delivered in the home.
Researchers focused on doing implementation projects to improve patient safety in health care settings that are not eligible under this funding opportunity announcement are encouraged to apply to the AHRQ Agency-wide R18 or program announcement (PA-14-291, PA-14-290 or PA-15-147).
This FOA highlights two research areas of interest based on their settings–ambulatory care and long term care, with a specific focus on developing and evaluating strategies to integrate evidence-based health care measures, metrics, tools and/or practices more broadly to make health care safer for more individuals and organizations. Projects may involve implementation pilots held at a single site, several local sites simultaneously, or be large and wide in scale. The investigator will need to determine the scale of the project based upon the measure, metric, tool, or practice of interest, status of testing, and available resources in their health care setting. Projects should include a focus on issues that are relevant to underserved and vulnerable populations. Additionally, AHRQ has a specific interest in settings that serve vulnerable populations, including Federally Qualified Health Centers (FQHC), Community Health Centers, safety-net hospital outpatient departments, physician offices and long term care facilities.
Applicants must provide the following:
- A detailed description of a measure, metric, tool and/or practice (i.e. data sources, attributes, units, scale, target or goal value, function, indicators to monitor progress and performance), and the results of the tests of validity that were performed;
- A detailed description of the plans for developing and evaluating an implementation of an existing measure, metric, tool, and/or practice;
- The outcome measure(s) that will be utilized to assess the success of the implementation including, but not limited to, feasibility, fidelity, penetration, acceptability, sustainability, uptake and costs, and how the independent factors that contribute to success will be assessed;
- The outcome measure that will be used to assess changes in patient safety, or changes in the incidence of adverse events;
- A detailed description of a dissemination plan for large, wide-scale implementations including the target audience, methods of dissemination, and uptake;
- Letter of support from the CEO or equivalent individual at each site where the implementation will occur.
External stakeholders often ask about the impact that AHRQ’s funded research is having in terms of making health care safer, higher quality, and less costly. Given increasing use of data visualization, infographic, extrapolation, modeling, and predictive and sensitivity analytic techniques in moving from the known to the unknown and to better portray the potential value and benefit resulting from research findings, applicants are asked to describe — recognizing the necessary precautions and the early stage nature of the request — the techniques that could be used to most understandably show the impact their proposed research aims could have. Applicants are to include in their application an estimate of potential impact based on the identified techniques
Investigations performed under this funding opportunity may require large amounts of data that are collected and stored in the electronic health record as part of the normal process of care. Applicants must demonstrate in the application that their institution(s) and/or site(s) have the capacity to continually assess the impact that the implementation intervention has on patient safety. Implementation projects of this kind generally require the involvement of all individuals at a site, including patients, health care providers, clinicians, and senior executives (e.g., the C-suite) to achieve successful change and improvement in patent safety outcomes.
Specific areas of interest for this FOA include the following examples:
- Development of strategies to ensure implementation of efficacious measures, metrics, tools and practices in ambulatory care settings and/or long term care facilities that improve patient safety;
- Factors that contribute to the successful implementation of a measure, metric, tool, and/or practice to improve patient safety in the ambulatory care setting or long term care facility;
- Interventions that implement a measure, metric, tool, and/or practice for improving coordination and continuity of care in the ambulatory and/or long term care setting in ways that improve patient safety;
- Interventions that implement a measure, metric, tool, and/or practice for improving appropriate follow-up of abnormal laboratory results, diagnostic tests, and specialty referrals in the ambulatory care setting in ways that improve patient safety;
- Interventions that implement a measure, metric, tool, and/or practice to ensure appropriate monitoring for individuals receiving high risk treatments in the ambulatory care setting such as anticoagulation therapy;
- Interventions that implement a measure, metric, tool, and/or practice to ensure monitoring of high risk conditions such as cancer in ways that improve patient safety;
- Interventions that implement a measure, metric, tool and/or practice to reduce post-hospital discharge adverse events in long term care facilities.
- Interventions that implement a measure, metric, tool, and/or practice for improving transitions between settings of care;
- Methodologically rigorous studies to better understand the extent of disparities in implementing measures, metrics, tools, or practices to improve patient safety processes , and factors that may contribute to these disparities in ambulatory care settings and/or long term care facilities;
- Studies of implementation strategies that can improve patient safety at different levels of the health care system including:
- The patient and caregiver;
- The provider-patient interactions;
- The community and health care system;
- Interventions that demonstrate the ability to spread new evidence-based processes that prevent adverse events in ambulatory care settings and long term care facilities.
Deadlines: standard dates apply
Filed Under: Funding Opportunities