Nursing-Related Initiative: What’s New at AHRQ? HEDDY HUBBARD, R.N., M. P. H. Acting Director,...

Nursing-Related Initiative: Nursing-Related Initiative: What’s New at AHRQ?What’s New at AHRQ?

HEDDY HUBBARD, R.N., M. P. H.HEDDY HUBBARD, R.N., M. P. H.Acting Director, Center for Outcomes and Effectiveness Research Acting Director, Center for Outcomes and Effectiveness Research

PATRICIA HINTON WALKER, PhD, RN, FAAN PATRICIA HINTON WALKER, PhD, RN, FAAN Scientific Advisor for Nursing Scientific Advisor for Nursing

MNRS Annual Research Conference MNRS Annual Research Conference April 2003April 2003

Agency for Healthcare Research Agency for Healthcare Research and Quality (AHRQ)and Quality (AHRQ)

Conduct and support research that Conduct and support research that develops and presents scientific evidence develops and presents scientific evidence on all aspects of health care. on all aspects of health care.

Synthesize and disseminate available Synthesize and disseminate available scientific evidence for use by patients, scientific evidence for use by patients, consumers, practitioners, providers, consumers, practitioners, providers, purchasers, policymakers, and educators. purchasers, policymakers, and educators.

AHRQ’s Customers and AHRQ’s Customers and Decisionmaking LevelsDecisionmaking Levels

Clinical Policy Decisionmakers

Health Care Systems Decisionmakers

Public Policy Decisionmakers

AHRQ’s GoalsAHRQ’s Goals

1) Support improvements in health outcomes1) Support improvements in health outcomes

2) Strengthen quality measurement and improvement2) Strengthen quality measurement and improvement

3) Identify strategies to:3) Identify strategies to:

- Improve access- Improve access

- Foster appropriate use- Foster appropriate use

- Reduce unnecessary expenditures- Reduce unnecessary expenditures

Key Agency ProgramsKey Agency Programs

Extramural & intramural researchExtramural & intramural research Evidence-based activitiesEvidence-based activities Patient safetyPatient safety Racial/ethnic disparities initiativeRacial/ethnic disparities initiative Data development activitiesData development activities

– MEPS, HCUP, CAHPSMEPS, HCUP, CAHPS®®

Research networksResearch networks DisseminationDissemination TrainingTraining

Priority Program AreasPriority Program Areas

Health outcomes researchHealth outcomes research Quality measurement & improvementQuality measurement & improvement Access, use, & expendituresAccess, use, & expenditures Cross-cutting interests:Cross-cutting interests:

– Ethical issues in health care Ethical issues in health care – Cost-effectiveness analysesCost-effectiveness analyses

Continuing PrioritiesContinuing Priorities

Patient safety and reducing errors in medicine Patient safety and reducing errors in medicine Information technology to improve patient careInformation technology to improve patient care Quality of careQuality of care Improving clinical preventive servicesImproving clinical preventive services Training of researchersTraining of researchers Medical Expenditures Panel SurveyMedical Expenditures Panel Survey

Evidence-based Activities Evidence-based Activities at AHRQat AHRQ

Evidence-based Practice CentersEvidence-based Practice Centers U.S. Preventive Services Task ForceU.S. Preventive Services Task Force National Guideline ClearinghouseNational Guideline Clearinghouse Centers for Education and Research on Centers for Education and Research on

Therapeutics (CERT)Therapeutics (CERT) Implementation research (“TRIP”)Implementation research (“TRIP”)

Institute of Medicine ReportInstitute of Medicine ReportTo Err is Human: Building a Safer Health SystemTo Err is Human: Building a Safer Health System

Preventable medical errorsPreventable medical errors 44,000 to 98,000 Americans die each year 44,000 to 98,000 Americans die each year Eighth leading cause of death in the U.S.Eighth leading cause of death in the U.S. Annual cost as much as $29 billion annuallyAnnual cost as much as $29 billion annually IOM conclusion: the majority of these problems IOM conclusion: the majority of these problems

are systemic, not the fault of individual providersare systemic, not the fault of individual providers

1

10

100

1,000

10,000

100,000

1 10 100 1,000 10,000 100,000 1,000,000 10,000,000

Number of encounters for each fatality

To

tal

liv

es

lo

st

pe

r y

ea

r

REGULATEDDANGEROUS(>1/1000)

ULTRA-SAFE(<1/100K)

HealthCare

Mountain Climbing

Bungee Jumping

Driving

Chemical Manufacturing

Chartered Flights

Scheduled Airlines

European Railroads

Nuclear Power

How Hazardous Is Health Care?How Hazardous Is Health Care?

Establish Center for Quality Improvement and Establish Center for Quality Improvement and Patient Safety (CQuIPS) at AHRQ:Patient Safety (CQuIPS) at AHRQ:– Integrating patient safety into broader quality frameworkIntegrating patient safety into broader quality framework– Conduct research into medical errors reductionConduct research into medical errors reduction– Convert findings into improved practicesConvert findings into improved practices– Educate patients about their safetyEducate patients about their safety

Conduct National Summits within One YearConduct National Summits within One Year– AHRQ - Patient safety research and practices - AHRQ - Patient safety research and practices -

September 2000September 2000– FDA - Drug and device safety - spring 2001FDA - Drug and device safety - spring 2001– VA - Patient safety practices - spring 2001VA - Patient safety practices - spring 2001

Federal Response - LeadershipFederal Response - Leadership

Patient SafetyPatient Safety

AHRQ research: $55 million investment in 2002: world’s leading AHRQ research: $55 million investment in 2002: world’s leading funder!funder!

Diverse portfolio: centers of excellence; reporting Diverse portfolio: centers of excellence; reporting demonstrations; clinical informatics; working conditions -- demonstrations; clinical informatics; working conditions -- includes several projects focused on blood transfusions; surgeryincludes several projects focused on blood transfusions; surgery

AHRQ as lead for HHS: work closely with CDC, FDA, CMS and AHRQ as lead for HHS: work closely with CDC, FDA, CMS and others (Patient Safety Task Force)others (Patient Safety Task Force)

Research at HHS:Research at HHS:Where Does AHRQ Fit In?Where Does AHRQ Fit In?

NIH -- basic biomedical, lab bench research and “efficacy” NIH -- basic biomedical, lab bench research and “efficacy” clinical trialsclinical trials

CDC -- the public health system, community-based interventionsCDC -- the public health system, community-based interventions

AHRQ -- “effectiveness” of health care services and the health AHRQ -- “effectiveness” of health care services and the health care delivery systemcare delivery system

Health-Related Research Health-Related Research ContinuumContinuum

Biomedical ResearchBiomedical Research

Health Services ResearchHealth Services Research

Basic Science

Basic Science

Cost &Effectiveness

Trials

Cost &Effectiveness

Trials

ControlledClinical

Trials

ControlledClinical

Trials

Syntheses & Meta-

Analysis

Syntheses & Meta-

Analysis

Quality &OutcomesResearch

Quality &OutcomesResearch

Organization,Financing,

DeliveryResearch

Organization,Financing,

DeliveryResearch

AHRQ Research Focus:AHRQ Research Focus:How It Differs How It Differs

Patient-centered, not disease-specificPatient-centered, not disease-specific

Dual focus -- Services + Delivery SystemsDual focus -- Services + Delivery Systems

Considers cost-effectiveness -- trade-off between quality, Considers cost-effectiveness -- trade-off between quality, outcomes, access, and costsoutcomes, access, and costs

Effectiveness research focuses on actual daily practice, not Effectiveness research focuses on actual daily practice, not ideal situations (“efficacy”)ideal situations (“efficacy”)

Example: DiabetesExample: Diabetes

NIH -- develops and tests interventions that cure or prevent NIH -- develops and tests interventions that cure or prevent disease (what disease (what cancan work?) work?)

CDC -- evaluates health behaviors; tests community CDC -- evaluates health behaviors; tests community interventions, e.g., programs to increase exercise, improve interventions, e.g., programs to increase exercise, improve diet (broad population focus)diet (broad population focus)

AHRQAHRQ -- develops evidence to help clinicians and patients -- develops evidence to help clinicians and patients select the best interventions; evaluates quality improvement select the best interventions; evaluates quality improvement efforts (what efforts (what doesdoes work?) work?)

Agency for Healthcare Research and Quality

Cost andFinancingStudies

Organizationand Delivery

Studies

Outcomesand

EffectivenessResearch

PrimaryCare

Research

Practiceand

TechnologyAssessment

QualityMeasurement

and Improvement

Health Care Information

Steve B. Cohen, Ph.D.

Irene Fraser, Ph.D.

Heddy Hubbard, R.N., M.P.H.

(Acting)

Helen Burstin, M.D.

Jean Slutsky, P.A., M.S.P.H.

(Acting)

Daniel Stryer, M.D.

(Acting)

Chris G. Williams, M.Ed.

Management

Bruce Immerman, Acting

Office of the DirectorDirector

Carolyn M. Clancy, MD

Acting Deputy DirectorRobert Graham, M.D.

Research Review,Education, and Policy

Francis Chesley, M.D

Priority Populations Research

Carolyn M. Clancy, MD, Acting

FY 1990 - FY 2003FY 1990 - FY 2003Appropriation History Appropriation History

Dollar in MillionsDollar in Millions

$309$300$271

$98$115 $120

$128$154 $159

$125 $144 $147$171

$204

$50

$100

$150

$200

$250

$300

$350

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

Fiscal Years

FY ‘03 HHS Budget Priorities FY ‘03 HHS Budget Priorities

Protecting the Nation against bioterrorismProtecting the Nation against bioterrorism Investing in biomedical researchInvesting in biomedical research Increasing access to health careIncreasing access to health care Building upon the successes of welfare reformBuilding upon the successes of welfare reform Strengthening MedicareStrengthening Medicare Supporting healthy communitiesSupporting healthy communities Improving the management and performance of health and human Improving the management and performance of health and human

service programsservice programs

Nurses and Health Service Nurses and Health Service ResearchResearch

““Capacity BuildingCapacity Building””

Must Be A Major AgendaMust Be A Major Agenda

For The Nursing ProfessionFor The Nursing Profession

““I am fain to sum up with an urgent appeal I am fain to sum up with an urgent appeal for adopting this or some uniform system for adopting this or some uniform system of publishing the statistical records of of publishing the statistical records of hospitals. If they could be obtained…they hospitals. If they could be obtained…they would show subscribers how their money would show subscribers how their money was being spent, what amount of good was was being spent, what amount of good was really being done with it, or whether the really being done with it, or whether the money was doing mischief rather than money was doing mischief rather than good.”good.”

Florence Nightingale, 1863Florence Nightingale, 1863

An Early ChallengeAn Early Challenge

Why Nurse Researchers MUST be Why Nurse Researchers MUST be Involved in HSR Involved in HSR

Nursing care is a large, vital and integral component of Nursing care is a large, vital and integral component of health care and health outcomeshealth care and health outcomes

Nursing care is provided by the largest single group of Nursing care is provided by the largest single group of health care providers who also deliver a significant health care providers who also deliver a significant portion of medical care to patients portion of medical care to patients

Quality of care and health outcomes cannot be Quality of care and health outcomes cannot be accurately assessed without addressing nursing care accurately assessed without addressing nursing care and nursing practiceand nursing practice

Nurse researchers are under-represented in health Nurse researchers are under-represented in health services researchservices research

Capacity Building Capacity Building

AHRQ interested in increasing the numbers of AHRQ interested in increasing the numbers of applications submitted by and funded to applications submitted by and funded to nursesnurses

Variety of AHRQ mechanisms availableVariety of AHRQ mechanisms available New focus on Patient Safety must have New focus on Patient Safety must have

nursing perspective through funded researchnursing perspective through funded research

Nurse Staffing and Adverse Nurse Staffing and Adverse Post Surgical EventsPost Surgical Events

4.5% in urinary tract infection4.5% in urinary tract infection 4.2% in pneumonia4.2% in pneumonia 2.6% in thrombosis2.6% in thrombosis 1.8% in pulmonary compromise1.8% in pulmonary compromise

Increasing RN hours per patient by 30 Increasing RN hours per patient by 30 minutes is associated with a decrease of:minutes is associated with a decrease of:

Kovner C, Gergen PJ, Kovner C, Gergen PJ, Image:Image: Journal of NursingJournal of NursingScholarshipScholarship 1998;30 (4):315-321 1998;30 (4):315-321

Nurse Researchers are Making Nurse Researchers are Making Progress at AHRQ, Progress at AHRQ,

But More Research from a But More Research from a

Nursing Perspective is Needed!Nursing Perspective is Needed!

Nurses Are Making Progress!

Applications Assigned, Scored, & Applications Assigned, Scored, & Funded by All PIs: FY 1998-2002Funded by All PIs: FY 1998-2002

471

577

825 855809

291

372

554604 577

133 151

241 222 220

0

100

200

300

400

500

600

700

800

900

1998 1999 2000 2001 2002

Assigned

Scored

Funded

29%29%26%26%28%28% 26%26% 27%27%

Applications Assigned, Scored, & Applications Assigned, Scored, & Funded Nurse PIs: FY 1998-2002Funded Nurse PIs: FY 1998-2002

14

52 51

70

57

10

24

3339

47

4

1319 17

10

0

10

20

30

40

50

60

70

80

1998 1999 2000 2001 2002

Assigned

Scored

Funded

19%19%29%29% 19%19%29%29% 21%21%

National Advisory Council &National Advisory Council &Study Sections Have Nurse Members Study Sections Have Nurse Members

Barbara Ann Barth Fink, Ph.D., R.N., F.A.A.N.Barbara Ann Barth Fink, Ph.D., R.N., F.A.A.N. Enterprise Nurse Enterprise Nurse ExecutiveExecutivePatient Care and ICU SystemsPatient Care and ICU SystemsCerner CorporationCerner CorporationFaculty AssociateFaculty AssociateJohns Hopkins School of NursingJohns Hopkins School of Nursing

Marita Titler, Ph.D., R.N., FAANMarita Titler, Ph.D., R.N., FAAN Director, Research, Director, Research, Quality and Outcomes Management Department of Nursing Quality and Outcomes Management Department of Nursing Services and Patient Care University of Iowa Services and Patient Care University of Iowa Hospitals & ClinicsHospitals & Clinics

Mary Katherine Wakefield, Ph.D.Mary Katherine Wakefield, Ph.D.Director, Center for Rural HealthDirector, Center for Rural HealthUniversity of North Dakota University of North Dakota

Pamela Jean Woods, Ph.D.Pamela Jean Woods, Ph.D. Chief Nursing Officer & Administrator of Children’s Hospital & ClinicsChief Nursing Officer & Administrator of Children’s Hospital & ClinicsUniv. of New Mexico Health Sciences Center Hospitals & ClinicsUniv. of New Mexico Health Sciences Center Hospitals & Clinics

Nurses in AHRQ Leadership Nurses in AHRQ Leadership PositionsPositions

Heddy Hubbard, RN, MPHHeddy Hubbard, RN, MPH – Acting Director, Center – Acting Director, Center for Outcomes and Effectiveness Researchfor Outcomes and Effectiveness Research

Patricia Hinton Walker, PhDPatricia Hinton Walker, PhD - Scientific Advisor for - Scientific Advisor for NursingNursing

Joanna Siegel, ScD, RNJoanna Siegel, ScD, RN - Director, Clinical - Director, Clinical EconomicsEconomics

Sandra IsaacsonSandra Isaacson - Director, User Liaison Program - Director, User Liaison Program Kathie Kendrick, MSCS, BSNKathie Kendrick, MSCS, BSN - Director, Planning, - Director, Planning,

Evaluation, and Program DevelopmentEvaluation, and Program Development

Christine Kovner, Ph.D., M.S.N.Christine Kovner, Ph.D., M.S.N. (1995–97)(1995–97)New York University New York University

Lorraine Tulman, DNSc, R.N., FAANLorraine Tulman, DNSc, R.N., FAAN (1997–98) (1997–98)University of PennsylvaniaUniversity of Pennsylvania

Linda Moody, R.N. Ph.D., FAANLinda Moody, R.N. Ph.D., FAAN (1998–99) (1998–99)University of South FloridaUniversity of South Florida

Sally Lusk, R.N., Ph.D., FAANSally Lusk, R.N., Ph.D., FAAN (1999-00) (1999-00)University of MichiganUniversity of Michigan

Patricia Hinton Walker, Ph.D., RN., FAAN. Patricia Hinton Walker, Ph.D., RN., FAAN. (2001-(2001-02)02) University of ColoradoUniversity of Colorado

Senior Nurse ScholarsSenior Nurse Scholars

Strategies for Enhancing Nursing Strategies for Enhancing Nursing Contribution to HSRContribution to HSR

HSR is multidisciplinaryHSR is multidisciplinary: Think across : Think across disciplines in process and outcomedisciplines in process and outcome

Learn About AHRQ’s Priorities and Learn About AHRQ’s Priorities and Processes:Processes: PA’s, RFA’s & Concept Paper PA’s, RFA’s & Concept Paper

Visit AHRQ’s Website:Visit AHRQ’s Website: Focus on People, Focus on People, Process and New/Different OpportunitiesProcess and New/Different Opportunities

Spend Time at AHRQ, Talk with People at Spend Time at AHRQ, Talk with People at AHRQ and Those Funded by AHRQAHRQ and Those Funded by AHRQ

Differences: NIH and AHRQ Differences: NIH and AHRQ Approach to GrantsApproach to Grants

Similar in Style, Form, etcSimilar in Style, Form, etc NIH NIH

– Mostly Investigator InitiatedMostly Investigator Initiated– Peer Review Panels More HomogeneousPeer Review Panels More Homogeneous

AHRQAHRQ– Less Investigator InitiatedLess Investigator Initiated– More response to PA’s and RFA’sMore response to PA’s and RFA’s– Heterogeneous Peer Review PanelsHeterogeneous Peer Review Panels

AHRQ Policies and ProceduresAHRQ Policies and Procedures Similar to NIHSimilar to NIH

– Font sizeFont size– Over $500,000 approvalOver $500,000 approval– Limits on amended applicationsLimits on amended applications– Human subjectsHuman subjects

Just in Time IRBJust in Time IRB Inclusion of women and minoritiesInclusion of women and minorities

– New InvestigatorNew Investigator Different from NIHDifferent from NIH

– Modular budget at NIH only Modular budget at NIH only

Assignment/Screening ProcessAssignment/Screening Process

Coordination with NIHCoordination with NIH Funding assignmentFunding assignment

– PrimaryPrimary– Secondary or dualSecondary or dual

Review assignmentReview assignment– Usually AHRQ review if AHRQ is PrimaryUsually AHRQ review if AHRQ is Primary

AHRQ Center assignmentAHRQ Center assignment– When AHRQ is PrimaryWhen AHRQ is Primary

Self assignment requests via cover letterSelf assignment requests via cover letter

Communication of AHRQ Communication of AHRQ Program InterestsProgram Interests

Two types of announcements:Two types of announcements:– Program Announcements (PA)Program Announcements (PA)– Request for Applications (RFA) Request for Applications (RFA)

NIH Guide for Grants and ContractsNIH Guide for Grants and Contracts AHRQ Website and PublicationsAHRQ Website and Publications

– http://www.ahrq.govhttp://www.ahrq.gov– Funding OpportunitiesFunding Opportunities– Research ActivitiesResearch Activities

Award MechanismsAward Mechanisms

Generally-available MechanismsGenerally-available Mechanisms R01 - Research Project GrantR01 - Research Project Grant R18 - Research Demonstration and R18 - Research Demonstration and

Evaluation Project Evaluation Project R03 - Small Research Project GrantR03 - Small Research Project Grant R13 - Small or Large Conference GrantR13 - Small or Large Conference Grant

Award MechanismsAward Mechanisms

Specific-to-particular-opportunities MechanismsSpecific-to-particular-opportunities Mechanisms P01 - Program Project GrantP01 - Program Project Grant U01 - Research Project/Cooperative U01 - Research Project/Cooperative

Agreement Agreement U18 - Research Demonstration/Cooperative U18 - Research Demonstration/Cooperative

Agreement Various Agreement Various Training/Career Development AwardsTraining/Career Development Awards““New Investigator” (no longer a mechanism)New Investigator” (no longer a mechanism)

Mentored Clinical Scientist Mentored Clinical Scientist Development Awards (K08)Development Awards (K08)

To foster career development of promising new To foster career development of promising new investigatorsinvestigators

Clinician research scientists with a clinical doctoral Clinician research scientists with a clinical doctoral degree, who have identified a mentor and will spend degree, who have identified a mentor and will spend a minimum of 75% full time effort developing their a minimum of 75% full time effort developing their research careersresearch careers

Awards are three to five yearsAwards are three to five years Receipt dates are February 1, June 1, and October Receipt dates are February 1, June 1, and October

1 annually1 annually

Independent Scientist Independent Scientist Awards (K02)Awards (K02)

To foster career development of new To foster career development of new investigatorsinvestigators

Newly independent scientists with either a clinical Newly independent scientists with either a clinical or a research doctoral degree, who can or a research doctoral degree, who can demonstrate the need for a period of intensive demonstrate the need for a period of intensive research focusresearch focus

Awards are three to five yearsAwards are three to five years Receipt dates are February 1, June 1, and Receipt dates are February 1, June 1, and

October 1 annuallyOctober 1 annually

Explore website and publicationsExplore website and publications Identify the funding programs and Identify the funding programs and

mechanismsmechanisms Concept paperConcept paper Work with Project Officer(s)Work with Project Officer(s)

Suggestions for Next Steps

Concept Paper Guidelines Concept Paper Guidelines

PurposePurpose Significance of the problemSignificance of the problem Conceptual frameworkConceptual framework Methodology/approachesMethodology/approaches Evaluation and analysisEvaluation and analysis Selected referencesSelected references

The concept paper should state:The concept paper should state:

Other Opportunities at AHRQOther Opportunities at AHRQ

Training GrantsTraining Grants Minority SupplementsMinority Supplements Mentoring and Senior Scientist AwardsMentoring and Senior Scientist Awards Scholars ProgramsScholars Programs

Training Grant Initiatives AreTraining Grant Initiatives AreImportant for Doctoral Program DirectorsImportant for Doctoral Program Directors

Institutional Training ProgramsInstitutional Training Programs Individual Postdoctoral Individual Postdoctoral

FellowshipsFellowships Dissertation GrantsDissertation Grants

AHRQ Nursing ListservAHRQ Nursing Listserv

To help improve communication between Agency To help improve communication between Agency for Healthcare Research and Quality (AHRQ) and for Healthcare Research and Quality (AHRQ) and the nursing community, AHRQ has established a the nursing community, AHRQ has established a Nursing LISTSERV® to notify subscribers Nursing LISTSERV® to notify subscribers electronically about funding opportunities, electronically about funding opportunities, conferences, and other nursing-related activities.conferences, and other nursing-related activities.

Apply to AHRQ!Apply to AHRQ!

Quality of health care and outcomes can not be Quality of health care and outcomes can not be assessed without addressing nursing care and assessed without addressing nursing care and nursing practicenursing practice

To ensure that nursing care and practice are To ensure that nursing care and practice are carefully and accurately studied, nurses must carefully and accurately studied, nurses must provide leadership and serve as members of provide leadership and serve as members of teams studying health careteams studying health care

Assistance from Agency staff prior to Assistance from Agency staff prior to submission of proposalsubmission of proposal

Overall, good funding record for nursesOverall, good funding record for nurses

NURSES MUST BE AT THE NURSES MUST BE AT THE TABLE!TABLE!

Patricia Hinton Walker, PhD, RN, FAANPatricia Hinton Walker, PhD, RN, FAAN

Scientific Advisor for NursingScientific Advisor for Nursing

Examples of Funded Grants Examples of Funded Grants Submitted by Nurses to AHRQSubmitted by Nurses to AHRQ

Health Care Working Conditions Health Care Working Conditions on Quality of Careon Quality of Care

Staff Nursing Fatigue and Patient SafetyStaff Nursing Fatigue and Patient Safety (A. Rogers, University of Pennsylvania)(A. Rogers, University of Pennsylvania) Unit Level Nurse Workload Impacts on Patient Unit Level Nurse Workload Impacts on Patient SafetySafety (N. Donaldson, University of California, San (N. Donaldson, University of California, San Francisco)Francisco) The Impact of Nursing Unit Characteristics on The Impact of Nursing Unit Characteristics on OutcomesOutcomes (J. Verran, University of Arizona)(J. Verran, University of Arizona)

Nurses Working Conditions: Effects on Medication Nurses Working Conditions: Effects on Medication SafetySafety (G. Pepper, University of Colorado)(G. Pepper, University of Colorado)

Health Care Working Conditions Health Care Working Conditions on Quality of Care (cont’d)on Quality of Care (cont’d)

Nursing Home Working Conditions and Quality of Nursing Home Working Conditions and Quality of CareCare (J. Scott, University of Colorado)(J. Scott, University of Colorado)

Do Organizational Factors Influence Both Patients Do Organizational Factors Influence Both Patients and Worker Safety?and Worker Safety? (A. Trinkoff, B.S.N.,University of (A. Trinkoff, B.S.N.,University of Maryland, Baltimore)Maryland, Baltimore)

Patient Safety in Home CarePatient Safety in Home Care (C. Kovner, New York (C. Kovner, New York University)University)

Outcomes of ICU Working ConditionsOutcomes of ICU Working Conditions ((P. Stone, P. Stone, Columbia University)Columbia University)

Selected AHRQ Nursing GrantsSelected AHRQ Nursing Grants Nurse Staffing and Quality of CareNurse Staffing and Quality of Care (P. (P.

Buerhaus, Vanderbilt University)Buerhaus, Vanderbilt University)

Evidence-Based Practice: From Book to Evidence-Based Practice: From Book to BedsideBedside (M. Titler, University of Iowa School of (M. Titler, University of Iowa School of Nursing)Nursing)

Evidence-Based “Reminders” in Home Health Evidence-Based “Reminders” in Home Health CareCare (P.H. Feldman, Visiting Nurse Service of New (P.H. Feldman, Visiting Nurse Service of New York)York)

Quality of Hypertension Care for Asian Quality of Hypertension Care for Asian RefugeesRefugees (C.C. Wong, U.C. San Francisco School of (C.C. Wong, U.C. San Francisco School of Nursing)Nursing)

Selected AHRQ Nursing GrantsSelected AHRQ Nursing Grants

Care Management by Nurse Care Management by Nurse Practitioner/Hospitalist TeamPractitioner/Hospitalist Team (M. Cowan, (M. Cowan, University of California Los Angeles)University of California Los Angeles)

Quality Factors in Nursing Home ChoiceQuality Factors in Nursing Home Choice (J. (J. Congdon, University of Colorado)Congdon, University of Colorado)

APRNET: Practice-Based Networks Studying APRNET: Practice-Based Networks Studying Date, Privacy/Confidentiality IssuesDate, Privacy/Confidentiality Issues (M. Grey, (M. Grey, Yale University)Yale University)

Domestic Violence Assessment and Domestic Violence Assessment and Intervention Intervention (J. Dienemann, Georgetown University)(J. Dienemann, Georgetown University)

Selected AHRQ Nursing GrantsSelected AHRQ Nursing Grants Barriers to Anti-Inflammatory Use in Childhood Barriers to Anti-Inflammatory Use in Childhood

AsthmaAsthma ( H. Yoos, University of Rochester)( H. Yoos, University of Rochester)

Racism, Rcial Identity and Blood PressureRacism, Rcial Identity and Blood Pressure (L. Ferguson, (L. Ferguson, University of Virginia)University of Virginia)

Quality of Care for Homeless AdolescentsQuality of Care for Homeless Adolescents ((B. Ensign, B. Ensign, University of Washington)University of Washington)

Patient Outcomes Related to Discharge Planning Patient Outcomes Related to Discharge Planning Collaboration Collaboration (W. Corsar, Clinical Science Center, Wisconsin)(W. Corsar, Clinical Science Center, Wisconsin)

Selected AHRQ Nursing GrantsSelected AHRQ Nursing Grants

Improving Pain Management in Nursing HomesImproving Pain Management in Nursing Homes ((K. K. Jones, University of Colorado)Jones, University of Colorado)

Better Pediatric Outcomes Through Chronic CareBetter Pediatric Outcomes Through Chronic Care (J. (J. Fifield, University of Connecticut)Fifield, University of Connecticut)

Nurse Staffing and Adverse Patient OutcomesNurse Staffing and Adverse Patient Outcomes (S.Cho, (S.Cho, University of Michigan)University of Michigan)

A Model for Use of the Urinary Incontinence Guidelines A Model for Use of the Urinary Incontinence Guidelines in U.S. Nursing Homesin U.S. Nursing Homes (N. Watson, University of Rochester)(N. Watson, University of Rochester)

Competitive Demonstration Competitive Demonstration Program RFAsProgram RFAs

Health System Error Reporting, Analysis, and Safety Health System Error Reporting, Analysis, and Safety Improvement DemonstrationsImprovement Demonstrations

Clinical Informatics to Promote Patient Safety (CLIPS)Clinical Informatics to Promote Patient Safety (CLIPS) Centers of Excellence for Patient Safety Research and Centers of Excellence for Patient Safety Research and

Practice Practice Developing Centers for Patient Safety Research and PracticeDeveloping Centers for Patient Safety Research and Practice Effect of Working Conditions on Patient Safety Effect of Working Conditions on Patient Safety Patient Safety Research Dissemination and Education Patient Safety Research Dissemination and Education Supporting programs (e.g. coordinating, evaluation, and Supporting programs (e.g. coordinating, evaluation, and

dissemination centers)dissemination centers)

The Effect of Working Conditions of The Effect of Working Conditions of Quality of Care – RO1Quality of Care – RO1

To develop an understanding of how the To develop an understanding of how the environment of care impacts the ability of environment of care impacts the ability of providers to improve safety (e.g. the effect providers to improve safety (e.g. the effect of fatigue, stress, sleep deprivation, and of fatigue, stress, sleep deprivation, and shift work on cognitive ability and the shift work on cognitive ability and the relationship to patient safety)relationship to patient safety)

$2 Million set-aside for projects addressing $2 Million set-aside for projects addressing patient safetypatient safety

Clinical Informatics and Patient Clinical Informatics and Patient Safety Safety

To develop and test the use of appropriate To develop and test the use of appropriate technologies to reduce medical errors (such technologies to reduce medical errors (such as hand-held electronic medication and as hand-held electronic medication and specimen management systems and specimen management systems and prescription pads, training simulators for prescription pads, training simulators for medical education, bar-coding of medical education, bar-coding of prescription drugs, patient bracelets, and prescription drugs, patient bracelets, and automated dispensing of medication in a automated dispensing of medication in a hospital setting)hospital setting)

Reviewed, Scored, and Funded Reviewed, Scored, and Funded GrantsGrants

172

7254

46

0

20

40

60

80

100

120

140

160

180

1st Qtr

Total Subm

Rev., Not Scored

Scored, Not Funded

Funded

Type of GrantsType of Grants

29%

33%

17%

5% 1%4% 1%

8% 1%1%R01

R03

R13

R18

R21

P20

U01

U18

K08

F32

Preliminary Results: Data Audit of Submissions by Nurse ResearchersPreliminary Results: Data Audit of Submissions by Nurse Researchers

Type of Grants Submitted with Type of Grants Submitted with Number of RO1’s Funded/Not FundedNumber of RO1’s Funded/Not Funded

30

58

14 20

39

11

50

R13

R03

U18

Other (R18, P20, etc.)

UNFUNDED R01

FUNDED R01


Type of Grants Submitted with Type of Grants Submitted with Number of RO3’s Funded/Not FundedNumber of RO3’s Funded/Not Funded

30

50

1420

41

17

58

R13

R01

U18


Unfunded RO3's

Funded R03's


Type of Grants SubmittedType of Grants Submittedwith Number of R13’s Funded/Not Funded with Number of R13’s Funded/Not Funded

1999-20011999-2001

58

50

1420

20

10

30

R03

R01

U18


Unfunded R13's

Funded 13's


Profile of Populations Across the Lifespan: Profile of Populations Across the Lifespan: From Data Audit of Grants From Data Audit of Grants

Submitted by Nurse Researchers *Submitted by Nurse Researchers *

11

4

14

1

30 6

0

2

9

0

2

4

6

8

10

12

14

16

Peds MCH Adult Women Elderly

Funded

Unfunded

* Not all grants addressed a specific population or condition* Not all grants addressed a specific population or condition

Preliminary Results: Data Audit of Grants Submitted by Nurse Researchers Preliminary Results: Data Audit of Grants Submitted by Nurse Researchers

Profile of Illness/Conditions Populations: Profile of Illness/Conditions Populations: From Data Audit of Grants From Data Audit of Grants


3

6

5

9

3

0

1

4

11 4

6

1

2

100

2

4

6

8

10

12

14

Pain Cardio AIDS Pulmonary Transplant Psych Cancer Endocrine

Funded

Unfunded


Preliminary Results: Data Audit of Grants Submitted by Nurse Researchers Preliminary Results: Data Audit of Grants Submitted by Nurse Researchers

Profile of Focus on Health Care Delivery Setting: Profile of Focus on Health Care Delivery Setting: From Data Audit of Grants From Data Audit of Grants


17

35

10

4

91 18

4

0

10

20

30

40

50

60

Hospital NRS Home Home Care Community

Funded

Unfunded


Preliminary Results: Data Audit of Grants Submitted by Nurse ResearchersPreliminary Results: Data Audit of Grants Submitted by Nurse Researchers

AHRQ Funded Grants by Nurse AHRQ Funded Grants by Nurse Researchers: 1999-2000Researchers: 1999-2000

Conference Grants

R03 - NRSA or Small Pilot Work

R01, F32, P20,R18, U18, UO1, K08

AHRQ Funded Grants by MNRS Nurse AHRQ Funded Grants by MNRS Nurse Researchers: 1999-2001Researchers: 1999-2001

Conference Grants

R03 - NRSA or Small Pilot Work

R01, F32, P20,R18, U18, UO1, K08

Capacity Building Projects at Capacity Building Projects at AHRQAHRQ

Increase visibility of funding opportunities at AHRQ in Increase visibility of funding opportunities at AHRQ in the nursing communitythe nursing community

Explore factors in success rateExplore factors in success rate– Conceptual FrameworkConceptual Framework– Methodologies/Statistical ApproachesMethodologies/Statistical Approaches

Examine areas for improvement in those reviewed, but Examine areas for improvement in those reviewed, but not scored; and those scored but not fundednot scored; and those scored but not funded

Health Systems Health Systems ResearchResearch

Organization/financing of HCS; market; access; cost; workforce

Health Research Health Research Dissemination & Dissemination & ImplementationImplementation

Dissemination & implementation of findings/products; evidence-based reports; information products

HC Technology & HC Technology & Decision ScienceDecision Science

Development, refinement, assessment, cost-effectiveness, & application of computer technologies

AHRQ Standing Study SectionsAHRQ Standing Study Sections

HC Quality and Effectiveness

Quality and cost effectiveness; development/testing of quality measures, methods, tools, indicators, etc.

HC Research and Training

All training, career development, dissertation applications

AHRQ Standing Study SectionsAHRQ Standing Study Sections

Increasing AHRQ Grants Increasing AHRQ Grants and Success in Funding and Success in Funding

for for

New & Seasoned Nurse New & Seasoned Nurse ResearchersResearchers

Specific Strategies for Capacity Specific Strategies for Capacity Building from Senior Scholar Projects Building from Senior Scholar Projects

Issues, Challenges Issues, Challenges

and “Food For Thought”and “Food For Thought”

Based on Review of Based on Review of

Current Funded & Current Funded &

Non-funded GrantsNon-funded Grants

Notes from Preliminary Notes from Preliminary Review of StudiesReview of Studies

Conceptual Models Used for HSR on Funded Grants Conceptual Models Used for HSR on Funded Grants Statistical Methods Frequently UsedStatistical Methods Frequently Used Attention to RFA’sAttention to RFA’s Interdisciplinary Teams Members for Interdisciplinary Teams Members for

ConsiderationConsideration Use of Large Data SetsUse of Large Data Sets

Specific Approaches From Specific Approaches From Successfully Funded GrantsSuccessfully Funded Grants

*Based on Data Audit of AHRQ Funded Grants (all 2001with partial review of 2000 AHRQ funded grants) - a Work in Progress.

Examples of Conceptual Frameworks used Examples of Conceptual Frameworks used by Nurse Researchers in Successful Grantsby Nurse Researchers in Successful Grants

�Donabedian’s Classical Quality Donabedian’s Classical Quality FrameworkFramework

�Organizational Development ModelsOrganizational Development Models

�Roger’s Theory of Diffusion of InnovationRoger’s Theory of Diffusion of Innovation

�Reason’s Principles of Human Performance Reason’s Principles of Human Performance and Human Errorand Human Error

�AAN Quality Health Outcomes ModelAAN Quality Health Outcomes Model


ȹHealthcare Organization and Healthcare Organization and Delivery Model (based on Delivery Model (based on Donabedian)Donabedian)

ȹPreventable Model of Adverse EventsPreventable Model of Adverse Events

ȹModel for Collaboration of Nurse and MD Model for Collaboration of Nurse and MD InteractionInteraction

ȹEcological FrameworkEcological Framework


ȹThomas’ Eden Alternative ModelThomas’ Eden Alternative Model

ȹSelf-regulation Theory (Explanatory Self-regulation Theory (Explanatory Model)Model)

ȹGrounded Theory Technique Grounded Theory Technique (Glaser & Strauss(Glaser & Strauss

ȹProduction Process Model Production Process Model (Economic Model)(Economic Model)

ȹHealth Belief ModelHealth Belief Model


ȹLandenberger’s Theoretical Landenberger’s Theoretical FrameworkFramework

ȹSynergy ModelSynergy Model

ȹSociological FrameworksSociological Frameworks

ȹNeuman Systems ModelNeuman Systems Model

ȹSystems Theory Framework Systems Theory Framework (King’s)(King’s)

Examples of Statistics and Methodological Examples of Statistics and Methodological Approaches by Successfully-Funded Nurse Approaches by Successfully-Funded Nurse

Researchers at AHRQResearchers at AHRQ

ȹLogistic Regression ModellingLogistic Regression Modelling

ȹMultivariate RegressionMultivariate Regression

ȹMicrocostingMicrocosting

ȹPsychometric Analysis Psychometric Analysis of Instruments of Instruments



ȹEconometric ModelingEconometric Modeling

ȹBivariate Analysis Bivariate Analysis

ȹAnovaAnova

ȹFocus Group Qualitative Focus Group Qualitative AnalysisAnalysis



ȹDescriptive StatisticsDescriptive Statistics

ȹFactor AnalysisFactor Analysis

ȹDelphi TechniqueDelphi Technique

ȹChi Square & t testsChi Square & t tests

Interdisciplinary Team Members in Successfully Funded Grants by Nurses

Social PsychologistSocial Psychologist Experimental & Experimental &

Physiological psychologistPhysiological psychologist EpidemiologistEpidemiologist MDMD

•Social Psychologist

•Experimental and Physiological Psychologist

•Epidemiologist

•MD

Interdisciplinary Team Members in Successfully Funded Grants by Nurses

Social PsychologistSocial Psychologist Experimental & Experimental &

Physiological psychologistPhysiological psychologist EpidemiologistEpidemiologist MDMD

•Health Management and Policy

•Statistician and Methodologist

•PhD in Public Health

•Health Economist

Specific Approaches From Successfully Funded Grants

•HCUP State Inpatient Databases

•AHA Annual Survey Database

•HCFA’s (CMS) Hospital Case Mix Database

•OSCAR - HCFA’s (CMS) Online Certification and Reporting Systems

•State Level Hospital Discharge Data


•ANA Nurse Sensitive Outcomes

•HCFA (CMS) SNF Minimum Data Set

•NNIS (CDC’s National Nosocomial Infection Surviellance Database

•Medicare Claims Data

•Worker’s Comp Data


•MDS (Minimum Data Set) for Nursing Homes

•Quality Indicators

•Resident Assessment Data

•Cal NOC Statewide Data (California Nursing Outcomes Coalition Project

•Medicaid Cost Data

•Hospital Financial Data

Summary of Lessons Learned Summary of Lessons Learned

Language related to Language related to AHRQ InitiativesAHRQ Initiatives

Linkages to Large Linkages to Large Data Systems for Data Systems for Interdisciplinary Interdisciplinary ResearchResearch

Solid Methodology Solid Methodology Interdisciplinary Interdisciplinary

Health OutcomesHealth Outcomes

Some Areas of Attention Some Areas of Attention for AHRQ Funding for AHRQ Funding

TrainingTraining Translating research into Translating research into

practicepractice Becoming InterdisciplinaryBecoming Interdisciplinary Researchers Should Explore Researchers Should Explore

and Respond to PA’s and and Respond to PA’s and RFA’sRFA’s

Focus on Priority PopulationsFocus on Priority Populations

Profile of Patient Safety & Workforce Related Profile of Patient Safety & Workforce Related Focus: From Data Audit of Grants Focus: From Data Audit of Grants Submitted by Nurse Researchers *Submitted by Nurse Researchers *

29

8

15

8

0

5

10

15

20

25

30

35

40

Patient Safety Workforce Issues

Funded

UnFunded



Profile of Patient Safety & Workforce Related Profile of Patient Safety & Workforce Related Focus: From Data Audit of Grants Focus: From Data Audit of Grants Submitted by Nurse Researchers *Submitted by Nurse Researchers *

29

8

15

8

0

5

10

15

20

25

30

35

40

Patient Safety Workforce Issues

Un-Funded

Funded



Nurses Are Increasing Their Nurses Are Increasing Their Research Presence at AHRQ!Research Presence at AHRQ!

But, Doctoral Programs Need to But, Doctoral Programs Need to Foster Development of More New Foster Development of More New Nursing Health Service Researchers!Nursing Health Service Researchers!

Patricia Hinton Walker, PhD, RN, FAAN Patricia Hinton Walker, PhD, RN, FAAN Senior Advisor for Nursing Senior Advisor for Nursing

Agency for Healthcare Research and Quality Agency for Healthcare Research and Quality AHRQ Grant Funding Opportunities: Lessons AHRQ Grant Funding Opportunities: Lessons from Grants Submitted by Nurse Researchersfrom Grants Submitted by Nurse Researchers

Nursing-Related Initiative: What’s New at AHRQ? HEDDY HUBBARD, R.N., M. P. H. Acting Director,...

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