AHRQ Funded Projects
Search the entire portfolio of AHRQ-funded digital healthcare research projects. Projects can be identified by technology studied, medical condition, population, status of the project, principal investigator, organization, funding mechanism and location.
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Description: This project developed and deployed iHealth, an Internet-based disease management tool that collects data and generates reports to enhance management of Hepatitis C virus.Principal Investigator: Arora, SanjeevProject Dates: September 30, 2009 to July 31, 2013
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Description: This project deployed new functionality that allowed clinicians to view ‘real time’ measures of the delivery of clinical preventive services and added patient specific alerts and ‘one click’ options to act on missed opportunities for followup care.Principal Investigator: Wu, WinfredProject Dates: September 30, 2007 to September 29, 2010
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Description: Connected urban medical center disease experts with rural general practitioners and community health representatives over a telehealth network to effectively treat patients with chronic, common and complex diseases who do not have direct access to specialty health care providers.Principal Investigator: Arora, SanjeevProject Dates: September 30, 2004 to August 31, 2008
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Description: Strategic Goal:, Develop and disseminate health IT evidence and evidence-based tools to improve the quality and safety of medication management via the integration and utilization of medication management systems and technologies., Business Goal:, Knowledge Creation, Summary:, Project ECHO (Extension for Community Healthcare Outcomes) involves a partnership of academic medicine, public health offices, corrections departments, and community clinics dedicated to providing best practices and protocol-driven specialty health care in rural and underserved areas. This specific research project focused on using health information technology to provide improved treatment of hepatitis C virus (HCV). Project ECHO’s weekly scheduled telemedicine clinics, which are hosted by University of New Mexico (UNM) specialists in the areas of HCV, use telemedicine pathways and Internet-based access to provide community health care practitioners with the opportunity to present cases, which are discussed among the network participants to jointly reach treatment decisions. This particular form of case-based learning, called “learning loops,” allow community providers to learn from the experience of co-managing patients with specialists and their peer providers around the State. In these case-based learning clinics, partners rapidly gained deep domain expertise in HCV as they collaborated with university specialists in hepatology, infectious disease, psychiatry, and substance abuse in co-managing their patients. Expansion of this telehealth model to other chronic, complex diseases is underway., Specific Aims, Co-manage ECHO HCV patients by partnering urban specialists with community physicians. (, Achieved, ) Develop and expand access to treatment for HCV and eventually other complex diseases (diabetes, asthma, etc.) by building treatment capacity in New Mexico among rural medical providers. (, Achieved, ) Create a model for treatment of complex, chronic diseases in rural and/or underserved populations in New Mexico. (, Achieved, ) Provide extensive professional health care no-cost education through use of telemedicine technologies. (, Achieved, ) Develop Patient and Provider Outcomes Program. (, Achieved, ) Expand telehealth access and infrastructure. (, Achieved, ), 2008 Activities:, In 2008, Dr. Arora continued to offer teleconference clinics for HCV (during the first 8 months of 2008, 5,993 patient consultations were provided), while expanding to offer clinics for rheumatology, integrated addiction/psychiatry, child psychiatry, psychodynamic psychotherapy, gestational diabetes/high-risk pregnancy, cardiovascular risk reduction, pediatric obesity, asthma/pulmonary disease, HIV, occupational medicine, medical ethics, and chronic pain., Impact and Findings:, Provider outcome data demonstrated increased provider knowledge, self-efficacy in treating HCV patients, decreased professional isolation, and enhanced professional satisfaction. Preliminary patient outcome data analysis confirms co-managed HCV treatment by rural providers is as safe and effective as treatment delivered in an academic medical center HCV clinic., Selected Outputs, Berkley EM, Leslie K, Arora S, et al. Chronic hepatitis C in pregnancy. Obstet Gynecol 2008 Aug;112(2: Pt 1):304-10. Geppert CM, Arora, S. Widening the door: the evolution of hepatitis C treatment in patients with psychiatric disorders. Hepatology 2007 Oct;46(4):957-9. Gish RG, Arora S, Rajender RK, et al. Virological response and safety outcomes in therapy-naive patients treated for chronic hepatitis C with taribavirin or ribavirin in combination with pegylated interferon alfa-2a: a randomized, phase 2 study. J Hepatol 2007 Jul;47(1):51-9. Arora S, Thornton K, Jenkusky S, et al. Project ECHO: linking university specialists with rural and prison-based clinicians to improve care for people with chronic hepatitis C in New Mexico. Public Health Rep, 2007;122(S2):74-7. Arora S, Geppert C, Kalishman S, et al. Academic health center management of chronic diseases through knowledge networks: Project ECHO. Acad Med 2007 Feb;82(2):54-60. Arora S, O’Brien C, Zeuzem S, et al. Treatment of chronic hepatitis C patients with persistently normal alanine aminotransferase levels with the combination of peginterferon alpha-2a (40 kDa) plus ribavirin: impact on health-related quality of life. J Gastroenterol Hepatol 2006 Feb;21(2):406-12. Geppert CM, Arora S. Ethical issues in the treatment of hepatitis C. Clin Gastroenterol Hepatol 2005 Oct;3(10):937-44. Sulkowski M, Wright T, Rossi S, et al. Peginterferon alfa-2a does not alter the pharmacokinetics of methadone in patients with chronic hepatitis C undergoing methadone maintenance therapy. Clin Pharmacol Ther 2005 Mar;77(3):214-24. iHealth Electronic Clinical Management Tool: Real-time remote entry and access to patient-specific information is needed for co-management and during consultative clinics. An outside vendor, Infosys Technologies, Inc., completed a new Web-based clinical management database, iHealth (trademark application pending), in May 2008. This allowed all partners to access information even from remote sites, with HIPAA-compliant controlled access to protect confidentiality. Clinical personnel from ECHO Partner Sites continued to receive iHealth instruction. This database will ultimately be utilized by all ECHO Partner Sites that treat HCV patients., Grantee’s Most Recent Self-Reported Quarterly Status:, This project has been completed. Project ECHO will continue to offer clinics and services to rural New Mexico physicians. The project’s success has spurred further interest as well as funding from additional sources, and its methodology will be expanded to other diseases while using the same infrastructure developed with this grant., Milestones:, Progress is mostly on track., Budget:, On target.Principal Investigator: Arora, Sanjeev
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Description: Target Population:, Adults, Chronic Care * , Hepatitis C, Summary:, This project builds on the work of a previous Agency for Healthcare Research and Quality- funded project, Project ECHO: Extension for Community Healthcare Outcomes . Providers require access to patient-specific information to consult on cases, track patient progress, and evaluate clinical outcomes. At Project ECHO’s inception, community-based providers transmitted patient-specific information to specialists via a data management system. Data were entered and stored locally on a laptop, transmitted via a secure virtual private network (VPN), and maintained in a centralized Health Insurance Portability and Accountability Act-compliant structured query language database server to support both clinical and research activities. With Project ECHO’s rapid expansion, this type of data management proved inadequate because it presented numerous insurmountable barriers in site maintenance, VPN problems, and critical datafeed and reporting inadequacies. To address these issues, Project ECHO will use an Internet-based clinical management system for patients undergoing treatment for hepatitis C virus (HCV). This will improve quality of care, and lead to greater knowledge sharing among health care providers for rural and underserved populations. The enhancements to the electronic disease management tool, iHealth, and the clinical management system will standardize data collection, provide practice support, create a central data repository, and allow authorized personnel to view individual patient records. The iHealth tool will be accessed as a Web portal, the central identity for the HCV program, providing a single-access point for its resources. The portal includes search tools that program personnel can use to extract data for monitoring data quality, profiling, quality improvement, and research. Laboratory data from TriCore Reference Laboratories (TriCore) will be uploaded automatically into patients’ electronic health records. The underlying iHealth architecture supports effective management of patient data across multiple provider organizations. The Web portals for patients will provide educational links, and allow patients to see their summary reports, facilitating better communication with their providers. The provider portal can be used to coordinate training activities and provide the tools for HCV treatment. These patient needs will be assessed and determined via patient focus groups., Specific Aims:, Develop a disease management tool that will standardize data collection, provide practice support, create a central data repository, and allow authorized personnel to view individual patient records. (, Ongoing, ) Develop a Web portal that creates a central identity for the HCV program and provides a single-access point for its resources. Create search tools that program personnel can use to extract data for monitoring data quality, profiling, quality improvement, and research. (, Ongoing, ) Develop a system that automatically uploads laboratory data from TriCore. (, Ongoing, ) Promote adoption of iHealth clinical management system. (, Ongoing, ), 2010 Activities:, Many programming enhancements were completed including: improved screen flow with less mouse-clicking to access data; a home page dashboard to review and access common activities quickly; messaging system for e-mail, phone, and walk-ins; communication directly entered into chart and/or archived; improved readability of protocol summary and lab flow sheets; better entry of medication information with type-ahead lookup and single-click entry of information; a case presentation system to generate information for clinics easily; electronic documentation of recommendations are accessible via the patient’s flow sheet; HCV summary reports to follow treatment over time; calculation of visit schedule; display of priority medications in all the hepatitis C tabs; display of previous presentations done for the patient; ability to add or remove patients to or from a presentation; ability to freeze or unfreeze clinics; and the ability to print patient HCV reports. Beta testing of iHealth was conducted with nine ECHO HCV community participants, representing four ECHO partner health organizations and eight clinic locations. The pilot test was followed by a focus group to capture participants’ comments on the iHealth disease management tool. The team developed an electronic survey to query current participants of Project ECHO’s HCV Telehealth Clinic. This survey asks ECHO clinicians and their teams about their thoughts on electronic medical records, disease management tools, and access to a Web-based portal for HCV patient information. Fifty-five surveys were sent out and 40, or 72.7 percent, were completed and returned to Project ECHO. Project ECHO's database interface linking iHealth patients with TriCore’s master patient index has been established. Effectiveness is being evaluated on the test server., Grantee's Most Recent Self-Reported Quarterly Status (as of December 2010):, The project is mostly on track and is meeting its aims on time, but funds are somewhat under-spent. This is a result of delays in fully staffing the project as well as conservation of funds in anticipation of a no-cost extension., Preliminary Impact and Findings:, The project does not have any findings to date., Strategic Goal:, Develop and disseminate health IT evidence and evidence-based tools to improve health care decisionmaking through the use of integrated data and knowledge management., Business Goal:, Knowledge Creation *, AHRQ Priority Population, .Principal Investigator: Arora, Sanjeev
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Description: Target Population:, Adults, Inner City * , Low SES/Low Income * , Medicaid, Medically Underserved, Racial or Ethnic Minorities * : African American, Hispanic/Latino, Safety Net, Uninsured, Summary:, The overall goal of this project is to implement meaningful measurements of the quality of care that focus on public health priority issues, disadvantaged populations, and small office practices. The New York City Department of Health and Mental Hygiene (DOHMH) Take Care New York initiative has articulated 10 priority public health issues that require coordinated action between health care providers, patients, community organizations, and government agencies. The DOHMH Primary Care Information Project (PCIP) uses health information technology for population-wide measurement and improvement of clinical care in these 10 domains, particularly among disadvantaged populations. Over 1,000 medical providers have implemented electronic health records (EHRs) with enhanced preventive care functionality. Ambulatory Certification Commission for Health Information Technology-certified EHR products include Epic, NextGen, and eClinicalWorks. Clinical partners include New York City’s Federally Qualified Health Centers, several hospital outpatient departments, and hundreds of primary care providers in small office settings. A set of 38 clinical quality measures designed to address priority public health issues has been developed, and automated reporting of these measures internally and to the DOHMH will be coordinated with the EHR vendors. Successful EHR-enabled quality measurement requires that physicians document relevant information at the point of care. The research team developed a simple and intuitive clinical decision support system (CDSS) with eClinicalWorks, suitable for small office practices, that integrates quality measurement and clinical decision support at the point of care. The CDSS displays a dashboard of quality indicators as part of the patient’s record, showing the patient’s measurement cohorts and whether their care complies with screening and treatment recommendations. Integrated decision support tools enable providers to take appropriate action to bring the measure into compliance or remove the patient from the measurement cohort due to valid exclusions or contraindications. Limited to small physician owned practices, the project uses a randomized controlled trial to assess the impact of pay-for-quality incentives on quality measurement and improvement across four of the quality measurement areas. A case-control study was conducted to assess the impact of CDSS on quality measurement. The project also uses a pre- versus post- EHR survey to measure the impact of EHR adoption on provider attitudes and engagement with quality measurement and incentivized care., Specific Aims:, Validate a set of automated clinical quality measures that addresses priority public health issues. (, Achieved, ) Characterize provider attitudes and measure provider satisfaction with performance indicators. (, Achieved, ) Design a simple and intuitive point-of-care quality measurement and decision support user interface (quality dashboard). (, Achieved, ) Conduct a randomized clinical trial to determine the impact of this quality dashboard on the accuracy of, and provider satisfaction with, EHR-derived quality measures. (, Achieved, ) Disseminate findings through the National Quality Forum’s Standardizing Ambulatory Care Performance Measures project through the EHR vendors’ participation in this project and through reviewed publications. (, Achieved, ), 2010 Activities:, The PCIP EHR development team, in collaboration with eClinicalWorks, completed validation of the automated calculation of selected quality measures. The research team worked with the EHR vendor to test and verify the automated calculation of measures. A separate team compared the monthly data collected from the quality measures against other data sources (e.g., encounter data, self-reported practice and provider characteristics, and potential rise of symptoms related to infectious disease—syndromic surveillance) available within the health department. The grant team completed development of the provider survey, assessing provider attitudes and satisfaction with the performance indicators. The survey focused specifically on clinical decision support at the point of care, whether any of the features were used, the functionality of the features, and opinions about the features. Survey findings were supported by qualitative data which provided insights into how the technology was and was not working well. Recruited practices were enrolled in a privately-funded pilot recognition and pay-for-quality program, Health eHearts, because they had adopted an EHR prior to 2009 and were focusing on quality measurement through the incentive program. Of the 84 practices that participated in Health eHearts, 56 practices, representing 154 providers, agreed to electronic record review and abstraction. Interviews were conducted, and two sets of provider surveys were administered to the providers that adopted an EHR through the PCIP program. Analysis of the manual chart review data was completed and a regression model was used to assess whether practices experienced more rapid increases post-CDSS implementation. Charts were reviewed for three time periods: 1) pre-EHR implementation (likely to be paper documentation), 2) the period from EHR implementation until the reminder CDSS system was implemented (approximately 6 to 18 months), and 3) post-implementation of CDSS system (a minimum of 6 months later). Each patient record was reviewed for documentation to identify whether the patient was eligible for inclusion in the denominator and, if the patient was eligible, whether he or she met the numerator criteria., Grantee’s Most Recent Self-Reported Quarterly Status (as of December 2010):, The grant ended in September 2010 with all major aims achieved. The budget was somewhat underspent., Impact and Findings:, Across 56 practices and reviews of over 6,100 patient records, most practices did not have prior quality measurement experience or engage in quality improvement activities prior to adoption of an EHR. Following implementation of the CDSS and additional technical support from PCIP, practices increased their rates of clinical preventive services by at least five percentage points across six of ten selected quality measures. Providers found some documentation tasks within the EHR to be relatively straightforward, while other data entry processes posed challenges with downstream effects for quality measurement and reporting. Without manual review of the electronic records, many of the practices would underreport their performance when using automated EHR-derived quality reporting., Strategic Goal:, Develop and disseminate health IT evidence and evidence-based tools to improve health care decisionmaking through the use of integrated data and knowledge management., Business Goal:, Implementation and Use *, AHRQ Priority Population, .Principal Investigator: Wu, Winfred
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Description: Summary:, This project builds on the work of Project ECHO: Extension for Community Healthcare Outcomes Project ECHO: Extension for Community Healthcare Outcomes , which was previously funded by the Agency for Healthcare Research and Quality. Providers require access to patient-specific information to consult on cases, track patient progress, and evaluate clinical outcomes. At Project ECHO's inception, community-based providers transmitted patient-specific information to specialists via a data management system. Data were entered and stored locally on a laptop, transmitted via a secure virtual private network (VPN), and maintained in a centralized Health Insurance Portability and Accountability Act-compliant structured query language database server to support both clinical and research activities. With Project ECHO's rapid expansion, this type of data management proved inadequate because it presented numerous insurmountable barriers to site maintenance, VPN problems, and critical datafeed and reporting inadequacies. To address these issues, Project ECHO will use an Internet-based clinical management system for patients undergoing treatment for hepatitis C virus (HCV). This system will improve quality of care, and lead to greater knowledge sharing among health care providers for rural and underserved populations. The enhancements to the electronic disease management tool, iHealth, and the clinical management system will standardize data collection, provide practice support, create a central data repository, and allow authorized personnel to view individual patient records. The iHealth tool will be accessed as a Web portal, the central identity for the HCV program, providing a single-access point for its resources. The portal includes search tools that program personnel can use to extract data for monitoring data quality, profiling, quality improvement, and research. Laboratory data from TriCore Reference Laboratories (TriCore) will be uploaded automatically into patients' electronic health records. The underlying iHealth architecture supports effective management of patient data across multiple provider organizations. Web portals for patients will provide educational links and allow patients to see their summary reports, facilitating better communication with their providers. The provider portal can provide tools for HCV treatment and coordinate training activities. Patient needs will be assessed and determined via patient focus groups., Specific Aims:, Develop a disease management tool that will standardize data collection, provide practice support, create a central data repository, and allow authorized personnel to view individual patient records., (Achieved), Develop a Web portal that creates a central identity for the HCV program and provides a singleaccess point for its resources., (Ongoing), Create search tools that program personnel can use to extract data for monitoring data quality, profiling, quality improvement, and research., (Ongoing), Develop a system that automatically uploads laboratory data from TriCore., (Achieved), Promote adoption of iHealth clinical management system., (Ongoing), 2011 Activities:, Disease management tools were developed during the year. There are two safety reports. One is automatically-generated based on audit parameters that are established clinical criteria; the other is a safety report that can be generated by anyone with appropriate authorizations to query certain clinical parameters. The final iteration of the HCV summary report is in the software that tracks clinical data over time during the patient's course of HCV treatment. The following practice support tool has been developed: An internal calendar that identifies future dates for clinical encounters and labs that must be obtained for compliance with best-practices protocols. Adverse-event identification is accounted for in the safety report. The provider portal was completed and includes links to provider educational resources including clinical protocols, National Institute on Alcohol Abuse and Alcoholism guides for alcohol interventions, and ongoing clinical trials. Functions to strengthen learning and enhance clinical decisionmaking, including non-identified patient-mirrored cases to enhance learning loops, have been developed. An interface with the iECHO partner relations management tool is being developed for didactics, continuing medical education, and other training functions. It is now possible to obtain a subset of data from the database to develop outcome studies. Concerns regarding institutional review board and confidentiality have led the team to believe that this should not be a Web-based functionality at this time, and have opted for a human interface. The first extracted data set was used for research and the results were published in June in the, New England Journal of Medicine, . This functionality can be provided to any researcher meeting authorization requirements. The roll-out of iHealth clinical management system was initiated. As last self-reported in the AHRQ Research Reporting System, project progress and activities are mostly on track and project budget funds are somewhat underspent because of delays in staff hiring., Preliminary Impact and Findings:, The project has no findings to date., Target Population:, Adults, Chronic Care*, Hepatitis C, Strategic Goal: , Develop and disseminate health IT evidence and evidence-based tools to improve health care decisionmaking through the use ofintegrated data and knowledge management., Business Goal: , Knowledge Creation, * This target population is one of AHRQ's priority populations.Principal Investigator: Arora, Sanjeev
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Principal Investigator: Wu, Winfred
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Description: Summary:, This project builds on the work of Project ECHO: Extension for Community Healthcare Outcomes Project ECHO: Extension for Community Healthcare Outcomes , which was previously funded by the Agency for Healthcare Research and Quality. Providers require access to patient-specific information to consult on cases, track patient progress, and evaluate clinical outcomes. At Project ECHO’s inception, community-based providers transmitted patient-specific information to specialists via a data management system. Data were entered and stored locally on a laptop, transmitted via a secure virtual private network (VPN), and maintained in a centralized Health Insurance Portability and Accountability Act-compliant structured query language database server to support both clinical and research activities. With Project ECHO’s rapid expansion, this type of data management proved inadequate because it presented numerous insurmountable barriers to site maintenance, VPN problems, and critical datafeed and reporting inadequacies. To address these issues, Project ECHO will focus on the use of an Internet-based clinical management system for patients undergoing treatment for hepatitis C virus (HCV). This system will improve quality of care and lead to greater knowledge sharing among health care providers for rural and underserved populations. Enhancements are being made to the electronic disease management tool iHealth. iHealth and the clinical management system will standardize data collection, provide practice support, create a central data repository, and allow authorized personnel to view individual patient records. The iHealth tool will be accessed via a Web portal, the central identity for the HCV program, providing a single-access point for iHealth resources. The portal includes search tools that program personnel can use to extract data for monitoring data quality, profiling, quality improvement, and research. Laboratory data is being uploaded automatically into patients’ electronic health records. The underlying iHealth architecture supports effective management of patient data across multiple provider organizations. Web portals for patients are providing educational links and allow patients to see their summary reports, facilitating better communication with their providers. The provider portal can provide tools for HCV treatment and coordinate training activities. Patient needs were assessed and determined via patient focus groups., Specific Aims:, Develop a disease management tool that will standardize data collection, provide practice support, create a central data repository, and allow authorized personnel to view individual patient records., (Achieved), Develop a Web portal that creates a central identity for the HCV program and provides a single-access point for its resources., (Ongoing), Create search tools that program personnel can use to extract data for monitoring data quality, profiling, quality improvement, and research., (Achieved), Develop a system that automatically uploads laboratory data from TriCore., (Achieved), Promote adoption of iHealth clinical management system., (Achieved), 2012 Activities:, Patient focus groups were conducted and the patient portal prototype was developed. The team anticipated presenting the prototype before an HCV teleECHO clinic in spring 2013. Provider portal resources continued to be developed as informed by focus group findings. The treatment protocol was revised and made available with the summary report. The team continued to train practices and promote the use of iHealth. Development of the Web portal was initiated. Dr. Arora is using 1-year a no-cost extension to develop additional portal resources and continue data collection. As last self-reported in the AHRQ Research Reporting System, project progress and activities are on track and budget spending is on target., Preliminary Impact and Findings:, The project has no findings to date., Target Population:, Adults, Chronic Care*, Hepatitis C, Strategic Goal:, Develop and disseminate health IT evidence and evidence-based tools to improve health care decisionmaking through the use of integrated data and knowledge management., Business Goal:, Knowledge Creation, *This target population is one of AHRQ’s priority populations.Principal Investigator: Arora, Sanjeev
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Principal Investigator: Arora, Sanjeev