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
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 RO3’s Funded/Not FundedNumber of RO3’s Funded/Not Funded
30
50
1420
41
17
58
R13
R01
U18
Other (R18, P20, etc.)
Unfunded RO3's
Funded R03's
Preliminary Results: Data Audit of Submissions by Nurse ResearchersPreliminary Results: Data Audit of Submissions by Nurse Researchers
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
Other (R18, P20, etc.)
Unfunded R13's
Funded 13's
Preliminary Results: Data Audit of Submissions by Nurse ResearchersPreliminary Results: Data Audit of Submissions by Nurse Researchers
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
Submitted by Nurse Researchers *Submitted by Nurse Researchers *
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
* 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 Focus on Health Care Delivery Setting: Profile of Focus on Health Care Delivery Setting: From Data Audit of Grants From Data Audit of Grants
Submitted by Nurse Researchers *Submitted by Nurse Researchers *
17
35
10
4
91 18
4
0
10
20
30
40
50
60
Hospital NRS Home Home Care Community
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 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
Examples of Conceptual Frameworks used Examples of Conceptual Frameworks used by Nurse Researchers in Successful Grantsby Nurse Researchers in Successful Grants
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
Examples of Conceptual Frameworks used Examples of Conceptual Frameworks used by Nurse Researchers in Successful Grantsby Nurse Researchers in Successful Grants
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
Examples of Conceptual Frameworks used Examples of Conceptual Frameworks used by Nurse Researchers in Successful Grantsby Nurse Researchers in Successful Grants
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
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
ȹEconometric ModelingEconometric Modeling
ȹBivariate Analysis Bivariate Analysis
ȹAnovaAnova
ȹFocus Group Qualitative Focus Group Qualitative AnalysisAnalysis
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
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
Specific Approaches From Successfully Funded Grants
•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
Specific Approaches From Successfully Funded Grants
•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
* 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 ResearchersPreliminary Results: Data Audit of Grants Submitted by Nurse Researchers
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
* 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 ResearchersPreliminary Results: Data Audit of Grants Submitted by Nurse Researchers
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
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