In this section we include tables with grants complied from throughout the various sections of the report on Patient Safety, Telehealth, COVID-19, Clinical Decision Support, Women’s Health/Reproductive Health, Opioids, and Multiple Chronic Conditions.
Grants with a focus on health equity are indicated with this icon.
Patient Safety
The Table below includes all 30 AHRQ primary care grants from FYs 2021 and 2022 with a focus on patient safety. These grants are included in topic sections throughout the report, depending on the main focus of each grant, including Practice and Quality Improvement (12), Digital Healthcare (9), Person-Centered Care (3), Behavioral Health and Substance Use Disorders (1), and Health Equity (1), and Primary Care Workforce (1). In addition, this table includes the 3 grants included in the Patient Safety section.
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PI: Sigall Bell Organization: University of Texas Health Science Center Houston; Internal Medicine Develops a Diagnostic Center of Excellence that uses teaming science and patient engagement to bring patients and healthcare providers together to reduce diagnostic errors and improve safety in ambulatory care. |
| Re-engineering Patient and Family Communication to Improve Diagnostic Safety Resilience (R18) |
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PIs: Kathleen Elizabeth Walsh; Christopher Paul Landrigan Organization: Boston Children’s Hospital Develops a Diagnostic Center of Excellence focused on improving clinician-patient/family communication in pediatric outpatient settings. |
| Implementing Personalized Cross-Sector Transitional Care Management to Promote Care Continuity, Reduce Low Value Utilization, and Reduce the Burden of Treatment for High-Need, High-Cost Patients (R01) |
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PI: Sharon Hewner Organization: State University of New York at Buffalo; School of Nursing Tests a personalized, cross-sector, transitional care management model to improve care coordination across primary care and behavioral health settings using a health information exchange infrastructure. |
| Integrating Pharmacists into an Automated Discharge Process to Promote Comprehensive Medication Management (R18) |
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PI: Joel F. Farley Organization: University of Minnesota Examines pharmacist-provided comprehensive medication management to coordinate care for high-need/high-cost patients when they transition between the hospital and primary care settings. In this program, a health information exchange’s automated electronic alert system notifies primary care sites when patients need pharmacist-provided comprehensive medication management after a hospital visit. |
| Closed Loop Diagnostics: AHRQ R18 Patient Safety Learning Laboratories (R18) |
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PIs: Russell Scott Phillips; James C Benneyan; Gordon David Schiff Organization: Harvard Medical School Uses systems engineering methods to reduce diagnostic errors by creating “closed loop systems” or systems that ensure diagnostics tests and referrals are completed, results are conveyed to patients and primary care providers, and patients inform primary care providers about changes in symptoms that could alter a diagnosis. This study designs, develops, tests, and refines this “closed loop system” for diagnostic tests and referrals. |
| PROMIS Learning Lab: Partnership in Resilience for Medication Safety (R18) |
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PI: Yan Xiao Organization: University of Texas Arlington; School of Nursing Creates the Partnership in Resilience for Medication Safety Learning Lab (PROMIS Lab) which promotes patient safety in primary care. The PROMIS Lab is intended to develop and test strategies to reduce medication-related harms in older adults. |
| Comprehensive Pediatric Hypertension Diagnosis and Management (R01) |
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PI: Michael L Rinke Organization: Albert Einstein College of Medicine Engages primary care pediatric practices to test different models of subspecialist involvement in pediatric hypertension diagnosis and management. |
DECODE: Diagnostic Excellence Center on Diagnostic Error (R18) |
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PIs: Ramin Khorasani; Ronilda Lacson Organization: Brigham and Women’s Hospital; Independent Hospital Develops a Diagnostic Center of Excellence to reduce failures in timely performance of clinically necessary diagnostic imaging exams and interpretation errors. The team will implement information technology-enabled functions and workflows to enhance a clinical dashboard with improved EHR-integration and monitoring and learning capabilities to help reduce diagnostic errors and health disparities. In addition, they will provide opportunities for peer learning to reduce interpretive errors, and convene a team of clinicians to develop consensus recommendations for the management of lung, prostate, pancreatic and adrenal cancers and embed the recommendations into the EHR. |
| Diagnostic Safety Center for Advancing E-triggers and Rapid Feedback Implementation (DISCOVERI) (R18) |
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PI: Hardeep Singh Organization: Baylor College of Medicine; School of Medicine; Internal Medicine Develops a center that supports the implementation of surveillance and feedback systems to improve diagnostic safety in healthcare organizations. The center will work to accelerate the uptake of electronic trigger (e-trigger) tools, which mine large sets of clinical and administrative data to identify signals for likely adverse events. E-trigger algorithms can efficiently identify patterns of care indicating missed or delayed diagnoses in primary care as well as other settings. |
| Averting Diagnostic Error Through Improved Recognition of Child Abuse (K08) |
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PI: Irit R. Rasooly Organization: Children’s Hospital of Philadelphia; Independent Hospital Uses EHR data- and systems-analysis to develop CDS strategies that can identify and help diagnose child abuse in primary care settings. The research team is using EHR data to detect and validate markers of physical abuse to help identify children experiencing abuse; using EHR simulations to identify abuse-related diagnostic errors; and working to develop feasible, acceptable, and appropriate CDS strategies for improved child abuse detection and diagnosis. |
| Clinical Decision Support for Disseminating and Implementing Patient-Centered Outcomes Research (R18) |
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PI: Ronilda Lacson Organization: Brigham and Women’s Hospital; Independent Hospital Aims to develop and validate CDS-consumable knowledge artifacts based on clinical evidence for imaging that can be widely adopted. In previous work, a multi-disciplinary team of clinicians and medical informaticists developed and graded artifacts to represent clinical evidence and made them publicly available. This study will assess the technical capability of standardized EHR syntax and formats (e.g., FHIR, CQL, and SNOMED CT) to use the knowledge artifacts for imaging CDS. Specifically, the team will look at CDS for using MRI to diagnose a second incidence of breast cancer, using CT scan for pulmonary embolism, and for physician education about the risk for pulmonary embolism. Results will help inform clinical decision making for diagnostic imaging in primary care. |
| Improving Medication Safety for Medically Complex Children with mHealth Across Caregiving Networks (R18) |
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PIs: Ryan J Coller; Nicole E Werner Organization: University of Wisconsin—Madison; School of Medicine; Pediatrics Develops an app (MedS@HOME) to improve medication safety for children with medical complexity. The app supports standardized medication management across the caregiving network to increase administration accuracy and reduce medication-related adverse events. Learn more about this study in a recent NCEPCR webinar: Innovative Use of Technology for Primary Care Delivery. |
| A Turn-Key EHR Simulation Program to Reduce Diagnostic Error in Ambulatory Care (R18) |
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PIs: Jeffery A Gold; Raj M Ratwani Organization: Oregon Health & Science University; Domestic Higher Education Develops a library of validated EHR-based simulations to improve diagnostic safety in ambulatory care. The research team is using a combination of administrative and claims data to identify diagnoses at risk for diagnostic error in ambulatory care settings and the EHR use errors associated with those errors. The researchers will use this data to develop simulations for five ambulatory care settings, including primary care, and validate the use of the simulation activities as a training tool to change EHR use patterns and reduce diagnostic errors. |
| Adaptation and Pilot Implementation of a Validated, Electronic Real Time Clinical Decision Support Tool for Care of Pneumonia Patients in 12 Utah Urgent Care Centers (R18) |
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PI: Nathan C. Dean Organization: IHC Health Services Inc.; Non-Profit Adapts an existing CDS tool containing guidelines for pneumonia (“ePNa”) to urgent care centers. The research team is identifying barriers and facilitators to implementation and uptake of the ePNA tool, and testing it within urgent care centers by examining outcomes related to patient safety, antibiotic prescribing, and diagnoses without chest imaging. While this project is not primary care focused, it has implications for the coordination of care and follow-up care for patients with pneumonia by their primary care team. |
| Understanding CancelRx: Impact on Clinical Workflows, Medication Safety Risks, and Patient Outcomes (R21) |
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PI: Samantha Pitts Organization: Johns Hopkins University; School of Medicine; Genetics Conducts formative research on the development and optimization of CancelRx, an EHR functionality that sends electronic prescription cancellations from the EHR to pharmacies, to help reduce adverse drug events in ambulatory care settings. |
| Patient Choice of Telemedicine Encounters (R01) |
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PI: Mary Reed Organization: Kaiser Foundation Research Institute; Research Institute Examines the broad-scale implementation of telemedicine for primary care encounters within a healthcare system prior to the COVID-19 pandemic to understand how telemedicine compares in quality, care processes, and patient outcomes to in-person care; and to understand which patient characteristics are most closely associated with telemedicine utilization. |
| Implementing Telemedicine to Improve Appropriate Antibiotic Prescribing for Acute Respiratory Tract Infections (R01) |
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PIs: Tamar Barlam; Mari-Lynn Drainoni Organization: Boston Medical Center Examines if telehealth visits can be used to improve the management of acute respiratory tract infections, including reducing inappropriate prescribing of antibiotics in ambulatory settings. |
| ExPERTS-PC: Engaging Patients in Event ReporTing for Safety in Primary Care (K08) |
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PI: Anjana Estelle Sharma Organization: University of California, San Francisco; School of Medicine, Family Medicine Develops a tool for patients to report adverse drug events (ADEs) to their ambulatory care teams. The research team will use natural language processing to identify the patient, caregiver, and healthcare team related causes of ADEs from the reports of a multistate Patient Safety Organization. Using the information about identified causes, the team will develop a prototype of a patient-initiated ADE reporting system using text messaging, and will conduct feasibility testing with patients, family members, and primary care clinic staff. Learn more about this study in a recent NCEPCR webinar: Innovative Use of Technology for Primary Care Delivery. |
| Enhanced Kidney Follow-Up for AKI Survivors in Care Transitions (the ACT Study) (R03) |
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PI: Erin Frazee Barreto Organization: Mayo Clinic Rochester This pilot feasibility trial evaluates a program that supports patients discharged from the hospital to home after an episode of acute kidney injury. The findings from this study can assist primary care clinicians with providing high-quality, well-coordinated, and patient-centered care for survivors of AKI. |
| Reframing Optimal Management of Pain and Opioids in Older Adults (R18) |
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PIs: Daniel William Berland; Christine Elizabeth Stanik Organization: University of Michigan at Ann Arbor; School of Medicine, Internal Medicine Implements practice improvements for safely prescribing opioids or alternative medications for pain management in older adults in primary care. The project takes a multi-faceted approach, including educating and supporting prescribers, academic detailing, and use of electronic health record technology. |
| Medical Reversals: De-Implementing Ineffective and Unsafe Treatments (R01) |
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PI: Pinar Karaca-Mandic Organization: University of Minnesota; School of Public Health, Public Health & Preventive Medicine Looks at the de-implementation of treatments that have been found to be ineffective or unsafe. The research team examines the differences in de-implementation across different physicians and health care delivery organizations, taking into account varying characteristics and market environments. While this project is not focused exclusively on primary care, the findings can be used to understand barriers and facilitators to de-implementing the use of ineffective and unsafe treatments and screenings in a primary care setting. |
| Implementation of Digital Mental Health Tools in Ambulatory Care Coordination (R01) |
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PI: Emily Gardiner Lattie Organization: Northwestern University at Chicago; Domestic Higher Education Adapts a digital mental health platform and service model to improve access to, and coordination of, mental health services in ambulatory care. |
| Patient Perspectives on Prescription Opioid Discontinuation: Understanding and Promoting Safe Transitions (R01) |
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PI: Clarissa Wen-Ling Hsu Organization: Kaiser Foundation Research Institute Investigates the experiences of patients and providers who have discontinued opioids for long term opioid therapy (LTOT). It develops a patient decision aid to support patients when discontinuing LTOT and pilot tests the decision aid with patients. |
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PI: Heather Angier Organization: Oregon Health & Science University; School of Medicine, Family Medicine Identifies which parental factors (such their own health care receipt and burden of disease) are most strongly associated with children receiving recommended preventive health care (including annual well-child visits and routine childhood vaccinations). The research team also explores how social determinants of health influence healthcare utilization for the whole family. |
| Prioritizing Quality Improvement for the Treatment of Psychiatric Disturbances Following Traumatic Brain Injury (K01) |
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PI: Jennifer S. Albrecht Organization: University of Maryland Baltimore; School of Medicine, Public Health & Preventive Medicine Assesses treatment options for patients with traumatic brain injury (TBI) who are experiencing psychiatric disturbances such as depression, anxiety, and post-traumatic stress disorder. The grant examines barriers and facilitators to treatments across patient groups, quantifies disparities in treatment patterns associated with psychiatric disturbances following TBI, and develops a priority list of patient-selected strategies to overcome barriers to the receipt of treatment for psychiatric disturbances following TBI. While this project is not primary care focused, it has implications for the care of patients with TBI in a primary care setting. |
| Development and Validation of a Prediction Model to Address Physician Burnout (K08) |
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PI: Daniel Tawfik Organization: Stanford University; Domestic Higher Education Develops and validates a prediction model that uses existing operational data to identify primary care clinics at high-risk for clinician burnout. |
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PIs: Barbara Wells Trautner; Larisa Grigoryan Organization: Baylor College of Medicine; School of Medicine; Internal Medicine Examines how factors at the patient, healthcare system, and clinician encounter levels predict use of non- prescribed antibiotics by patients seen in safety net primary care clinics who are predominantly uninsured and often have low incomes. This work will result in the development of a communication tool designed to help clinics guide their patients toward safer antibiotic use. |
| Leveraging Evidence-based Practices for Ambulatory VTE Patients to be Safe with Direct Oral Anticoagulants: LEAVE Safe with DOACs (R18) |
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PI: Alok Kapoor Organization: University of Massachusetts, Medical School Worcester; Internal Medicine A multidisciplinary nonprofit organization recently published the direct oral anticoagulants (DOAC) Checklist for Optimal Care Transitions to elaborate the steps required to ensure a safe transition of care in ambulatory venous thromboembolism (VTE) patients. This project operationalizes the items of the Checklist to create a comprehensive care transition intervention that can be delivered by clinical pharmacists and a pharmacy technician. The care transition intervention will have the potential to prevent DOAC-related medication errors, improve the quality of care during care transitions, and increase patient knowledge and medication adherence. |
| Watchful Waiting as a Strategy for Reducing Low-value Spinal Imaging (R18) |
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PI: Joshua J Fenton Organization: University of California at Davis; Internal Medicine Refines and evaluates a simulated intervention, which uses actors playing patients, to teach primary care physicians to build skills recommending watchful waiting to patients who request low-value and potentially harmful imaging for low back pain. This study has the potential to develop useful communication strategies that primary care physicians can use to steer patients away from potentially harmful testing while maintaining the patient-doctor relationship. |
| Enhancing Antibiotic Stewardship in Primary Care (R01) |
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PI: Mark Herbert Ebell Organization: University of Georgia; Public Health and Preventive Medicine This observational study collects and examines data on the clinical presentation, evaluation, management, and outcomes for 1400 patients with lower respiratory tract infections. The research team will use the findings to develop tools primary care clinicians can use to effectively identify patients who are likely to have an uncomplicated treatment course. The goal is to help reduce inappropriate antibiotic prescriptions and the related costs and harms of inappropriate antibiotic use. |
Telehealth
The Table below includes all 13 AHRQ primary care grants from FYs 2021 and 2022 with a focus on telehealth. These grants are included in topic sections throughout the report, depending on the main focus of each grant, including Practice and Quality Improvement (4), COVID-19 (3), Digital Healthcare (2), Healthcare Systems and Infrastructure (1), Person-Centered Care (1), Behavioral Health and Substance Use Disorders (1), and Health Equity (1).
| Comparing Family Decision Making Engagement in Telehealth Versus In-person Primary Care for Children with Chronic Conditions (R01) |
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PI: Ellen A. Lipstein Organization: Cincinnati Children’s Hospital Medical Center Aims to compare the telehealth and in-person decision-making processes and outcomes in pediatric primary care for children with chronic conditions. This grant used a combination of family surveys, video recordings of healthcare visits, and qualitative interviews to understand experiences of decision-making during telehealth and in-person visits. Learn more about this study in a recent NCEPCR webinar: Qualitative Methods Used in AHRQ Funded Primary Care Research. |
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PI: Edmond Ramly Organization: University of Wisconsin—Madison; School of Medicine, Family Medicine Aims to develop a customizable toolkit for implementing cardiovascular disease guidelines in primary care after telehealth expansion. The toolkit includes a menu of options to help practices address specific local barriers without requiring the engagement of an expert for a costly tailoring process. |
| Implementing Telemedicine to Improve Appropriate Antibiotic Prescribing for Acute Respiratory Tract Infections (R01) |
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PIs: Tamar Barlam; Mari-Lynn Drainoni Organization: Boston Medical Center Examines if telehealth visits can be used to improve the management of acute respiratory tract infections, including reducing inappropriate prescribing of antibiotics in ambulatory care settings. |
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PIs: Anya Day; Theresa L Walunas Organization: Altarum Institute The Healthy Hearts for Michigan (HH4M) project establishes a statewide cooperative in Michigan to provide QI support to help primary care practices implement interventions to improve hypertension management and tobacco cessation. These efforts will be coupled with optimization of health IT and telehealth approaches to address barriers to access in rural parts of the State. |
| Screening and Management of Unhealthy Alcohol Use in Primary Care: Dissemination and Implementation of PCOR Evidence (R18) |
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PIs: Darren A. Dewalt; Daniel E Jonas Organization: University of North Carolina Chapel Hill; School of Medicine, Internal Medicine Aims to determine if primary care practice facilitation can support rapid dissemination and implementation of evidence-based screening, counseling, and medication assisted therapy (MAT) for unhealthy alcohol use. In addition, the research team aims to test if providing embedded telehealth services accelerates dissemination and implementation for practices with slower uptake. |
| Evaluating the Impact of Telemedicine on Ambulatory Care (R01) |
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PIs: Michael Patrick Thompson; Chandy Skaria Ellimootil Organization: University of Michigan at Ann Arbor; School of Medicine; Surgery Uses a national cohort of Medicare beneficiaries to understand the impact of ambulatory care telemedicine visits on hospital admissions for ambulatory care-sensitive conditions (such as congestive heart failure, diabetes, and hypertension), and on healthcare spending. |
| Patient Choice of Telemedicine Encounters (R01) |
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PI: Mary Reed Organization: Kaiser Foundation Research Institute; Research Institute Examines the broad-scale implementation of telemedicine for primary care encounters within a healthcare system prior to the COVID-19 pandemic to understand how telemedicine compares in quality, care processes, and patient outcomes to in-person care; and to understand which patient characteristics are most closely associated with telemedicine utilization. |
| Tele-Recovery: Engaging Stakeholders to Adapt and Pilot Test a Scalable Transitional Rehabilitation Intervention for Older, Rural ICU Survivors (K08) |
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PIs: Scheunemann, Leslie Page Organization: University of Pittsburgh at Pittsburgh; School of Medicine, Pediatrics Tests a transitional care model, TeleRecovery, where a nurse practitioner and occupational therapist deliver telehealth-based rehabilitation services for older adults and their caregivers in rural areas after a transfer from the intensive care unit to home. The TeleRecovery teams work with home health providers to implement the patients’ care plans until they are well enough to be managed in primary care. |
 ECHO-F Model to Expand Medication Assisted Treatment in Rural Primary Care (R18) |
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PI: Julie G Salvador Organization: University of New Mexico Health Sciences Center; School of Medicine; Psychiatry Uses the Extensions for Community Healthcare Outcomes (ECHO©) model to train rural primary care clinicians to use medication-assisted treatment (MAT) to treat opioid use disorder. |
The Effect of Rurality and the COVID-19 Pandemic on Telemedicine and Preventive Healthcare Use (K01) |
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PIs: Annie Elizabeth Larson Organization: OCHIN, INC Investigates the role of telemedicine in improving access to primary care for rural patients. The research team is looking at the frequency and type of preventive care visits, differences between urban and rural patients on uptake of telemedicine, and the effect of telemedicine on the quality and equity of care for chronic health conditions among rural and urban patients. |
A Multi-Site Evaluation of Primary Care Accessibility and Utilization During COVID-19 (R01) |
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PIs: Raj M Ratwani and Ethan A Booker Organization: Medstar Health Research Institute Examines the impact of COVID-19 disruptions on access and utilization of primary care for patients in three healthcare systems. The study looks at which patients received care via which modalities (in-person, telehealth, or both); what subpopulations were disproportionately affected by disruptions in care; and the barriers and facilitators to telehealth across the three sites. |
| Quality, Safety, Value: Impact of Sudden Shift to Telehealth Due to COVID-19 Within Nurse-Led Care Models Located in Colorado Rural and Urban Communities (R01) |
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PI: Amy J Barton Organization: University of Colorado Denver; School of Nursing Examines the impact of the sudden shift to telehealth for behavioral health, primary and prenatal care, and home visitation appointments, as a response to the COVID-19 pandemic, on innovative nurse-led care models used to provide care throughout Colorado. The research team considers utilization, both intended and unintended patient outcomes, as well as provider and patient experiences. |
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PI: Yan Xiao Organization: University of Texas Arlington This supplemental grant evaluates the impact of changes in visit modalities due to COVID-19, such as the use of telehealth, on access and safety. Based on the findings of this evaluation, the research team will develop practice guidelines to help primary care clinics provide safe and equitable care during disruptions brought on by the pandemic. [Read about the parent study PROMIS Learning Lab: Partnership in Resilience for Medication Safety in the Healthcare Systems and Infrastructure section of this report]. |
COVID-19
The Table below includes all 11 AHRQ primary care grants from FYs 2021 and 2022 with a focus on COVID-19. These grants are included in the topic sections throughout the report, depending on the main focus of each grant, including Practice and Quality Improvement (2), Health Equity (2), Healthcare Systems and Infrastructure (1), Digital Healthcare (1), and Person-Centered Care (1). In addition, the 4 grants described in the COVID-19 section are included in the table below.
| Comparing Family Decision Making Engagement in Telehealth Versus In-person Primary Care for Children with Chronic Conditions (R01) |
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PI: Ellen A. Lipstein Organization: Cincinnati Children’s Hospital Medical Center Aims to compare the telehealth and in-person decision-making processes and outcomes in pediatric primary care for children with chronic conditions. This grant used a combination of family surveys, video recordings of healthcare visits, and qualitative interviews to understand experiences of decision-making during telehealth and in-person visits. Learn more about this study in a recent NCEPCR webinar: Qualitative Methods Used in AHRQ Funded Primary Care Research. |
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PI: Edmond Ramly Organization: University of Wisconsin—Madison; School of Medicine, Family Medicine Aims to develop a customizable toolkit for implementing cardiovascular disease guidelines in primary care after telehealth expansion. The toolkit includes a menu of options to help practices address specific local barriers without requiring the engagement of an expert for a costly tailoring process. |
| Implementing Telemedicine to Improve Appropriate Antibiotic Prescribing for Acute Respiratory Tract Infections (R01) |
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PIs: Tamar Barlam; Mari-Lynn Drainoni Organization: Boston Medical Center Examines if telehealth visits can be used to improve the management of acute respiratory tract infections, including reducing inappropriate prescribing of antibiotics in ambulatory care settings. |
The Cost of Illness: The Impact of COVID-19 on Patient Financial Outcomes (K08) |
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PI: Nora V Becker Organization: University of Michigan at Ann Arbor; School of Medicine; Internal Medicine Examines "financial toxicity," or the financial consequences of illness. The grant first investigates which patient subgroups are at the highest risk of financial burden; then estimates the objective financial burden of a COVID-19 infection; and assess patients’ subjective financial distress related to their illness. While this study is not primary care focused, it has implications for the care of patients with COVID-19 in a primary care setting. |
The Effect of Rurality and the COVID-19 Pandemic on Telemedicine and Preventive Healthcare Use (K01) |
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PI: Annie Elizabeth Larson Organization: OCHIN, INC Investigates the role of telemedicine in improving access to primary care for rural patients. The research team is looking at the frequency and type of preventive care visits, differences between urban and rural patients on uptake of telemedicine, and the effect of telemedicine on the quality and equity of care for chronic health conditions among rural and urban patients. |
| Evaluating the Impact of Telemedicine on Ambulatory Care (R01) |
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PIs: Michael Patrick Thompson; Chandy Skaria Ellimootil Organization: University of Michigan at Ann Arbor; School of Medicine; Surgery Uses a national cohort of Medicare beneficiaries to understand the impact of ambulatory care telemedicine visits on hospital admissions for ambulatory care-sensitive conditions (such as congestive heart failure, diabetes, and hypertension), and on healthcare spending. |
| Novel, High-Impact Studies Evaluating Health System and Healthcare Professional Responsiveness to COVID-19 |
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PI: Rebecca Sarah Etz Organization: Virginia Commonwealth University; Family Medicine Examines the impact that COVID-19 had on primary care’s digital healthcare expansion, using a set of surveys developed and implemented during the public health emergency. |
A Multi-Site Evaluation of Primary Care Accessibility and Utilization During COVID-19 (R01) |
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PIs: Raj M Ratwani and Ethan A Booker Organization: Medstar Health Research Institute Examines the impact of COVID-19 disruptions on access and utilization of primary care for patients in three healthcare systems. The study looks at which patients received care via which modalities (in-person, telehealth, or both); what subpopulations were disproportionately affected by disruptions in care; and the barriers and facilitators to telehealth across the three sites. |
| Quality, Safety, Value: Impact of Sudden Shift to Telehealth Due to COVID-19 Within Nurse-Led Care Models Located in Colorado Rural and Urban Communities (R01) |
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PI: Amy J Barton Organization: University of Colorado Denver; School of Nursing Examines the impact of the sudden shift to telehealth for behavioral health, primary and prenatal care, and home visitation appointments, as a response to the COVID-19 pandemic, on innovative nurse-led care models used to provide care throughout Colorado. The research team considers utilization, both intended and unintended patient outcomes, as well as provider and patient experiences. |
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PI: Yan Xiao Organization: University of Texas Arlington This supplemental grant evaluates the impact of changes in visit modalities due to COVID-19, such as the use of telehealth, on access and safety. Based on the findings of this evaluation, the research team will develop practice guidelines to help primary care clinics provide safe and equitable care during disruptions brought on by the pandemic. [Read about the parent study PROMIS Learning Lab: Partnership in Resilience for Medication Safety in the Healthcare Systems and Infrastructure section of this report]. |
| Integrating Patient-Reported Outcomes into Routine Primary Care: Monitoring Asthma Between Visits (R18) |
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PI: Robert Samuel Rudin Organization: RAND Corporation This supplemental project enhances a mobile health intervention for home monitoring of asthma symptoms between primary care visits by adding COVID-19 symptom screening and information. [Read about the parent study, with the same name as this supplemental grant, in the Digital Healthcare section of this report]. |
Clinical Decision Support
The Table below includes all 11 AHRQ primary care grants from FYs 2021 and 2022 with a focus on Clinical Decision Support. These grants are included in the topic sections throughout the report, depending on the main focus of each grant, including Practice and Quality Improvement (5), Digital Healthcare (3), Person-Centered Care (3).
DECODE: Diagnostic Excellence Center on Diagnostic Error (R18) |
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PIs: Ramin Khorasani; Ronilda Lacson Organization: Brigham and Women’s Hospital; Independent Hospital Develops a Diagnostic Center of Excellence to reduce failures in timely performance of clinically necessary diagnostic imaging exams and interpretation errors. The team will implement information technology-enabled functions and workflows to enhance a clinical dashboard with improved EHR-integration and monitoring and learning capabilities to help reduce diagnostic errors and health disparities. In addition, they will provide opportunities for peer learning to reduce interpretive errors, and convene a team of clinicians to develop consensus recommendations for the management of lung, prostate, pancreatic and adrenal cancers and embed the recommendations into the EHR. |
| Averting Diagnostic Error Through Improved Recognition of Child Abuse (K08) |
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PI: Irit R. Rasooly Organization: Children’s Hospital of Philadelphia; Independent Hospital Uses EHR data- and systems-analysis to develop CDS strategies that can identify and help diagnose child abuse in primary care settings. The research team is using EHR data to detect and validate markers of physical abuse to help identify children experiencing abuse; using EHR simulations to identify abuse-related diagnostic errors; and working to develop feasible, acceptable, and appropriate CDS strategies for improved child abuse detection and diagnosis. |
| Adaptation and Pilot Implementation of a Validated, Electronic Real Time Clinical Decision Support Tool for Care of Pneumonia Patients in 12 Utah Urgent Care Centers (R18) |
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PI: Nathan C. Dean Organization: IHC Health Services Inc.; Non-Profit Adapts an existing CDS tool containing guidelines for pneumonia (“ePNa”) to urgent care centers. The research team is identifying barriers and facilitators to implementation and uptake of the ePNA tool, and testing it within urgent care centers by examining outcomes related to patient safety, antibiotic prescribing, and diagnoses without chest imaging. While this project is not primary care focused, it has implications for the coordination of care and follow-up care for patients with pneumonia by their primary care team. |
| Identify, Teach and Treat (IT2): Automating Clinical Decision Pathways for the Care of Women (U18) |
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PIs: Kimberly Sue Kenton; Steven Persell Organization: Northwestern University at Chicago; Schools of Medicine, Internal Medicine This project’s multi-level implementation strategy aims to improve care for urinary incontinence for women in primary care through systematic and equitable screening, supporting patient-centered decision making for selecting treatment options, and accelerating the uptake of evidence-based nonsurgical treatment modalities. This project will take place in the largest health system in Illinois, with 65 primary care practices and 327 primary care physicians. |
| Improving Recognition and Management of Hypertension in Youth: Comparing Approaches for Extending Effective CDS for Use in a Large Rural Health System (R18) |
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PIs: Elyse Olshen Kharbanda; Catherine Pastorius Benziger Organization: HealthPartners Institute Compares high and low intensity interventions to implement an EHR-linked clinical decision support in rural primary care practices to provide evidence-based clinical care recommendations for blood pressure management in youth. |
| Assessing the Use of Practice Facilitation to Optimize Scale Up of CDS for Hypertension Management (R18) |
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PIs: Hang Pham-Singer; Saul B. Blecker Organization: Fund for Public Health in New York, Inc. Examines if receiving practice facilitation would improve the use of a hypertension-focused CDS to effectively improve blood pressure control rates in small primary care practices. |
| Implementation of Electronic Health Screening in Primary Care to Improve STI Testing (R18) |
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PI: Fahd Aqeeb Ahmad Organization: Washington University; School of Medicine; Pediatrics Integrates an electronic risk assessment tool into four pediatric primary care clinics to help identify adolescents at- risk for sexually transmitted infections (STIs) during annual preventive maintenance visits. |
| Prevent Diabetes Mellitus (PreDM) Clinical Decision Support Intervention in Community Health Centers (R18) |
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PI: Matthew James O’Brien Organization: Northwestern University at Chicago; School of Medicine, Internal Medicine Evaluates a CDS-based intervention to improve care at community health centers for patients with prediabetes. |
| Scaling Interoperable Clinical Decision Support for Patient-Centered Chronic Pain Care (R18) |
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PIs: Christopher Albert Harle; George Ramzi Solloum Organization: University of Florida; School of Medicine Adapts an existing clinical decision support tool, AHRQ's Pain Manager for pain treatment shared decision-making between primary care clinicians and their patients, for clinics in a research consortium. They aim to increase adoption of the adapted Pain Management tool and investigate its impact on patient outcomes, pain, and physical function in a multisite pragmatic trial. |
| Clinical Decision Support for Collaborative Diet Goal Setting in Primary Care (R21) |
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PI: Marissa Burgermaster Organization: University of Texas at Austin; School of Medicine, Public Health, and Preventive Medicine Refines an existing health information technology tool that provides clinicians with data-driven guidance for personalized and collaborative diet goal setting. The research team will pilot test the tool with primary care providers in federally qualified health centers, with the goal of implementing clinical workflows to serve patients experiencing health disparities. |
| Shareable, Interoperable Clinical Decision Support for Older Adults: Advancing Fall Assessment and Prevention Patient-Centered Outcomes Research Findings into Diverse Primary Care Practices (ASPIRE) (U18) |
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PIs: Patricia C. Dykes; Robert J. Lucero Organization: Brigham and Women’s Hospital Aims to develop a shareable, standards-based fall prevention software to improve the implementation of a clinical decision support program into primary care settings using Fall Care Managers to promote fall prevention decision-making. |
Women’s Health/Reproductive Health
The Table below includes all 11 AHRQ primary care grants from FYs 2021 and 2022 with a focus on women’s health or reproductive health. These grants are included in topic sections throughout the report, depending on the main focus of each grant, including Practice and Quality Improvement (8), Healthcare Systems and Infrastructure (1), Behavioral Health and Substance Use Disorders (1), and Health Equity (1).
| Group Well Child Care Intervention for Infants of Mothers in Treatment for Opioid Use Disorder (R18) |
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PIs: Neera Goyal; Vanessa L Short Organization: Alfred I. Du Pont Hospital for Children; Independent Hospital Looks at the use of comprehensive group well child visits for mothers with opiate use disorder and their children. The group visits examined in this study allow for increased time with the pediatrician, peer-to-peer learning, and an enhanced focus on behavior change and self-care. Learn more about this study in a recent NCEPCR webinar: Qualitative Methods Used in AHRQ Funded Primary Care Research. |
| The Community Health Center - Reproductive Life Plan (CHC-RLP) Project (R03) |
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PI: Lisa Marie Masinter Organization: Alliance Chicago Aims to use structured reproductive health assessments, known as reproductive life plans, embedded in the EHR to improve reproductive health care for women in a primary care setting. |
| EHR-based Screening and Intervention for Intimate Partner Violence (R18) |
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PIs: Leslie A. Lenert; Alyssa Ann Rheingold Organization: Medical University of South Carolina; School of Medicine, Public Health & Preventive Medicine Evaluates the implementation of an EHR-based decision support program to support universal screening of women for intimate partner violence (IPV) in primary care clinics. The decision support program includes a referral to a national IPV counseling hotline for those who screen positive. |
| Identify, Teach and Treat (IT2): Automating Clinical Decision Pathways for the Care of Women (U18) |
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PIs: Kimberly Sue Kenton; Steven Persell Organization: Northwestern University at Chicago; Schools of Medicine, Internal Medicine This project’s multi-level implementation strategy aims to improve care for urinary incontinence for women in primary care through systematic and equitable screening, supporting patient-centered decision making for selecting treatment options, and accelerating the uptake of evidence-based nonsurgical treatment modalities. This project will take place in the largest health system in Illinois, with 65 primary care practices and 327 primary care physicians. |
| Empowering Women and Providers for Improved Care of Urinary Incontinence: EMPOWER Study (U18) |
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PIs: Adonis K Hijaz; Goutham Rao Organization: University Hospitals of Cleveland Uses an integrated, multilevel approach to address key barriers to diagnosing and managing urinary incontinence in primary care. The approach will be implemented across a large network of primary care practices, and include large-scale screening, empowering patients to discuss urinary incontinence with their providers, provider education and training, practice facilitation through nurse navigation, and a “chatbot” to support patient self- management. The project will also implement a system-based strategy for streamlined referrals and treatment. |
| Improving Primary Care Understanding of Resources and Screening for Urinary Incontinence to Enhance Treatment (PURSUIT) (U18) |
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PIs: Alayne Denise Markland; Elizabeth Camille Vaughan Organization: University of Alabama at Birmingham; School of Medicine, Internal Medicine Aims to improve access for women Veterans in the southeastern U.S. to evidence-based, nonsurgical treatment for urinary incontinence. The study will compare the effectiveness of the interactive treatment modality with or without additional urinary incontinence clinical expertise delivered via telehealth in 62 primary care practices that treat women Veterans. Participating practices will receive practice facilitation support, training, and health information technology assistance. Researchers will explore women Veterans’ and providers’ perceptions of remote urinary incontinence treatment to advise future scalability. |
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PIs: Anger, Jennifer Tash Organization: University of California, San Diego; School of Medicine, Urology Aims to improve the quality of urinary incontinence care provided to a diverse population of women in primary care, with the goals of improving care and reducing the need for specialty care. Three Southern California medical groups (a total of 60 clinics) will participate in a practice-based incontinence intervention. The intervention will be led by a “clinical champion dyad” including a primary care provider and urologist/urogynecologist from each medical group and will include physician education and performance feedback, electronic decision support, patient education from dedicated advanced practice providers (APPs), and an electronic referral service. |
| Bridging Community-based Continence Promotion and Primary Care (U18) |
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PIs: Heidi Wendell Brown; Kathryn E Flynn; Joan Marie Neuner Organization: University of Wisconsin—Madison; School of Medicine Tests an intervention for increasing the proportion of patients who are screened and offered treatment for urinary incontinence in 50 primary care practices. The intervention, called UI Assist, includes screening, education, and evidence-based treatment. The research team will also compare implementation of UI Assist alone or in combination with partnership building to help practices overcome barriers to intervention implementation. |
| Implementation of Electronic Health Screening in Primary Care to Improve STI Testing (R18) |
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PI: Fahd Aqeeb Ahmad Organization: Washington University; School of Medicine; Pediatrics Integrates an electronic risk assessment tool into four pediatric primary care clinics to help identify adolescents at-risk for sexually transmitted infections (STIs) during annual preventive maintenance visits. |
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PI: Erika K. Barth Cottrell Organization: OCHIN, Inc. Studies the impact of Affordable Care Act and Medicaid expansion on reproductive healthcare provided in community health centers, including examining what individual-, clinic-, and State-level factors are associated with improved reproductive health provision. |
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PI: Jessica N Sanders Organization: University of Utah Uses a matched-control design to evaluate the impacts of a county-level contraceptive initiative on unintended pregnancies and birth outcomes at a population-level. The study will also use linked all-payer claims, electronic medical records, geospatial markers, demographic profiles, and birth certificates to identify regional disparities in family planning access and outcomes. |
Opioids
The Table below includes all 10 AHRQ primary care grants from FYs 2021 and 2022 with a focus on opioid use. These grants are included in topic sections throughout the report, depending on the main focus of each grant, including Person-Centered Care (3), Behavioral Health and Substance Use Disorders (3), Practice and Quality Improvement (2), Healthcare Systems and Infrastructure (1), and Digital Healthcare (1).
| Impact of a Novel Community-based Biobehavioral Chronic Pain Team Training Program (4PCP) on Practitioner and Patient Outcomes (R01) |
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PI: Thomas C Chelimsky Organization: Virginia Commonwealth University; School of Medicine; Neurology Looks at using a “biopsychosocial” approach to treating chronic pain rather than a “biopharmacologic” approach. This “biopsychosocial” approach treats chronic pain syndrome as a brain disorder, which has been reinforced though negative cognitive, emotional, and behavioral habits. In a previous pilot study, the researchers demonstrated that primary care practitioners were eager to implement this new approach, and those who did so had increased confidence with chronic pain management, reduced visit times, and improved patient pain. The primary care practices in this study will receive training from a paired psychologist and a physical therapist to build a clinical team. The study will examine if patient improvements can be sustained for 2 years and if increased practitioner confidence leads to a tapering of prescribed opioids. |
| Group Well Child Care Intervention for Infants of Mothers in Treatment for Opioid Use Disorder (R18) |
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PIs: Neera Goyal; Vanessa L Short Organization: Alfred I. Du Pont Hospital for Children; Independent Hospital Looks at the use of comprehensive group well child visits for mothers with opiate use disorder and their children. The group visits examined in this study allow for increased time with the pediatrician, peer-to-peer learning, and an enhanced focus on behavior change and self-care. Learn more about this study in a recent NCEPCR webinar: Qualitative Methods Used in AHRQ Funded Primary Care Research. |
ECHO-F Model to Expand Medication Assisted Treatment in Rural Primary Care (R18) |
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PI: Julie G Salvador Organization: University of New Mexico Health Sciences Center; School of Medicine; Psychiatry Uses the Extensions for Community Healthcare Outcomes (ECHO©) model, with additional supports as needed, to train primary care providers in rural New Mexico to provide medication to treat opioid use disorders. |
| Addressing Opioid Use Disorder in Older Adults Through Primary Care Innovation (OUD-PCI) (R18) |
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PIs: Steven Allen Crawford; Alexandra Lee Jennings; Zsolt J. Nagykaldi Organization: University of Oklahoma Health Sciences Center Implements a multi-faceted person-centered and scalable chronic management program in primary care practices. The program was systematically tailored to older adults and those with functional disabilities or increased social risks with the goal of increasing functioning and decreasing pain and adverse events. |
| Scaling Interoperable Clinical Decision Support for Patient-Centered Chronic Pain Care (R18) |
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PIs: Christopher Albert Harle; George Ramzi Solloum Organization: University of Florida; School of Medicine Adapts an existing clinical decision support tool, AHRQ's Pain Manager for pain treatment shared decision-making between primary care clinicians and their patients, for clinics in a research consortium. They aim to increase adoption of the adapted Pain Management tool and investigate its impact on patient outcomes, pain, and physical function in a multisite pragmatic trial. |
| Patient Perspectives on Prescription Opioid Discontinuation: Understanding and Promoting Safe Transitions (R01) |
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PI: Clarissa Wen-Ling Hsu Organization: Kaiser Foundation Research Institute Investigates the experiences of patients and providers who have discontinued opioids for long term opioid therapy (LTOT). It develops a patient decision aid to support patients when discontinuing LTOT and pilot tests the decision aid with patients. |
| PROMIS Learning Lab: Partnership in Resilience for Medication Safety (R18) |
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PI: Yan Xiao Organization: University of Texas Arlington; School of Nursing Creates the Partnership in Resilience for Medication Safety Learning Lab (PROMIS Lab) which promotes patient safety in primary care. The PROMIS Lab is intended to develop and test strategies to reduce medication-related harms in older adults. |
| ExPERTS-PC: Engaging Patients in Event ReporTing for Safety in Primary Care (K08) |
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PI: Anjana Estelle Sharma Organization: University of California, San Francisco; School of Medicine, Family Medicine Develops a tool for patients to report adverse drug events (ADEs) to their ambulatory care teams. The research team will use natural language processing to identify the patient, caregiver, and healthcare team related causes of ADEs from the reports of a multistate Patient Safety Organization. Using the information about identified causes, the team will develop a prototype of a patient-initiated ADE reporting system using text messaging, and will conduct feasibility testing with patients, family members, and primary care clinic staff. Learn more about this study in a recent NCEPCR webinar: Innovative Use of Technology for Primary Care Delivery. |
| Reframing Optimal Management of Pain and Opioids in Older Adults (R18) |
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PIs: Daniel William Berland; Christine Elizabeth Stanik Organization: University of Michigan at Ann Arbor; School of Medicine, Internal Medicine Implements practice improvements for safely prescribing opioids or alternative medications for pain management in older adults in primary care. The project takes a multi-faceted approach, including educating and supporting prescribers, academic detailing, and use of electronic health record technology. |
| Prescription Drug Monitoring Program Integration in the Electronic Health Record (R21) |
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PI: Daniel M Hartung Organization: Oregon State University; School of Pharmacy; Other Health Professions Evaluates how integrating Oregon’s electronic registry of controlled-substance prescription dispensing data (prescription drug monitoring program) into the EHR of primary care clinics impacts provider use of registry data and prescribing behavior. |
Multiple Chronic Conditions
The Table below includes all 9 AHRQ primary care grants from FYs 2021 and 2022 with a focus on multiple chronic conditions (also referred to as multimorbidity). These grants are included in the topic sections throughout the report, depending on the main focus of each grant, including Digital Healthcare (4), Person-Centered Care (3), Healthcare Systems and Infrastructure (1), and Behavioral Health and Substance Use Disorders (1).
| Care Transitions App for Patients with Multiple Chronic Conditions (R01) |
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PIs: Lipka Samal; Patricia C Dykes Organization: Brigham and Women’s Hospital; Independent Hospital Develops and tests the effectiveness of an app to support care transitions between the hospital, home, and primary care clinic to reduce post-discharge adverse events. The app contains a digital post-discharge transitional care plan, modules for multiple chronic conditions, relevant lab values, education specific to the patient’s prescribed medications, and a functionality that allows patients to ask questions to support their recovery goals. |
| Care System Analytics to Support Primary Care Patients with Complex Medical and Social Needs (R18) |
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PI: Richard W Grant Organization: Kaiser Foundation Research Institute; Research Institute Develops and tests an EHR-based dashboard to help clinical teams ensure patients with multiple chronic conditions and socially determined barriers to care receive high-quality primary care. |
| Improving Medication Safety for Medically Complex Children with mHealth Across Caregiving Networks (R18) |
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PIs: Ryan J Coller; Nicole E Werner Organization: University of Wisconsin—Madison; School of Medicine; Pediatrics Develops an app (MedS@HOME) to improve medication safety for children with medical complexity. The app supports standardized medication management across the caregiving network to increase administration accuracy and reduce medication-related adverse events Learn more about this study in a recent NCEPCR webinar: Innovative Use of Technology for Primary Care Delivery. |
| Using Smart Devices to Implement an Evidence-based eHealth System for Older Adults (R18) |
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PIs: David H Gustafson; Marie-Louise Mares Organization: University of Wisconsin—Madison; Biomedical Engineering/College of Engineering; Engineering Implements a smart-system (a smart speaker plus display) version of an existing Elder Tree intervention – a program that supports the self-management of health for older adults with multiple chronic conditions. This grant tests a smart-system version compared to the computer-based system on outcomes, including quality of life, hospital readmission, and medication adherence. While this project is not primary care focused, it has implications for the care of older adults who are being medically managed in a primary care setting. |
| SDMo – a Measure of the Occurrence of SDM in the Care of Patients with Chronic Conditions (R01) |
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PI: Ian Hargraves Organization: Mayo Clinic Rochester Develops a measure of SDM occurrence and estimates the measure's reliability and validity. This new measure of SDM occurrence can help uncover how frequently SDM techniques are used in the care of patients with chronic conditions (including primary care), and test associations between SDM and behavioral and physical health outcomes. |
| Addressing Opioid Use Disorder in Older Adults Through Primary Care Innovation (OUD-PCI) (R18) |
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PIs: Steven Allen Crawford; Alexandra Lee Jennings; Zsolt J. Nagykaldi Organization: University of Oklahoma Health Sciences Center Implements a multi-faceted person-centered and scalable chronic management program in primary care practices. The program was systematically tailored to older adults and those with functional disabilities or increased social risks with the goal of increasing functioning and decreasing pain and adverse events. |
| Enhanced Care Planning and Clinical-Community Linkages to Comprehensively Address the Basic Needs of Patients with Multiple Chronic Conditions (R01) |
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PI: Alexander H. Krist Organization: Virginia Commonwealth University; School of Medicine, Medicine Implements and tests an enhanced care planning program to help patients manage multiple chronic conditions. The intervention includes the use of an enhanced care planning tool in primary care to screen patients for health behavior, mental health, and social needs. Working with a navigator, patients help prioritize their needs, create a care plan, and write a narrative to guide care; and then connects patients to needed resources in the community. The research team implemented a clinician-level randomized controlled trial to study how primary care clinicians participate in models for connecting patients to needed community services, and measures whether it improves their health outcomes. |
| Implementation of Digital Mental Health Tools in Ambulatory Care Coordination (R01) |
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PI: Emily Gardiner Lattie Organization: Northwestern University at Chicago; Domestic Higher Education Adapts a digital mental health platform and service model to improve access to, and coordination of, mental health services in ambulatory care. |
| Implementing Personalized Cross-Sector Transitional Care Management to Promote Care Continuity, Reduce Low Value Utilization, and Reduce the Burden of Treatment for High-Need, High-Cost Patients (R01) |
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PI: Sharon Hewner Organization: State University of New York at Buffalo; School of Nursing Tests a personalized, cross-sector, transitional care management model to improve care coordination across settings using a health information exchange infrastructure. |
