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Article Excerpt
BACKGROUND
One of the central activities of the Agency for Healthcare Research and Quality (AHRQ) patient safety initiative has been the use of its appropriated funding to support research and development work to expand knowledge on patient safety epidemiology and practices. At the start of the initiative, AHRQ identified a set of priorities to guide its funding choices (Keyes et al. 2005). AHRQ was informed in that task by two sources. The first was a report by the Quality Interagency Coordination Task Force (QuIC), which described > 100 actions that the QuIC and its participating agencies planned to take to improve patient safety, including expansion of the knowledge base about the causes and prevention of errors (QuIC 2000a). (1) The second was a research agenda generated from the first National Summit on Patient Safety Research convened by the QuIC in September 2000 (QuIC 2000b).
The history of AHRQ funding for patient safety grants is presented in Table 1 (see Appendix A for project group summaries). Each group of projects addressed different aspects of the priority topic areas and methodological issues identified by the QuIC and Summit research agenda. The first project group funded was the systems-related best practice grants, for which the Request for Application (RFA) was released in late 1999 (AHRQ 1999), as the Institute of Medicine (IOM) report To Err Is Human (2000) was being published. RFAs for another six groups of projects were released in fiscal year (FY) 2001 as AHRQ launched the patient safety initiative (AHRQ 2000a, b, 2001a-d). Subsequent groups of grants differed from these first two groups in their greater focus on testing the implementation of patient safety practices and requirements for cost sharing by the grantee organizations. These included the Challenge grants (FY 2003), several groups of health information technology (IT) grants (FY 2004), and the "Partnerships in Implementing Patient Safety" grants (FY 2005) (AHRQ 2003a-d, 2004a, b, 2005). In FY 2006, AHRQ funded a set of projects to examine use of simulation techniques to improve patient safety (AHRQ 2006).
Reflecting their central role in the patient safety initiative, the funded projects were a core focus of the work of the patient safety evaluation center, which AHRQ funded in 2002. Within the five-component system framework established to guide our process evaluation (see Farley and Battles 2008, in this issue), these projects should be contributing to the two knowledge development components, with the resulting expanded knowledge then informing and supporting practice improvements in the field. Throughout the 4-year term of the evaluation (2002-2006), we examined the potential for each new group of projects funded through 2005 to make such contributions to knowledge on patient safety issues and practices.
We use the term "potential to contribute to knowledge" because actual contributions could not be documented or assessed until after the project results were published in the scientific literature and could be tested against standards of evidence. This long process would not be completed for these projects within the 4-year evaluation timeline. Using information from the project descriptions and proposals, however, we could characterize their potential contributions by examining the mix of patient safety issues and health care settings being addressed by the projects, as well as the practices being tested, and their attention to special populations.
Purpose of This Evaluation Task
To assess the potential contributions of the patient safety projects funded by AHRQ we characterized the nature of the projects, and we assessed whether the practices they addressed were among those requiring additional evidence on effectiveness. Specifically, we sought to address the following evaluation questions:
1. What patient safety issues, practices, and settings are being examined by the projects funded by AHRQ through its patient safety initiative?
2. To what extent are these projects contributing new knowledge regarding practices for which additional scientific evidence is needed?
3. What progress has been made by the projects in documenting effects of patient safety practices and tools on patient safety outcomes?
We focused separately on the projects' potential contributions to epidemiological knowledge and to knowledge on the effectiveness of patient safety practices. We also examined trends in the generation of products from these projects to assess their progress in documenting their findings (question 3).
METHODS
We used three types of data in this evaluation task: information abstracted from proposals for the patient safety projects, information on evidence for safety practices from the AHRQ Evidence Report on Patient Safety Practices (Shojania et al. 2001), and published products from the projects through June 2006. An Access database was developed containing data on each project in AHRQ's patient safety portfolio, including projects funded through FY 2005.
Characterization of the AHRQ-Funded Patient Safety Projects
The patient safety portfolio contained a total of 234 projects funded by AHRQ in FY 2000 through FY 2005. AHRQ provided us copies of the proposals for all of these projects.
Two types of information were abstracted from the proposals: (I) basic project information and (2) categorical variables characterizing the nature of the projects. (2) Basic project information, including the project tire, AHRQ project number, RFA number, principal investigator (PI), institution, and project start and end dates, was obtained directly from the project proposals or AHRQ master file. The evaluation center leadership team defined the coding categories for the categorical variables that characterized the projects (e.g., patient safety issue addressed, health care setting). For the health IT projects, additional variables were defined to characterize the types and purposes of the health IT that the projects were addressing, which were adapted from IT taxonomies used in previous RAND work (Girosi, Meili, and Scoville 2005). Projects could be coded for more than one category for a given variable (e.g., a project could examine care in both inpatient and outpatient settings).
To provide data on projects' potential contributions to patient safety epidemiology, we included coding categories in the variable for patient safety actions for "studying the epidemiology of patient safety risks and hazards" and "studying the underlying causes of medical errors or adverse events." (3) If a project was studying epidemiological issues or causes of medical errors, it was categorized as generating knowledge in patient safety epidemiology, even if this was not its primary focus.
Variables for the 234 projects that were not provided from the AHRQ master file were coded...
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