Helen Burstin, MD, MPHDirector, Center for Primary Care Research

Agency for Healthcare Research and Quality

April 16, 2001

The Effect of Working Conditions on Quality of Care

Fiscal Year 2001 Patient Safety requests for Fiscal Year 2001 Patient Safety requests for applications (RFAs):applications (RFAs):

Competitive Demonstration ProgramCompetitive Demonstration Program

Centers of Excellence for Patient Safety Research and Practice (closed) Developing Centers for Patient Safety Research and Practice (closed) Health System Error Reporting, Analysis, and Safety Improvement

Demonstrations (open) Clinical Informatics to Promote Patient Safety (open) The Effect of Healthcare Working Conditions on Quality of Care (open) Patient Safety Research and Dissemination (TBA)

Crossing the Quality ChasmCrossing the Quality Chasm Clarifying National Aims for ImprovementClarifying National Aims for Improvement

Safety -- As safe in health care as in our homesSafety -- As safe in health care as in our homes Effectiveness -- Matching care to science; avoiding Effectiveness -- Matching care to science; avoiding

overuse and underuse overuse and underuse Patient Centeredness -- Honoring the individual, and Patient Centeredness -- Honoring the individual, and

respecting choicerespecting choice Timeliness -- Less waiting for both patients and those who Timeliness -- Less waiting for both patients and those who

give caregive care Efficiency -- Reducing wasteEfficiency -- Reducing waste Equity -- Closing racial and ethnic gaps in health statusEquity -- Closing racial and ethnic gaps in health status

Health care Working Conditions and Health care Working Conditions and Quality of Care:Quality of Care:

Key Conferences:Key Conferences: Research Agenda Setting Conference, October 1999Research Agenda Setting Conference, October 1999

– Cosponsored by Agency for Healthcare Research and Quality (AHRQ), Cosponsored by Agency for Healthcare Research and Quality (AHRQ), National Institute for Occupational Safety and Health (NIOSH), National Institute for Occupational Safety and Health (NIOSH), Occupational Safety and Health Administration (OSHA), and Department Occupational Safety and Health Administration (OSHA), and Department of Veterans Affairs (VA)of Veterans Affairs (VA)

– Identified substantive and methodological gaps in current knowledge on Identified substantive and methodological gaps in current knowledge on how to link working conditions, quality of care, patient safety.how to link working conditions, quality of care, patient safety.

– Participants from a wide range of academia, the health care industry and Participants from a wide range of academia, the health care industry and labor.labor.

– Summary of research themes: Summary of research themes: www.quic.gov/summit/research.htmwww.quic.gov/summit/research.htm Best Practices Conference, October 2000Best Practices Conference, October 2000

Healthcare Working Conditions and Healthcare Working Conditions and Quality of CareQuality of Care

Overall AHRQ Portfolio:Overall AHRQ Portfolio: Working Conditions and Quality request for applications Working Conditions and Quality request for applications

(RFAs)(RFAs)– Practice-based research networks (PBRNs)Practice-based research networks (PBRNs)

Institute of Medicine (IOM) Report: working conditions Institute of Medicine (IOM) Report: working conditions and safetyand safety

Evidence-based Practice Centers (EPC)s: evidence base Evidence-based Practice Centers (EPC)s: evidence base for working conditions and patient safetyfor working conditions and patient safety

Integrated delivery system research networks (IDSRNs)Integrated delivery system research networks (IDSRNs)

Goals: Explore the relationship between working

conditions that affect health care workers and the safety and quality of care they provide;

Test innovative approaches to working conditions that have been effective in improving the quality of a product or service in industries other than health care.

RFA: Healthcare Working Conditions and Quality of Care

Develop systematic knowledge of the impact of working conditions on safety and quality:– Physical environment– Workflow design– Workforce staffing– Working hours– Organizational culture

Must demonstrate impact of working conditions on healthcare workers and on clinical performance

RFA: Healthcare Working Conditions and Quality of Care

Key definitions: Working conditions: characteristics of the health

care workplace and workforce, including physical environment, workflow design, workforce staffing and organizational culture.

Health care workers: workers employed in the direct care of patients in the health care setting, including but not limited to: nurses, physicians, pharmacists, nursing assistants, and other health care providers.

RFA: Healthcare Working Conditions and Quality of Care

Key definitions: Patient Safety: the risk to a patient from medical

errors (the failure of a planned action to be completed as intended or the wrong use of a plan to achieve an aim)

Quality improvement: projects designed to improve care by ensuring that the right care is delivered to the right patient at the right time in the right way (could target misuse, underuse, and overuse)

RFA: Healthcare Working Conditions and Quality of Care

Key technical items: R01 - due May 21st One-time solicitation Letter of intent not required, though preferred Institutional review boards (IRB) approval is required in mid-

July. Exact date to be announced in the NIH Guide. 1-2 year projects preferred (will consider up to 3 year projects) Total costs per year not to exceed $500,000. Requires prior

approval of Dr. Burstin

RFA: Healthcare Working Conditions and Quality of Care

Key financial items: $7.5 million total costs (direct + overhead) Total costs per year not to exceed $500,000.

Requires prior approval of Dr. Burstin Set-asides:

– $3 million: for healthcare organizations – $2 million: for patient safety projects– $500,000: for primary care Practice-Based Research

Networks (PBRNs)

RFA: Healthcare Working Conditions and Quality of Care

Key content questions: Endpoints must be related to patient safety or

quality of care Intermediate education outcomes are not

acceptable unless quality outcomes are included All health care sites are eligible, including inpatient,

ambulatory, home care, and long-term care. All health care disciplines are eligible (e.g., dental,

pharmacy)

RFA: Healthcare Working Conditions and Quality of Care

Key partner questions: Grants can only be made to non-profit entities For-profit entities are only acceptable as sub-

contractors or members of consortia Department of Veterans Affairs (VA) sites and

sub-contractors are acceptable (cannot use grant funds to cover the salary of a VA employee)

RFA: Healthcare Working Conditions and Quality of Care

Center for Primary Care Research:Center for Primary Care Research:Key ContactsKey Contacts

Kelly Morgan, Program Analyst– technical/financial questions– kmorgan@ahrq.gov

Helen Burstin, Director– scope/content questions– hburstin@ahrq.gov