Ambulatory Safety and Quality Program: Enabling Patient-Centered Care Through Health Information Technology (PCC)

Ambulatory Safety and Quality Program: Enabling Patient-Centered Care Through Health Information Technology (PCC) is sponsored by Agency for Healthcare Research and Quality (AHRQ). Funds projects that leverage health IT to improve patient-centered care, such as diabetes self-management education.

Expired RFA-HS-07-007: Ambulatory Safety and Quality: Enabling Patient-Centered Care through Health IT (R18) This notice has expired. Check the NIH Guide for active opportunities and notices. Part I Overview Information Department of Health and Human Services Participating Organizations Research and Quality (AHRQ) ( http://www.

ahrq. gov ) Components of Participating Organizations Improvement and Patient Safety Primary Care, Prevention, and Clinical Partnerships Title: Ambulatory Safety and Quality: Enabling Patient-Centered Care through Health IT (R18) Note: The policies, guidelines, terms and conditions stated in this announcement may differ from those used by the NIH.

Request For Applications (RFA) Number: RFA-HS-07-007 Catalog of Federal Domestic Assistance Release/Posted Date: December Opening Date: January 15, 2007 Letters of Intent Receipt NOTE : On time submission requires that applications be successfully submitted to Grants. gov no later than 5:00 p. m.

local time (of the applicant institution/organization).

Application Submission/Receipt Dates: Peer Review Date: April/May, 2007 Earliest Anticipated Start Date: July, 2007 Technical Assistance Teleconference: January 4, 2007 Expiration Date: February 16, 2007 This funding opportunity announcement (FOA) solicits Research Demonstration (R18) grant applications from applicant organizations that propose to explore the use of health information technology (IT) and related policies and practices to establish and enhance patient-centered care in ambulatory settings.

Patient-centered care is responsive to the needs and preferences of individual patients, provides patients with access to their medical information, and empowers patients to be active participants in care decisions and in the daily management of their health and illnesses. This Funding Opportunity Announcement (FOA) will utilize the R18 grant mechanism. The total amount expected to be awarded is $6 million.

Awards issued under this FOA are contingent upon the availability of funds and the submission of a sufficient number of meritorious applications. AHRQ intends to award at least $1. 5 million to primary care Practice-Based Research Networks, $1.

5 million to projects focusing on practices that serve vulnerable populations, and $2 million to projects that include a focus on medication management. It is expected that many projects will be included in more than one of these priority areas. Awards in these areas are contingent upon the submission of a sufficient number of meritorious applications.

The anticipated number of awards is 15 - 20. Because the nature and scope of the proposed research will vary from application to application, it is anticipated that the size and duration of each award will also vary. The total amount awarded and the number of awards will depend upon the numbers, quality, duration, and costs of the applications received.

All AHRQ-supported research, evaluation, or demonstration projects must comply with the AHRQ policy on Inclusion of Priority Populations (see http://grants. nih. gov/grants/guide/notice-files/NOT-HS-03-010.

html ). Investigators should consider and discuss inclusion of subjects from one or more AHRQ priority populations within the context of developing an application as appropriate to the scientific objectives of the planned Project Period and Award Amounts: The total project period for an application submitted in response to this funding opportunity may not exceed three years. Total costs are limited to $1.

2 million over three years, with no more than $500,000 in total costs allowed in any single Eligible organizations: You may submit (an) application(s) if your domestic organization is a: Public or non-profit private institution, such as a university, college, or a faith-based or community-based organization; Units of local or State government; Eligible agencies of the Federal government; Indian/Native American Tribal Government (Federally Indian/Native American Tribal Government (Other than Indian/Native American Tribally Designated Organizations.

Foreign organizations are not eligible under this FOA. For-profit organizations that produce health IT systems are encouraged to apply in partnership with a Project Directors/Principal Investigators (PD/PIs): Any individual with the skills, knowledge, and resources necessary to carry out the proposed research is invited to work with their institution to develop an application for support.

This individual should devote a considerable portion of his/her time to the project (at least 20% through the project duration). Individuals from underrepresented racial and ethnic groups as well as individuals with disabilities are always encouraged to apply for AHRQ support. See Section IV.

1 and Section application materials. The SF424 (R&R) Application Guide for this FOA is located at these Web sites: (R&R) Application and Electronic Submission Information: http://grants. nih.

gov/grants/funding/424/index. htm information on Electronic Submission of Grant Applications: http://era. nih.

gov/ElectronicReceipt/ NOTICE: Applications submitted in response to this Funding Opportunity Announcement (FOA) for Federal assistance must be submitted electronically through Grants. gov ( http://www. grants.

gov ) using the SF424 Research and Related (R&R) forms and the SF424 (R&R) MAY NOT BE SUBMITTED IN PAPER FORMAT. FOA must be read in conjunction with the application guidelines included with this announcement in Grants. gov/Apply for Grants (hereafter called Grants.

gov/Apply). registration process is necessary before submission and applicants are highly encouraged to start the process at least four weeks prior to the grant submission date. See Section Hearing Impaired.

Telecommunications for the hearing impaired is available at: TTY 301-451-5936. grant awards are made to institutions rather than individuals, this announcement and its instructions are written to inform individual researchers of this funding opportunity and facilitate the submission of grant applications Part I Overview Information II Full Text of Announcement I. Funding Opportunity Description III.

Eligibility Information - Special Eligibility Criteria IV. Application and Submission Information Request Application Information Content and Form of Application Submission Submission Dates and Times Submission, Review and Anticipated Start Dates Submitting an Application Electronically to AHRQ V.

Application Review Information Review and Selection Process Additional Review Criteria Additional Review Considerations Sharing Research Resources Anticipated Announcement and Award Dates VI. Award Administration Information Administrative and National Policy Requirements Scientific/Research Contact(s) Financial/ Grants Management Contact(s) Section VIII. Other Information - Required Federal - Full Text of Announcement Section I.

Funding Opportunity General Purpose of the Ambulatory Safety and Quality (ASQ) Program purpose of the Agency for Healthcare Research and Quality’s (AHRQ) Ambulatory Safety and Quality (ASQ) program is to improve the safety and quality of ambulatory health care in the United States.

The program s components, with the exception of the announcement on risk assessment, have an emphasis on the role of health information technology (health IT). Emerging information about ambulatory care suggests that the patient safety crisis in hospitals is only the tip of the iceberg. The scope of ambulatory care has increased over the past decade, as the volume and complexity of interventions has burgeoned.

Safe, high quality ambulatory care requires complex information management and coordination across multiple settings, especially for patients with chronic illnesses.

The opportunity to turn the potential of health IT towards improving safety and quality in the ambulatory care setting, especially within care transitions, will form the cornerstone of this proposed Ambulatory Safety and Quality (ASQ) Specific Purpose of this FOA The purpose of this FOA, ASQ: Enabling Patient-Centered Care through Health IT, is to investigate novel methods or evaluate existing strategies for using health IT to create or enhance patient-centered models of care in the ambulatory setting.

Applicants are expected to demonstrate how patient-centered care can improve health outcomes, patient safety, and patients' reported experience with care. Applicants are encouraged to consider projects that focus decision-making and patient-clinician communication, personal health records, integration of patient information across transitions in care, or patient self-management of chronic conditions.

The long term goal of this effort is to improve the delivery of patient-centered care in ambulatory settings, with a particular focus on transitions of care, personal health records, and improved patient-clinician communication and decision making. Overview: Ambulatory Safety and Quality Program Ambulatory Safety and Quality (ASQ) Program offers an integrated approach to improving ambulatory safety and quality of care.

While there are strategies that could improve the quality and safety of ambulatory care, there are unknown risks in ambulatory care and across transitions that need to be better understood and described before appropriate interventions can be developed.

Where effective strategies exist to drive ambulatory safety and quality, such as health IT, there is a need for research to demonstrate value, as well as best approaches to broader diffusion, implementation, and effective use.

In particular, the high risk associated with medication use in ambulatory care and across transitions in care provides some urgency for targeted risk assessment and health services interventions related to medication management. Finally, effective strategies to improve ambulatory care will be limited by the capacity of current electronic health systems to measure and report on ambulatory safety and quality.

measurable improvements, the 4 funding opportunity announcements (FOAs) that comprise the Ambulatory Safety and Quality (ASQ) Program address research needs that share a common focus on ambulatory care clinicians, patients, and information technology.

This funding opportunity is 1 of the 4 in the ASQ program, as described below: ASQ: Risk Assessment in Ambulatory Care: This announcement has a broad view on ambulatory care that includes the ambulatory care clinician, as well as the patient cared for in ambulatory settings and across high risk transitions in care. Research will focus on assessing the risks associated with ambulatory care that have not yet been fully elucidated.

Unlike the rest of the ASQ program, this announcement does not include a primary focus on health information technology. ASQ: Improving Quality through Clinician Use of Health IT: This announcement has a primary focus on the ambulatory care clinician.

Research will focus on strategies to improve medication management and the delivery of evidence to the point-of-care resulting in improved clinical decision-making and clinical quality for priority conditions.

Issues to be addressed include the relationship between health IT and workflow redesign, systemic barriers to health IT adoption, care for patients with multiple chronic conditions, enhanced patient-centered models of care delivery, and improved use of effective alert strategies for decision support.

ASQ: Enabling Patient-Centered Care through Health IT: This announcement has a primary focus on patients and their interaction with the ambulatory health care system. Research will focus on strategies to improve the patient experience of care through the use of health IT.

It will include work to improve the delivery of patient-centered health information to ensure patients and clinicians have the information they need to make better health care decisions. Specific topics to be addressed include shared decision-making and patient-clinician communication, personal health records, integration of patient information across transitions in care, and patient self-management of chronic conditions.

ASQ: Enabling Patient Safety and Quality Measurement through Health IT: This announcement has a primary focus on integrating patient safety and quality measurement with information technology. Research will focus on strategies to improve transparency for patients in ambulatory care through the development, deployment and export of quality measures from electronic health record systems.

Issues to be addressed include measure development across episodes of care, clinical data needs for quality measurement export and reporting, and the reporting of quality The research themes within these announcements were developed through expert consultation, new and emerging areas of federal and State focus, including the breakthroughs of the American Health Information Community and the work of federal partners, such as the Centers for Medicare and Medicaid Services, Indian Health Service, and the Health Resources and Services Administration.

The July 2006 release of the Institute of Medicine (IOM) report entitled Preventing Medication Errors: Quality Chasm Series offered important insights into risks of medication use in the ambulatory setting and across transitions in care, as well as potential strategies for improvement in need of demonstration projects.

The recent series of three IOM reports on the status of emergency services in the United States also confirmed the importance of emergency departments as high risk ambulatory care sites.

Finally, the IOM report entitled Priority Areas for National Action: Transforming Health Care Quality (2003) provided focus for the ASQ program on the ambulatory care priority areas identified for the nation, including care coordination, asthma, cancer screening, diabetes, children with special health care needs, hypertension, immunizations, ischemic heart disease, and frailty associated with old age.

Definition of Ambulatory Care For the purpose of the ASQ program, ambulatory care refers to all types of health services provided by health care professionals on an outpatient basis, in contrast to services provided in the home or to persons who are inpatients.

While many inpatients may be ambulatory, the term ambulatory care usually implies that the patient must travel to a location to receive services which do not require an overnight stay. This program will specifically focus on the following ambulatory settings: health care clinician offices; large and small practices, outpatient clinics, community health centers, emergency departments, urgent care centers, and ambulatory surgery centers.

Though not usually considered an ambulatory setting, home care entities are also encouraged to apply. For the purpose of the ASQ program, health care transitions will refer to the movement of patients between health care providers and settings as their conditions and care needs change during the course of a chronic or acute illness (Coleman and Berenson, 2004; see also http://www. caretransitions.

org/definitions. asp). Non-ambulatory settings with a strong interest in fostering safe, high quality ambulatory care and transitions are welcome to apply in partnership with an ambulatory organization.

In particular, a focus on transitions between ambulatory care settings and hospitals, home care, assisted living centers, and nursing homes are critical to the success of ambulatory care for many elderly and chronically ill populations. Program Purpose and Evaluation The goal of the ASQ program is to improve the quality and safety of health care.

AHRQ will measure progress toward that goal by evaluating whether patients are receiving the appropriate care for prevention, treatment and management of the IOM's priority areas; whether patients are able to access reports of ambulatory care quality and safety for their providers; whether patients report satisfaction with their care.

Each project in the ASQ program will be required to have a robust evaluation plan that addresses one or more of these goals. In order to facilitate comparisons across ASQ projects, AHRQ suggests evaluation measures and instruments in these FOAs. We encourage the use of these measures whenever possible and scientifically appropriate.

Researchers are encouraged to propose projects in low resourced rural and urban safety net settings where health IT diffusion is likely low, as well as projects that seek to improve the care provided to priority populations.

AHRQ is strongly committed to supporting research in priority populations, which include women, children, elderly, minority, rural, urban, and low-income populations, as well as patients with special health care needs and disabilities. AHRQ encourages the development of strong public and private partnerships that may include the health IT vendor community.

Background: Patient-Centered Care care integrates the perspectives, understanding, and preferences of patients and their families into the delivery of health care. Patient-centeredness is a characteristic of the relationship between clinicians and patients and of the larger health care systems in which these relationships exist.

In Crossing the Quality Chasm (IOM 2001), the IOM included patient-centeredness as an essential component of quality care. In this context, patient-centeredness includes both the patient s experience of care and the presence of an effective partnership between clinician and patient (and the patient’s family and friends, when appropriate).

In addition to being a key domain of quality, patient-centeredness is important to ensuring patient safety.

care is based on an effective clinician-patient partnership that is the product of a relationship in which the clinician’s recommendations are informed by an understanding of the individual patient’s needs and the context in which he or she lives (e.g., home life, job, family relationships) to enhance the patient’s ability to act on the information provided.

Additional features of an effective clinician-patient partnership include informed, shared decision making and development of patient knowledge and skills needed for self-management of chronic conditions (Davis et al. , 2005) .

In contrast to care that is clinician- or disease-centered, patient-centered care customizes treatment recommendations and decision making in response to an individual patient’s preferences, knowledge and beliefs. studies have demonstrated that patients who are involved with their care decisions and management have better outcomes than those who are not (Wagner, Grothaus, et al. , 2001; Wagner, Glasgow, et al.

, 2001; Greenfield et al. , 1985; Greenfield et al. , 1988) .

Patient self-management, particularly for chronic conditions, has been shown to be associated with improvements in health status and decreased utilization of services (Loring et al. , 1999) . Nonetheless, approaches to engage patients in their care, in particular patients with one or more chronic illnesses, have not yet become a routine part of clinical care (Wagner, 1998) .

A recent international Commonwealth Fund study of sicker patients found that patients across many countries including the U.S. report lack of care coordination and inadequate understanding of their care (Schoen et al, 2005) . Health care delivery organizations are engaged in system improvements to improve chronic illness care, incorporating self-management support, clinical information systems, and decision support.

(Wagner et al, 2001) Organizations can assess the patient’s experience of chronic illness care as health care delivery organizations change, gaining insight into progress toward meeting a patient-centered goal (Glasgow et al. , 2005) . IOM issued ten design rules for redesigning health care for the 21 st century.

These included: care based on continuous healing relationships, customization based on patient needs and values, the patient as the source of control, shared knowledge and the free flow of information. Applications of health IT can help build a patient-centered health care system in which patients share information and control with professionals.

detecting and reducing the burden of chronic disease and disability is an important goal for both patients and health care providers. These are also core activities and indicators in demonstrating improvements in the quality of care. The advice of health care providers to change high risk behaviors, such as tobacco use, has been shown to be important in motivating people to change.

Changing personal health behaviors, whether to prevent illness or manage chronic illnesses, is difficult. Clinical practices alone are unlikely to be of sufficient intensity or frequency to improve these health behavior outcomes. Patients need support not only through their health care provider but also where they live, work, go to school, and play.

Success is more likely, and wasteful duplication of efforts less likely, if health care providers and community-based programs work together to support patients in self-management activities and in health behavior change efforts. These types of support can be facilitated through linkages between clinical practice and public health/community programs, linkages which can benefit from the use of health information technology.

Examples of the use of health information technology in these ways include the sharing of clinical information through personal health records, and the development and implementation of electronic resources for use by patients, clinical providers, and community programs.

Resources such as these have the potential to make evidence available to support decisions by health care providers and patients at the point of care and in day-to-day self-management.

Evidence to support decision-making can also be combined with information about local, community based and public health programs to support patients and families where they live, which is integral to experience confirms that when patients are given the chance to bridge the information gap between themselves, their health data, and their health care providers, many people enthusiastically take a more active role (Working Group on Policies for Electronic Information Sharing between Doctors and AHRQ’s Health IT portfolio Health IT has the potential to deliver evidence-based information to the point-of-care; expand the range and ease of potential electronic health record (EHR)-based quality measures; and improve the value and quality of health care.

AHRQ has funded over 30 years of research in the use of health IT to improve quality (Fitzmaurice et al. , 2002) . The projects span the research and development spectrum, from innovations in health IT, planning for adoption, implementation, evaluation of outcomes, and taking the systems to scale through participation in regional and statewide health information exchange.

AHRQ’s projects have historically addressed issues of knowledge representation, delivery of tailored evidence, quality feedback, workflow and systems changes, and new approaches to care, including delivery in non-traditional settings. One major component of AHRQ’s health IT portfolio is the National Resource Center (NRC) for Health IT.

The NRC captures the lessons learned in health IT adoption, and documents the progress of the portfolio grants.

Collective learning from the health IT portfolio pointed to implementation of health IT is one part technology, two parts organizational culture and workflow change IT adoption requires a systems approach to changing the health care team IT system implemented in different organizations can have different outcomes stakeholders need to see what value the new system brings them evaluation of the outcomes after health IT system implementation is crucial More information about AHRQ’s health IT portfolio can be found at http://healthit.

ahrq. gov . of this FOA is to identify, promote, and disseminate models of patient-centered care that include the use of personal health data and evidence-based information to support patients in managing their health and illnesses and improve health outcomes in ambulatory care and across health care transitions.

AHRQ expects this initiative will inform health care professionals, payers, policy makers, and the public about the value of patient-centered care, including the ability of health IT to improve ambulatory health care quality and safety by providing patient-centered care. There are many ways health IT may be used to provide patient-centered ambulatory care.

While attentive to the full spectrum of ideas, AHRQ has identified the following four areas of particular Shared decision-making and patient-clinician communication Personal health records (PHRs) Integration of patient information across transitions in care Patient self-management of chronic conditions Shared decision-making and patient-clinician communication What are the essential patient-centered components of effective patient-provider communication about medication interventions and their What is the mechanism by which health IT-enabled shared decision-making approaches improve the quality and safety of care improved patient knowledge, enhanced self-efficacy, and/or other pathways?

For which patients and under which circumstances is non-synchronous communication such as secured messaging with clinicians most effective? How do enhanced communications between providers, patients, and families enhance and/or substitute for office or home visits?

What are the effects of PHRs, patient-oriented health data, and customizable health information on health outcomes, patient safety, patient and clinician satisfaction, health care costs, and efficiency? What are the core elements of effective PHRs? What are the advantages and disadvantages of different methods of populating PHR data?

What are the most effective ways for patients and consumers to access PHRs?

How do differences in how PHRs are structured, populated, and accessed effect their security, usability, and effect on patient satisfaction Can PHRs be utilized to engage patients in avoiding overuse (e.g., unnecessary tests or procedures or unnecessary duplication of tests or procedures), under-use (e.g., failure to screen for high blood pressure or to not treat with a beta-blocker when clinically indicated), or misuse (e.g., prescribing drugs having dangerous interactions or taking the wrong dose of a medication)?

Integration of patient information across transitions in care Which components of patient information from which settings (i.e. primary care practices, patient homes, ancillary services) enable effective ambulatory care and improve patient outcomes?

How can the integration of information from all providers (e.g., physicians, nurses, and other clinicians) improve the quality and safety, patient-centeredness, and the efficiency and equity of health care service organizational, payment, market, and financing models are effective at supporting and sustaining the incorporation of health IT to deliver patient-centered care in ambulatory settings?

How can health IT strategies be used to alleviate miscommunication at the time of patient hand-offs and transitions in institutional and community Patient self-management of chronic conditions Which technologies effectively engage patients participation in self management, allow for the sharing of information between patients and their clinicians, and improve patient outcomes?

How can methods/programs shown to be effective in select circumstances and populations be tailored to meet the special needs of populations now experiencing health care disparities, including individuals with low health literacy and language and communication barriers?

How can health IT be harnessed to link ambulatory practices, community health programs and resources, and patients to support patient health behavior change, health promotion, and disease prevention? How can patients and families use information technology and internet-based strategies to enhance self care and co-management and utilization of evidence-based disease management?

its earliest investments in health IT research initiatives, AHRQ has emphasized the importance of the privacy and security of personal health information whether in electronic or other media to individual trust in health information exchange. Without this trust and faith in an information system, patients and other users will not use it fully, and system data will be inaccurate or incomplete.

As a result, the potential for quality and safety improvement from investments in health IT will be lost. More importantly, assuring privacy and security are values patients should expect and receive from the health care system. For these reasons, AHRQ is interested in efforts to enhance the privacy and security of electronic health information in proposed projects.

Applicants are expected to: describe an intervention to be studied, place the intervention in context and discuss how it is expected or known to affect patient-centered care, provide a detailed implementation plan with appropriate methods, describe a robust analysis and evaluation plan with measures for assessing patient-, office-, and health system-level outcomes, and include a dissemination plan.

The applicant must address the following project requirements in the Research Plan portion of the application. the Specific Aims section: 1. The applicant must specify an intervention, the type of ambulatory settings in which it will be applied, the health professional groups involved (note that interdisciplinary teams are encouraged whenever possible), and the patient populations included in the intervention.

It is expected that some aspect of the intervention will include the use of some form of health IT. the Background and Significance section: 2. The applicant must demonstrate an understanding of the nature of the ambulatory care, the current challenges to the provision of patient centered care, and how HIT can enable better quality of care.

The narrative should include a brief review of the salient literature with respect to the focus area and the anticipated benefits, limitations, and scientific, clinical or performance-based significance of the proposed research, the purpose and expected impact of the intervention, objectives or hypotheses to be evaluated, the supporting theoretical or conceptual framework, underlying assumptions, and scope or boundary conditions of the proposed research.

the Research Design and Methods section: 3. Given the project objectives, and taking into account practical constraints, the applicant must describe the research design or methodology that will best enable the research objectives to be realized. The applicant should describe the health IT component of the intervention.

When possible, the health IT intervention should conform to interoperability standards and use certified products (see http://www. cchit. org ).

The design must include a timeline with specific milestones, covering all major phases of the project. 4. Applicants must specify the project’s primary and secondary outcome measures.

These may include health outcome, patient satisfaction, process measures, costs, and measures of patient safety. (Please refer to the next two sections below for AHRQ’s recommendations for outcome measures.) The narrative should also include data collection plans, instruments and tools to be used, and a well-developed analysis plan.

Applicants are encouraged to incorporate into the project a strategy for monitoring and assessing salient reportable financial and organizational dimensions of implementing health IT under the initiative and to develop strategies to report estimates of the rate of return on investments required for implementation under the initiative.

To the extent possible, applicants should discuss any anticipated limitations or cautions needing to be exercised in generalizing results. 5. The applicant should describe how the intervention could be integrated into the delivery of ambulatory care throughout the applicant organization and potentially into sites across the nation.

The applicant should discuss the future sustainability of the intervention by their organization after the grant funded period has ended. The applicant must also present a project dissemination plan, including a proposal for widespread dissemination should the project results be generalizable and meritorious.

While AHRQ plans to offer additional funding through limited competition to further the dissemination of important findings and activities that result from these projects, these dissemination supplements will only be considered should future funds become available.

Applicants must include a project dissemination plan within the project plan dissemination plan may include activities in cooperation with AHRQ's National Resource Center on Health IT, http://healthit. ahrq. gov .

6. The applicant must describe how, in the development and implementation of the intervention, privacy and security issues related to the exchange of sensitive health information will be identified and addressed. Keeping health information in electronic format introduces new risks, real and perceived, to the privacy and security of health information.

New concerns arise, such as who has access to and use of electronic data, disclosure to patients regarding the collection and use of the data, patient consent requirements, the ability of patients to decline participation in electronic data collection, patient access to audit records, what happens to data after research is completed, and informing patients of any security breaches.

Developers of electronic health information systems have promulgated policies for consideration with participating consumers and patients in order to assure patient awareness of, comfort with, and participation in electronic data collection and use.

While privacy and security solutions are not intended to be the focus of projects under this announcement, interventions should be designed to incorporate emerging privacy and security principles that may be applicable (see http://healthit. ahrq. gov/hiepolicyissues ).

Applicants should describe the resources and processes they will use to assure that these privacy and security concerns are being met throughout the project period.

These could include the inclusion of participating patients in periodic reviews in order to solicit their input and consultation with knowledgeable professionals over the course of the project, as well as a description of any existing privacy or security practices and technology consistent with those policies that will be incorporated into the project and reviewed for compliance on a regular basis.

Patient Experience with Care are encouraged to use the new AHRQ- funded CAHPS Clinician & Group Survey as an outcome measure. The survey is designed to assess patients perceptions of care at both the individual clinician level and the group practice