AHRQ-Funded Resources and Research for Improving the Care of PLWMCC

AHRQ-Funded MCC Research

AHRQ continues its longstanding history of awarding grants and contracts to support cutting edge research designed to improve the structure, organization, and processes of delivery for People Living With Multiple Chronic Conditions (PLWMCC). AHRQ has funded a large number of research grants and contracts aimed at improving care delivery for PLWMCC. Some of these research projects explicitly reference the needs or challenges of PLWMCC, while other focus on specific topics that are known to disproportionately—though not exclusively—impact care for PLWMCC.

• Models of High-Value Care:
  • Academy for Integrating Behavioral Health (BH) Into Primary Care (PC): The Academy is a web portal housing online resources and tools for healthcare providers seeking to meet the needs of patients with chronic behavioral conditions within the primary care setting. These patients are among those most likely to present with multiple chronic conditions as well. Effective management of care for people with MCC requires the integration of behavioral health and primary care. The Academy features downloadable written products (e.g., "The Integration Playbook), a collaborative online community, and expert insights (articles, blog posts, videos, webcasts).
  • Screening and Management of Unhealthy Alcohol Use in Primary Care (PC): Excessive alcohol use affects almost a third of adults, the large majority of whom suffer from at least one additional chronic condition. Under this $16 million initiative, AHRQ funded six grants to disseminate and implement evidence for effective management of unhealthy alcohol use in PC and one task order to provide technical assistance and a learning community for the grantees and an evaluation of their efforts.
  • Research to Improve Opioid Management in Older Adults. The majority of older adults have MCC, and MCC increases the risk of adverse events from opioid use. This project will begin with a research contract to conduct an evidence review on prevention (including opioid stewardship and avoidance), diagnosis, and management of opioid misuse and abuse. A follow-on contract will assess awareness of these issues across different practice settings and approaches to addressing this problem, as well as develop and test innovative tools and practice models to address the challenge, especially in primary care settings.
  • Evidence Summary Integrating Palliative Care in Ambulatory Care of Noncancer Serious Chronic Illness: A Mixed-Methods Review.

• Patient and Family Engagement
  • Systematic Review on Interventions for Caregivers of persons With Dementia-Outcomes for Patients, Outcomes for Caregivers.
  • AHRQ's SHARE Approach is a five-step process for shared decision making that includes exploring and comparing the benefits, harms, and risks of each option through meaningful dialogue about what matters most to the patient.

• Health IT Solutions for Person-, Practice-, and System-Level Challenges
  • Advancing the Collection and Use of Patient-Reported Outcomes Through Health Information Technology is a research contract through which AHRQ is pilot testing two user-friendly apps that are designed to support the collection and user of standardized patient-reported outcome (PRO) data. Use of these apps will support patient centeredness and whole-person care by providing MCC patients with new ways to communicate about their health needs and new opportunities for shared decision making. A more complete description of this project is included in this compilation of project summaries.
  • AHRQ Step Up App Challenge was a multiphase competition aimed to develop user-friendly applications capable of collecting standardized PRO data in a variety of ambulatory settings. The grand prize winner, the PROMIS Reporting and Insight System from Minnesota (PRISM) app, was pilot tested in the research contract mentioned above. In addition to being the grand prize winner in the challenge competition, the PRISM app also won second place in the FHIR® App Showcase in the 2019 AMIA Annual Symposium. More information about the challenge competition winning teams is available at https://www.ahrq.gov/stepupappchallenge/phase2-winners.html.
  • The E-Care Plan Initiative, a joint project between AHRQ and the National Institute of Diabetes and Digestive and Kidney Diseases, aims to build capacity for pragmatic, patient-centered outcomes research by developing an interoperable electronic care plan to facilitate aggregation and sharing of critical patient-centered data across home-, community-, clinic-, and research-based settings for people with MCC. The joint project deliverables include 1) data elements, value sets, clinical information models, and FHIR mappings to enable standardized transfer of data across health and research settings for kidney disease, diabetes, cardiovascular disease, chronic pain and long-term COVID-19; 2) pilot-tested patient-, clinician-, and caregiver-facing e-care plan applications that integrate with the EHR to pull, share, and display key patient data; and 3) an HL7 FHIR Implementation Guide based on defined use cases and standardized MCC data elements, balloted for trial use. AHRQ has a research contract to support the development as well as pilot testing the e-care plan applications.
  • Under its Program Announcement (funding solicitation) titled Implementation and Evaluation of New Health Information Technology (IT) Strategies for Collecting and Using Patient-Reported Outcome (PRO) Measures (PA-17-247), AHRQ invited applications to stimulate innovative and collaborative research by utilizing new health IT strategies for collecting and using PRO measures in primary care and other ambulatory care settings. Although collection of PROs is advancing rapidly, and PROs have been widely used in research and select clinical settings, little is known about how to best use them in primary care and with the diverse populations served in ambulatory care settings, especially populations with MCC. AHRQ funded five grants under this initiative.
  • Using Data Analytics to Support Primary Care and Community Interventions to Improve Chronic Disease Prevention and Management and Population Health (RFA-HS-19-002) invited applications aimed at using data and analytics to inform primary care and community interventions to prevent MCC and to improve chronic disease management, particularly for individuals with MCC. Three grants were funded under this $6 million initiative, further described in this blog post.

AHRQ Funding Opportunities

AHRQ welcomes research grant proposals that address multiple chronic conditions and support AHRQ's broad mission of producing evidence to make healthcare safer, higher quality, more accessible, equitable, and affordable. Applicants interested in MCC can either apply to specific Notices of Funding Opportunities (NOFOs) or reference a Special Emphasis Notice (SEN) when applying to one of AHRQ's general Program Announcements.

• Notice of Funding Opportunities
  • Improving Quality of Care and Patient Outcomes During Care Transitions (R01, PA-20-068) invites applications that will test promising health information technology (IT) interventions aimed at improving communication and coordination during care transitions. The results of these studies will lead to new approaches to use interoperable health IT innovations to improve care transitions for MCC patients that could be implemented in and spread to multiple health systems. Access grants awarded under this NOFO.
  • Large Health Services Research Grants (General R01, PA-19-795)
  • Small Health Services Research Grants (General R03, PA-18-794)
  • Research Dissemination & Dissemination Grants (General R18, PA-18-793)
  • Research Training & Education Grants (Multiple Opportunities)
  • All Notices of Funding Opportunity

• Special Emphasis Notices
  • Optimizing Care for People Living With Multiple Chronic Conditions Through the Development of Enhanced Care Planning
  • Advancing the Collection and Use of Patient-Reported Outcomes and Patient Contextual Data to Improve Quality and Outcomes in Ambulatory Care Through Health Information Technology
  • Health Services Research to Advance Health Equity
  • Improving Organizational Health Literacy to Prevent and Manage Chronic Disease
  • Shared Decision Making as a Tool to Improve the Quality of Care for Low-Income and Racial and Ethnic Minority Patients
  • Innovative Research in Primary Care
  • All Special Emphasis Notices