Topics of Study 

RWJF seeks to dramatically improve the quality of care that people with chronic illnesses   receive in outpatient settings. To that end, RWJF invites research proposals that offer      solutions towards improving health care quality. RWJF encourages researchers to include data and analyses in their proposals.

To provide a clear focus for applicants to The New Connections Initiative, each programming team was asked to develop specific research projects or questions that would help inform their strategies and grant making. These specific questions are described below. Applicants are asked to submit proposals for one of the topics described below.

Please note that not all teams have research questions at this time and the detail provided below by each team varies according to each team's needs and interests. Finally, some of the research questions will be more suitable for Junior Investigators and other questions will be more suitable for Senior Consultants. Thus, applicants should consider the following guidelines.

Senior Consultants
Projects that are more qualitative and can yield recommendations and products for the team should be answered by a senior consultant. Senior Consultants should refer to the examples of activities, potential products and deliverables that could be conducted included on page 2 of the Letter of Invitation.

Junior Investigators
Questions that would be more suitable for secondary analysis should be answered by a junior investigator. When responding to this solicitation, Junior Investigators must indicate how they will incorporate the secondary datasets when responding to research questions. Junior Investigators should provide a description of the data and rationale for its appropriateness given the research question.  Junior Investigators are responsible for identifying and acquiring the dataset.

Junior Investigators or Senior Consultants must respond to one of the following questions.

1. Many groups have developed quality guidelines for specific chronic medical conditions.  What are the factors involved in the implementation of these guidelines? How do the following possible contributing factors fit in the wider context of provider behaviors and redesign of practice as it relates to chronic care management? Please address any or all of the following:

a. Providers' "readiness to change." Providers and their organizations will differ in terms of readiness to change. The barriers to change need to be identified and assessed.

b. Practice environment. What financial and staff resources, workload, community linkages, and other resources are needed to improve quality?

c. Administrative support. What types of clinical information systems are adequate and optimal for quality improvement?

d. Other (e.g. lack of awareness of guidelines, lack of incentives to implementation, etc.)

2. Most research literature focuses on what providers believe are important measures of quality, while less is known about the perception of other stakeholders such as consumers and purchasers. Stichler and Weiss describe in their recent article 

"Quality is an elusive concept with different meanings to different people. Providers often define quality in terms of patient outcomes, professional standards of practice, predetermined criteria used to measure quality, and even subjective opinion. Patients describe quality in terms of the interpersonal aspects of care, how well they were treated, and the responsiveness of the provider to their needs." Thus:

a. Which measures of quality do consumers find meaningful and what actions do they take as a result?

b. How can quality measures deemed important by other stakeholders (e.g., health plans, physicians) better address the interests of consumers and their families? 

c. Are there other stakeholders whose perspectives on what is quality are underrepresented in the available measures?  Who are those stakeholder groups and how would including their perspective affect measurement?

The research for the above question may be conducted by comparing patient opinions of health care quality (through listservs, chat rooms and blogs) and publicly available reports. Additionally, data can be collected through interviews and focus groups.

3. Pay for performance may be a powerful tool for quality improvement, especially within regional health care "markets" or communities.  However, it is important to monitor the impacts (positive and negative) of these local and regional forces.  Please address any or all of the following:

a. Monitor and describe the range of impacts within a single market or region;

b. Contrast two or more markets where similar pay for performance strategies/policies have  been implemented; and/or

c. Contrast different pay for performance strategies within a single market.

 

4. Which consumer engagement  strategies have improved quality in non-healthcare industries?  Examine the impact of these strategies in other industries and draw lessons that can be applied to healthcare.

a. Review the literature on a selected industry's consumer engagement strategies and apply  best practices and lessons to specific issues in health care, for example:
• Choice of medical provider
• Choice of procedures
• Self-care
• Role of the family in creating better awareness, management of conditions, etc.

 

 

 

  1.Stichler JF, Weiss ME - Through the eye of the beholder: multiple perspectives on quality in women's health care. Qual Manag Health Care. 2000 Summer;8(4):1-13.  
  2.A community is the area where people live and work and receive their care in the ambulatory setting. A market is that economic unit in which the various community health care stakeholders (e.g., health care providers, including physicians and safety net providers, health care plans,  employers and consumers) interact.
  3.Consumer engagement in healthcare involves raising the level of individuals' awareness of health status and the risk factors to which individuals are exposed, including the sources of those risks. Engagement implies that there will be behavioral implications associated with knowing more about one's health and illnesses such that more information and knowledge better arms consumers to address needs