General Program Questions
Eligibility
Data Collection
Data Use and Privacy
Educational Webinars and Program Activities
General Program Questions
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1. How do I apply for the program?
To apply for the program, complete the online application form available on the Join the Program page.
The deadline to apply is August 28, 2023.
2. How many practices will participate in the program?
150-300 practices across the United States will participate in the program.
3. What are the benefits of participating?
Using evidence-based, scientific, practical implementation strategies, we can help members of your practice expand their knowledge of the science of safety and implement quality improvements in the diagnostic process within the telemedicine environment. Members of your practice will learn how to implement improvements in teamwork, communication, patient safety culture, and behavior change to minimize diagnostic delays.
By participating, your practice will—
- Receive continuing education units (CEUs), continuing medical education credits (CMEs), and American Board of Internal Medicine (ABIM) Maintenance of Certification points (MOCs).
- Improve cancer diagnostic followup in telemedicine and hybrid environments by closing the loop at critical points in the diagnostic process.
- Improve patient safety and prevent patient harm associated with missed or delayed cancer diagnoses.
- Receive direct access to expert support and implementation troubleshooting.
4. Who is sponsoring the program?
This program is funded and guided by the Agency for Healthcare Research and Quality (AHRQ), which is part of the U.S. Department of Health and Human Services. NORC at the University of Chicago is conducting the work in collaboration with Johns Hopkins University and Baylor College of Medicine.
5. What does it cost for our practice to participate in the program?
Participation in the program is free. Participating practices will also not receive any payment for participation.
6. What is the commitment?
The program runs for 12-months, beginning in Fall 2023 with an onboarding webinar to orient your staff. The following bullets show key tasks and due dates.
- Submit your Commitment Form: August 2023
- Learn and apply interventions: Fall 2023 through Fall 2024
- Submit practice data relevant to the cancer diagnostic process: Fall 2023 through Fall 2024
7. What is required of our practice to participate in the program?
Each practice will identify a Diagnostic Process team, which could consist of physicians (M.D., D.O.) including residents and fellows, midlevel providers (P.A., N.P.), clinical support staff (R.N., L.P.N., M.A.), and, if available, schedulers and practice staff who perform care coordination or navigation. One or more people within the team will facilitate data collection and submission at your practice. Expected activities include the following:
- Participate in regular webinars (about 30 minutes each). Participants will receive monthly training via webinars, which are held live and posted online for self-paced learning. Webinars will be offered at varying times so that staff can participate at a time convenient for them.
- Check-in with an Implementation Adviser. Each practice will be paired with an Implementation Adviser, who will provide technical assistance in implementing practice changes, help troubleshoot challenges, and support data collection through monthly check-in meetings.
- Determine and implement approaches to improve the diagnostic process. Using approaches discussed in the webinars, Diagnostic Process teams will develop and implement strategies to improve the diagnostic process in their practice.
- Collect and review data. Practices will be asked to complete several surveys throughout the program. Practices will also be asked to complete a Clinical Data Collection Form for patients suspected of having cancer. Your team is encouraged to review the data collection forms together to reflect on areas of strength and areas for improvement as they relate to diagnostic verification, timeliness, and communication with the patient.
8. Who should be the practice leads for the program?
We encourage you to have multiple people at your practice serve as practice leads. A practice lead should have:
- Sufficient time to engage in program materials and webinars
- Commitment from stakeholders to support the program at your practice
- The necessary knowledge to complete the data collection forms or work with clinician colleagues to complete the forms
9. Who should be on the team for the program?
The team could consist of physicians (M.D., D.O.) including residents and fellows, midlevel providers (P.A., N.P.), clinical support staff (R.N., L.P.N., M.A.), and, if available, schedulers and practice staff who perform care coordination or navigation. One or more people within the team will facilitate data collection and submission at your practice.
10. How much time will the program take our staff?
We anticipate that all participating team members will need to spend a minimum of 2 hours per month on the AHRQ Safety Program for Telemedicine: Improving the Diagnostic Process, participating in webinars, office hours, and team meetings. Administrative leads may also need to devote 1 additional hour each month to collect, submit, and review data.
11. Is a contract required to participate in the program?
No, a contract is not required to participate in the program. The program requests a Commitment Form, but this is not a contract; rather, it is an agreement to work with us.
12. What materials do I need to complete before the program begins?
You need to complete the online application and a Commitment Form, which will need to be signed by practice leaders.
13. Do we need IRB approval to participate?
Johns Hopkins Armstrong Institute for Patient Safety and Quality Institutional Review Board (IRB) has determined this program is not human subjects research (Johns Hopkins IRB #IRB00338433). This program does not involve human subjects research, so no IRB approval is required. Your practice should be able to frame this program as a quality improvement study. If your practice requires an IRB submission for informational purposes, we will be glad to help you as needed.
14. Can my facility drop out of the program if we find it isn’t working for our organization or we experience significant unplanned events?
Yes. We will work with you to address any unplanned events that may occur. But we understand that circumstances change and can impact participation.
15. What is meant by “closing the loop” in healthcare?
"Closing the loop includes all mechanisms that ensure that all patient data and information that may require an action are delivered and communicated to the right individuals, at the right time, through the right mode to allow interpretation, critical review, reconciliation, initiation of action, acknowledgment, and appropriate documentation" (Partnership for Health IT Patient Safety, 2018).
16. How does this program define closing the loop?
This program defines closing the loop as a set of processes designed to ensure that abnormal clinical findings (e.g., incidental findings, positive cancer screening tests) are followed up, tests and referrals are completed, and patients and clinicians work together to establish a timely final diagnosis. This program will assist your practice in quality improvement strategies to close loops throughout the diagnostic process.
Eligibility
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17. Who is eligible to participate?
This program is recruiting ambulatory and primary care practices that diagnose cancer. Practices must provide video-based telemedicine care and have a brick-and-mortar location.
Eligibility
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Practices
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Eligible Practices
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- Primary care practices (adult and family)
- Gynecology practices
- Community-based health clinics (e.g., Federally Qualified Health Centers or FQHCs)
- Urgent care clinics
- Health systems providing primary care
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Ineligible Practices
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- Pediatric clinics, including adolescent health clinics
- Standalone specialty practices
- Ambulatory surgery centers
- Retail clinics
- Emergency departments
- Student health clinics
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18. What are examples of specialty practices excluded from this program?
Specialty practices that are not eligible for this program include oncology, radiology, pathology, occupational health, surgery centers, diagnostic laboratories, and dialysis centers.
19. How does the program define telemedicine?
This program defines telemedicine as any synchronous (i.e., “live”) communication between a provider and a patient regarding their care. This includes videoconferencing and telephone calls in which patient care is discussed. Asynchronous methods of communication, such as exchanges of messages in a patient portal, are not considered telemedicine for this program.
Additionally, practices should use videoconferencing for at least a portion of their telemedicine visits. Practices that solely use audio-only methods (e.g., telephone calls) to conduct telemedicine visits are not eligible.
20. My practice has multiple locations/facilities. Does each location have to apply separately?
Yes. If your practice has multiple locations/facilities, each location will need to apply separately.
Data Collection
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21. What data will be collected from our practice?
Please see the table below.
Tool
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Purpose
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To Be Completed by
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Estimated Time To Complete
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Frequency of Data Collection
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Structural Assessment
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Understand practices’ infrastructure and capacity to implement the program
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Practice leader/champion at participating practices
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12 minutes
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- Once at the beginning of the intervention period
- Once post-implementation
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AHRQ Office Readiness Survey
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Assess practices’ readiness to implement the intervention
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All staff at participating practices
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5 minutes
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Once at the beginning of the intervention period
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AHRQ Medical Office Survey on Patient Safety Culture (MOSOPS)
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Assess patient safety issues, medical errors, and event reporting practices
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All staff at participating practices
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30 minutes
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- Once at the beginning of the intervention period
- Once post-implementation
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AHRQ Diagnostic Safety Supplement
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Assess patient safety practices specific to diagnosis
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All staff at participating practices
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12 minutes
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- Once at the beginning of the intervention period
- Once post-implementation
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Participant Experience Survey
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Assess the usefulness, ease of use, ease of learning, and satisfaction with the program and whether the program helped practices reduce errors in the diagnostic process and improve timely followup of abnormal test results
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Practice leader/champion at participating practices
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10 minutes
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Once post-implementation
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Key Informant Interviews (optional participation)
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Learn about the facilitators and barriers to implementing the program, characteristics of teams associated with successful implementation and improvements, and drivers of outcomes
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One to two healthcare providers in among a sample (~20) of participating practices; selected based on a combination of contextual and structural factors (e.g., representation across telemedicine practice size, type, and HHS location).
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1 hour
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Once post-implementation
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Clinical Data Collection Form
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Understand steps in the diagnostic process and whether practices follow closed-loop processes along the diagnostic pathways for patients suspected of having cancer
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Practice leader/champion or data coordinator at participating practices
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20 minutes each (1 hour per month)
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Three forms completed monthly, submitted quarterly
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22. How will practice data be submitted?
Your practice will submit data through the program’s website via structured online forms. You will need to access your practice’s electronic health record data to complete the Clinical Data Collection Form.
23. What is being measured in the Clinical Data Collection Form?
The Clinical Data Collection Form assesses (1) whether a timely diagnosis was made and (2) whether the safety program was effective in improving accuracy, timeliness, and communication of findings for patients with suspected cancer. We will be measuring the proportion of patients receiving a timely diagnosis throughout the program, anticipating that the proportion will increase over time.
24. Will the program share the data collected from this project with program participants?
We are able to provide information and data from your specific practice. The program includes a webinar about how you can use your practice’s data.
Data Use and Privacy
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25. Is a data use agreement (DUA) required to participate in the program?
No, a DUA is not required for participation in the program. The data are being collected both for program assessment purposes and as a tool for each practice’s own quality improvement efforts. Each practice should use the data it collects to evaluate its cancer diagnostic process improvement efforts. NORC at the University of Chicago, Johns Hopkins University, and Baylor College of Medicine, the program implementers, will use the collected data to assess the adoption and effectiveness of the program overall.
Since the program only requests deidentified information and does not request any protected health information (PHI), program participation does not require a data use agreement. However, if your practice determines that it still needs a DUA to define the transaction, we can provide a template for your review.
26. Will participating practices have to provide PHI about their patients?
The program only requests de-identified information; it does not request any PHI.
27. For what purpose will the data be used?
The program is collecting data as a tool for quality improvement efforts and program assessment purposes. Each practice should use the data it collects to evaluate its cancer diagnostic process improvement efforts. NORC at the University of Chicago, Johns Hopkins University, and Baylor College of Medicine, the program implementers, will use the collected data to assess the adoption and effectiveness of the program overall. The program is collecting only de-identified data and will not identify any individually participating practices.
28. Where specifically will our data be shared, and will it be “published” with our practice identifiers?
The program only collects de-identified data. Your data will be aggregated and anonymized by NORC at the University of Chicago, the program implementers, and then shared only with partners Johns Hopkins University, Baylor College of Medicine, and AHRQ. Individual practices will not be identified.
29. How will submitted data be managed?
The data will be stored on NORC’s secure server, and only NORC at the University of Chicago staff will be authorized to access the data.
Educational Webinars and Program Activities
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30. What will the educational webinars discuss?
The webinars will focus on (1) how to improve communication across the diagnostic pathway and (2) best practices in cancer diagnosis in the telemedicine environment. Educational webinars may cover the following topics:
- Training in the science of safety and diagnostic excellence
- Pitfalls in the diagnosis of cancer within a telemedicine environment
- Interventions to promote teamwork, communication, patient safety culture, and behavior change among practice team members
- Approaches to ensure all patients receive consistent evidence-based care via telemedicine
- Methods to close the loop throughout the diagnostic process, including incidental findings, referrals, test results, abnormal screenings, and patient communication and followup
- Approaches to identify and mitigate local barriers that can impede uptake of diagnostic process interventions in telemedicine
31. Who should participate in the webinars?
Any available members of your Diagnostic Process team should attend webinars, ideally including the designated administrative lead and at least one clinical staff person. Content will also be available on-demand through the program website.
32. Are in-person meetings required?
This program does not require any in-person meetings. All program content will be delivered via webinars and eLearning modules. Meetings and communications with the program team (e.g., monthly check-ins with Implementation Advisers, office hours with experts) will be held virtually over conference calls, video calls, or email. Internal meetings with team members in your practice may be held in person or virtually.
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