AHRQ-11-10006- Attachment 1 Background Statement.pdf

Attachment 1: Background Statement

1. Background

1.1. Authorizing Legislation

The Agency for Healthcare Research and Quality (AHRQ) was established in 1989, by Public Law 101-239, as the Agency for Health Care Policy and Research. Re-authorizing legislation passed in November 19991

a) To sponsor and conduct research which develops evidence-based information on health care outcomes, quality, safety, cost, use, and access that can be used by decision makers in the public and private sectors; and establishes AHRQ’s mission to improve the quality, safety, efficiency, and effectiveness of health care for all Americans. In its role as the lead Federal agency for health care research and quality, AHRQ has two principal responsibilities:

b) To ensure that information resulting from its research, demonstration, and evaluation activities is disseminated rapidly, widely, and in a readily usable form.

The information helps health care decision-makers —patients and clinicians, health system and hospital leaders, purchasers, and policymakers — make more informed decisions and improve the quality of health care services.

1.2. AHRQ Activities

Legislation re-authorizing AHRQ specifically directs it to support activities that:

• Establish health care improvement research centers and networks. AHRQ is to employ research strategies and mechanisms that will link research directly with clinical practice in order to address the full continuum of care and outcomes research, to link research to practice improvement, and to speed the dissemination of research findings to community practice settings.

• Develop information on health care quality. AHRQ is to coordinate, conduct, and support research, demonstrations, and evaluations related to the measurement and improvement of health care quality. AHRQ is also to disseminate scientific findings about what works best and facilitate public access to information on the quality of, and consumer satisfaction with, health care.

• Advance the use of information technology for coordinating patient care and conducting quality and outcomes research. AHRQ is to promote the use of information systems to develop and disseminate quality measures and tools; create effective linkages between health information sources to enhance health care delivery and coordination of evidence-based health care services; and promote protection of individually identifiable patient information used in health services research and health care quality improvement.

• Promote innovation in evidence-based health care practices. AHRQ is to conduct and support research on the development, diffusion, and use of health care

1 http://www.ahrq.gov/hrqa99a.htm http://www.ahrq.gov/hrqa99a.htm� technology; develop, evaluate, and disseminate methodologies for assessments of health care practices; and promote education and training and provide technical assistance in the use of health care practice and technology assessment methodologies and results.

1.3. Health Care Delivery Challenges

As the federal agency charged with improving the health care quality of all Americans, AHRQ understands the challenges faced by the U.S. health care system’s stakeholders toward improving quality and reducing disparities.2

Indeed, AHRQ has funded and continues to fund initiatives aimed at addressing these challenges. In the late 1990’s, AHRQ supported the Translating Research Into Practice initiative and in the early 2000’s funded the Partnerships for Quality program. More recently, the Agency has funded/continues to fund a network of partners aimed at accelerating change and transformation in organizations and networks (ACTION) – these partners focus on promoting and accelerating the development, implementation, dissemination and sustainability of evidence-based innovation in health care delivery and organization to measurably improve health care in the U.S. An innovation is an idea, practice, or object that is perceived as new by an individual, or other unit of adoption.3

AHRQ continues to focus on applied processes of diffusion and implementation of innovations, and the related fields of knowledge transfer or knowledge exchange (a two-way transfer), to increase the adoption, implementation and spread of health care improvement and disparities reduction strategies and innovations in the United States.

Despite its initial investments in promoting innovation and change in the health care system as vital elements in providing the highest quality health care possible much more work needs to be done; the American health care system is complex, and diffusion, not to mention massive spread, of innovation is extraordinarily slow. Innovation in health care delivery has been defined as “a novel set of behaviors, routines and ways of working, which are directed at improving health outcomes, administrative efficiency, cost-effectiveness, or user experience, and which are implemented by means of planned and coordinated action.”4

The Innovations Exchange definition of innovation is provided in section 1.5.2.

2 Dougherty D, Conway PH. The “3T’s” road map to transform U.S. health care: The “how” of high-quality care.

JAMA. 2008;299(19):2319-2321

3 Rogers EM. Diffusion of innovations. Fifth Edition. New York, NY: Free Press. 2003

4 Greenhalgh T, Robert G, Bate P. How to spread good ideas. A systematic review of the literature on diffusion, dissemination, and sustainability of innovations in health service delivery and organization. Report for the National Co-ordinating Centre for NHS Service Delivery and Organisation R&D (NCCSD). April 2004.

http://www.sdo.lshtm.ac.uk/changemanagement.htm Downloaded and accessed 12/30/2004.

http://www.sdo.lshtm.ac.uk/changemanagement.htm�

1.4. AHRQ Programs Supporting Innovation and Change in Health Service Delivery

Each of AHRQ’s active research portfolios (Health Information Technology (Health IT);

Patient Safety ; Prevention/Care Management; Comparative Effectiveness; and Value) have invested in studies and initiatives aimed at addressing challenges associated with incremental and break-through improvements in health care delivery. Those with substantial relation to this acquisition are described here to illustrate how the Innovations Exchange is a cross-cutting AHRQ initiative, and stimulate thinking about how to leverage AHRQ’s other investments for mutual benefit while remaining within scope of this work effort (e.g., seeking innovation and tool leads from ACTION program outputs; suggesting special innovation and tool content collections regarding creative Health IT implementation efforts).

ACTION I and II

Accelerating Change and Transformation in Organizations and Networks (ACTION I) is an implementation initiative specifically developed by AHRQ to capitalize on the research capacity of, and research opportunities in, integrated delivery systems.

ACTION is a model of field-based research that fosters public-private collaboration in rapid-cycle, applied research.

ACTION promotes innovation in health care delivery by accelerating the development, implementation, diffusion and uptake of demand-driven and evidence-based products, tools, strategies and findings. ACTION develops and diffuses scientific evidence about what does and does not work to improve health care delivery systems. It provides an impressive cadre of delivery-affiliated researchers and sites with a demonstrated capacity to “turn research to practice” along with the means of testing the application and uptake of the research knowledge. Details on the ACTION solicitation can be viewed in AHRQ’s online contract archive at: http://www.ahrq.gov/fund/contrarch.htm

The goal of ACTION II is to promote and accelerate the development, implementation, dissemination and sustainability of evidence-based innovation in health care delivery to measurably improve the effectiveness, safety, quality and efficiency of health care in the U.S. In support of this goal, ACTION II will support practice-based research focused on achieving one or more of the following four objectives:

• Test or expand investigation of innovations that are new to the health care field, (proofs of concept).

• Implement, in additional settings, interventions or improvement approaches that have been demonstrated to have worked in a limited type or number of settings.

• Spread, or take to scale, one or more proven innovations or delivery system improvements.

• Sustainability, to increase knowledge about the factors that contribute to, or impede, the long term sustainability of innovation.

A deliverable of ACTION task orders is submission of innovations to the Innovations Exchange.

http://www.ahrq.gov/fund/contrarch.htm�

AHRQ’s Primary Care Practice-based Research Network (PBRN) Initiative

The Primary Care Practice-based Research Network (PBRN) initiative is an AHRQ initiative that was started in 2000 after AHRQ was designated by Congress to “serve as the principal source of funding for primary care research in the Department of Health and Human Services.”5

Between 2000 and 2003, AHRQ provided some early infrastructure funding to PBRNs.

Since then, over 52 PBRNs have received AHRQ funding for various research projects including, but not limited to, patient safety, quality improvement, primary care transformation, sleep apnea, and health information technology. PBRNs receive funding for research through other government agencies, foundations, and non-profits in addition to AHRQ. AHRQ currently supports PBRNs through

A PBRN is a group of ambulatory care practices that are 1) devoted to the primary care of patients and 2) are engaged in research to improve primary care practice. Currently, there are over 115 PBRNs that have registered with AHRQ.

• Grants and contracts;

• Technical assistance through the PBRN Resource Center (currently under contract with the University of Minnesota);

• Peer Learning Groups that are facilitated by Resource Center staff;

• AHRQ’s Annual PBRN Research Conference that is attended by approximately 250 individuals who represent the full spectrum of primary care practitioners, researchers, and staff; and

• Secure web portal to enable and encourage sharing between PBRNs.

PBRNs have conducted innovative research that is improving primary care practice. The following are a few examples of innovations from PBRN settings; each is captured in the Innovations Exchange:

• The use of Practice Enhancement Assistants (PEAs) to improve quality in primary care settings (Oklahoma Physicians Resource/Research Network).

• The use of Community Health Educator Referral Liaisons (CHERLS) that link patients to community resources to reduce risky behaviors (Great Lakes Research Into Practice Network).

• Incorporating prompts for behavioral counseling and referral into a clinicians daily work flow (Virginia Ambulatory Care Outcomes Research Network).

More information about PBRNs is available on AHRQ’s PBRN Web site at http://www.ahrq.gov/research/pbrn/pbrninit.htm and also the Resource Center Web site at http://pbrn.ahrq.gov/portal/server.pt/.

5 Healthcare Research and Quality Act of 1999, amendment to Title IX of the Public Health Service Act (42 U.S.C. 299 et seq.)

http://www.ahrq.gov/research/pbrn/pbrninit.htm� http://pbrn.ahrq.gov/portal/server.pt/�

Patient Safety

The Patient Safety Portfolio’s mission is to prevent, mitigate, and decrease the number of medical errors, patient safety risks and hazards, and quality gaps associated with health care and their harmful impact on patients. This mission is accomplished by funding health services research in the following activities: Patient Safety Threats and Medical Errors, Patient Safety Organizations (PSOs), Patient Safety and Medical Liability Reform, and Healthcare-Associated Infections (HAIs). Projects within the program seek to inform multiple stakeholders including health care organizations, providers, policymakers, researchers, patients and others; disseminate information and implement initiatives to enhance patient safety and quality; and maintain vigilance to prevent patient harm. The projects funded in this portfolio have the potential to deliver innovative changes in patient safety.

AHRQ Patient Safety Network (PSNet)

AHRQ Patient Safety Network (PSNet) is a national web-based resource featuring the latest news and essential resources on patient safety. The site offers weekly updates of patient safety literature, news, tools, and meetings (“What’s New”), and a vast set of carefully annotated links to important research and other information on patient safety (“The Collection”). Supported by a robust patient safety taxonomy and web architecture, AHRQ PSNet provides powerful searching and browsing capability, as well as the ability for diverse users to customize the site around their interests (My PSNet). It also is tightly coupled with AHRQ WebM&M, the popular monthly journal that features user-submitted cases of medical errors, expert commentaries, and perspectives on patient safety.

Searching the AHRQ PSNet Web site for innovation, identifies a number of potential content leads for the Innovations Exchange.

Additional information about AHRQ PSNet is available at the AHRQ PSNet Web site, http://www.psnet.ahrq.gov/about.aspx.

Health Information Technology (Health IT)

AHRQ's health information technology (health IT) initiative is part of the Nation's strategy to put information technology to work in health care. By developing secure and private electronic health records for most Americans and making health information available electronically when and where it is needed, health IT can improve the quality of care, even as it makes health care more cost-effective.

The broad mission of AHRQ's health IT initiative is to improve the quality of health care for all Americans. The Agency has focused its health IT activities on the following goals:

• Improve health care decisionmaking.

• Support patient-centered care.

• Improve the quality and safety of medication management.

To address the mission, AHRQ has invested over $260 million in contracts and grants to over 150 communities, hospitals, providers, and health care systems in 48 States to http://www.psnet.ahrq.gov/about.aspx� promote access to and encourage the adoption of health IT. These projects constitute a real-world laboratory for examining health IT at work and aim to achieve the following:

• Help clinicians provide higher quality, safer health care.

• Put the patient at the center of health care.

• Stimulate the implementation of health IT, especially in rural and underserved areas.

• Identify the most successful approaches and barriers to health IT implementation.

• Make the business case for health IT by evaluating costs and benefits.

While health IT innovations are not the focus of the Innovations Exchange, AHRQ does not want to exclude them either. Health IT innovations represented in the Innovations Exchange will be those that occurred concomitantly with other health service delivery innovations. The AHRQ Health IT Web site will serve as resource to identify potential content for the Innovations Exchange.

Additional information about AHRQ Health IT is available at www.healthit.ahrq.gov

Value

AHRQ’s value portfolio develops measures, data, evidence, tools, and strategies that health care organizations, systems, insurers, purchasers, and policymakers use to reduce unnecessary costs while maintaining or improving quality. Improvement strategies include process redesign, leadership and management strategies, organizational and community-wide quality improvement initiatives, legal and regulatory changes, consumer choice, public reporting, incentives, and payment changes.

Portfolio-related activities that generate innovations of potential relevance to the Innovations Exchange include the work of the AHRQ Learning Network for Chartered Value Exchanges (CVEs). This is a national program that brings together 24 CVEs, or community quality collaboratives, from across the country. In aggregate, these collaboratives involve more than 600 healthcare leaders and represent more than 124 million lives, more than one-third of the U.S. population. The collaboratives are multistakeholder initiatives with a mission of quality improvement and transparency.

Additionally, the value portfolio, in cooperation with the Prevention and Care Management portfolio, developed a set of American Recovery and Reinvestment Act (ARRA)-supported grant projects on delivery system change and the spread of comparative effectiveness findings through delivery system networks. In 2012 the projects funded under this initiative are likely to begin reporting on innovations in care coordination, payment, reporting, and the organization of primary care to ensure quality and value.

Medicaid Medical Directors Learning Network

The Medicaid Medical Directors Learning Network (MMDLN) is one of several projects that falls under AHRQ’s Knowledge Transfer Program. The Knowledge Transfer program is intended to accelerate the dissemination and implementation of AHRQ’s evidence-based products, tools, and research findings into the health care system. The MMDLN, established in November 2005, is a learning network of Medicaid Medical Directors or other officials making clinical decisions for the Medicaid population. It is http://www.healthit.ahrq.gov/� open to all States and territories. Currently, members represent 41 States and the District of Columbia. The members developed a charter and established a steering committee in 2008. Activities include: approximately three in person meetings a year, Web conferences on specific topics, open mic conference calls to discuss current pressing issues, and a very active online member forum. One of the members serves on the Health Care Innovations Exchange Expert Panel.

The purpose of this learning network is to create an ongoing collaborative relationship between AHRQ and Medicaid Medical Directors. The goals are to: 1) to share AHRQ products with members to help them make policy and practice decisions 2) get input and feedback from members that can inform AHRQ decisions; and 3) provide an environment for the members to learn from one another. As a result of learning and sharing with AHRQ and each other, members have made changes to Medicaid policy and practice. A few examples are below.

• Connecticut Medicaid: Used AHRQ’s Efficacy and Effectiveness of Off-Label Use of Atypical Antipsychotics as a rationale for adding mental health drugs to Medicaid’s preferred drug list, which allows the program to ensure that these drugs are being appropriately prescribed. Used AHRQ’s Cesarean Delivery on Maternal Request to develop a policy to monitor the rate of c-section deliveries.

• Massachusetts Medicaid: Used ARHQ’s Comparative Effectiveness and Safety of Oral Diabetes Medications for Adults With Type 2 Diabetes report and the Comparative Effectiveness of Second-Generation Antidepressants in the Pharmacologic Treatment of Adult Depression report to develop drug-specific (as opposed to disease-specific) guidelines for Medicaid beneficiaries. Used AHRQ’s Effectiveness of Noninvasive Diagnostic Tests for Breast Abnormalities report to help set clinical guidelines regarding when a suspicious mammogram should be followed-up with a breast MRI, and when a biopsy would be more likely to find cancerous cells

• Pennsylvania Medicaid: Used AHRQ’s Registries for Evaluating Patient Outcomes:

A User's Guide as guidance for the design of their own registry, and as a way to convince provider practices of the value of a patient registry.

NHQR/NHDR/State Snapshots

Beginning in 2003, Congress charged AHRQ with providing an annual portrait of the quality of the nation’s healthcare as well as for presentation of healthcare disparities experienced by subpopulations which materialized as the National Healthcare Quality Reports and the National Healthcare Disparities Reports (NHQR/DR) and related tools.

The NHQR/DRs measure quality organized around 9 areas, which include:

Effectiveness, Safety, Timeliness, Patient Centeredness, Care Coordination, Efficiency, Health System Infrastructure, Access to Care, and Priority Populations. Utilizing the data collected and used in the NHQR/DRs, the State Snapshots present quality and disparities measures and data by State, allowing for users to develop action plans, policies, and programs to create improvement at a more localized level. The principal website for the NHQR/DR is http://www.ahrq.gov/qual/measurix.htm from which users may access current and previous years’ reports as well as the other NHQR/DR tools. In addition, the appendices (which includes data specifications and tables) can be located within each year’s individual site, the QRDR-net, where users can conduct their own customized analyses of presented measures and data is located at http://www.ahrq.gov/qual/measurix.htm� http://nhqrnet.ahrq.gov/nhqrdr/jsp/nhqrdr.jsp#snhere#snhere, and the State Snapshots are located at http://statesnapshots.ahrq.gov/snaps08/index.jsp.

The NHQR/DR and the State Snapshots interact with the Innovations Exchange in 3 principal ways. First, there have been a number of measures and tools that have been developed to support analyses presented in the NHQR/DR and State Snapshots; some of these are included in the HCIE, and the HCIE aides in disseminating these new tools.

Second, information in the NHQR/DR and State Snapshots have been used by the current Innovations Exchange team to prepare the content presented in the Innovations Exchange. Lastly, the NHQR/DR and State Snapshots are primarily used to increase awareness of and diagnose quality and disparities problems. Often, the NHQR/DR and State Snapshots point to the HCIE for examples of strategies that have led to improvements in quality or disparities.

1.5. AHRQ Health Care Innovations Exchange 2006-2010

1.5.1. Original need, goals

Health care providers, health plans, quality improvement organizations, and other health care organizations and professionals embarking on quality improvement or disparities reduction activities frequently scan the field and networks for ideas or solutions that have worked elsewhere. Web sites, journal articles and other resources describing quality improvement strategies that work often chronicle them from a single initiative or setting.

In addition, these information sources do not scan the full range of clinical to workforce to system design solutions, do not include innovative solutions or if they do lack sufficient information for replication, and do not permit readers to upload their own innovative solutions. Equally important, these information sources do not present solutions that didn’t work, omitting an opportunity for those designing solutions to learn from efforts that were not successful. These, and other features, were deemed important and necessary by a panel of innovators and potential users of this Web site when the concept for the Innovations Exchange was first vetted in 2005.

The AHRQ Health Care Innovations Exchange (HCIE) was envisioned as a vehicle to promote the widespread diffusion of innovations that would lead to improvements in quality, efficiency and effectiveness and reductions in disparities thereby contributing to AHRQ’s progress in these strategic areas. In addition, the Web site would capture health system or practice innovations that were used (trialed, piloted, or incorporated enterprise-wide) and did not lead to the improvements of interest but may have lead to other positive findings and generated a number of lessons learned. Including this type of innovation would provide educational opportunities not available elsewhere. The research community would find this valuable also.

The goal of the Innovations Exchange was, and continues, to be to be a national repository of health system and health practice innovations, associated tools and lessons learned, promoting change and further innovations and tool development in the health care system for the purpose of improving health care quality and reducing health care disparities for all Americans. The objectives of the first solicitation were:

• Integrate AHRQ’s QualityTools database and Web site into the Innovations Exchange

• Collect a comprehensive accumulation of innovations and lessons learned http://nhqrnet.ahrq.gov/nhqrdr/jsp/nhqrdr.jsp#snhere#snhere� http://statesnapshots.ahrq.gov/snaps08/index.jsp�

• Seek and capitalize on relevant expert input

• Design, develop, deploy and maintain the Innovations Exchange Web site

• Emphasize innovations targeting public health priority diseases/conditions, priority populations, and efforts to reduce disparities in quality

• Provide appropriate and timely technical assistance to users

• Provide dynamic opportunities for learning and networking among the users of the Web site

1.5.2. Overview of current resource, accomplishments to-date

Since its inception in September 2006, the Health Care Innovations Exchange has been an ambitious project to serve as a “one stop shop” about health care delivery innovations and tools used in quality improvement and disparities reduction efforts.

The design and content of the Web site responds to many of the expressed needs of its users by providing:

• indexed content and a searchable database of innovations and tools where users can assess strategies for potential applicability to a similar, or a completely different, setting and environment;

• innovation profile content in sufficient detail to facilitate adoption decision making

• expert commentary and/or human interest back stories for select innovations and tools aimed at more fully informing an adoption decision;

• online and offline networking and communication opportunities as a method of learning about a particular innovation; and

• educational opportunity not available elsewhere by capturing health system or practice innovations that were used (trialed, piloted, or incorporated enterprise-wide) and did not result in targeted improvements.

The project team, including the editorial board, carefully considered a definition of innovation and the specific criteria for inclusion and general criteria for exclusion.

The Innovations Exchange defines innovation as the implementation of new or altered products, services, processes, systems, organizational structures, or business models as a means of improving one or more domains of health care quality. Note: AHRQ and the project team, including the Editorial Board, chose not to put too tight a frame around this term based on a review of the innovation literature and expert consultations.

Innovation can mean different things to different people, depending on sector as well as organizational factors. An activity that is standard practice in one health care system may be cutting-edge for another.

All innovations in the Innovations Exchange meet explicit criteria for inclusion:

• the innovation relates to patient care processes

• the innovation aims to improve one or more domains of health care quality

• the activity is truly innovative in the context of its setting or target population

• information about the innovation is publicly available

• the innovator (or representative) will contribute information to the

Innovations Exchange

• there is reason to believe the innovation will be effective*

Note: Attempts at innovation do not have to meet this criterion

Specifically excluded are: product or technical innovations; policy innovations;

educational innovations; clinical innovations; health service delivery innovations without any evidence of effect.

These criteria are more fully described on the Innovations Exchange Web site:

http://www.innovations.ahrq.gov/submit/submit.aspx#4.

1.6. Current Health Care Innovation Exchange Challenges

Looking Forward – where do we go from here?

The Health Care Innovations Exchange will continue to be an ambitious project.

Whereas the initial phases of the project were devoted to heavily developing the database and Web site of Innovations and Quality Tools and stabilizing associated content development, content production and IT systems processes, the next iteration will continue to populate the database, as well as broaden content and address key challenges that have been identified through sources such as the Innovations Exchange expert panel and editorial board, AHRQ colleagues, Federal partners, interactions with outside parties, user testing, and so on.

Broadening Content. The Patient Protection and Affordable Care Act (PPACA, or ACA in short) of 2009 puts into place comprehensive health insurance reforms that will hold insurance companies more accountable and will lower health care costs, guarantee more health care choices, and enhance the quality of health care for all Americans.

Reducing disparities in care is emphasized in ACA 2009. This legislation presents a ripe opportunity for the Innovations Exchange to expand its content holdings to include policy innovations. As the result of ACA 2009 and its focus on prevention, the Innovations Exchange team is working with HRSA to explore inclusion of healthy weight policy/public health type innovations.

In addition to this targeted effort, AHRQ is keenly aware that through the ACA 2009 States and other policy makers may develop novel policy changes aimed at improving health care quality or reducing disparities and these policy changes may drive equally novel changes in clinical processes or community services. AHRQ wants to position the Innovations Exchange to be a repository of these policy changes and, when possible, explicitly relate them to associated clinical process and/or community service changes.

Challenges. The challenges that have become apparent include:

• raising awareness about this resource and reframing it as a solutions source.

Many quality improvement change agents looking for solutions don’t know about http://www.innovations.ahrq.gov/submit/submit.aspx#4� the Health Care Innovations Exchange or don’t think about health service delivery innovations as potential solutions to quality improvement problems.

• as the database of innovations grows, the level of effort to keep content current grows and budget projections show maintenance will overtake new postings.

AHRQ is in the early stages of implementing a strategy to streamline efforts at providing content that is up-to-date; results of that effort may inform next steps.

Coincident with this issue is the issue of archiving innovations that no longer meet criteria or which have been so widely implemented that the innovation becomes usual practice or policy. The current Innovations Exchange does not have an archive or a “classics” section.

• the QualityTools database contains over 1500 tools meeting very general criteria for inclusion, stated on the Innovations Exchange Web site:

http://www.innovations.ahrq.gov/faq.aspx#13. Is this too many? Should the criteria for inclusion be modified in such a way as to sharpen specificity of the tool types of interest? Or to capture tools from select tool developers? If inclusion criteria are modified, should a tool archive be created to continue to make public previously recorded tool information that no longer meets criteria?

• almost all innovations are unsuccessful in the early stages of the innovation lifecycle (or process) and it’s through an iterative, prototyping and lessons learned effort that an innovation gains new form and/or function – this is normal and expected – yet the number of unsuccessful innovation (or innovation attempts) in our database is small (~2%);

• increasing the uptake of innovations by connecting potential adopters with innovators. The Innovations Exchange has hosted a number of Web-based events aimed at connecting adopters/potential adopters with innovators. Others mechanisms of promoting uptake are needed.

• developing and maintaining collaborations/strategic partnerships that serve as an effective way to spread the word about the Health Care Innovations Exchange as well as garner profiles and content to populate the database, and connect innovators with potential adopters. The Innovations Exchange has responded favorably when solicited by others to join forces but project resources, including AHRQ program staff resources, are limited to reach out to high value potential partners/collaborators. Two examples of how the Innovations Exchange collaborated with either internal or external collaborators are:

o Space has been created on the Innovations Exchange Web site for “Linking Clinical Practices and the Community for Prevention”, a collaboration within AHRQ and connected to CDC initiatives. This space provides information on page on how to promote healthy patients, families, and communities. The content hosts profiles that highlight how to integrate the delivery of clinical and community-based prevention and health promotion interventions.

o A partnership between AHRQ and the Diversity Rx “Your Voice” project centers on activities that focus on reducing disparities through cultural competency. The Innovations Exchange hosts profiles/attempts/tools related to cultural competence and is in the process of creating space to showcase the collection of such innovations and tools. When the Innovations Exchange featured a number of innovations and tools related to culture competence, during one of the publication cycles, the project http://www.innovations.ahrq.gov/faq.aspx#13� co-hosted a webinar with Diversity RX highlighting subject-related innovations.