In this section we include the Ƶprimary care research grants organized by additional topics of focus for AHRQ: Children and Adolescents, Telehealth, Rural Health, Multiple Chronic Conditions, Women’s Health, Older Adults, and Opioids. The grant summaries presented here are the same as those presented in Section 3: Primary Care Grants and Resources, and are presented again here to allow for easy scanning by these additional, cross-cutting topics. Information about Ƶinitiatives and resources has also been included, where relevant. As with Section 3, the grants are presented in alphabetical order by grant title.
Children and Adolescents
Children and Adolescents are one of the priority populations established by the Healthcare Research and Quality Act of 1999 (Public Law 106-129).14 Ƶfunds several efforts related to understanding and improving child and adolescent health. For a recent Ƶresource related to primary care for children, go to a topic brief on .
The list below shows the 19 Ƶprimary care grants active in FYs 2023 and 2024 with a focus on children and adolescents. These summaries first appeared across topic areas in Section 3, including five in Patient Safety, five in Health Disparities, three in Behavioral Health and Substance Use Disorders, three in Practice and Quality Improvement, two in Person-Centered Care, and one in Public Health and Community Integration.
(K01)
PI: Kendra Liljenquist
Organization: Seattle Children’s Hospital
Grant Start Date: September 30, 2023
Aims to help address inequities in access to developmental screening for children from low-income and ethnic/racial minority families by developing a prototype for a new computer-adaptive developmental assessment to be used in primary care. The research team identifies culturally and contextually appropriate assessment items in both English and Spanish, as well as develops specifications for building a high-fidelity, computer-adaptive developmental assessment for integration into clinical care.
(K08)
PI: Irit R. Rasooly
Organization: Children’s Hospital of Philadelphia
Grant Start Date: September 30, 2022
Uses electronic health record (EHR) data and systems analysis to develop clinical decision support (CDS) strategies that can identify and help diagnose child abuse in primary care settings. Research team is using EHR data to detect and validate markers of physical abuse to identify children experiencing abuse; using EHR simulations to identify abuse-related diagnostic errors; and to develop feasible, acceptable, and appropriate CDS strategies for improved child abuse detection and diagnosis.
Learn more about this study in a NCEPCR Impact Story: Advancing Primary Care Research Careers (PDF, 1 MB).
(R03)
PI: Arik V. Marcell
Organization: Johns Hopkins University
Grant Start Date: April 1, 2023
Aims to understand the benefits of preventive care about substance use for adolescents in primary care using the National Institutes of Health NEXT Study data. Specifically, the study seeks to understand the extent to which substance-using adolescents participate in well-visits, the proportion of adolescents who are asked and advised annually about substance use at well-visits, and the extent to which being asked and advised about substance use during adolescence is related to the prevention of future substance use initiation or reduction of substance use over time.
(R03)
PI: Abigail Williams-Butler
Organization: Rutgers University
Grant Start Date: September 30, 2024
Examines healthcare use among Black youth in foster care and the role that coordinated medical care homes (i.e., when primary care and specialty care are provided in the same setting) play in improving their health outcomes compared with youth who receive services through multiple systems. The study uses 11 years of linked child welfare and electronic health records data along with the voices of young people in the foster care system. Results can be used to improve the health of Black youth in foster care and to potentially reduce the overall cost of healthcare among foster youth.
(R01)
PI: Ellen A. Lipstein
Organization: Cincinnati Children’s Hospital Medical Center
Grant Start Date: September 30, 2022
Aims to compare the telehealth and in-person decision-making processes and outcomes in pediatric primary care for children with chronic conditions. Uses a combination of family surveys, video recordings of healthcare visits, and qualitative interviews to understand experiences of decision-making during telehealth and in-person visits.
Learn more about this study in a NCEPCR webinar: Qualitative Methods Used in AHRQ-Funded Primary Care Research.
(K01)
PI: Nadja Vielot
Organization: University of North Carolina – Chapel Hill
Grant Start Date: August 1, 2024
Aims to (1) collaborate with healthcare personnel in rural primary care clinics to measure appropriateness and acceptability of starting HPV (human papillomavirus) vaccination at age 9, allowing more time to achieve up-to-date coverage by age 13, and use findings to develop an intervention plan; (2) gauge acceptability of HPV vaccination starting at age 9 among family caregivers in rural areas and modify the intervention plan to maximize caregiver acceptability; and (3) pilot the intervention in four rural clinics, using electronic medical records to measure HPV vaccination coverage in a cohort of 9-year-old patients over 2 years.
(R01)
PI: Sarah Beal
Organization: Cincinnati Children’s Hospital Medical Center
Grant Start Date: September 30, 2022
Evaluates the impact of different delivery models on health outcomes for children in foster care and examines the factors that contribute to variations in healthcare use and health outcomes for these youth. The findings can be used to implement health delivery practice changes, often in primary care, to improve the health outcomes of these vulnerable youth.
(R18)
PIs: Neera Goyal; Vanessa L. Short
Organization: Nemours Children’s Hospital, Delaware
Grant Start Date: April 1, 2020
Looks at the use of comprehensive group well-child visits for mothers with opioid use disorder and their children. The group visits examined in this study allow for increased time with the pediatrician, peer-to-peer learning, and an enhanced focus on behavior change and self-care.
Learn more about this study in a recent NCEPCR webinar: Qualitative Methods Used in ƵFunded Primary Care Research.
(R18)
PIs: Ryan J. Coller; Nicole E. Werner
Organization: University of Wisconsin – Madison
Grant Start Date: May 2, 2022
Develops an app (MedS@HOME) to improve medication safety for children with medical complexity who may receive care in pediatric primary care and from specialists. The app supports standardized medication management across caregivers to increase administration accuracy and reduce medication-related adverse events.
Learn more about this study in a recent NCEPCR webinar: Innovative Use of Technology in Primary Care Delivery.
(R18)
PIs: Elyse Olshen Kharbanda; Catherine Pastorius Benzinger
Organization: HealthPartners Institute
Grant Start Date: September 30, 2020
Compares high- and low-intensity interventions to implement an electronic health record–linked clinical decision support in rural primary care practices to provide evidence-based clinical care recommendations for blood pressure management in youth.
Learn more about this study in a Primary Care Research Profile: Identifying and Managing Hypertension Among Rural Youth (PDF, 291 KB).
(K08)
PI: Caleb Ward
Organization: Children’s Research Institute
Grant Start Date: August 1, 2024
Refines and pilot tests the Pediatric Observation Priority Score (POPS) for use by Emergency Medical Services (EMS) technicians as a risk assessment tool to identify which children can be safely managed without going to an emergency department (ED). First, the study identifies factors associated with under triage of children who are not transported by EMS to an ED; then works to optimize the acceptability, appropriateness, and feasibility of the POPS tool with clinical end-users; and finally, uses simulations and field pilot studies to assess the refined POPS tool. Once validated, the POPS will be useful to study EMS innovations for caring for children, including treatment in pace, telemedicine, and integration of primary care.
(K08)
PI: Jamie Peterson
Organization: Oregon Health & Science University
Grant Start Date: March 1, 2023
Develops and pilots a package of pediatric clinic-based school readiness interventions that are specifically designed to target the needs and desires of Latino families.
(K08)
PI: Hsin-Hsiao Scott Wang
Organization: Boston Children’s Hospital
Grant Start Date: July 1, 2024
Aims to reduce the risk of renal injury from febrile urinary tract infection in children by developing and implementing prediction modeling to assist primary care clinicians and families in determining the most optimal timing for a voiding cystourethrogram. Develops the machine-learning prediction model using a combination of pediatric practice data and advice from experts in related fields and then piloted to further adapt the model to maximize adoption and sustainability.
(R18)
PIs: Lisa Ross Decamp; Meredith Parrish Fort
Organization: University of Colorado – Denver
Grant Start Date: September 30, 2023
Develops the Nav-TEAM intervention to improve asthma management in children in families who communicate in a language other than English (LOE). The research team will use community-engaged processes to tailor asthma navigation for families that communicate in LOE in primary and subspecialty pediatric pulmonary care settings at a large academic children’s health system. The team will evaluate the effectiveness of Nav-TEAM on pediatric asthma outcomes, evaluate the application of implementation strategies, and assess cost and contextual factors to support sustained implementation and scaling of the intervention.
(R01)
PI: James A. Feinstein
Organization: University of Colorado – Denver
Grant Start Date: April 1, 2023
Assesses the effectiveness of a pharmacist-led Pediatric Medication Therapy Management intervention compared with usual care (e.g., primary care or specialist provider) to reduce medication-related problems (such as inappropriate therapy, undertreated symptoms, or adverse drug events) for children with medical complexity in an outpatient complex care program.
(R18)
PI: Manuel E. Jimenez
Organization: Rutgers Biomedical and Health Sciences
Grant Start Date: September 30, 2021
Tests an online family wellness program that uses anticipatory guidance on health topics important to school readiness (e.g., nutrition and physical activity) to introduce language and literacy skills to Latino dual language learners from families with a low income. Conducts a developmental evaluation to refine and optimize the program for implementation in primary care. Then, conducts a randomized control trial to test the effects of the program on child and parent outcomes, and a process evaluation to explore reach, implementation, and user experience.
(R03)
PI: Erin Fitzgerald Carlton
Organization: University of Michigan at Ann Arbor
Grant Start Date: July 1, 2023
Uses national multi-payer data to measure how often children have a primary care follow-up visit within seven days after a pediatric intensive care unit stay after experiencing a critical illness. The study also assesses disparities in primary care follow-up by patient age, comorbidities, and socioeconomic status and examines whether receipt of timely follow-up is associated with reduced 90-day acute healthcare utilization.
(R13)
PI: Christina Tortolani
Organization: Rhode Island College
Grant Start Date: September 30, 2023
Supports a research development conference to advance evidence-based care of pediatric eating disorders in primary care. Various presentations and breakout groups contribute to the development of a “research roadmap,” outlining priorities such as education needs and practical screening, diagnosis, and treatment decisions. Although primary care clinicians are often the first contact of families of children suffering from eating disorders, they are often undertrained in the assessment and management of these conditions. This conference is a first step in getting primary care clinicians the support they need to confidently identify, manage, and treat pediatric eating disorders. (Read for additional information on this topic and the conference proceedings).
(R01)
PI: Monica Perez Jolles
Organization: University of Colorado – Denver
Grant Start Date: September 30, 2024
Evaluates the effectiveness of a system-level intervention designed to increase service referrals and follow-up to address the psychosocial needs of caregivers and children identified through primary care screenings (e.g., exposure to violence, racism, and insecure housing). The intervention being tested uses Process Service Mapping, a novel methodology that maps patients’ journeys to identify inequities, challenges, and action points to optimize service pathways.
Telehealth/Telemedicine
As described in Digital Healthcare, telehealth (also called telemedicine) is the use of phone calls, video conferences, or other online tools to host virtual consultations between patients and clinicians. The use of telehealth expanded rapidly during the COVID-19 public health emergency, and it continues to be used widely because it expands access to care. Ƶfunds research on telehealth implementation, safety, and effectiveness, and shares resources and from this work.
Watch a from AHRQ’s Evidence-Based Practice Center Program sharing findings from two evidence reports:
- .
- .
The list below shows the 12 Ƶprimary care grants active in FYs 2023 and 2024 with a focus on telehealth. These summaries first appeared across topic areas in Section 3, including three in Healthcare Systems and Infrastructure, three in Practice and Quality Improvement, three in Digital Healthcare, one in Patient Safety, one in Health Disparities, one in Behavioral Health and Substance Use Disorders, and one in Person-Centered Care.
(K01)
PI: Edmond Ramly
Organization: Trustees of Indiana University
Grant Start Date: April 8, 2022
Aims to develop a customizable toolkit for implementing cardiovascular disease guidelines in primary care after telehealth expansion. The toolkit includes a menu of options to help practices address specific local barriers without requiring the engagement of an expert for a costly tailoring process.
(R01)
PI: Ellen A. Lipstein
Organization: Cincinnati Children’s Hospital Medical Center
Grant Start Date: September 30, 2022
Aims to compare the telehealth and in-person decision-making processes and outcomes in pediatric primary care for children with chronic conditions. Uses a combination of family surveys, video recordings of healthcare visits, and qualitative interviews to understand experiences of decision-making during telehealth and in-person visits.
Learn more about this study in a NCEPCR webinar: Qualitative Methods Used in AHRQ-Funded Primary Care Research.
(R18)
PI: Tyler S. Oesterle
Organization: Mayo Clinic Rochester
Grant Start Date: September 30, 2023
Develops an integrated behavioral health collaborative care platform using the Senyo Health app to deliver screening, brief intervention, and referral to treatment (SBIRT) for SUDs in primary care. This grant is part of the grant initiative.
(K01)
PI: Annie Elizabeth Larson
Organization: OCHIN, Inc.
Grant Start Date: August 1, 2022
Investigates the role of telemedicine in improving access to primary care for rural patients. The research team is looking at the frequency and type of preventive care visits, differences between urban and rural patients on uptake of telemedicine, and the effect of telemedicine on the quality and equity of care for chronic health conditions among rural and urban patients.
Learn more about this study in the NCEPCR webinar: Using Large Datasets for Primary Care Research and the Impact Story: Advancing Primary Care Research Careers (PDF, 1 MB).
(U18)
PIs: Anya Day; Theresa L. Walunas
Organization: Altarum Institute
Grant Start Date: January 1, 2021
Establishes a statewide cooperative in Michigan to provide QI support to help primary care practices implement interventions to improve hypertension management and tobacco cessation. These efforts are coupled with optimization of health information technology and telehealth approaches to address barriers to access in rural parts of the state. This grant is part of the EvidenceNOW: Building State Capacity program.
(R01)
PIs: Tamar Barlam; Mari-Lynn Drainoni
Organization: Boston Medical Center
Grant Start Date: June 1, 2022
Examines whether telehealth visits can be used to improve the management of acute respiratory tract infections, including reducing inappropriate prescribing of antibiotics in ambulatory care settings including primary care.
(U18)
PIs: Alayne Denise Markland; Elizabeth Camille Vaughan
Organization: University of Alabama at Birmingham
Grant Start Date: February 1, 2022
Aims to improve access for women Veterans in the southeastern United States to evidence-based, nonsurgical treatment for urinary incontinence. The study compares the effectiveness of the interactive treatment modality with or without additional urinary incontinence clinical expertise delivered via telehealth in 62 primary care practices that treat women Veterans. Participating practices receive practice facilitation support, training, and health information technology assistance. Researchers explore women Veterans’ and clinicians’ perceptions of remote urinary incontinence treatment to advise future scalability. This grant is part of AHRQ’s EvidenceNOW: Managing Urinary Incontinence program.
(R01)
PI: Leslie Page Scheunemann
Organization: University of Pittsburgh at Pittsburgh
Grant Start Date: June 1, 2024
Tests, via a randomized controlled trial, the Post-Intensive Care Transitional Care, Rehabilitation, and Family Support (PIC-TRFS) model that aims to improve outcomes and prevent rehospitalizations for intensive care unit (ICU) survivors. The intervention supports the health and social care needs of patients in the six months following a critical illness hospitalization as they transition from the hospital setting to the home setting with healthcare support from home health and primary care.
(R18)
PIs: Raj M. Ratwani; Ethan A. Booker
Organization: MedStar Health Research Institute
Grant Start Date: September 30, 2022
Aims to develop the SafE-T C2 Learning Laboratory, which will address issues related to chronic conditions, health disparities, and primary care. The laboratory will help identify safety issues for telehealth patients (particularly patients with chronic conditions) and guide the development and implementation of solutions. The laboratory uses the socio-technical system engineering framework, which underscores that technology, policies, processes, and people all play a role in patient safety issues. Implements identified solutions across multiple outpatient clinics.
(R03)
PIs: Goutham Rao; Kelsey Ufholz
Organization: University Hospitals of Cleveland
Grant Start Date: September 1, 2023
Aims to develop a digital skills training intervention to prepare older, mostly African American adults with Type II diabetes to participate in and benefit from telemedicine appointments for primary care. Feedback is collected from patients who complete the training about their satisfaction with it and whether it helped them during their telemedicine appointment (if applicable).
(K08)
PI: Leslie Page Scheunemann
Organization: University of Pittsburgh at Pittsburgh
Grant Start Date: September 30, 2019
Tests a transitional care model, TeleRecovery, where a nurse practitioner and occupational therapist deliver telehealth-based rehabilitation services for older adults and their caregivers in rural areas after a transfer from the intensive care unit to home. The TeleRecovery teams work with home health providers to implement the patients’ care plans until they are well enough to be managed in primary care.
(R01)
PI: Lindsay Allen
Organization: Northwestern University at Chicago
Grant Start Date: September 30, 2023
Aims to measure the impact of different telehealth delivery models on cost, downstream care (e.g., primary care) and immediate access to care among low-income individuals to provide Medicaid agencies and policymakers with information needed to decide whether to permanently extend COVID-era telehealth policies.
Rural Health
Rural areas face unique healthcare challenges such as geographic isolation, persistent shortages of healthcare providers, and the closing of rural hospitals and health centers. Ƶfunds several efforts related to understanding and improving rural health. For recent Ƶprimary care research resources related to rural health see the Impact Story: Increasing Access to Treatment for Opioid Use Disorder in Rural Communities Through a Virtual Clinician Training and Support Program (PDF, 477 KB) and a from AHRQ’s Evidence-Based Practice Center Program sharing findings from the evidence report Improving Rural Health Through Telehealth-Guided Provider-to-Provider Communications.
The list below shows the nine Ƶprimary care grants active in FYs 2023 and 2024 with a focus on rural health. These summaries first appeared across topic areas in Section 3, including two in Practice and Quality Improvement, two in Health Disparities, two in Healthcare Systems and Infrastructure, one in Public Health and Community Integration, one in Behavioral Health and Substance Use Disorders, and one in Patient Safety.
(R01)
PIs: Patricia C. Dykes; Jin Chen
Organization: Brigham and Women’s Hospital
Grant Start Date: September 1, 2024
Develops an advanced, data-driven electronic clinical quality measure to measure timely, delayed, and missed venous thromboembolism (VTE) diagnoses in ambulatory and urgent care settings. Uses EHR data and stakeholder expertise to understand risk factors for VTE diagnostic errors, disparities in care, and health outcomes. Develops artificial intelligence and statistical learning tools to identify and address vulnerabilities in workflows to help reduce delayed and missed VTE diagnoses.
(R18)
PI: Tyler S. Oesterle
Organization: Mayo Clinic Rochester
Grant Start Date: September 30, 2023
Develops an integrated behavioral health collaborative care platform using the Senyo Health app to deliver screening, brief intervention, and referral to treatment (SBIRT) for SUDs in primary care. This grant is part of the grant initiative.
(K01)
PI: Nadja Vielot
Organization: University of North Carolina – Chapel Hill
Grant Start Date: August 1, 2024
Aims to (1) collaborate with healthcare personnel in rural primary care clinics to measure appropriateness and acceptability of starting HPV (human papillomavirus) vaccination at age 9, allowing more time to achieve up-to-date coverage by age 13, and use findings to develop an intervention plan; (2) gauge acceptability of HPV vaccination starting at age 9 among family caregivers in rural areas and modify the intervention plan to maximize caregiver acceptability; and (3) pilot the intervention in four rural clinics, using electronic medical records to measure HPV vaccination coverage in a cohort of 9-year-old patients over 2 years.
(K01)
PI: Annie Elizabeth Larson
Organization: OCHIN, Inc.
Grant Start Date: August 1, 2022
Investigates the role of telemedicine in improving access to primary care for rural patients. The research team is looking at the frequency and type of preventive care visits, differences between urban and rural patients on uptake of telemedicine, and the effect of telemedicine on the quality and equity of care for chronic health conditions among rural and urban patients.
Learn more about this study in the NCEPCR webinar: Using Large Datasets for Primary Care Research and the Impact Story: Advancing Primary Care Research Careers (PDF, 1 MB).
(U18)
PIs: Anya Day; Theresa L. Walunas
Organization: Altarum Institute
Grant Start Date: January 1, 2021
Establishes a statewide cooperative in Michigan to provide QI support to help primary care practices implement interventions to improve hypertension management and tobacco cessation. These efforts are coupled with optimization of health information technology and telehealth approaches to address barriers to access in rural parts of the state.
(R18)
PI: Meghan McHugh
Organization: Northwestern University at Chicago
Grant Start Date: September 1, 2023
Examines the effectiveness of worksite health clinics providing hypertension control and smoking cessation interventions to improve cardiovascular care in manufacturing communities. Evidence-based interventions are drawn from AHRQ’s EvidenceNOW model, a blueprint for delivering external support to primary care practices to improve primary care delivery. Measurements collected include facilitators and barriers to sustainability, the effectiveness of the interventions, and budget implications.
(R18)
PIs: Elyse Olshen Kharbanda; Catherine Pastorius Benzinger
Organization: HealthPartners Institute
Grant Start Date: September 30, 2020
Compares high- and low-intensity interventions to implement an electronic health record–linked clinical decision support in rural primary care practices to provide evidence-based clinical care recommendations for blood pressure management in youth.
Learn more about this study in a Primary Care Research Profile: Identifying and Managing Hypertension Among Rural Youth (PDF, 291 KB).
(R03)
PI: Anna M. Kerr
Organization: Ohio University – Athens
Grant Start Date: September 15, 2023
Aims to understand facilitators and barriers to high-quality care coordination and continuity of care for patients with vascular anomalies in primary care, specifically those living in rural areas. The study includes interviews with vascular anomalies specialists, patients, and their caregivers, as well as pediatricians.
(K08)
PI: Leslie Page Scheunemann
Organization: University of Pittsburgh at Pittsburgh
Grant Start Date: September 30, 2019
Tests a transitional care model, TeleRecovery, where a nurse practitioner and occupational therapist deliver telehealth-based rehabilitation services for older adults and their caregivers in rural areas after a transfer from the intensive care unit to home. The TeleRecovery teams work with home health providers to implement the patients’ care plans until they are well enough to be managed in primary care.
Multiple Chronic Conditions
Ƶdefines multiple chronic conditions (MCC), also referred to as multimorbidity or medical complexity, as “the co-occurrence of two or more chronic physical or mental health conditions.”39 MCC treatment and management is common in primary care, and can be costly and burdensome for the patients, their caregivers, clinicians, and health systems. With a growing number of people living with MCC, Ƶfunds health systems research that builds evidence and tests interventions to transform care for people with MCC.
In a previous Ƶprimary care research grant led by PI Richard W. Grant, researchers examined how to best identify health-related social needs and provide support for patients with multiple chronic conditions. The systematic approaches developed for this study can be used to improve how primary care practices serve these complex patients, potentially improving the effectiveness of the care provided and improving health outcomes.
To learn more about this study and how the predictive model it developed can be tailored for your health system, read the NCEPCR Impact Story: An EHR-Based Predictive Model to Identify Higher Likelihood of Social Needs Among Patients with Multiple Chronic Conditions (PDF, 556 KB).
The list below shows the eight Ƶprimary care grants active in FYs 2023 and 2024 with a focus on MCC. These summaries first appeared across topic areas in Section 3, including two in Digital Healthcare, two in Patient Safety, one in Healthcare Systems and Infrastructure, one in Person-Centered Care, one in Primary Care Workforce, and one in Public Health and Community Integration.
(R01)
PIs: Lipika Samal; Patricia C. Dykes
Organization: Brigham and Women’s Hospital
Grant Start Date: September 30, 2022
Develops and tests the effectiveness of an app to support care transitions between the hospital, home, and primary care clinic to reduce adverse events post-discharge from the hospital. The app contains a digital post-discharge transitional care plan, modules for multiple chronic conditions, relevant lab values, education specific to the patient’s prescribed medications, and a functionality that allows patients to ask questions to support their recovery goals.
(R01)
PI: Alexander H. Krist
Organization: Virginia Commonwealth University
Grant Start Date: March 5, 2019
Implements and tests an enhanced care planning program to help patients manage multiple chronic conditions. Includes the use of an enhanced care planning tool in primary care to screen patients for health behavior, mental health, and social needs. Working with a navigator, patients help prioritize their needs, create a care plan, and write a narrative to guide care; and then connects patients to needed resources in the community. Implemented a clinician-level randomized controlled trial to study how primary care clinicians participate in models for connecting patients to needed community services, and measures whether it improves their health outcomes.
Learn more about this study in a recent NCEPCR webinar: Research on Person-Centered Care.
(R01)
PIs: Amelia Bond; Dhruv Khullar
Organization: Weill Medical College of Cornell University
Grant Start Date: April 1, 2023
Assesses whether health system expansion improves care for medically complex Medicare patients, particularly those in acquired primary care practices. The study aims to understand what health system strategies and characteristics contribute to successes or failures in improving quality of care.
Learn more about this study in a recent NCEPCR webinar: The Impact of Consolidation and Ownership on Primary Care.
(R36)
PI: Amy L McMenamin
Organization: Columbia University Health Sciences
Grant Start Date: June 1, 2023
Assesses care environments for NPs to understand how primary care practices can support NPs providing complex care for people with multiple chronic conditions (MCCs), particularly in communities with low socioeconomic resources. Investigates the relationship between NP care environments (e.g., level of support for NP practice, collegiality between clinicians, and an organizational understanding of the NP role), community characteristics (i.e., socioeconomic resources and availability of primary care), and acute care utilization among older adults with MCCs.
(R01)
PI: Sharon Hewner
Organization: State University of New York at Buffalo
Grant Start Date: April 1, 2021
Tests a personalized, cross-sector, transitional care management model in primary care and behavioral health settings to improve care coordination across settings using a health information exchange infrastructure for high-need/high-cost patients or patients with multiple chronic conditions, functional disabilities, and/or social needs.
Learn more about this study in a Primary Care Research Profile: Supporting Patients with Complex Medical and Social Needs During Transitions in Care (PDF, 277 KB).
(R18)
PIs: Ryan J. Coller; Nicole E. Werner
Organization: University of Wisconsin – Madison
Grant Start Date: May 2, 2022
Develops an app (MedS@HOME) to improve medication safety for children with medical complexity who may receive care in pediatric primary care and from specialists. The app supports standardized medication management across caregivers to increase administration accuracy and reduce medication-related adverse events.
Learn more about this study in a recent NCEPCR webinar: Innovative Use of Technology in Primary Care Delivery.
(R01)
PI: James A. Feinstein
Organization: University of Colorado – Denver
Grant Start Date: April 1, 2023
Assesses the effectiveness of a pharmacist-led Pediatric Medication Therapy Management intervention compared with usual care (e.g., primary care or specialist provider) to reduce medication-related problems (such as inappropriate therapy, undertreated symptoms, or adverse drug events) for children with medical complexity in an outpatient complex care program.
(R18)
PIs: David H. Gustafson; Marie-Louise Mares
Organization: University of Wisconsin – Madison
Grant Start Date: August 1, 2020
Implements a smart-system (a smart speaker plus visual display) version of an existing Elder Tree intervention—a program that supports the self-management of health for older adults with multiple chronic conditions who live independently and whose care is managed by primary care clinicians. This grant tests a smart-system version compared with the computer-based system on outcomes, including quality of life, hospital readmission, and medication adherence.
Learn more about this study in a recent Digital Healthcare Research webinar: .
Women’s Health
Women face different health risks and concerns and require different approaches to treatment and care than men do. Although women make up half of the U.S. population, they have historically been left out of clinical trials, limiting research and understanding. Ƶfunds research to build our understanding of women’s unique health needs, and shares information to improve women’s healthcare, including information about cancer, diabetes, heart disease, mental health, pregnancy and perinatal care, and gynecologic care, among other topics.
To learn more about AHRQ’s primary care research on women’s health, watch the NCEPCR webinar Research on Women's Health in Primary Care; read the Impact Story: A Better Approach for Screening Women for Intimate Partner Violence in Primary Care (PDF, 607 KB); and go to resources resulting from the EvidenceNOW: Managing Urinary Incontinence program in Initiatives and Resources in Practice and Quality Improvement in Section 3.
AHRQ’s Evidence-Based Practice Center Program also held a sharing findings from two evidence reports:
- .
- .
The list below describes the eight Ƶprimary care grants active in FYs 2023 and 2024 with a focus on women’s health. These summaries first appeared across topic areas in Section 3, including six in Practice and Quality Improvement, one in Behavioral Health and Substance Use Disorders, and one in Digital Healthcare.
(R21)
PI: Mark Allen Clapp
Organization: Massachusetts General Hospital
Grant Start Date: August 1, 2024
Builds a clinical decision support tool to identify iron deficiency and anemia in pregnancy and prevent postpartum hemorrhage. The tool comprises an iron deficiency screening and management predictive model for individuals at high risk for postpartum hemorrhage. Tool includes prompts for clinicians to screen and treat identified patients during routine obstetric care. Conducts a randomized controlled trial to determine the tool's efficacy.
(R01)
PIs: Mark Allen Clapp; Jessica Lee Cohen
Organization: Massachusetts General Hospital
Grant Start Date: September 30, 2024
Develops and evaluates an intervention to strengthen coordination and transition of obstetric and primary care for postpartum patients. The intervention consists of default scheduling for primary care visits, tailored nudge messages to patients, ongoing care recommendations sent to the primary care clinician, and giving a summary of after-pregnancy recommendations to the patient.
Learn more about this study in a recent NCEPCR webinar: Factors That Impact Perinatal Care Experiences and Outcomes.
(U18)
PIs: Joan Marie Neuner; Heidi Wendell Brown; Kathryn E. Flynn
Organization: Medical College of Wisconsin
Grant Start Date: February 1, 2022
Aims to increase the proportion of patients who are screened and offered treatment for urinary incontinence (UI) in 50 primary care practices. The intervention, called UI Assist, includes screening, education, and evidence-based treatment. The research team compares implementation of UI Assist alone or in combination with partnership building to help practices overcome barriers to intervention implementation. This grant is part of AHRQ’s EvidenceNOW: Managing Urinary Incontinence program.
(U18)
PIs: Adonis K. Hijaz; Goutham Rao
Organization: University Hospitals of Cleveland
Grant Start Date: February 1, 2022
Uses an integrated, multilevel approach to address key barriers to diagnosing and managing urinary incontinence in primary care. Implements the approach across a large network of primary care practices, including large-scale screening, empowering patients to discuss urinary incontinence with their clinicians, clinician education and training, practice facilitation through nurse navigation, and a “chatbot” to support patient self-management. The project also implements a system-based strategy for streamlined referrals and treatment. This grant is part of AHRQ’s EvidenceNOW: Managing Urinary Incontinence program.
Learn more about this study in a recent NCEPCR webinar: Research on Women’s Health in Primary Care
(R18)
PIs: Neera Goyal; Vanessa L. Short
Organization: Nemours Children’s Hospital, Delaware
Grant Start Date: April 1, 2020
Looks at the use of comprehensive group well-child visits for mothers with opioid use disorder and their children. The group visits examined in this study allow for increased time with the pediatrician, peer-to-peer learning, and an enhanced focus on behavior change and self-care.
Learn more about this study in a recent NCEPCR webinar: Qualitative Methods Used in ƵFunded Primary Care Research.
(U18)
PIs: Stephen Persell; Kimberly Sue Kenton
Organization: Northwestern University at Chicago
Grant Start Date: February 1, 2022
This project’s multilevel implementation strategy aims to improve care for urinary incontinence for women in primary care through systematic and equitable screening, supporting patient-centered decision making for selecting treatment options, and accelerating the uptake of evidence-based nonsurgical treatment modalities. This project takes place in the largest health system in Illinois, with 65 primary care practices and 327 primary care physicians.
(U18)
PIs: Alayne Denise Markland; Elizabeth Camille Vaughan
Organization: University of Alabama at Birmingham
Grant Start Date: February 1, 2022
Aims to improve access for women Veterans in the southeastern United States to evidence-based, nonsurgical treatment for urinary incontinence. The study compares the effectiveness of the interactive treatment modality with or without additional urinary incontinence clinical expertise delivered via telehealth in 62 primary care practices that treat women Veterans. Participating practices receive practice facilitation support, training, and health information technology assistance. Researchers explore women Veterans’ and clinicians’ perceptions of remote urinary incontinence treatment to advise future scalability. This grant is part of AHRQ’s EvidenceNOW: Managing Urinary Incontinence program.
(U18)
PI: Jennifer Tash Anger
Organization: University of California, San Diego
Grant Start Date: February 1, 2022
Aims to improve the quality of urinary incontinence care provided to a diverse population of women in primary care, with the goals of improving care and reducing the need for specialty care. Includes three Southern California medical groups (a total of 60 clinics) in a practice-based incontinence intervention led by a “clinical champion dyad” comprising a primary care clinician and a urologist/urogynecologist for each medical group. Includes clinician education and performance feedback, electronic decision support, patient education from dedicated advanced practice clinicians, and an electronic referral service. This grant is part of AHRQ’s EvidenceNOW: Managing Urinary Incontinence program.
Older Adults
Older adults are another Ƶpriority population established by the Healthcare Research and Quality Act of 1999 (Public Law 106-129).14 Older adults are expected to make up almost 25% of the U.S. population by 2060,(40) and often live with and manage multiple chronic conditions, leading to complex and costly healthcare needs that are often managed within a primary care setting. Ƶfunds several efforts related to the health of older adults. Go to Initiatives and Resources in Behavioral Health and Substance Use Disorders in Section 3 for information about recent Ƶresources for opioid use in older adults, including a compendium of resources for treating opioid use in older adults.
The list below shows the seven Ƶprimary care grants active in FYs 2023 and 2024 with a focus on older adults. These summaries first appeared across topic areas in Section 3, including two in Person-Centered Care, two in Digital Healthcare, one in Primary Care Workforce, one in Patient Safety, and one in Healthcare Systems and Infrastructure.
(R36)
PI: Amy L McMenamin
Organization: Columbia University Health Sciences
Grant Start Date: June 1, 2023
Assesses care environments for NPs to understand how primary care practices can support NPs providing complex care for people with multiple chronic conditions (MCCs), particularly in communities with low socioeconomic resources. Investigates the relationship between NP care environments (e.g., level of support for NP practice, collegiality between clinicians, and an organizational understanding of the NP role), community characteristics (i.e., socioeconomic resources and availability of primary care), and acute care utilization among older adults with MCCs.
(R21)
PIs: Zhe He; Mia Liza A. Lustria
Organization: Florida State University
Grant Start Date: April 1, 2024
Develops and evaluates LabGenie: a web-based patient engagement tool to help patients understand and act upon their lab results. LabGenie is particularly geared towards older adults, who face unique barriers to patient portals including low health literacy and technology skills. The project examines the potential impact of Lab Genie on clinical workflow and burden in primary care settings.
Learn more about this study in a Primary Care Research Profile: An AI-Powered Tool to Support Older Adults in Understanding Lab Test Results (LabGenie) (PDF, 284 KB).
(R21)
PI: Min Soon Kim
Organization: University of Missouri – Columbia
Grant Start Date: April 1, 2022
Develops an educational decision aid that enables older adults with diabetes to choose a strategy for diabetes self-management education and support that has the best potential to achieve clinical and health benefits for them. Refines and tests the decision aid for feasibility in primary care and diabetes specialty care settings and for preliminary outcomes.
(R18)
PIs: Ranjit Singh; Heui-Yen Chen; David Jacobs
Organization: State University of New York at Buffalo
Grant Start Date: September 1, 2023
Aims to develop a learning lab for older adult patients and caregivers to decrease risk for medication harm during transitions of care. The learning lab encourages patients and their caregivers to work with their healthcare team to achieve safer medication use during this vulnerable time, which leads to the design, development, and testing of scalable human-centered interventions across the transition of care continuum, including in primary care.
(R03)
PIs: Goutham Rao; Kelsey Ufholz
Organization: University Hospitals of Cleveland
Grant Start Date: September 1, 2023
Aims to develop a digital skills training intervention to prepare older, mostly African American adults with Type II diabetes to participate in and benefit from telemedicine appointments for primary care. Feedback is collected from patients who complete the training about their satisfaction with it and whether it helped them during their telemedicine appointment (if applicable).
(K08)
PI: Leslie Page Scheunemann
Organization: University of Pittsburgh at Pittsburgh
Grant Start Date: September 30, 2019
Tests a transitional care model, TeleRecovery, where a nurse practitioner and occupational therapist deliver telehealth-based rehabilitation services for older adults and their caregivers in rural areas after a transfer from the intensive care unit to home. The TeleRecovery teams work with home health providers to implement the patients’ care plans until they are well enough to be managed in primary care.
(R18)
PIs: David H. Gustafson; Marie-Louise Mares
Organization: University of Wisconsin – Madison
Grant Start Date: August 1, 2020
Implements a smart-system (a smart speaker plus visual display) version of an existing Elder Tree intervention—a program that supports the self-management of health for older adults with multiple chronic conditions who live independently and whose care is managed by primary care clinicians. This grant tests a smart-system version compared with the computer-based system on outcomes, including quality of life, hospital readmission, and medication adherence.
Learn more about this study in a recent Digital Healthcare Research webinar: .
Opioids
As a subset of the work on substance use disorders (SUDs) more broadly, Ƶfunds research on the treatment and prevention of opioid use disorder (OUD) and the use of opioids to treat chronic pain. Go to Initiatives and Resources in Behavioral Health and Substance Use Disorders in Section 3 for information about recent Ƶresources for opioid use in older adults, including a compendium of resources for treating opioid use in older adults, a topic brief on , andthe Impact Story: Increasing Access to Treatment for Opioid Use Disorder in Rural Communities Through a Virtual Clinician Training and Support Program (PDF, 477 KB).
The list below shows the five Ƶprimary care grants active in FYs 2023 and 2024 with a focus on opioids. These summaries first appeared across topic areas in Section 3, including three in Behavioral Health and Substance Use Disorders and two in Person-Centered Care.
(R18)
PIs: Neera Goyal; Vanessa L. Short
Organization: Nemours Children’s Hospital, Delaware
Grant Start Date: April 1, 2020
Looks at the use of comprehensive group well-child visits for mothers with opioid use disorder and their children. The group visits examined in this study allow for increased time with the pediatrician, peer-to-peer learning, and an enhanced focus on behavior change and self-care.
Learn more about this study in a recent NCEPCR webinar: Qualitative Methods Used in ƵFunded Primary Care Research.
(R01)
PI: Thomas C. Chelimsky
Organization: Virginia Commonwealth University
Grant Start Date: September 30, 2022
Looks at using a “biobehavioral” approach to treating chronic pain rather than a “biopharmacologic” approach. The biobehavioral approach treats chronic pain syndrome as a brain disorder that has been reinforced through negative cognitive, emotional, and behavioral habits. In a previous pilot study, the researchers demonstrated that primary care practitioners were eager to implement this new approach, and those who did so had increased confidence with chronic pain management, reduced visit times, and improved patient pain. The primary care practices in this study receive training from a paired psychologist and a physical therapist to build a clinical team. The study examines whether patient improvements can be sustained for 2 years and whether increased practitioner confidence leads to a tapering of prescribed opioids.
(R18)
PIs: Babak Tofighi; Helen-Maria Lekas; Crystal Fuller Lewis
Organization: Friends Research Institute, Inc.
Grant Start Date: September 30, 2023
Examines the effectiveness of a previously developed artificial intelligence (AI)–driven texting tool to facilitate buprenorphine treatment through primary care for Black and Latino people who use opioids. The tool uses natural language processing to facilitate real-time text responses to patient queries (without requiring real-time staff engagement), combined with automated texts. The study conducts a three-arm, comparative effectiveness trial comparing text-based care coordination for people who use opioids along with AI-driven social determinants of health (SDOH)-enhanced text messaging (intervention arm-1) vs. AI-driven SDOH-enhanced text messaging only (intervention arm-2) vs. usual care including printed social services and clinical referrals (usual care arm). The research team also conducts a comprehensive economic evaluation to compare the relative economic value of each approach.
This grant is part of the grant initiative.
(R01)
PI: Clarisa Wen-Ling Hsu
Organization: Kaiser Foundation Research Institute
Grant Start Date: June 1, 2022
Investigates the experiences of patients and primary care providers who have discontinued long-term opioid therapy (LTOT). Develops a patient-centered decision aid to improve patient-provider communication around discontinuation of LTOT and pilot tests the decision aid with patients.
(R18)
PIs: Ramzi George Salloum; Christopher Albert Harle
Organization: University of Florida
Grant Start Date: September 13, 2021
Develops and tests a clinical decision support tool to help primary care clinicians work with their patients to choose a pain treatment approach that best balances the potential risks and benefits for the individual patient. This tool helps to avoid inappropriate discontinuation of opioids for the patients for whom the benefits of opioids outweigh the risks.
