AHRQ Grants to Fund Analytics Efforts to Support SDOH, Whole-Person Care

March 22, 2019
Example: use of hot spotting methods to identify geographic areas of higher rates of uncontrolled diabetes

The Agency for Healthcare Research and Quality (AHRQ) is proposing to fund efforts to use data analytics to enable primary care providers to better prevent and manage chronic illness. The agency also is seeking to support public health and community organizations in using local social determinants of health (SDOH) information to address the health needs of at-risk individuals and communities.

AHRQ plans to offer up to $6 million in grant funding over 3 years to support up to three data analytics projects focused on primary care interventions and/or community interventions.

Grant winners will supply data analytics to providers of primary care, healthcare delivery systems, public health departments, and/or community organizations to help them address SDOH and contribute to the delivery of whole person, 360-degree care that meets physical, behavioral and oral health, as well as social services, needs, the agency said.

Priority populations include low-income groups, minority groups, women, children, the elderly, and individuals with special healthcare needs, including individuals with disabilities and individuals who need chronic care or end-of-life care.

For example, AHRQ noted, applicants could consider use of hot spotting methods to identify geographic areas of higher rates of uncontrolled diabetes that community planners could use to allocate outreach workers, develop safe exercise spaces, and introduce healthy eating education. Or they might discover a high prevalence of depression and poor eating habits among elderly women with residential and social isolation. Equipped with that data, community planners could develop recreational and nutritional outreach programs.

Another example of using data analytics to inform a community intervention would be a data platform that outreach workers, police, and the public could access with mobile devices to identify in real time available shelter beds, nearby food pantries, or other services to address SDOH. Data collected about inquiries that measured unmet needs could guide expansion plans for housing and hunger programs. Data on community levels of stress due to discrimination could inform the provision of cultural sensitivity training of police, case workers, and other service providers.

To foster enduring relationships between the grantee and stakeholders in the selected geographic region, AHRQ will require that applicants be located in same state as the geographic region they have selected. If a region crosses state borders, the applicant may be located in any of the area's states, as long as the portion of the area in that state is not trivial.

Grantees will be askedto create a dashboard view to present data analytics to stakeholders and/or integrate with existing information systems. For primary care interventions, applicants are encouraged to consider how such a data and analytic platform could interface with EHRs and/or registries already in use. (AHRQ's authorizing legislation does not allow for-profit organizations to be eligible to lead applications under this research mechanism.  For-profit organizations may participate in projects as members of consortia or as subcontractors only.)