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AHRQ Annual Report on Research and Management, FY 2001

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AHRQ's Research Portfolio

The needs of AHRQ's customers drive the Agency's research agenda and provide the key to our success. We seek input from our customers in a variety of ways, including: the National Advisory Council, meetings with stakeholder groups, Federal Register notices, and through comments submitted by the public via the Agency's Web site (www.ahrq.gov).

AHRQ's research agenda is reflected in a variety of activities that together build the infrastructure, tools, and knowledge for measurable improvements in America's health care system. Researchers—including grantees, contractors, and intramural investigators—build on the foundation laid by biomedical science in determining which interventions can work under ideal circumstances. But knowing that these interventions work is only a first step. We also need to make sure that the interventions are used correctly to improve patients' health and that they are effective in everyday practice.

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Opportunities for Research

The mission of AHRQ could not be achieved without talented health services researchers who are dedicated to excellence in their own work and the work of their colleagues. They understand the importance of evidence to inform decisionmaking and improve health care quality. In addition to the researchers on AHRQ's staff, about three-quarters of the Agency's budget is awarded as grants and contracts to support the work of researchers at universities, in clinical sites such as hospitals and doctor's offices, and in research institutions.

AHRQ's research funds are awarded either through targeted announcements that address specific research questions or in response to ideas generated by researchers on significant issues in the health care system. Both of these mechanisms—targeted research requests and unsolicited investigator-initiated research proposals—are important and complementary. The Agency's targeted research initiatives respond to the specific needs of individual customers or the needs of the health care system as a whole, although researchers have latitude to design their own projects within the scope of a targeted request.

Unsolicited Research

The topics addressed by unsolicited investigator-initiated research proposals reflect timely issues and ideas from the top health services researchers. Forty-one percent of the grants and cooperative agreements funded by AHRQ in FY 2001 were initiated by individual investigators who developed research proposals within an area of interest to the Agency.

Usually, researchers develop their investigator-initiated proposals in response to program announcements (PAs) that broadly describe the Agency's areas of interest. A PA is a formal statement that invites applications on new or ongoing research topics, usually with multiple application receipt dates. AHRQ issued two new program announcements in FY 2001.

FY 2001 Program Announcements

  1. Impact of Payment and Organization on Cost, Quality, and Equity. Projects funded under this PA are examining the effects of payment and organizational structures and processes on the cost, quality, and equity of health care.
  2. Patient-Centered Care: Customizing Care to Meet Patients' Needs. Projects funded under this PA focus on design and evaluation of care processes to empower patients, improve patient-provider interaction, help patients and clinicians navigate through complicated health care systems, and improve access, quality, and outcomes.

Recent Investigator-Initiated Projects

In FY 2001, research funded through unsolicited investigator-initiated grants included many studies to help us understand and reduce costs, improve access to care, and identify ways to achieve better health outcomes.

  • Economic Analysis of Pulmonary Artery Catheter Use, University of Pittsburgh. The researchers are assessing patient costs and outcomes for two alternative approaches to diagnosing and managing acute respiratory distress syndrome and acute lung injury: the pulmonary artery catheter (PAC) and the central venous catheter (CVC).
  • Maine Lumbar Spine Study, Maine Medical Assessment Foundation. These researchers are assessing the long-term outcomes of surgical and nonsurgical treatment of two common lumbar spine conditions: herniated intervertebral disc and degenerative spinal stenosis. They will continue the followup of nearly 500 currently enrolled patients to 10 years from initial enrollment, with emphasis on costs to managed care and work-related outcomes, including disability compensation and work status.
  • U.S. Valuation of the EuroQol Group's EQ-5D, University of Arizona. Cost-effectiveness analysis (CEA) helps decisionmakers weigh the value of alternative health care investments. Despite the value of this approach when health care expenditures are rapidly increasing, the usefulness and comparability of CEAs are limited by the lack of nationally representative information about individuals' preferences for health outcomes. This study will obtain such preferences from a nationally representative sample of the U.S. population. The study population reflects the increasing demographic diversity of the U.S. population in the 21st century. The results of this project will help decisionmakers assess the costs and return on investment of promising new interventions.

Targeted Research Requests

In FY 2001, quality of care—and in particular patient safety—was the dominant priority for new research. AHRQ issued a series of solicitations in this area. These solicitations formed an integrated set of activities to design and test best practices for reducing errors in various settings of care, develop the science base to inform these efforts, improve provider education to reduce errors, capitalize on advances in information technology to translate proven effective strategies into widespread practice, and build the capacity to further reduce errors.

  • Supporting demonstration projects to report medical errors data. These activities include 24 projects for $24.7 million to study different methods of collecting data on errors or analyzing existing data to identify factors that put patients at risk of medical errors.
  • Using computers and information technology to prevent medical errors. These activities include 22 projects for $5.3 million. The researchers will develop and test the use of computers and information technology to reduce medical errors, improve patient safety, and improve quality of care.
  • Understanding the impact of working conditions on patient safety. These activities include eight projects for $3 million to examine how staffing, fatigue, stress, sleep deprivation, and other factors can lead to errors. These issues—which have been studied extensively in aviation, manufacturing, and other industries—have not be closely examined in health care settings. [Note: In all, AHRQ allocated about $10 million in FY 2001 to working conditions and health care quality.]
  • Developing innovative approaches to improving patient safety. These activities include 23 projects for $8 million to research and develop innovative approaches to improving patient safety at health care facilities and organizations in geographically diverse locations across the country.
  • Disseminating research results. These activities include seven projects for $2.4 million to help educate clinicians and others about the results of patient safety research. This work will help develop, demonstrate, and evaluate new approaches to improving provider education in order to reduce errors, such as applying new knowledge on patient safety to curricula development, continuing education, simulation models, and other provider training strategies.
  • Other patient safety research initiatives. These include 10 other projects for $6.4 million that will expand the evidence base on what works and doesn't work in improving safety; support meetings of State and local officials to advance local patient safety initiatives; help small businesses explore new products to help improve safety; assess the feasibility of implementing a patient safety improvement corps; and carry out other patient safety initiatives.

Examples of Targeted Research

  • Consumer Assessment of Health Plans II (CAHPS™ II). This request for applications (RFA), issued in late FY 2001, provides support for projects to expand CAHPS™ and enhance the usefulness of CAHPS products. Awards under this project are expected in spring 2002.
  • Research Infrastructure and Capacity. Nine projects were funded for nearly $3 million to build and strengthen the Nation's research infrastructure, particularly those entities that serve racial/ethnic minorities, and broaden the geographic distribution of health services research funding. The projects were funded under two AHRQ research infrastructure development initiatives announced in FY 2001:

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Building the Research Infrastructure

AHRQ contributes to excellence in health care delivery through research conducted by a cadre of well-trained and talented health services researchers. To maintain and nurture this vital resource, the Agency supports a variety of training and career development opportunities through individual and institutional grant programs. In FY 2001, AHRQ provided support for 232 trainees through these programs:

  • Dissertation research support.
  • Predoctoral fellowships for minority students.
  • National Research Service Awards (pre- and postdoctoral fellowships), including both institutional and individual programs.
  • Independent Scientist Awards (K awards).

Investing in development of the research infrastructure—including training of new investigators—is fundamental to producing the next generation of health services researchers. These investments also return a more immediate payoff in the form of high-quality research. The products and lessons learned from such research are useful to regional, State, and national decisionmakers in assessing the effectiveness of current programs and planning for future policies that address the costs and financing of health care, the use of health care services, and access to care across diverse regions and populations.

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Investments in Training

An integral component of AHRQ's training efforts is support for fellowships and dissertation research. Many trainees are focusing on issues related to managed care, Medicare and Medicaid, and health care costs, including the costs of prescription medicines. Examples of AHRQ-supported dissertation research and fellowships include:

  • Quality-adjusted cost functions for HMOs. This researcher is examining how the quality of services provided by HMOs affects the cost to enrollees and whether there are financial paybacks to organizations that invest in quality.
  • Impact of managed care on minority physicians and patients. This trainee is investigating the effects of managed care contracting on access to minority providers and the use of health services by minority patients, who tend to rely heavily on minority providers.
  • Effects of public insurance on dental health outcomes. This researcher is comparing children's dental health status and receipt of services through two State-sponsored programs in North Carolina: Health Choice, which provides dental services through the State's private Blue Cross/Blue Shield program, and the State Medicaid program. The goal is to determine the benefits of public dental insurance for low-income children when it is structured similar to private insurance.
  • Medical group response to HMO selective contracting. This trainee is focusing on managed care selective contracting and how it is affected by market power and State policies such as those broadening the rights of patients to choose their health care providers.
  • Effects of drug advertising on prescription choice. The goal of this study is to examine the effects of direct-to-consumer drug advertising on prescription drug choices and costs. The student hopes to determine the extent to which such advertising undermines insurers' efforts to induce price sensitivity in prescribing behavior.
  • Effects of WIC on children's Medicaid dental use and costs. This researcher is looking at the relationship between the Women, Infants, and Children Supplemental Food Program (WIC) on use of oral health care services and costs to the Medicaid program for children under 5 years of age.

Additional information on all of the Agency's funding opportunities—including an ongoing program announcement that describes the priorities for investigator-initiated research, targeted initiatives, and career-related grant programs—is available online.

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Partnerships and Coordination

Collaboration allows organizations to make progress and achieve results far beyond what they could do as individual groups. Two or more organizations can leverage their resources by working together on projects of mutual interest. AHRQ works in partnership with many other agencies and organizations to pool ideas and resources in research and dissemination. Our partner organizations include the various HHS agencies, other components of the Federal government, State and local governments, and private-sector organizations, all of whom help us achieve our goals.

Most of these partnerships are related to the development of new knowledge, development of tools and other decision-support mechanisms, and/or the translation of research findings into practice. Examples of this collaboration include efforts to:

  1. Develop new knowledge through research.
    • AHRQ co-funds individual research projects and sponsors joint research solicitations with other HHS agencies.
    • In FY 2001, AHRQ and the Kaiser Family Foundation completed a random national survey of more than 2,000 adults to determine how consumers judge health care quality. The survey, "Americans as Health Care Consumers: The role of Quality Information," was developed and sponsored jointly by AHRQ and the Kaiser Family Foundation.
  2. Develop tools, measures, and decision-support mechanisms.
    • Many agencies (e.g., the National Institutes of Health, the Centers for Medicare & Medicaid Services, and the Department of Veterans Affairs) are working closely with AHRQ's evidence-based practice centers (EPCs) to develop assessments of existing scientific evidence to guide their work.
    • Evidence reports prepared by AHRQ-supported EPCs are being used in the development of clinical practice guidelines by a number of private-sector organizations, including the American Psychiatric Association, the American Academy of Pediatrics, the American Heart Association, and many others.
  3. Translate research into practice.
    • A number of companies and organizations have joined AHRQ in disseminating smoking cessation materials. These include the American Cancer Society, the American Academy of Pediatrics, and the Michigan Department of Community Health.
  4. Coordinate patient safety activities.
    • In FY 2001, AHRQ joined other Department of Health and Human Services agencies as a member of the new HHS Patient Safety Task Force. The Federal agencies leading this effort include AHRQ, the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), and the Centers for Medicare & Medicaid Services (CMS). The goal is to work closely with the States and private sector in this effort and to improve existing systems to collect data on patient safety. The Patient Safety Task Force will study how to implement a user-friendly, Internet-based patient safety reporting format to enable faster cross-matching and electronic analysis of data and more rapid responses to patient safety problems.

Working in partnership:

  • HRSA and AARP partnered with AHRQ to develop the Put Prevention into Practice personal health guide for adults over 50.
  • The Healthcare Cost and Utilization Project (HCUP) is a long-standing public-private partnership between AHRQ and 25 partner States to build a multistate data system.
  • Thanks to partnerships between AHRQ and 14 companies/organizations (e.g., Midwest Business Group on Health, IBM, United Parcel Service, and others), we have been able to greatly enhance dissemination of our Quality Navigational Tool, a guidebook to help individuals apply research findings on quality measures and make major decisions about health plans, doctors, treatments, hospitals, and long-term care.

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