| AHRQ Annual Report on Research and Management, FY 2002
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AHRQ's Research Portfolio
The Agency's research agenda is user- or customer-driven; that is, the needs of AHRQ's customers determine our research priorities and are pivotal to our success. We ask for and receive input from our customers through various means, 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 (http://www.ahrq.gov).
The Agency carries out a variety of activities to accomplish its research mission. Together, these activities 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 researchers who have determined which interventions can work under ideal circumstances. But knowing that these interventions work is only a first step. We also need to know in which circumstances they work, for whom they work and don't work, and other critical information 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
Talented and imaginative health services researchers are a critical component of our work at AHRQ. They are essential to our ability to pursue and fulfill the agency's mission. These researchers are dedicated to excellence in their own work, and they collaborate with other researchers and health care decisionmakers so they can address relevant research questions and ensure that the findings are translated as improvements in health care. 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 settings such as hospitals and doctor's offices, and in health care organizations. See appendix D for more information on AHRQ's research cycle.
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Unique AHRQ Research Investments
In FY 2002, quality of care, practice-based research, disparities, and research on pharmaceuticals and other therapeutics were priorities for new research. AHRQ issued solicitations in these and several other areas, as follows:
- Partnerships for Quality. This initiative is designed to accelerate the pace with which research findings are translated into improved quality of care and the health care system's ability to deliver care. The goal is to support models or prototypes of change led by organizations or groups with the immediate capacity to influence the organization and delivery of health care, as well as measure and evaluate the impact of their improvement efforts. In FY 2002, 24 partnership grants totaling $2.357 million were funded under this announcement.
- National Research Service Awards. Institutional Training Grants. Believing that tomorrow's health care quality is achieved through an investment in educational excellence today, AHRQ is firmly committed to building a strong, visible infrastructure for the conduct of future health services research through support of a network of NRSA institutional training programs located throughout the country. Funds are provided to support approximately 150 clinical and nonclinical predoctoral and postdoctoral students annually in order to equip them with the necessary knowledge, skills, and experiences to conduct health services research that will meet the needs of patients, providers, plans, purchasers, and policymakers. The awards allow scholars to gain the necessary methodological and substantive multidisciplinary expertise required to address critical issues facing the Nation's health care system, including patient safety and the delivery of cost-effective care.
Primary Care Practice-Based Research Networks. The goal of these developmental/exploratory grants is to assist new or established primary care Practice-Based Research Networks (PBRNs) to enhance their capacity to conduct research and translate research findings into practice. A PBRN is a group of ambulatory practices devoted principally to providing primary care to patients that are affiliated with each other (and often with an academic or professional organization) in order to investigate questions related to community-based practice. AHRQ funded 36 PBRNs in FY 2002, totaling over $3 million in the first year and $6 million over 3 years. Although headquartered in 25 States, the networks receiving grants include primary care practices in all 50 States and the District of Columbia. Many of the practices serve minority and low-income patients, as well as patients in underserved rural and urban locations.
Select for map showing grants awarded for Practice-Based research Networks (PBRNs)
- Changing Practices, Changing Lives. This announcement was issued by AHRQ in partnership with the Bureau of Primary Health Care, Health Resources and Services Administration (HRSA) to support assessments of the HRSA-sponsored Health Disparities Collaboratives, which were initiated in 1998 and represent a major sustained effort to enhance the quality of care provided through HRSA's community health centers and ultimately improve the outcomes of underserved people. The results of this initiative will assure that newly established Community Health Centers can incorporate successful components of programs to improve quality and reduce disparities in health care from the outset. AHRQ and HRSA funded two projects in FY 2002 totaling $1.24 million as a result of this announcement.
- Rewarding Results. This announcement provided support for a comprehensive evaluation and analysis of demonstration projects supported under the "Rewarding Results" initiative, which is being funded by AHRQ, the Robert Wood Johnson Foundation, and several other funding and technical assistance partners. The program is intended to develop, evaluate, and translate innovations in systems of provider payments and nonfinancial incentives that encourage and reward high-quality care.
Examples of Current Projects
The following summaries are representative of projects funded in FY 2002 that are focused on well-defined research areas or topics.
- Closing the Gap: Partnering for Change. The ACP-ASIM, the national organization for 100,000 of the nation's internists, is leading a project to test a team-oriented, multifaceted continuing education intervention strategy that will target improvements in care for patients with type 2 diabetes. The project includes 34 large, multiphysician internal medicine practices in two States. The project involves national medical and nursing societies, health plans, volunteer organizations, and other key stakeholders, as well as physicians, nurses, and administrators who interact directly with patients in the practices.
- Outcomes, Incentives, and Improvements in Collaboratives. In 1998, the Health Resources and Services Administration began a major 6-year effort designed to reduce health disparities and improve the quality of care in health centers. This project involves 200 health centers in the Midwest and West Central regions of the country. The goals are to (1) determine if the Health Disparities Collaboratives (HDCs) have improved quality and reduced disparities in the care and outcomes of patients over the 6-year span of the initiative; (2) identify ways to enhance the effectiveness, sustainability, and spread of the HDCs; and (3) evaluate the costs and cost-effectiveness of the HDCs to determine whether they are financially viable from health center and societal perspectives.
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Innovative Research: Addressing Current and Emerging Challenges
The topics addressed by innovative research proposals reflect timely issues and ideas from the top health services researchers. Forty percent of the large grants and cooperative agreements funded by AHRQ in FY 2002 were initiated by individual investigators who developed research proposals within an area of interest to the Agency.
A program announcement (PA) is a formal statement that clarifies priorities and encourages applications on new research topics.
FY 2002 Program Priorities
- Translating Research into Practice. Projects funded under this PA, which was issued jointly by AHRQ, the Department of Veterans Affairs, and the National Institutes of Health, are conducting innovative and rigorous research and evaluation projects related to the translation of research findings into measurable improvements in quality, patient safety, health care outcomes, and costs, use of services, and access to care. Two specific priorities are to: one, compare the use of interventions to translate research into practice across different health care systems; and two, measure the impact of translation activities, including the testing of interventions that foster measurable and sustainable improvements in quality and safety or consistent quality and patient safety at a lower cost.
- Patient-Centered Care: Customizing Care to Meet Patients' Needs. These projects 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.
- Impact of Payment and Organization on Cost, Quality, and Equity. Many health care leaders have concluded that the chasm between the level of quality that could be provided and that which is provided to most people is attributable to a lack of incentives and rewards, as well as inattention to organizational factors that make doing the right thing the easy thing to do. These projects focus on the effects of payment and organizational structures and processes on the cost, quality, and equity of health care.
Selected Examples of Recently Funded Projects
- Applied Regionalization of Emergency Care. These University of Pennsylvania researchers are developing an innovative mathematical tool to guide health planners in maximizing access to their State's emergency medical services systems. They will build on a related tool, the Trauma Resource Allocation Model for Ambulances and Hospitals (TRAMAH), which was developed with support from AHRQ. TRAMAH can be used to locate both trauma centers and helicopter depots for State trauma care systems. This new project will augment TRAMAH by adding hospital volume constraints. The researchers will apply the new model to 12 State trauma care systems and compare the States with each other to assess the model's flexibility as a tool for future trauma systems planning and evaluation. Based on the remote geography and general lack of access to trauma centers, the new model will greatly benefit rural and frontier areas by creating more efficient trauma care systems.
- Impact of Risk Talks on Patient Colorectal Screening. These researchers are testing the usefulness of a physician or staff-initiated discussion of personalized patient risk information for cancer on patient compliance for colorectal cancer screening (fecal occult blood test, FOBT; sigmoidoscopy or colonoscopy, if indicated) within 3 months of intervention. This project will be implemented in Arizona's most populous county within the indigent health care system to reach a high proportion of underserved, often minority, patients.
- Vaginal Birth After Cesarean Section: Linking Hospital and Clinical Factors to Outcomes. VBAC is a common indicator used to monitor maternal health care quality and hospital performance. There is marked variation in VBAC rates, yet little is known about the specific hospital organizational factors and clinical factors associated with labor and delivery that contribute to this variation. These researchers are identifying and characterizing the specific factors associated with safe VBAC rates for both mothers and babies. The goal is to assess the relationship of hospital-specific organizational factors and labor and delivery clinical policies with use of VBAC (primary study outcomes: repeat cesarean, attempted VBAC, and successful VBAC) and with maternal and neonatal outcomes among women with a history of prior cesarean delivering in California hospitals during the study period. The researchers hypothesize that hospital-specific organizational and clinical factors vary among hospitals in California, and that these factors are related to VBAC outcomes. By linking hospital organizational factors and clinical polices to patient outcomes, this information could serve as the basis for the development of evidence-based policy recommendations regarding "best practices" to promote safe VBAC use in different hospital settings.
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Building the Research Infrastructure
We continue to benefit from the efforts of a national cadre of well-trained, talented, and energetic health services researchers. One way that AHRQ contributes to excellence in health care delivery is by providing support to maintain and nurture this vital resource.
AHRQ believes that future improvements in health care depend in large part on the investments we make today in the research infrastructure. 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 findings that accrue naturally as a result of the training process. 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.
The agency supports a variety of training and career development opportunities through individual and institutional grant programs. In FY 2002, AHRQ provided support for 216 trainees and new investigators through these programs:
- Dissertation research support.
- Kerr White Visiting Scholars Program.
- Predoctoral fellowships for minority students.
- National Research Service Awards (pre- and postdoctoral fellowships), including both individual and institutional programs.
- Career development awards (K awards).
- Building Research Infrastructure and Capacity (BRIC) awards.
- Minority Research Infrastructure Support Program (M-RISP) awards.
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Investments in Training
The following examples illustrate the types of projects AHRQ has funded under the BRIC and M-RISP initiatives.
- Effects of sleep loss and night work on patient safety. This project is focused on the impact of sleep deprivation and night work on patient safety. Using comprehensive error-detection methods for the measurement of sleep, the researchers are quantifying the roles of time of day, time on duty, and sleep inertia in the occurrence of medical errors.
- Doctor-patient communication and antibiotic over-prescribing. The focus of this project is the role of doctor-parent communication as a determinant of both inappropriate antibiotic prescribing for respiratory infections in children and parents' satisfaction with care. Data have been collected from 38 pediatricians working in 27 clinical sites and from parents whose children have experienced an upper respiratory illness.
- Quality of diabetes care in the primary care setting. These researchers are building on previously completed projects that focus on barriers to diabetes care in family physicians' offices to examine the processes and quality of diabetes care within primary care practice.
- Cost-effectiveness of domestic violence interventions. This project is focused on domestic violence intervention in primary care practice, including the effectiveness of domestic violence intervention components, cost-benefit analysis, and monitoring of outcomes with a longitudinal cohort study.
- Center for Minority Health Services Research. The goal of this project is to establish the Center for Minority Health Services Research at Howard University. The center will significantly expand the health services research and outcomes research capacity of Howard University's Colleges of Pharmacy and Nursing and Allied Health Sciences. A research focus of this M-RISP program will be pharmaceutical outcomes research. One study will assess the usefulness and validity of the Medical Expenditure Panel Survey (MEPS) database in the analysis of HIV diagnosis and treatment data.
- Minority Elderly Research Center. The goal of this Shaw University project is to establish the infrastructure to support junior level faculty to conduct health services research on racial disparities among various minority populations, with a focus on the elderly population. For example, one study will assess whether physician workforce transitions affect certain groups of elders by limiting their opportunity to receive continuous primary care over time from the same physician. The project is providing training, resources, and mentoring opportunities through collaborative linkages with senior investigators at other universities.
- Clinical Faculty Research Training Program. The goal of this program at Morehouse School of Medicine is to enhance the capacity of individual faculty members to conduct health services research aimed at eliminating racial/ethnic health disparities and improving the quality of health care services for blacks and other vulnerable populations. One study will evaluate the impact of a provider-based intervention on immunization levels among low-income preschool-aged children enrolled in Medicaid.
Please visit the agency's Web site at http://www.ahrq.gov for more information on all of the Agency's funding opportunities, including an ongoing program announcement that describes the priorities for research and career-related grant programs.
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