NIH Guide: Notice of AHCPR Special Emphasis Area: Investigator-Initiated Grants
NIH Guide for Grants and Contracts, December 23, 1998
Agency for Health Care Policy and Research
The Agency for Health Care Policy and Research (AHCPR) announces that it has a special interest in health services research that will support improvements in outcomes of care provided to the elderly and those with chronic conditions. This special emphasis area is under AHCPR's program priority area, Improvements in Health Care Outcomes, within its ongoing its Health Services Research Program Announcement (PA 98-049, released March 26, 1998). This notice expands on that emphasis, with a particular focus on special populations, including members of racial and ethnic minorities, persons of low socioeconomic status and women. This special program emphasis invites investigator-initiated research projects that will:
- Focus on the relationship between processes and outcomes of care for older populations with one or more chronic conditions.
- Clarify which are the most effective interventions or components of programs intended to improve functional outcomes or prevent deterioration in functional status in older people with chronic illness.
- Assess the effect of co-existing illness on clinical management, patient decision-making and preferences for care, and health outcomes.
- Clarify the comparative effectiveness and cost-effectiveness of alternative strategies, with a specific focus on combined clinical and organizational interventions such as disease-management programs, patient self-management programs, group visits, and efforts led by multidisciplinary teams, to improve outcomes in older people with chronic conditions.
Also of interest are research or demonstration programs that facilitate the assessment of function and the use of patient-reported outcome measures for older populations with chronic illness in routine practice, as well as assessments of the extent to which patients and clinicians agree on outcomes of care. Studies conducted in ambulatory care settings or that assess episodes of care involving transitions in settings of care are of particular interest.
Methodologic challenges in this priority area include approaches for assessing comorbidity in ambulatory care; theoretical and conceptual approaches for identifying general factors and specific models of care delivery that improve outcomes; and the utility of different approaches for estimating disease burden.
Investigator-initiated applications addressing these issues should be submitted on the research application form PHS-398 (rev. 4/98) in accordance with the standard receipt dates in the application materials.
AHCPR has previously supported a large portfolio of research that has examined the relationship between processes of care and outcomes, including functional status, quality of life, patient satisfaction and costs, in addition to morbidity and mortality. An assessment of the first decade of this research has demonstrated substantial advances in information available to enhance patient outcomes, but substantial opportunities for translating the fruits of these studies into practice remain ("The Outcome of Outcomes Research at the Agency for Health care Policy and Research", internal AHCPR document). We now know that evidence about which interventions are most effective is necessary but not sufficient. Improved knowledge must be linked with supportive practice environments and incentives for change for the majority of patients to benefit.
Research to date has also described patterns of care for members of racial and ethnic minorities, those of lower socioeconomic status and women suggesting that these individuals receive less care than majority populations in multiple clinical domains. Research that identifies strategies for addressing inappropriate practice variations associated with race/ethnicity, gender or socioeconomic status to inform interventions for improving outcomes has not been a dominant area of inquiry. In addition, much prior research on the outcomes and effectiveness of alternative interventions has addressed medical practices but has not focused on the interaction between clinical interventions and practice or organizational characteristics (including incentives, type of practitioner, and market characteristics), nor has it examined the specific components of treatments or programs that require the involvement of multiple health professionals.
Information on AHCPR's outcomes research program is available online. Copies of the draft report, "The Outcomes of Outcomes Research at AHCPR," can be obtained by calling Joanne Book at: (301) 427-1488.
AHCPR welcomes the opportunity to clarify issues or questions about this Notice. Programmatic questions may be directed to:
Debbie Rothstein, Ph.D.
Office of Extramural Research, Education and Priority Populations
Agency for Healthcare Research and Quality
540 Gaither Road, Suite 2000
Rockville, MD 20850
Telephone: (301) 427-1525