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AHCPR invites suggestions for outcomes/effectiveness
The Agency for Health Care Policy and Research has begun the
process of identifying topics and setting priorities for its
outcomes and effectiveness research program. This program focuses
on the prevention, diagnosis, treatment, and/or management of
common diseases and clinical conditions.
Outcomes and effectiveness research encompasses three main areas
of emphasis: 1) determination of the clinical interventions that
are most effective, cost effective, and appropriate; 2)
development of methods and data to advance effectiveness
research; and 3) dissemination of research findings and
evaluation of their impact on clinical practice and outcomes. The
program focuses on conditions that meet the following criteria:
- Have a high incidence or prevalence in the general
population or major population subgroups.
- Involve controversy or uncertainty about the effectiveness of
available clinical strategies.
- Result in high health care costs.
- Have an impact on the Medicare and Medicaid programs.
- Lend themselves to study because data are available or can
be readily developed.
All outcomes and effectiveness research is expected to be: 1)
generalizable—concerned with the outcomes that can be
expected in typical patients; 2) practical—address questions
that have high clinical and policy significance with a design
that takes into consideration the eventual implementation of
findings; 3) patient-centered—evaluate health care in terms
of outcomes that emphasize the patient's experience and
perspective; and 4) multidisciplinary—involve teams of
researchers who bring together the knowledge and expertise of
both the clinical and social sciences.
Since 1989, AHCPR has supported significant advances in medical
effectiveness research, especially through its Patient Outcomes
Research Teams (PORTs). PORTs are large-scale, 5-year studies
designed to determine "what works best" in clinical treatment for
common diseases and conditions. Examples of clinical conditions
previously addressed include: ischemic heart disease, low back
pain, cataracts, and stroke prevention.
In 1993, AHCPR introduced a new generation of PORT research,
known as PORT II. Like the original PORTs, PORT II projects are
pragmatic, methodologically sophisticated, multidisciplinary and
focus on patient outcomes for common clinical problems. However,
they differ from the original PORTs by their individualized
research strategies and their expected impact on clinical
practice, patient outcomes, and health care policy. PORT IIs
focus on the establishment of direct linkages between practice
and outcomes and on research methods that facilitate direct
comparisons of two or more distinct clinical strategies. Examples
of clinical conditions previously addressed include: localized
breast cancer, cardiac arrhythmia, and prostate disease.
AHCPR has initiated a three-stage process to identify and
prioritize topics for future outcomes and effectiveness research:
1) develop a preliminary list of priority topics and reasons for
importance; 2) convene an expert panel to review and assess the
preliminary research priorities and suggested criteria; and 3)
identify which topic areas can be addressed most appropriately
using outcomes and effectiveness research methods.
AHCPR invites suggestions of topics and priorities from health
care providers, insurers, health-related societies, consumers,
and others. Nominees should provide a clear rationale and
supporting evidence for the importance and clinical relevance of
their suggested topic. Suggestions must be received by July 29,
1996. Responses and programmatic inquiries should be directed
to: Carolyn Clancy, M.D., Acting Director,
Center for Outcomes and Effectiveness Research, (301) 427-1600.
AHCPR will not reply to individual responses but will
consider all submissions in developing the research priorities.
This request for suggestions on future research topics was
published in the Federal Register on May 28, 1996.
Emphasis areas identified for AHCPR's small grant
The Agency for Health Care Policy and Research has announced a
special emphasis area under its ongoing Small Project Grant
Program. AHCPR and the Robert Wood Johnson Foundation (RWJ) are
entering a partnership to cosponsor this special initiative for
funding projects that involve collaboration between medical and
public health organizations. (Select PA PAR-96-028 published in the
NIH Guide for Grants and Contracts, February 23, 1996.) To
facilitate this partnership initiative, a single one-time receipt
date of July 31, 1996, has been established.
This activity is intended to advance and continue the work of the
national Medicine/Public Health Initiative. The purpose is to
create an ongoing working partnership between the two professions
to improve the health and health care of the American people. A
conference held in March 1996, "National Congress: Medicine and
Public Health Initiative," yielded recommendations for potential
new collaborative activities, such as this special emphasis area.
A copy of the conference summary can be obtained by contacting
Stanley J. Reiser, M.D., M.P.A., Ph.D., at (713) 792-5140.
AHCPR's special program emphasis under this initiative is for
research and demonstration grants facilitating medicine and
public health collaboration in health services research or
demonstrations. Of particular interest are projects focused on
addressing the health needs of populations through enhanced
cooperation between medical practitioners, public health
entities, and health care delivery organizations. Meritorious
applications will be funded under the AHCPR Small Project Grant
RWJ plans to fund separately small project and conference grants
under this initiative that facilitate convening key stakeholders
within a community to promote collaboration between medical and
public health organizations.
It should be noted that because of limited funding for these
special emphasis small grants, AHCPR expects to limit individual
awards to up to $25,000 for direct costs, with approximately four
to five awards. RWJ expects to limit awards to less than $20,000
in total costs, with approximately five to six awards. RWJ's
policies for funding of indirect costs differ from AHCPR/HHS
policies. For information on RWJ's indirect cost policies,
contact Stanley J. Reiser, M.D., M.P.A., Ph.D. (see inquiries
Applications for Research and Demonstration Grants under this
initiative involving medicine and public health collaboration in
health services research should be submitted to AHCPR no later
than July 31 to: Office of Scientific Affairs, Attention:
Medicine/Public Health Initiative, Small Project Grants, Suite
400, 2101 East Jefferson Street, Rockville, MD 20852.
Applications submitted to AHCPR will be reviewed in accordance
with ongoing AHCPR Small Project Grant review criteria and
procedures, and grants will be administered in accordance with
AHCPR and HHS grants policies.
Applications for RWJ funding for project and conference grants
addressing RWJ interests should be submitted no later than July
31, to: Stanley J. Reiser, M.D., M.P.A., Ph.D., Program on
Humanities and Technology in Health Care, University of Texas,
6431 Fannin, P.O. Box 20708, Houston, TX 77225.
Applications submitted for RWJ funding will be reviewed in
accordance with RWJ procedures for grants review and will be
administered in accordance with RWJ grants policies and
procedures. Although investigators may apply to both AHCPR and
RWJ, they are encouraged to focus on only one topic and select
one or the other potential funding source, depending on the topic
selected. Applications submitted for this initiative will not be
funded jointly by AHCPR and RWJ. AHCPR and RWJ intend to operate
separate, parallel review processes and to share funding
decisions prior to awards to avoid duplicative funding.
Investigators will be asked to provide a signed statement
specifically authorizing the sharing of applications and, as
applicable, summary statements of initial reviews, between AHCPR
For AHCPR application materials, contact the AHCPR Publications Clearinghouse
Programmatic inquiries should be directed to Carolyn M. Clancy,
M.D., Director, Center for Primary Care Research, AHCPR, (301) 427-1600.
For information about RWJ application procedures and specific
questions about this initiative, contact the RWJ designated
representative, Stanley J. Reiser, M.D., M.P.A., Ph.D., (713)
AHCPR to support new quality measurement network
The Agency for Health Care Policy and Research is accepting
proposals to create a new national resource for quality
measurement. The project, to be called the Quality Measurement
Network (QMNet), ultimately may aid in the creation of a
free-standing quality network. The purpose of QMNet is to further
the state of the art in clinical performance measurement and to
assist clinicians, quality improvement managers, health care
administrators, health plans, and purchasers in identifying and
using clinical performance measures.
According to AHCPR's Administrator Clifton R. Gaus, Sc.D., the
goal is for QMNet to become a comprehensive, publicly accessible,
quality measurement resource to help both public and private
sector efforts to improve the quality of health care.
QMNet will focus on maximizing the capabilities of CONQUEST 1.0
(the Computerized Needs-Oriented Quality Measurement Evaluation
System), a landmark computer tool designed to make it easier for
health plans, providers, and purchasers to identify, choose, and
use clinical performance measures.
Editor's Note: See CONQUEST 1.0 for more
Through the advice of an expert panel, the QMNet contractor will
examine and evaluate the framework of CONQUEST 1.0, modifying and
expanding it where necessary and appropriate to improve its
clinical relevance and value. The contractor also will develop a
feasibility study for transforming QMNet into a self-supporting
entity at the end of the contract period.
This solicitation was published in the May 14 Commerce Business
Daily and was released May 29, 1996. The closing date for
proposals is July 15, 1996.
AHCPR funds new projects
The Agency for Health Care Policy and Research has awarded new
research and conference grants, as described below. Please note
that investigators generally do not publish findings until a
study has ended or is nearing completion.
AHCPR UI guideline: Application in nursing homes
Prin. investigator: Nancy M. Watson, Ph.D.
Organization: University of Rochester,
Project no: AHCPR grant HS08491
Period: 6/1/96 to 5/31/99
First year funding: $201,635
Facilitating home care of neonatal chronic lung
Prin. investigator: Thomas M. O'Shea, M.D.
Organization: Bowman Gray School of Medicine,
Project no: AHCPR grant HS07928
Period: 7/1/96 to 6/30/01
First year funding: $266,967
Right heart catheterization: Appropriate/effective use
Prin. investigator: Alfred F. Connors, M.D.
Organization: Case Western Reserve University,
Project no: AHCPR grant HS08354
Period: 7/1/96 to 6/30/98
First year funding: $372,595
Selective cervical spine radiography in blunt trauma
Prin. investigator: William R. Mower, M.D.
Organization: University of California, Los Angeles,
Los Angeles, CA
Project no: AHCPR grant HS08239
Period: 8/1/96 to 7/31/98
First year funding: $621,570
Superspecialization of medical and surgical
Prin. investigator: Jose Escarce, M.D.
Organization: University of Pennsylvania,
Project no: AHCPR grant HS08573
Period: 6/1/96 to 5/31/98
First year funding: $271,721
Understanding health values of HIV-infected patients
Prin. investigator: Joel Tsevat, M.D.
Organization: University of Cincinnati,
Project no: AHCPR grant HS09103
Period: 9/1/96 to 8/31/97
Assessing pediatric quality of life in a clinical
Prin. investigator: Robert D. Annett, Ph.D.
Organization: University of New Mexico,
Project no: AHCPR grant HS09123
Period: 6/1/96 to 5/31/98
First year funding: $36,329
Child health services research
Prin. investigator: Christopher B. Forrest, M.D.,Ph.D.
Organization: Johns Hopkins School of Hygiene
and Public Health,
Project no: AHCPR grant HS09320
Period: 5/1/96 to 4/30/97
HMO research network national conference
Prin. investigator: Andrew F. Nelson, M.P.H.
Organization: Group Health Foundation,
Project no: AHCPR grant HS09319
Period: 5/1/96 to 4/30/97
Medicine/public health initiative
Prin. investigator: Stanley J. Reiser, M.D., Ph.D.
Organization: University of Texas,
Project no: AHCPR grant HS09252
Period: 3/1/96 to 2/28/97
Public-private health care purchasing partnerships
Prin. investigator: James D. Mortimer, B.A.
Organization: Midwest Business Group on Health,
Project no: AHCPR grant HS09292
Period: 5/1/96 to 4/30/97
Second annual NRSA training meeting, 1996
Prin. investigator: Kevin A. Schulman, M.D.
Organization: Georgetown University,
Project no: AHCPR grant HS09289
Period: 5/1/96 to 4/30/97
New publications available from NTIS
The following final reports of research projects funded by AHCPR
are now available from the National Technical Information Service
Refer to the NTIS accession number when ordering.
Impact of Program Eligibility Criteria on Recipient Access and
Continuity of Care: Experience of the MaineCare and Washington
Basic Health Plans. AHCPR grant HS08448, 8/1/94 to 12/31/95.
Elizabeth Kilbreth, M.S., Brandeis University, Waltham, MA.
This study compared a subsidized small business health insurance
initiative and an income-eligibility family coverage initiative
with regard to their impact on the scope of medical indigence in
the respective States. Participant survey information was used to
develop enrollment profiles for each program. Multinomial logit
models were used to identify enrollee characteristics predictive
of return to uninsured status and link disenrollment dynamics to
program eligibility criteria.
Findings were that program eligibility criteria strongly
influenced both enrollment and involuntary disenrollment. The
individual income-based plan reached a far more heterogeneous
uninsured population and had higher rates of enrollment than the
small employer-based plan. Rates of involuntary disenrollment
were proportionately much higher in the small business initiative
plan and resulted in a return to uninsured status among
approximately half of disenrollees (compared with 19 percent in
the individual plan). Job change and family labor force
characteristics were the factors that determined enrollment
disposition in both programs. The enrollment success of the
income-based program helped build political momentum in the host
State for passage of a comprehensive reform measure, but the
small business initiative failed to generate support among
business interest groups for broader government intervention in
health policy. (Abstract, executive summary, and final report of
dissertation; NTIS accession no. PB96-159884, 244 pp; $44.00
paper, $19.50 microfiche)
Nursing Home Policy via Hierarchical Duration. AHCPR grant
HS07306, 7/1/92 to 6/30/95. Carl N. Morris, Ph.D., Harvard
Medical School, Boston, MA.
The primary goal of this study was to develop and apply
statistical methods for estimation of duration (survival) times
in nursing home lengths of stay and in other relevant health
policy applications. Improved statistical analyses of duration
data have increased understanding of nursing home spend-down and
of the long-term care demands on Medicaid resources.
Additionally, the methods developed in this study expand the set
of policy questions that can be answered in other settings where
problems of length-of-stay bias, multiple outcomes,
heterogeneity, and censoring occur. (Abstract, executive summary,
and final report; NTIS accession no. PB96-166327, 25 pp; $19.50
Predictions and Outcomes in Congestive Heart Failure.
AHCPR grant HS06274, 4/1/90 to 3/31/95. Wally R. Smith, M.D.,
Virginia Commonwealth University, Richmond, VA.
Little is known about how well physicians make triage decisions
about which patients should be admitted to the intensive care
unit (ICU). Current guidelines suggest physicians faced with
triage decisions should estimate the probability that their
patients will soon develop severe complications, as well as the
patients' comparative survival probabilities. This unique cohort
study followed patients with new and existing congestive heart
failure (CHF) seen initially in the emergency room. All patients
were followed, whether admitted to the ICU, a regular hospital
unit, or discharged home. Physicians were asked to predict their
patients' outcomes. Measurements included the quality of
physicians' judgments of the probability of CHF complications in
their patients at 4 days and survival at 90 days and 1 year, as
well as the development and validation of predictive models of
these outcomes. The prevalence of complications at 4 days was low
(4.3 percent). Physicians were only moderately able to predict
complications and/or survival. Models of 90-day and 1-year
survival based on traditionally used variables, and those based
on "off-the-shelf" models of ICU survival, performed no better or
only marginally better than the physicians. The difficulty
physicians and current predictive models have in distinguishing
which patients may experience poor short-term CHF outcomes
suggests that utilization of ICU resources may not be improved by
applying current guidelines. (Abstract, executive summary, and
final report; NTIS accession no. PB96-163951, 70 pp; $21.50
paper, $10.00 microfiche)
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