Improving the Health Care of Older Americans
A Report of the AHRQ Task Force on Aging
In this report, the Task Force on Aging provides a rationale for the Agency for Healthcare Research and quality (AHRQ) to develop, implement, and disseminate an agenda on health services research related to aging. The report recommends that AHRQ expand and sharpen its focus on aging issues in several specific areas.
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By Arlene Bierman, M.D., M.S., COER; William Spector, Ph.D., CODS (Co-Chairs); David Atkins, M.D., M.P.H, CPTA; Jayasree Basu, Ph.D., CPCR; Carolyn Clancy, M.D., COER; Marcy Gross, Women's Health Coordinator; Anne Lebbon, IOD; Linda Moody, Ph.D., CPCR; Jeffrey Rhoades, Ph.D., CCFS; Debbie Rothstein, Ph.D., ORREP; Judy Sangl, Sc.D., CQuIPS; Barbara Schone, Ph.D., CCFS; Christine Williams, M.Ed., OHCI
The Task Force on Aging was established in early 1999 by the Director of the Agency for Healthcare Research and Quality (AHRQ) to make recommendations on the appropriate role of AHRQ in aging-related health services research. The Task Force on Aging examined the Agency's intramural and extramural aging-related research portfolio. Over a period of several months, Task Force members also met and talked with staff working in other Federal agencies, professional societies, and foundations also supporting research on aging.
The Task Force focused on the need for evidence on cost-effective interventions that enhance health-related quality of life (HRQOL) by preventing disability, reducing functional decline, and extending active life expectancy in older adults. Accordingly, the Task Force focused on gaps in areas that influence the ability of health care services to improve functioning and HRQOL—costs, financing, barriers to access, organization and delivery of care, and clinical practice—as well as how these factors interact with individual patient characteristics and preferences, family, and the community.
This report summarizes the findings and recommendations of the Task Force and provides a rationale for developing, implementing, and disseminating an agenda on health services research related to aging. The report recommends that AHRQ expand and sharpen its focus on aging issues in several specific areas. It also underscores the need to strengthen the Agency's organization and resources for support of aging research in order to develop, coordinate, and disseminate a research agenda and the findings of this research.
An aging population, together with rising health care costs and rapid health system change, presents a major challenge in the delivery of health care to older Americans. Not only do the unique challenges in providing and financing health care services for older people require a targeted research focus, but aging-related research shares common issues with research in other areas (e.g., care for the chronically ill and disabled). Health services research is uniquely able to address the multiple factors that affect health outcomes in the elderly—comorbidity; patient beliefs, values, and preferences; social support; multiple sites and settings of care; and financial and policy factors. Aging-related health services research can provide answers to key questions about outcomes and effectiveness; cost, use, and access; and quality measurement and improvement for older people.
The Agency's mandate to study quality and outcomes uniquely positions AHRQ to provide answers to basic questions about health care for older people. AHRQ is the primary Federal agency that supports research on the health care system by focusing on the relationships among health policy, the organization and financing of health care services, clinical practice, patient preferences, and health outcomes. AHRQ's support of research on the cost-effectiveness of care for the elderly also positions the Agency for a leadership role in informing those health care discussions that may affect changes in health benefits and financing mechanisms, including those relating to the Medicare and Medicaid programs.
The Federal Government, as a principal payer for care for the elderly through these two programs, has a major stake in finding answers to policy questions that affect the quality and cost of health care for older people. AHRQ-supported research can help provide those answers.
Building a Research Agenda and Infrastructure
AHRQ's health services research agenda on aging should focus directly on answering the overarching question "What are the most effective and efficient means of providing health care to older people so that the end result is a measurable improvement in the health of this group?" Three key strategies can help provide the requisite knowledge to improve the health and functioning of older Americans:
- Finding new models of care—acute, preventive, chronic, rehabilitative, and long-term—for improving the organization, delivery, and primary care practice of health care for older persons.
- Aligning financial incentives and benefit decisions with desired clinical care and outcomes.
- Improving access to care and reducing health disparities related to income, education, race, ethnicity, and gender.
Creating and translating new knowledge into practice, as well as improving the uptake of what is already known about high quality care for older persons, remain key issues facing the health services research community and primary care providers. Successfully developing and implementing an aging-related research agenda depends as well on continued development of data that can be used to measure outcomes of care, use, and cost and on adequate training of the next generation of health services researchers to further advance research in this field.
To build and support the agenda outlined above, the Task Force recommended that AHRQ do the following:
- Designate older adults as a priority population.
- Undertake a major initiative to improve the health and health care of older Americans. Resulting research initiatives should aim especially to increase our knowledge about cost-effective interventions for an increasingly diverse older population and to identify strategies to assure that research findings are implemented in everyday practice.
- Continue a dialog with stakeholders, researchers, and other Federal agencies to further develop an agenda for aging research. A forum for long-term planning should be included.
- Build an infrastructure to foster the successful implementation of the Task Force recommendations. The quality and availability of needed data should also be enhanced by:
- Increasing the capacity AHRQ databases to answer aging-related questions.
- Seeking to facilitate access to other Federal data (e.g., Health Care Financing Administration [HCFA]).
- Developing partnerships with other Federal agencies, consumer and professional organizations, and private foundations to maximize resources for research, development of data and measures, and dissemination.
- Build the foundation for making aging health services research a long-term priority within AHRQ's current research initiatives. AHRQ's extramural research initiatives should, when appropriate, solicit research that addresses key questions specific to the needs of older people. AHRQ should also assure that selection of topics for the Evidence-based Practice Centers considers important health issues for the elderly population.
- Promote awareness of past agency accomplishments and current and future activities in aging-related research. This should include developing products on elderly health care research and incorporating aging-specific research into the AHRQ Internet site.