[Federal Register Volume 67, Number 131 (Tuesday, July 9, 2002)]
[Notices]
[Pages 45514-45517]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 02-17063]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Agency for Healthcare Research and Quality
Request for Planning Ideas
AGENCY: Agency for Healthcare Research and Quality, HHS
ACTION: Notice.
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SUMMARY: The Agency for Healthcare Research and Quality (AHRQ) invites
recommendations for future initiatives in areas identified as
priorities in the Agency's current strategic plan which can be viewed
at http://www.AHRQ.gov/about/stratpln.htm. This plan describes the
framework that the Agency will use to guide the development and
implementation of budget proposals for Fiscal Years 2004 and 2005 as
well as decisions on resource allocations for research, translation
(including tool development), dissemination, and evaluation activities
that will facilitate the implementation of research findings at all
levels of the health care system.
Nature of Recommendations
AHRQ encourages written suggestions from users of AHRQ research
information and stakeholders for future Agency activities. Submissions
should provide the following:
A description of the focus of the activity and its
alignment with Agency priorities;
The gap addressed by the proposal;
The population addressed by the activity;
An indication of the health care issues that are of most
concern for the proponent (of the activity);
Background information to help AHRQ assess the urgency of
the need for the results of the proposed projects (i.e., realizing that
projects undertaken by the Agency will take a year [minimally] to
begin, what is the magnitude of the problem addressed, how soon could
the results be implemented, and what change would be anticipated);
An estimate of the budget required to adequately address
the proposed activity;
Potential partners for the Agency; and
A description of the desired end product(s) (research
knowledge; information; tools such as instruments for measurements,
databases, informatics, and other applications that can be used to
assess and improve care; or systems intervention) and how the product
could be used in the health care system.
One of the criteria that will be used in prioritizing suggestions
submitted will be the extend to which customers and stakeholders can
point to examples of how prior results of the Agency's work have been
used to improve health care as well as the impact of this use on
quality, outcomes, costs, use or access.
DATES: The responses to this request will be accepted on an ongoing
basis.
ADDRESSES: Submissions should be brief (no more than three pages) and
may be in the form of a letter, preferably with an electronic file in a
standard word processing format on a 3\1/2\ floppy disk,
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or via e-mail. Responses to this request should be submitted to: Kathie
Kendrick, Planning Officer, Agency for Healthcare Research and Quality,
2101 E. Jefferson Street, Suite 600, Rockville, Maryland 20852,
[email protected].
In order to facilitate the handling of submissions, please include
full information about the person submitting the recommendation: (a)
Name, (b) title, (c) organization, (d) mailing address, (e) telephone
number, and (f) e-mail address. Please do not use acronyms. Electronic
submissions are also encouraged to [email protected].
All responses will be available for public inspection at AHRQ's
Immediate Office of the Director, weekdays between 8:30 a.m. and 5 p.m.
AHRQ will not respond to individual responses, but will consider all
nominations in selecting topics. Arrangements for reviewing the
submissions may be made by calling (301) 594-7196. Responses may also
be accessed two weeks after receipt by the Agency through AHRQ's
Electronic FOIA Reading Room also on AHRQ's web site.
AHRQ routinely publishes new research interests, policies, and
initiatives in the Federal Register (see GPO Access web site http://www.access.gpo.gov/su docs/aces/aces140.html) and the NIH Guide for
Grants and Contracts (see Funding Opportunities through AHRQ's web site
http://www.AHRQ.gov). The budget priorities for each fiscal year
published in the President's budget for the Department of Health and
Human Services. Following is the web site: http://www.hhs.gov/progorg/asmb/budget/fy2000.html.
FOR FURTHER INFORMATION CONTACT: Additional information about AHRQ can
be accessed on the AHRQ web site (www.ahrq.gov). The AHRQ strategic
plan is available at http://www.AHRQ.gov/about/stratpln.htm.
Information about topic nomination can be obtained by contacting:
Kathie Kendrick, Planning Officer, Immediate Officer of the Director,
2101 E. Jefferson St., Suite 600, Rockville, Maryland 20852; telephone
(301) 594-7196; E-mail address: [email protected].
SUPPLEMENTARY INFORMATION:
Background
The mission of AHRQ is to support, conduct, and disseminate
research that improves access to care as well as the outcomes, quality,
cost, and utilization of health care services. The Agency sponsors and
conducts health care research that helps the American health care
system, which includes patients, providers, plans, purchasers and
policymakers, provide access to high quality, cost-effective services;
be accountable and responsive to consumers and purchasers; and improve
health status and quality of life.
Wide variations in practice patterns, quality, and outcomes
continue, and a gap persists between what we know and the care that we
deliver. It is clear today that AHRQ now has knowledge of what can be
improved and can commit to a significant investment in promoting the
adoption and use of research findings. This commitment also focuses on
being able to demonstrate that the potential benefits demonstrated by
the research are actually achieved in daily practice. This must be done
while continuing to support new research on priority health issues and
the development of new tools, so that in the future this knowledge and
the new tools based on research findings can be translated and
implemented to produce improved health care.
AHRQ Strategic Goals
The Agency has identified three strategic goals, each of which will
contribute to improving the quality of health for all Americans.
1. Support Improvements in Health Outcomes
The field of health outcomes research studies the end results of
the structure and processes of health care on the health and well-being
of patients and populations. (Institute of Medicine, 1996) A unique
characteristic of this research is the incorporation of the consumer's
or patient's perspective in the assessment of effectiveness.
Policymakers in the public and private sectors are also concerned with
the end results of their investments in health care, whether at the
individual, community, or population level.
AHRQ has a particular interest in outcomes research related to
conditions that are common, expensive, and/or for which significant
variations in practice or opportunities for improvement have been
demonstrated. Also important is research linking types of delivery
systems or processes by which care is provided with their effects on
outcomes as well as research on clinical preventive services that may
prevent premature death and disability in the United States.
2. Strengthen Quality Measurement and Improvement
At its most basic level, high quality health care is doing the
right thing, at the right time, in the right way, for the right person.
The challenge that clinicians and health system managers face every day
is knowing what the right thing is, when the right time is, and what
the right way is. Patients and their families are also confronted with
making choices about treatments and care settings with little
information on the relative quality, risks, and benefits of the options
available to them. Policy makers, at all levels, also need quality
information to support their deliberations. AHRQ has developed and
tested measures of quality and studied the best ways to collect,
compare, and communicate these data. The Agency will also focus on
research that determines the most effective way to improve health care
quality. This includes how to promote the use of information on quality
through a variety of strategies such as determining effective ways to
disseminate the information and illustrating the impact that the use of
quality information can have on the provision and financing of health
care.
3. Identify Strategies To Improve Access, Foster Appropriate Use, and
Reduce Unnecessary Expenditures
Adequate access to health care services continues to be a challenge
for many Americans. This is particularly so for the poor, the
uninsured, members of minority groups, rural residents, and other
vulnerable populations. In addition, the changing organization and
financing of care has raised new questions about access to a range of
health services, including emergency and specialty care. At the same
time, examples of inappropriate use of care, including overutilization
and misuse of services, continue to be documented. The increasing
portion of our Nation's resources devoted to health care expenditures
remains a concern. The continued growth in public spending for Medicare
and Medicaid, in particular, raises important questions about the care
delivered to the elderly, poor, children, and people with disabilities.
Together, these factors require concerted attention to the determinants
of access, use, and expenditures as well as effective strategies to
improve access, contain costs, and assure appropriate and timely use of
effective services.
Priority Populations
In addition to the strategic research goals, certain population
groups warrant a special focus from AHRQ and the health services
research community: Racial and ethnic minorities, women, children, the
elderly, low-income populations, people living in rural areas, and
people living with chronic illnesses and/or disabilities. These are
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all groups for whom public policy struggles to find effective solutions
to improve health care. Health services research has consistently
documents the persistent, and at times great, disparities in health
status and access to appropriate health care services for certain
groups, notably racial and ethnic minorities and low income families
and children. Gender-based differences in access, quality, and outcomes
are also widespread, but whether these differences should be eliminated
or are appropriate is not well understood. Despite the dramatic changes
occurring in the organization and financing of children's health
services, the knowledge base for guiding these changes or assessing
their impact is less well developed than that for adults. Health care
issues that exist for the elderly and for people with chronic illnesses
and disabilities also require attention. Health services research
should do a better job of bringing science-based information to bear on
these disparities so that the health of these groups is enhanced.
Career Development
AHRQ invests in the training and career development of health
services researchers to address the research, analytic and improvement
needs of the changing health care system. Areas of focus include: (1)
Training that is designed to reflect and incorporate evolving
innovations in data systems and research tools so that the researchers
of the future not only identify and address significant research
questions, but also employ cutting edge methodological, analytic, and
data handing techniques, including appropriate privacy and
confidentiality safeguards; (2) carrier development that allows new
investigators to obtain additional, concentrated research experience to
facilities the transition from a trainee or fellow status to that of an
independent investigator with an established area of research expertise
and demonstrated productivity; (3) training that provides a solid
foundation in general health services research methods and concepts
within a multi-disciplinary environment with special emphasis placed on
the unique needs of the identified population groups, i.e., minority
populations and children. As part of this initiative, AHRQ is
interested in recruiting Historically Black Colleges and Universities
and Hispanic Service Institutions to apply independently or in
partnership with other institutions, to develop programs to train
health care research investigators; and (4) training that focuses on
conducting research using personally identifiable health care
information without injury or disclosure to individuals. This training
will directly address the growing concerns about the privacy of health
care information.
Types of AHRQ Activities in Support of the Goals
Producing meaningful contributions to the Nation and to research on
health care requires continuous activity focused on iterative
improvements in priority setting, on developing research initiatives,
and on research products and processes. The following research cycle
describes the processes AHRQ uses to conduct its ongoing activities in
order to make the most productive use of its resources.
1. Needs Assessment
AHRQ conducts needs assessments through a variety of mechanisms
including expert meetings, conferences, and consultations with
stakeholders and customers of its reach, publishing notices for comment
in the Federal Register, as well as regular meeting with its National
Advisory Council and government leaders. The results of these
assessments are used to determine and prioritize information needs.
2. Knowledge Creation
AHRQ supports and conducts research to produce the next generation
of knowledge needed to improve the health care system. Building on the
last 12 years of investment in outcomes and health care research, AHRQ
will focus on national priority areas for which much remains unknown.
3. Translation and Dissemination
Simply producing knowledge is not sufficient; findings must be
useful and made widely available to practitioners, patients, and other
decision makers. In order to accelerate the pace of quality
improvement, the focus must be on closing the gap between what we know
and what we do. The Agency will systematically identify priority areas
for improving care through integrating findings into practice and will
determine the most effective ways of doing this. Additionally, AHRQ
will continue to synthesize and translate knowledge into products and
tools based on research findings that support its customers in problem-
solving and decision making. It will then actively disseminate the
knowledge, products, and tools to appropriate audiences. Effective
dissemination involves forming partnerships with other organizations
and leveraging resources.
4. Evaluation
Knowledge development is a continuous process. It includes a
feedback loop that depends on evaluation of the research's utility to
the end user and impact on health care. In order to assess the ultimate
outcomes of AHRQ research, the Agency is placing increased emphasis on
the evaluation of the impact and usefulness of Agency-supported work in
health care settings and policymaking. The evaluation activities will
include a variety of projects, from smaller, short-term projects that
assess process, outputs, and interim outcomes to larger, retrospective
projects that assess the ultimate outcomes/impact of AHRQ activities on
the health care system.
AHRQ Customers
The AHRQ research agenda is designed to be responsive to the needs
of its customers/stakeholders and what they value in health care. These
include consumers and patients; clinicians and other providers;
institutions; plans; purchasers; and policymakers in all sectors (e.g.,
Federal, State, and local governments; voluntary associations;
international organizations; and foundations). All of these customers
require evidence-based information to inform health policy decisions.
Health policy choices in this context represent three general levels of
decision making: (1) Clinical Policy Decisions--Information is used
every day by clinicians, consumers, patients, and health care
institutions to make choices about what works, for whom, when, and at
what cost; (2) Health Care System Policy Decision--Health plan and
system administrators and policymakers are confronted daily by choices
on how to improve the health care system's ability to provide access to
and deliver high-quality, high-value care; (3) Public Policy Decisions-
-Information is used by policymakers to expand their capability to
monitor and evaluate the impact of system changes on outcomes, quality,
access, cost, and use of health care and to devise policies designed to
improve the performance of the system. These decisions include those
made by Federal, State, and local policymakers and those that affect
the entire population or certain segments of the public.
In summary, AHRQ seeks suggestions for agency activities within the
framework of priorities set out in the AHRQ strategic plan, goals,
activities, and customers, as described above.
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Dated: June 10, 2002.
Carolyn M. Clancy,
Acting Director.
[FR Doc. 02-17063 Filed 7-8-02; 8:45 am]
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