[Federal Register Volume 64, Number 72 (Thursday, April 15, 1999)]
[Notices]
[Pages 18619-18622]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 99-9445]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Agency for Health Care Policy and Research
Request for Planning Ideas
AGENCY: Agency for Health Care Policy and Research, HHS.
ACTION: Notice.
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SUMMARY: The Agency for Health Care Policy and Research (AHCPR) invites
recommendations for future initiatives in areas identified as
priorities in the Agency's current strategic plan. This plan describes
the framework that the Agency will use to guide the development of
budget proposals for Fiscal Years 2000, 1001, and 2002 as well as
decisions on resource allocations for research, translation (including
tool development), dissemination, and evaluation activities that will
facilitate the implementation of
[[Page 18620]]
research findings at all levels of the health care system.
Nature of Recommendations
AHCPR encourages written suggestions from its customers 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 AHCPR 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
will be used in the health care system.
DATES; Trepsonses to this request will be accepted on an ongoing basis.
ADDRESSES: Submissiosn 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, or e-mail.
Responses to this request should be submitted to: Lisa Simpson, M.B.,
B.Ch., M.P.H., Deputy Administrator, Agency for Health Care Policy and
Research, 2101 E. Jefferson Street, Suite 600, Rockville, Maryland
20852, [email protected].
All responses will be available for public inspection at AHCPR's
Immediate Officer of the Administrator, weekdays between 8:30 a.m. and
5 p.m. AHCPR will not respond to individual responses, but will
consider all nominations in selecting topics. AHCPR 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 AHCPR's web site http://www.ahcpr.gov).
The budget priorities for each fiscal year are published in the
President's budget for the Department of Health and Human Services
(http://www.hhs.gov/progorg/asmb/budget/fy2000.html).
Arrangements for reviewing the submissions may be made by calling
(301) 594-0152. Responses may also be accessed two weeks after receipt
by the Agency through AHCPR's Electronic FOIA Reading Room also on
AHCPR's web site.
FOR FURTHER INFORMATION CONTACT: Additional information about AHCPR can
be accessed on the AHCPR web site. In particular the AHCPR strategic
plan is available at http://www.ahcpr.gov/about/stratpln.htm.
Information about topic nomination can be obtained by contacting:
Jane Osborne, Planning Officer, Immediate Office of the Administrator,
2101 E. Jefferson St., Suite 600, Rockville, Maryland 20852; telephone
(301) 594-0152; E-mail address: [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].
SUPPLEMENTARY INFORMATION:
Background
The mission of AHCPR 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 AHCPR 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.
AHCPR 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.\1\ 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.
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\1\ Institute of Medicine, 1996.
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High priority for AHCPR's outcomes research will be given to
research relating 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.
AHCPR's second research goal will include developing and testing
measures of quality, as well as studying the best ways to collect,
compare, and communicate these data. The Agency
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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, with some indicators suggesting
that the rate of increase may accelerate once again. The continued
growth in public spending for Medicare and Medicaid, in particular,
raises important questions about the care delivered to the elderly,
poor, 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 AHCPR 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 all
groups for whom public policy struggles to find effective solutions to
improve health care. Health services research has consistently
documented 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.
Training
AHCPR invests in the training of health services researchers to
address the research and analytic 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 handling techniques, including
appropriate privacy and confidentiality safeguards; (2) training that
allows new investigators to obtain additional, concentrated research
experience to facilitate 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 multidisciplinary 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, AHCPR is interested in recruiting Historically Black
Colleges and Universities and Hispanic Serving Institutions to apply
independently or in partnership with other institutions, to develop
programs to train minority 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 ACHPR Activities in Support of the Goals
Producing meaningful contributions to the Nation and to research on
health care requires continuous activity focused on iterative
improvement in priority setting, on developing research initiatives,
and on research products and processes. The following research cycle
describes the processes AHCPR uses to conduct its ongoing activities in
order to make the most productive use of its resources.
1. Needs Assessment
AHCPR conducts needs assessments through a variety of mechanisms
including expert meetings, conferences, and consultations with
stakeholders and customers of its research, publishing notices for
comment in the Federal Register, as well as regular meetings with its
National Advisory Council and government leaders. The results of these
assessments are used to determine and prioritize information needs.
2. Knowledge Creation
AHCPR supports and conducts research to produce the next generation
of knowledge needed to improve the health care system. Building on the
last 10 years of investment in outcomes and health care research, AHCPR
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
decisionmakers. 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, AHCPR
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 AHCPR 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,
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and interim outcomes to larger, retrospective projects that assess the
ultimate outcomes/impact of AHCPR activities on the health care system.
AHCPR Customers
The AHCPR 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
decisionmaking: (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 Decisions--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, AHCPR seeks suggestions for agency activities within
the framework of priorities set out in the AHCPR strategic plan goals,
activities, and customers, as described above.
Dated: March 31, 1999.
John M. Eisenberg,
Administrator.
[FR Doc. 99-9445 Filed 4-14-99; 8:45 am]
BILLING CODE 4160-90-M