[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]


=======================================================================
-----------------------------------------------------------------------

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.

-----------------------------------------------------------------------

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.
---------------------------------------------------------------------------

    \1\ Institute of Medicine, 1996.
---------------------------------------------------------------------------

    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

[[Page 18621]]

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,

[[Page 18622]]

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