AHRQ: Health Services Research (R01)

Sponsor: Agency for Healthcare Research and Quality (AHRQ)

AHRQ seeks research on a wide range of topics under the Priority Program Areas:

1) Supporting Improvements in Health Outcomes, 2) Improving Quality and Patient Safety, and 3) Identifying Strategies To Improve Access and Foster Appropriate Use and Reduce Unnecessary Expenditures.

A continuing challenge to health services research is to improve the translation, dissemination, and use of research findings for clinicians, other providers, patients, consumers, policy makers, and other decisionmakers to effect needed health care changes, and to measure the impact of changes at all levels of health care delivery.

AHRQ is especially interested in projects across its program areas that demonstrate innovative strategies for effecting systemic and sustained behavior changes to improve outcomes, quality, access, cost, and use, and document the impact of changes at systems, state, and community levels.

Priority Program Areas

o Supporting Improvements in Health Outcomes Research on clinical outcomes examines the effectiveness of different strategies for preventing, diagnosing, treating, or managing conditions that are common, expensive, and for which significant variations in practice or outcomes exist, or opportunities for improvement have been demonstrated. Research in this area also includes improving our understanding of how outcomes data can be incorporated into informed decision-making at the patient, provider, and organizational levels of the health care system. Outcomes of clinical interventions include functional status, quality of life, patient satisfaction, and costs, in addition to morbidity and mortality. A particular emphasis is on the outcomes of care provided to the elderly and those with chronic illnesses, including studies that assess when in the course of illness intervention is most effective. Research may focus on the type of delivery system or financial arrangements by which care is provided and the effects of these on clinical outcomes. Interests include:

1. Effectiveness and cost effectiveness of clinical and organizational interventions, including trials of interventions across the spectrum of health care settings and those used for multiple conditions, or innovative approaches to health care delivery to improve outcomes.

2. Assessment of the impact of diagnostic and other health care technologies on cost and patient outcomes, and how to prioritize such assessments.

3. Development and testing of practical, ready-to-use outcomes measures addressing functional status, quality of life, and severity and risk adjustment, as well as general measurement issues, and strategies for improving outcome measures for patients with multiple comorbid conditions, including incorporation of an individual patient’s values and preferences. In particular, increased use of patient-reported outcome measures as dependent variables in clinical trials offers new opportunities for ancillary studies that can enhance our understanding of the characteristics and use of these measures.

4. Development and evaluation of strategies for informed decision-making, including evaluation of alternative strategies for implementing an infrastructure for collection, analysis and presentation of data, and real-time incorporation of outcomes and evidence into decision-making for patients, providers, and policy-makers.

5. Development and evaluation of strategies for the use of outcome measures including patient-oriented measures in practice (e.g., shared decisionmaking), or development, validation and use of measures that incorporate patient values and preferences.

6. The relationship between processes and outcomes of care, including timing of services.

7. Evaluation of, and development of measures for outcomes, effectiveness, and cost effectiveness of clinical preventive services for all ages.

8. Analysis of the causes of variations in clinical practice and the use of health care technologies, including the clinical behaviors of primary care and specialty providers, provider training, patient characteristics and preferences, or other factors.

9. Observational studies using Medicare, Medicaid, or managed care data to answer discrete questions related to the outcomes, effectiveness, cost, cost-effectiveness or quality of medical care.

10. The impact of models of undergraduate, graduate, and continuing education on the knowledge, skills, and attitudes of providers and associated patient outcomes.

11. Therapeutic outcomes, including:

a. Relative safety, effectiveness, and cost effectiveness of available pharmaceuticals or combinations of therapies, as well as comparison to other treatment options.

b. Relationships among prescribing decisions, pharmaceutical services, use of prescription drugs, and patient outcomes.

Methodological approaches may include quasi-experimental studies using existing data or experimental studies.

o Improving Quality and Patient Safety

The Agency encourages research to improve the capacity of the health care system to deliver quality care and protect patients from medical errors. There is increasing emphasis on understanding how to measure quality and prevent errors across the full spectrum of care, in various settings and in transition across settings, and for different population groups. Key to this understanding is the ability to describe the influence of organizational as well as clinical factors on levels of quality and occurrence of errors. Of special interest are efforts to develop and test interventions to improve quality and patient safety in these varying contexts, especially where evidence can be presented that the interventions have widespread applicability.

A. Quality Measurement and Improvement. Interests include:

1. Innovative approaches to measuring quality, including the perspectives of providers, patients, and consumers.

2. Methods to identify, understand the causes of, and prevent medical errors and improve patient safety.

3. Adaptation of existing measures as well as development and validation of new measures for use with diseases, conditions, and procedures and in settings where gaps in knowledge exist, including the impact of comorbidities on measurement of quality of end-of-life care.

4. General quality measurement methods, including risk and severity adjustment, and methods for measuring functional status and quality of life.

5. Evaluation of the kinds of quality improvement systems that promote systemic and sustainable changes in clinical practice to improve the quality of care.

6. Evaluation of the appropriateness of different data sources for quality measurement, and development and evaluation of methods for using data to improve quality of care.

7. Description and testing of the effects of (1) computerized decision-support systems, (2) integrated information systems, (3) electronic medical records, (4) Internet-based information and consultation for use by patients, and (5) other information technology applications on improving quality of care.

8. Development and validation of methods for changing the behavior of clinicians, provider institutions, employers, plans, and patients to improve quality of care and patient safety.

9. Evaluation of strategies for integrating quality measurement and improvement and patient safety into office-based, worksite-based, and primary care settings, as well as acute and long-term care settings.

10. Formulation of strategies for improving the delivery of clinical preventive services (CPS), including research on quality measurement for CPS and on system changes in primary care that enhance the access to and quality of CPS.

11. Studies of the impact of public policy and other system changes, and organizational and financial arrangements, on health care quality at the national, State, and subpopulation levels.

12. Development and evaluation of typologies and measurement techniques that allow study of the effects of organizational and communication strategies on quality improvement.

13. Research on patient and consumer issues. AHRQ is particularly interested in: (1) the perceptions of care of priority populations, including those cognitively impaired, institutionalized or living with complex care decisions such as people with chronic illness or disability, including HIV/AIDS, (2) innovative ways to present information on quality to patients and consumers that increase salience, usefulness and use, and (3) strategies to assist patient and consumer communication with health professionals and participation in health care decisionmaking.

B. Evidence-based Practice. Integral to improving quality of care is the development, use, and evaluation of evidence-based tools and information. Interests include:

1. Methods for optimal systematic reviews of evidence, including methodological research on meta-analysis, decision analysis, and cost-effectiveness analysis.

2. Evaluation and comparison of different methods to implement evidence-based information and tools in diverse health care settings and/or among practitioners or various populations, including:

a. Assessment of the role of organizational structure, capacity, and culture in effective use of the tools.

b. Effectiveness of different types of evidence-based information and specific tools in changing behavior of practitioners, patients, and organizations.

3. Evaluation of the effects of specific evidence-based guidelines or other tools on access, utilization, quality, outcomes, costs, and/or patient satisfaction.

4. Studies of the cost effectiveness/cost benefit of important new or existing health care technologies.

5. Assessment of the extent to which evidence-based information is used in determinations of medical necessity and coverage decisions.

6. The role of informatics in dissemination of evidence-based information, and its impact on patient and clinician behavior.

7. The role of evidence-based information in the development of informatics tools and information sources, the impact of evidence-based decision making and increasing role of “just-in-time” information systems, and how evidence is incorporated into these systems.

C. Clinical Preventive Services. Interests include:

1. Interventions to address specific patient barriers to preventive care, with specific focus on vulnerable populations, including older women, who may receive fewer or lower quality services.

2. Interventions to improve quality of screening services, including reducing false-positive and false-negative rates, improving follow-up procedures, and improving patient satisfaction.

3. Improving cost-effectiveness of preventive care through interventions to reduce overuse of services, target interventions more effectively to high-risk groups, or reduce adverse effects and costs of screening (including costs and consequences of followup in persons with positive screening results).

4. Identifying elements of preventive counseling interventions that have greatest impact on behavior change, developing more comprehensive quality measures for counseling services and other preventive care that extend beyond utilization rates.

5. Interventions to improve patient involvement in preventive care and to improve communication between clinicians and patients around screening results.

o Identifying Strategies to Improve Access, Foster Appropriate Use, and Reduce Unnecessary Expenditures Research is needed on the impact of system changes on access to, cost, and use of health care services. Research is also needed to examine expenditures, cost and financing, and organizational arrangements, and to assess the effects of these interrelated factors on the delivery of health care, including preventive services, that is accessible and equitable, and that demonstrates high quality.

A. Access, Costs, and Use of Health Services. Interests include:

1. Studies that use MEPS and other AHRQ data sources to assess the cost and utilization of health resources (See "AHRQ Data").

2. Impact of the trends in health care prices, costs, and sources of payment for services on access, expenditures, and outcomes.

3. Development of new and more effective ways to measure the range of health care costs and to organize and analyze data on costs by clinical condition, sociodemographic factors, site of care, and payment sources.

4. Studies assessing the impact of different outreach and social marketing strategies to increase enrollment in public insurance (e.g., Medicaid, SCHIP) among persons eligible for coverage.

5. Assessment of the determinants of access to care and strategies to improve access, especially for underserved populations.

6. The development and use of policy-relevant models to simulate and understand behavior governing the use, cost, financing, and organization of care.

B. Organization, Financing, and Delivery. Interests include studies of major changes in health care markets and studies examining how variations in health care organization, structure, and delivery affect the outcomes, quality, access to, cost, and use of care, such as:

1. New purchasing activities by employers, coalitions, and governments, and their impact on managed care organizations, providers, employees, and communities.

2. The aggregate impact of major changes in public programs and health care markets on health care costs and quality, including the impact on providers and beneficiaries.

3. Dynamics and impact of recent major changes in financial and legal arrangements such as consolidations, conversions to for-profit status, development of national ownership links among facilities, new relationships among acute, subacute, and long-term care facilities, and new methods of sharing financial risk and contracting for services on quality, cost, access, and use of services.

4. The impact of the movement of care from inpatient to outpatient settings, and from nursing homes to home care on cost and outcomes.

5. The effects of disease management and "carve-in" and "carve-out" arrangements on health care costs, accessibility, and quality of care, particularly for persons with chronic conditions.

6. Conceptual models, measures, and financial and organizational factors supporting clinical integration of health care services and studies of the impact of clinical integration on access, quality, and cost of care.

7. The implementation and use of new staffing and other clinic-level configurations, and evaluations of the effectiveness of particular models in improving access, quality, and cost of care.

8. The use of information technology applications in providing and supporting the delivery of health care and their effects on cost, quality, and access.

9. The role of non financial incentives and organizational characteristics, such as organizational structure and culture, in affecting the behavior of health care organizations and units and individuals within them.

10. Evolving definitions of medical necessity used by managed care organizations to determine when and under what circumstances services will be covered, and the impact of different methods and processes for medical decisionmaking by health plans.

Methods can include rigorous qualitative studies as well as quantitative research, and conceptual and methodological as well as empirical work. Research partnerships using private sector data sources, such as managed care data, are particularly encouraged.

C. Primary Care Practice. The characteristics of primary care practice play a crucial role in facilitating access to and use of services, influencing health costs, and the resulting outcomes and levels of quality.

Interests include:

1. Characteristics of primary care practice that lead to improvements in outcomes and quality of care.

2. Effective models of organizing, financing, and managing primary care services.

3. Factors that influence access to primary care services, including socioeconomic, cultural, and geographic factors.

4. Optimal delivery of health care, including primary care services, in low-income inner-city and rural areas.

5. Access to and availability of clinical preventive services.

6. Effects of information technology applications in primary care practice, such as computerized decision-support systems, remote monitoring of patient conditions, and electronically secure exchange of patient health data, on access to care and the costs and quality of health care.

7. Clinical decision-making in primary care, including an emphasis on facilitating shared patient-clinician decision-making.

8. Strategies for integrating quality measurement and improvement into office-based, worksite-based, and primary care settings.

9. Strategies for reducing medical errors and improving patient safety in office-based, worksite-based, and primary care settings.

10. Strategies for facilitating the integration of research findings into office-based, worksite-based, and community primary care practices.

11. Improving the quality, value, and access to health care for American workers and individuals with disabilities.

12. Effective strategies in primary care settings for eliminating racial and ethnic disparities in health-related outcomes.

13. Issues related to the outcomes, costs, and delivery of primary care services to the elderly.

14. Improved care for those at the end of life.

15. Organizational and other factors affecting the cost and quality of transitions between ambulatory and other settings, including home, hospital, and long-term care settings.

16. Health care workforce organization, including communication and coordination of services among primary care clinicians and other members of the health care team.

17. The readiness of the health care system, in particular its entry points such as emergency rooms and primary care, to recognize and respond to the effects of exposure to agents of biological or chemical terrorism.

To enhance generalizable results, primary care research may involve large data bases or primary care practice-based research networks.

Amount: The total costs awarded under this FOA will not exceed $300,000 annually for the entire project period. Funding beyond the first year will be contingent upon a review by Agency staff of the non-competing continuation report. An application with a budget that exceeds $300,000 total costs per year will not be accepted..

Deadline: Release/Posted Date: March 6, 2007

Application Submission/Receipt Date(s): February 5, June 5,and October 5

Expiration Date: January 8, 2010

For further information, please visit: http://grants.nih.gov/grants/guide/pa-files/PA-07-243.html