[Federal Register Volume 67, Number 131 (Tuesday, July 9, 2002)]
[Pages 45514-45517]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 02-17063]



Agency for Healthcare Research and Quality

Request for Planning Ideas

AGENCY: Agency for Healthcare Research and Quality, HHS

ACTION: Notice.


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 

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,

[[Page 45515]]

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, 
    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 kkendrick@AHRQ.gov.
    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: kkendrick@AHRQ.gov.



    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 

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

[[Page 45516]]

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.

[[Page 45517]]

    Dated: June 10, 2002.
Carolyn M. Clancy,
Acting Director.
[FR Doc. 02-17063 Filed 7-8-02; 8:45 am]