Department of Health and Human Services
	Research, Demonstration, and Evaluation Activities FY 2003 Plan and Budget February 2002

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RESEARCH AND DEMONSTRATIONS

(by HHS Strategic Plan Objective)

ENHANCE OUR UNDERSTANDING OF HOW TO IMPROVE THE QUALITY, EFFECTIVENESS, UTILIZATION, FINANCING, AND COST-EFFECTIVENESS OF HEALTH SERVICES (OBJECTIVE 6.3)

FY 2003 Priorities

RESEARCH ON HEALTH COSTS, QUALITY, AND OUTCOMES (AHRQ)

Research: FY 2003 priorities include:

• improving clinical and provider practices
• increasing the number of technology assessments that improve health outcomes
• expanding the number of quality measurement tools
• assessing the burden of illness
• assessing the role of provider organizations and financing models on health care.

Studies will be undertaken to learn what strategies are effective for improving quality of care:

• examination of what expansions will make the National Guideline Clearinghouse more user friendly for health care workers at the bedside or in the clinic.
• research concerning what information and tools are useful to providers and policymakers caring for low-income children.
• research on what impact managed care and other changes have on purchaser behavior, provider, and plan behavior.
• examination of what the impact is of major system changes on access, quality, outcomes, and cost in states and their communities.
• supporting research relevant to HHS' mental health activities, i.e., to improve quality of care and address access issues in primary care settings for patients and their families.
• supporting research on quality of care for priority populations, such as children with special needs. Research will also examine improvements relative to patient safety issues for this population.

Priorities for health care effectiveness include:

• supporting data development needs for a national disparities study which will include priority populations such as elderly, children, women, racial and ethnic minorities, urban residents, rural residents, and persons with low income.
• supporting studies to improve our understanding of the quality and outcomes of care for persons with HIV.

Priorities for health care utilization include:

• supporting research to identify and treat domestic violence victims. These priorites include continuing to fund longitudinal studies on the outcomes and effectiveness of medical interventions designed to indentify and treat domestic violence vidtims and those at risk.
• supporting the development and acquisition of information tha fosters and supports knowledge of major clinical and policy issues that affect the long-term care population, such as assistance with basic activities of daily living, homemaking activities, and other normal life activities.
• supporting research toward understanding the determinants of access to primary care services, as well as research to understand the effectiveness of various strategies to improve access for minority populations. Expanding agency support of primary care research networks and engaging in major informatics activities focused on primary care settings will also be a priority.

Demonstrations: We will conduct demonstratons to translate knowledge and tools gained from Agency-sponsored research into measurable improvements in the health care Amerincans receive. Priorities include:

• translating prevention research into practice, e.g., comparison of two methods of integrating preventive services in a group practice plan serving a low income medicaid population.
• managed care organization use of Pediatric Asthma Management Program, focusing on comparing the effectiveness of different improvement programs to determine which results in better outcomes for children with asthma.

Evaluations: AHRQ will conduct numerous evaluations that will:

• assess an array of strategies for improving health care quality.
• analyze the relative utility and costs of various approaches to quality improvement.
• qualitatively review primary care work force grants.
• identify private sector uses of AHRQ findings and assess the impact on clinical practice and patient care.
• assess the use of Medicare Expenditure Panel Survey data and modeling on the potential impact of programmatic changes in health care financing and delivery.

URBAN RESEARCH CENTERS (CDC)

Research: The Urban Research Centers (URC) were established to assess and improve the health of urban communities. Using a community-based participatory research approach, URCs engage government, academic, private, and community organizations as partners in priority- setting, designing, implementing, and evaluating community-focused public health interventions. Current priorities include social determinants of health, asthma, violence, HIV, hepatitis C, and health-care access and quality.

In FY 2003, CDC will continue to identify, measure and quantify social determinants that effect the quality of life of urban residents, and prioritize major issues in evaluating community interventions in collaboration with local health departments and community participants.

IMMUNIZATION (CDC)

Research: CDC will support research to identify the costs of implementing standing orders programs and their components compared to other organized immunization programs in long term care facilities (LTC) and, subsequently, to determine the cost-effectiveness of such programs and their components.

Evaluations: CDC will conduct a controlled before-and-after evaluation to:

• determine the degree to which standing orders programs are implemented;
• compare effectiveness of peer review organization (PRO) methods in the adaptation and implementation of standing orders programs;
• measure the impact of standing orders programs and their components on influenza and pneumococcal vaccination coverage levels in nursing homes; and
• measure the costs of the programs.

INFECTIOUS DISEASE - SEXUALLY TRANSMITTED DISEASES (CDC)

Research: FY 2003 priorities include cost effectiveness of behavioral interventions in reducing STD acquisition; cost effectiveness of risk reduction interventions delivered on the sexual Internet; differential cost effectiveness of innovative strategies to achieve partner notification and treatment; economic impact of high risk human papillomavirus diagnoses; and assessment of the relative cost effectiveness of multi level synergistic interventions to promote adolescents' reproductive health.

HEALTH SERVICES RESEARCH (NIH)

Research: In FY 2003, NIH funds will be used to support a variety of research projects that seek to improve the organization, delivery, access, financing, management, outcomes, effectiveness, utilization, and quality of health services related to many diseases and disorders. FY 2003 priorities include:

The National Institute of Mental Health (NIMH) will support research on:

• studies to obtain information on levers and barriers to appropriate mental health service use by children and adolescents in diverse types of service systems (e.g., mental health, general health, social welfare, education, and juvenile justice systems).
• research examining the effects of various health care delivery organizational factors on the availability, access, use, and costs of mental health care.
• studies designed to improve delivery of mental health services for persons with co- morbid conditions that typically are treated both in and outside of the specialty mental health sector.
• examinations of the impacts of different reimbursement schema on the treatment of depression, anxiety, and other conditions in the primary care sector.
• studies of the role of specific contextual factors in the diffusion of mental health treatments and services to “real world” community settings.

The National Institute of Child Health and Human Development (NICHD) will support two projects. The first deals with the elderly and disabled who often have chronic disabilities that limit the amount they can improve their quality of life, and therefore measures of the cost- effectiveness of health care programs targeted toward these groups appear relatively unfavorable. This project will examine an approach to overcome this bias by testing and refining, in six studies, the person trade-off method (PTO), which measures the societal value of health care programs. In a second project, the NICHD will continue to fund a study that compares the success rates and cost-effectiveness of a fast track to in vitro fertilization (IVF) therapy to the success rates and cost of conventional infertility therapy. If successful, this research should lead to a re-consideration of policies and practices regarding the appropriate use of various infertility treatments.