Health Services and Primary Care Research Study

In 2018, Congress directed the Agency for Healthcare Research and Quality (AHRQ) to commission an independent assessment of federally funded health services research (HSR) and primary care research (PCR) conducted between 2012 and 2018 to increase the impact of research by identifying research gaps and proposing strategies for better coordination across the Federal enterprise. AHRQ contracted with the RAND Corporation to conduct this independent analysis.

Since its emergence in the 1960s, HSR has established evidence necessary to improve the delivery of care and health of patients. PCR also has emerged as a distinct field attending to a critical, yet often neglected, component of healthcare.

Key findings from the RAND study are presented below; the summary and full report are available here (PDF, 1.5 MB; HTML).

Purpose

While the study builds upon the 2018 National Academies of Medicine “Future of HSR” report, the RAND study is the first attempt to categorize HSR projects funded by HHS agencies according to their audiences and topic areas. Rather than providing general recommendations for additional HSR/PCR funding, RAND's analysis catalogues the types of research being funded while exploring research gaps and barriers to achieving greater impact through improved coordination.

Study Research Questions focused on these 5 areas of HSR and PCR research among Federal agencies:

Breadth and focus of existing research portfolios.
Overlap and coordination that occurs between research portfolios.
Impacts and challenges to assessing and achieving impacts.
Research gaps and approaches to prioritizing gaps.
Options for improving the outcomes, value, and impact of future research.

Methods

RAND’s study methodology included both quantitative and qualitative measures. Primary study methods centered on:

Technical expert panels.
Stakeholder interviews.
Environmental scan and portfolio analysis.

Key Findings

The RAND study presented findings and recommendations related to HSR and PCR. Some of the findings applied to both areas:

HSR and PCR conducted across HHS agencies is mostly complementary and not duplicative, with distinct missions and areas of focus, such as research organized around specific diseases, body systems, populations, or injuries, and research focusing on prevention and health promotion.
Enhancing cross-agency coordination and more sophisticated data systems would lead to improved impact through better prioritization, tracking, and collaboration.
HHS should explore methods for funding both HSR and PCR that support more rapid, engaged approaches, such as learning health system models, and find new approaches to dissemination to improve healthcare for all Americans.

There were also findings unique to each:

Health Services Research

HSR has made a difference in patients’ lives and is vital for improving the quality, safety, and value of healthcare for all Americans.
There are opportunities for new types of HSR that can improve HSR’s impact.
AHRQ is the only Agency that has statutory authorization to generate HSR, with a focus on system-based outcomes. These include making healthcare safer, higher quality, more accessible, equitable, and affordable, as well as approaches to implementing improvements across U.S. healthcare settings and populations.

Primary Care Research

PCR is critical and underfunded, but has likewise had a significant impact on patients’ lives and the quality, safety, and value of the healthcare services they receive.
These impacts are often cumulative across agencies’ portfolios.
With distinct missions and focus areas, HHS agencies play unique roles in PCR funding.
A coordinating center for PCR is needed to adequately support research on core functions of primary care and coordinate and prioritize PCR across HHS.
AHRQ is the only federal agency with the statutory authority to be the home for PCR, but is currently not funded to carry out PCR.
As with HSR more generally, there are opportunities for novel forms of PCR that will improve PCR’s impact.

Recommendations

Following their thorough investigation of the Federal HSR and PCR research endeavors over the study period, the researchers from RAND fulfilled the congressional directive of proposing strategies for cross-enterprise coordination with recommendations in three areas that were overarching for both research topics:

Prioritization and Coordination—improve processes across agencies in strategic planning; HHS data systems, especially for intramural work and contracts; proactive review for potential overlap; and funding to allow proactive coordination, cooperation, prioritization, and innovation.
Relevance and Timeliness—stimulate rapid, engaged research approaches; promote methods that generate evidence on implementation of change; and support high-risk, high-reward research.
Dissemination—communicate actionable results by preparing researchers to share in formats that stakeholders can use readily; require researchers to build implementation issues and theories of change into study and results planning; and expand funding for evidence synthesis across studies.

While the study authors reached similar conclusions and recommendations for both research topics, Section 7 of the full RAND report lists more detailed approaches to improve the impact of HSR and PCR.

Next Steps

AHRQ is excited to work with our Federal partners and stakeholders to analyze the potential of these recommendations to increase the impact in HSR and PCR across the Federal enterprise in order to achieve our goal of improving healthcare for all Americans.