Maximizing the Impact of Federally Funded Health Services Research and Primary Care Research

JUN

2020

Gopal

Khanna,

M.B.A.

The COVID-19 pandemic has shown us that we need answers, now more than ever, to the complex challenges that can undercut our healthcare system’s effectiveness:

How can we shorten the time frame between identifying the most urgent research questions and producing research findings?
Once research is completed, how can we make sure that findings and tools are rapidly disseminated and applied to improve patient care?
How do we strike the right balance between adherence to the tenets of scientific rigor while responding to today’s real-world needs to improve care?
How do we assess and document the impact of the research we oversee?

As director of AHRQ, an agency long dedicated to supporting health services research, these are among the questions that keep me up most nights.

My colleagues and I are not alone, of course, in wanting to push the healthcare system forward in ways that make patient care safe, effective and high value. These goals are shared by policymakers, particularly those at the Federal level who rightly want to know that research investments are appropriately strategic and are having measurable impacts.

To this end, Congress mandated an independent study to be conducted in 2019 to assess the breadth, scope and impact of federally funded research in two domains—health services research (HSR) and primary care research (PCR)—that are integral to the functioning of the nation’s healthcare system. The study was designed to identify research gaps and propose recommendations to AHRQ for maximizing the outcomes, value, and impact of research investments in these areas during the years and decades ahead, including strategies for better coordination of research agendas.

Conducted by the RAND Corporation, the study was the first effort to capture and categorize HSR and PCR projects across the Federal government. Eight agencies within the Department of Health and Human Services and the Department of Veterans Affairs provided data on HSR and PCR projects funded between 2011 and 2018.

The RAND team cast a wide net. It assessed more than 93,000 research projects using a combination of manual and automated reviews of each project description. RAND also convened two panels of technical experts and conducted interviews with more than 50 stakeholders.

With such a high volume of HSR and PCR being conducted by multiple agencies, Congress wanted to know if some of the research was redundant. Unsurprising to me, there was very little overlap. The study found that the HSR and PCR research portfolios of federal HSR and PCR funders were largely complementary, not duplicative. For the most part, each agency’s research was consistent with its legislative mandate and target audience.

The study identified several potential challenges to coordinating HSR and PCR across agencies: the sheer breadth and volume of research activity; the differing time frames of research across agencies; and the lack of targeted funding for coordinating research.

The expert panels recommended several strategies that could be used more frequently to improve coordination: interagency steering committees and task forces; advisory committees and other processes for regular information sharing; project-specific advisory committees; and the Federal departmental clearance process. The team cited interagency collaboration around the opioid crisis and an interagency workgroup on diagnostic safety as examples of successful interagency coordination.

Overall, the study found that HSR and PCR are vital for improving the quality, safety, and value of healthcare for all Americans. Several action steps were suggested across the following domains:

Improving the relevance and timeliness of HSR and PCR.
Maximizing the impact of Federally funded HSR and PCR.
Improving translation of HSR and PCR into practice.
Encouraging innovation in research.

The results of the RAND study will be discussed at AHRQ’s National Advisory Council meeting in July. In the meantime, I would be pleased to learn what questions and suggestions you have for increasing the impact of HSR and PCR. We know from the overwhelming response to our recent COVID-19 funding opportunity announcements (we received over 250 applications!) that the research community is poised to tackle today’s most pressing research questions. I look forward to engaging with all of you in the coming months as we use this report to build an even brighter future for health services and primary care research and their importance in improving patients’ lives.

Gopal Khanna, M.B.A., is director of AHRQ.