NIH GUIDE, Volume 26, Number 25, August 1, 1997


P.T. 34


  Health Services Delivery 




Agency for Health Care Policy and Research


I.  Purpose


The Agency for Health Care Policy and Research (AHCPR) is planning to

enter into ~Cooperative Research and Development Agreements~ (CRADAs)

and other public-private partnerships pursuant to the Federal

Technology Transfer Act of 1986, as amended, and Executive Order

12591 of October 10, 1987.  AHCPR is now seeking expressions of

specific interest and general public comments regarding the Agency~s

intention to develop additional public-private partnerships for

research to enhance quality and access in the nation~s health care



II.  Background


AHCPR is the Federal agency charged with supporting research to

enhance the quality, appropriateness, and effectiveness of health

care services and access to those services.  AHCPR supports the

development of scientific knowledge and disseminates information to

strengthen consumer and clinical decisionmaking, and to improve the

organization of public and private systems of health care delivery.

AHCPR also has the lead for the special initiative of the Secretary

of Health and Human Services (DHHS) on improving the quality of care

throughout the nation's health care systems.


AHCPR's strategic goals in research encompass projects designed to:


o  Help consumers make more informed choices.

o  Determine what works best in clinical practice.

o  Measure and improve quality of care.

o  Monitor and evaluate health care delivery.

o  Improve the cost-effective use of health care resources.

o  Assist health care policymakers.

o  Build and sustain the health services research infrastructure.


AHCPR historically has used public-private partnerships to strengthen

its dissemination activities, including the publication of clinical

practice guidelines and co-sponsorship of conferences designed to

expedite the translation of research findings into everyday health

care practice.  More recently, AHCPR has expanded its partnership

roles with collaborations to support health services research

projects through a variety of models, including the Cooperative

Research and Development Agreement (CRADA).


AHCPR~s interest in expanding its public-private partnerships is

precipitated by three primary factors.  First, demand for the

products of health services research is growing beyond the Agency's

ability to support it alone.  Second, the rapid changes in health

care markets and delivery systems create a need to re-examine the

assumptions underlying the organization and delivery systems of

health care.  Third, some of the relevant data required to support

health services research on health care innovations currently reside

in the private sector.  AHCPR believes that collaborations with the

private sector will help to better target Federal resources, and

ensure the relevance of AHCPR~s research to the emerging needs of the

health care delivery systems and the growing demand for information.


AHCPR is encouraging new public-private partnerships for

collaborative research projects, with groups representing every

segment of the health care community:


o  Patients and consumers.

o  Practitioners and organizations concerned with the delivery of

clinical care.

o  Health plans and related organizations.

o  Purchasers of health care, including employers, labor unions, and

other group purchasers.

o  Producers of health care products and equipment, including

research-based manufacturers of pharmaceuticals, medical devices, and

biotechnology products.

o  Researchers, policymakers, and research organizations.


AHCPR will permit CRADA partners to negotiate with the Agency for a

patent license, or similar license, to use or market (and develop

further) any inventions, intellectual property, or copyrightable

material created or developed through the collaboration.  Partners

will be expected to provide resources to facilitate the

collaboration, including funds to support the costs of the research.

The typical term of a CRADA will range from 2 to 5 years.


Other Federal agencies, including the National Institutes of Health

(NIH) and Health Care Financing Administration (HCFA) of the

Department of Health and Human Services (DHHS), share AHCPR~s

interest in conducting research projects, as well as in disseminating

and utilizing the Agency~s research results, frequently leading to

joint support and technical collaborations.  For example, HCFA, as a

purchaser of health care services for Medicare and Medicaid

beneficiaries, shares AHCPR~s interest in the area of health care

quality measurement and improvement.  AHCPR and HCFA anticipate that

it will often be effective and appropriate to cooperate in joint

public-private partnerships for collaborative research endeavors.


AHCPR's Role in Partnerships


As a recognized leader in health services research, AHCPR has unique

capabilities to bring to public-private partnerships, including:


o  Expertise in research methodology, including both quantitative and

qualitative methods.


o  Demonstrated objectivity and recognized excellence in research.


o  Management of large national and state health care databases

(including the Medical Expenditures Panel Surveys (MEPS), Health Care

Cost and Utilization Project (HCUP), and HIV Cost and Services

Utilization Study (HCSUS), as well as access to, and experience with,

other major health-related national databases.


o  Expertise in evaluating cost-effectiveness, medical outcomes, and

appropriateness of different clinical approaches and technologies for

specific diseases or treatment regimes.


o  Expertise in working with policymakers and legislators to evaluate

trends occurring in the health care market and to provide data to

assist in decisionmaking.


Recent AHCPR partnerships with nongovernmental organizations, leading

toward important research initiatives, include:


o  Development of the Computerized Needs-Oriented Quality Measurement

Evaluation System (CONQUEST), which enables health plans,

practitioners, employers, and other users to identify and compare

alternative quality of care measures in a meaningful way; and

inauguration of the Quality Measurement Network (QMNet), which builds

on the CONQUEST system and attempts to create a self-sufficient,

comprehensive and publicly accessible quality measurement resource to

improve the quality of care.  These quality of care activities have

involved AHCPR~s working with private-sector lead organizations in

health care quality improvement and measurement, academia, and



o  Study of stroke prevention strategies in managed care

organizations, particularly in ways to translate the findings of

AHCPR's Patient Outcomes Research Team (PORT) into actual clinical

practice across a variety of managed care models, using a three-way

agreement involving AHCPR, PORT research institutions, and a major

drug manufacturer.


o  Support for HCSUS, an HIV-related research project employing a

cooperative agreement between AHCPR and RAND, in which investigators

look at the delivery and cost of HIV/AIDS treatment.  A partnership

stemming from the HCSUS project, with funding from major

pharmaceutical firms and technical assistance from AHCPR and other

research partners, is enabling RAND to examine factors associated

with initiating and adhering to combination therapies, which include

protease inhibitors, for HIV/AIDS.


AHCPR is now exploring new models for partnerships with other

organizations.  Areas for potential collaborations include, but are

not limited to:


o  How the structure and organization of health care markets and the

evolving managed care systems impact on cost, quality, and access;


o  Changes in the delivery of care such as clinical integration and

new models of care, and how particular elements of managed care

affect quality and outcomes;


o  Changes in financing mechanisms for health care coverage,

including the impact of employer coalitions and value-based

purchasing efforts;


o  Ways to use governmental and private sector health care databases

for applying advanced data-analysis techniques to improve health care



o  Examining primary care delivery in terms of cost, quality, and

patient outcomes;


o  The use of consumer satisfaction initiatives in the design of

improved health care systems;


o  Development of syntheses of scientific evidence on specific

clinical topics and technologies;


o  Disseminating evidence-based practice information to the clinical



o  Evaluating the relative impact (in terms of cost, quality, and

outcomes) of new medical technologies, interventions, and

innovations; and


o  Expanding efforts to explore and evaluate outcomes and

effectiveness of various treatments for the same condition.


Partners' Role


The role of the private-sector partner in these research

collaborations could include opportunities to:


o  Support research design and study through the provision of funding

or other valuable research resources (such as data, research

personnel, equipment).


o  Partner in the design, coordination, and conduct of research

studies to evaluate the effectiveness and cost of health care



o  Provide clinical or other technical support for studies.


o  Improve consumer and practitioner access to research results

through innovations in dissemination and evaluation.


Submission of Proposals and Comments


To receive immediate consideration, proposals or public comments must

be received no later than September 23, 1997.  However, proposals may

be submitted at any time.  Portions of proposals containing

proprietary information may be labeled as confidential, if necessary.


Proposals or comments may be sent directly to:


Larry T. Patton

Director, Office of Policy Analysis

Agency for Health Care Policy and Research

2101 E. Jefferson Street, Suite 603

Rockville, MD 20852

Email: lpatton@ahcpr.gov




Questions or concerns regarding this notice may be directed to:

Howard Cohen, J.D., 301-594-1321, ext.1016.



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