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Release Date:  December 23, 1998


Agency for Health care Policy and Research


The Agency for Health Care Policy and Research (AHCPR) announces that it has a
special interest in health services research that will support improvements in
outcomes of care provided to the elderly and those with chronic conditions.  This
special emphasis area is under AHCPR's program priority area, Improvements in
Health Care Outcomes, within its ongoing its Health Services Research Program
Announcement (PA 98-049, released March 26, 1998).  This notice expands on that
emphasis, with a particular focus on special populations, including members of
racial and ethnic minorities, persons of low socioeconomic status and women.

This special program emphasis invites investigator-initiated research projects
that will:

o  focus on the relationship between processes and outcomes of care for older
populations with one or more chronic conditions; and/or

o  clarify which are the most effective interventions or components of programs
intended to improve functional outcomes or prevent deterioration in functional
status in older people with chronic illness; and/or

o  assess the effect of co-existing illness on clinical management, patient
decision-making and preferences for care, and health outcomes; and/or

o  clarify the comparative effectiveness and cost-effectiveness of alternative
strategies, with a specific focus on combined clinical and organizational
interventions such as disease-management programs, patient self-management
programs, group visits, and efforts led by multidisciplinary teams, to improve
outcomes in older people with chronic conditions.

Also of interest are research or demonstration programs that facilitate the
assessment of function and the use of patient-reported outcome measures for older
populations with chronic illness in routine practice, as well as assessments of
the extent to which patients and clinicians agree on outcomes of care.  Studies
conducted in ambulatory care settings or that assess episodes of care involving
transitions in settings of care are of particular interest.

Methodologic challenges in this priority area include approaches for assessing
comorbidity in ambulatory care; theoretical and conceptual approaches for
identifying general factors and specific models of care delivery that improve
outcomes; and the utility of different approaches for estimating disease burden.

Investigator-initiated applications addressing these issues should be submitted
on the research application form PHS-398 (rev. 4/98) in accordance with the
standard receipt dates in the application materials.


AHCPR has previously supported a large portfolio of research that has examined
the relationship between processes of care and outcomes, including functional
status, quality of life, patient satisfaction and costs, in addition to morbidity
and mortality.  An assessment of the first decade of this research has
demonstrated substantial advances in information available to enhance patient
outcomes, but substantial opportunities for translating the fruits of these
studies into practice remain.  ("The Outcome of Outcomes Research at the Agency
for Health care Policy and Research", internal AHCPR document)  We now know that
evidence about which interventions are most effective is necessary but not
sufficient.  Improved knowledge must be linked with supportive practice
environments and incentives for change for the majority of patients to benefit. 
Research to date has also described patterns of care for members of racial and
ethnic minorities, those of lower socioeconomic status and women suggesting that
these individuals receive less care than majority populations in multiple
clinical domains.  Research that identifies strategies for addressing
inappropriate practice variations associated with race/ethnicity, gender or
socioeconomic status to inform interventions for improving outcomes has not been
a dominant area of inquiry.  In addition, much prior research on the outcomes and
effectiveness of alternative interventions has addressed medical practices but
has not focused on the interaction between clinical interventions and  practice
or organizational characteristics (including incentives, type of practitioner,
and market characteristics), nor has it examined the specific components of
treatments or programs that require the involvement of multiple health


Information on AHCPR's outcomes research program is available through AHCPR's
website (www.ahcpr.gov.)  Copies of the draft report, "The Outcomes of Outcomes
Research at AHCPR," can be obtained by calling Joanne Book; 301-594-4039.

AHCPR welcomes the opportunity to clarify issues or questions about this Notice. 
Programmatic questions may be directed to:

Carolyn M. Clancy, MD
Center for Outcomes and Effectiveness Research
Agency for Health Care Policy and Research
6010 Executive Boulevard
Rockville, MD 20852
Telephone:  (301) 594-2829
FAX:  (301) 594-3211
Email:  cclancy@ahcpr.gov

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