Evaluating the Productivity of VA, NIH, and AHRQ Health Services Research Career Development Awardees

PURPOSE

To evaluate the academic advancement and productivity of Department of Veterans Affairs Health Services Research and Development (HSR&D) Career Development Award (CDA) program recipients, National Institutes of Health (NIH) K awardees in health services research (HSR), and Agency for Healthcare Research and Quality (AHRQ) K awardees.

METHOD

In all, 219 HSR&D CDA recipients from fiscal year (FY) 1991 through FY2010; 154 NIH K01, K08, and K23 awardees FY1991-FY2010; and 69 AHRQ K01 and K08 awardees FY2000-FY2010 were included. Most data were obtained from curricula vitae. Academic advancement, publications, grants, recognition, and mentoring were compared after adjusting for years since award, and personal characteristics, training, and productivity prior to the award.

RESULTS

No significant differences emerged in covariate-adjusted tenure-track academic rank, number of grants as primary investigator (PI), major journal articles as first/sole author, Hirsch h-index scores, likelihood of a journal editorship position or membership in a major granting review panel, or mentoring postgraduate researchers between the HSR&D CDA and NIH K awardees from FY1991-FY2010, or among the three groups of awardees from FY2000 or later. Among those who reported grant funding levels, HSR&D CDAs from FY1991-2010 had been PI on more grants of $100,000 than NIH K awardees. HSR&D CDAs had a higher mean number of major journal articles than NIH K awardees from FY1991-2010.

CONCLUSIONS

Findings show that all three HSR career development programs are successfully selecting and mentoring awardees, ensuring additional HSR capacity to improve the quality and delivery of high-value care.

Using AHRQ's evidence-based reports to improve managed care pharmacy practice: oral antidiabetic agents

Managed care pharmacists are faced daily with choices regarding how to deliver the best care with finite resources. Whether it is through encouraging appropriate utilization of medications via formulary management and drug utilization evaluation or through chronic diseasemanagement programs, pharmacists are guiding patient care with effectiveness, quality, and an eye toward value. It is with these goals in mind that pharmacists can benefit from the research produced by the Agency for Healthcare Research and Quality (AHRQ).

Financial incentives to promote health care quality: the hospital acquired conditions nonpayment policy

Over a decade ago it was estimated that in the United States 98,000 patients die each year from hospital acquired conditions (HAC). Recently it has been reported that this many patients now die annually from hospital acquired infections (HAI) alone. Currently, HAI affects 1.7 million U.S. citizens each year. Although these conditions are often called "preventable errors," some are associated with particular hospital and physician cultures, and many of these conditions, such as pressure ulcer formation and infections, may be a sign of low facility staffing levels. Protocols have been developed that have been shown to lower the incidence of many HAC, but these have been slow to be adopted. Voluntary reporting mechanisms to ensure health care quality are reported as having reduced effectiveness by the Joint Commission and U.S. Department of Health and Human Services, Office of Inspector General reports. Transparency and public education have also met with resistance, but in the case of infections now have the support of major national medical organizations. As a further initiative to promote quality, financial incentives have been implemented by the Centers for Medicare and Medicaid Services. Surgeons have lived under stringent financial incentives since the mid-1980s when they were placed under global surgical fees. Medicare currently must make expenditure reductions because it is at risk of becoming insolvent within the decade. Implementation of financial incentives should depend upon a balance between the nonpayment of providers for nonpreventable HAC verses the promotion of health care quality and patient safety, the reduction in patient morbidity and mortality, the spurring of mechanisms to further reduce HAC, and the recouping of taxpayer dollars for HAC that could have been prevented.

AHCPR and the changing politics of health services research

The Agency for Health Care Policy and Research has had a turbulent history. Created with little opposition in 1989, it narrowly escaped being eliminated in 1995, only to be reauthorized (with a new mandate and name--the Agency for Healthcare Research and Quality, or AHRQ) with overwhelming support in 1999. In focusing on budgetary history, this paper sheds light on why health services research (HSR) has difficulty obtaining funding from a government that is willing to spend vast sums on basic biomedical research. The paper argues that three strategies--bureaucratic, marketing, and constituency building--that advocates adopted in the late 1980s made HSR more visible and consequential and were responsible for AHCPR's budgetary successes as well as its near-demise.

Back to the future

The paper by Brad Gray and colleagues summarizes a decade of challenge, growth, and evolution within what is now called the Agency for Healthcare Research and Quality (AHRQ) and the field of health services research, and it gives new depth to the old saying, "May you live in interesting times". Their assessment of the significance of the agency's reauthorization and description of continued challenges for AHRQ and the field are insightful. This commentary focuses on continued maturation of AHRQ's mission and focus, recent achievements, new external factors, and emerging policy dilemmas that AHRQ is uniquely poised to address.

An Insider's Perspective On The Near-Death Experience Of AHCPR

The story of AHCPR's struggle with Congress to remain a federal agency is an example of the longer struggle health services research (HSR) has had to hold a priority in the federal budget. But from another perspective, the growth of HSR has been substantial, albeit an up-and-down experience. Its survival during the turbulent years of 1995-1996 is attributed to a fundamental restructuring of its program priorities and building a new base of support from major health care associations and leaders. A fortunate sequence of events also contributed to the reversal of what could have been a cataclysmic occurrence for the field of HSR.

Clifton Gaus, Administrator of the Agency for Health Care Policy and Research. Interview by Mark Hagland

Clifton Gaus, Sc.D., joined the federal Agency for Health Care Policy and Research (AHCPR) last July, at a time when the agency's star had reached its zenith. With positive response from the field for its work in outcomes measurement research and the development of clinical guidelines, AHCPR was able to cite an array of accomplishments since its creation by Congress in 1989 (when the National Center for Health Services Research was subsumed into the new agency). But now AHCPR faces possibly severe budget cuts, or even elimination, by congressional leaders bent on balancing the budget. Gaus spoke last month with executive editor Mark Hagland on the agency's budget battles, its achievements to date, and its future.

Republicans turn health reform into a revolution

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