improve the quality of care. The range of these activities includes an assessment of emergency room services provided to young victims of violence and an evaluation of the effectiveness of a quality improvement initiative for improving HIV care.
As with other agencies, two themes emerge in HRSA’s research: obtaining information on patient perceptions of care and developing performance models for the management of chronic illness. To these ends, HRSA has created a patient satisfaction survey for its direct providers of care that differs somewhat from the CAHPS survey used by Medicaid; consequently, most community health centers (for which Medicaid is a major payer) must administer multiple surveys. Through collaboration with grantees, HRSA has also developed and implemented evidence-based chronic care performance models for the management of diabetes, asthma, and depression. In addition, HRSA conducts evaluations of the efficacy of its patient safety protocols. Significantly, the agency’s research agenda envisions greater collaboration on quality-related research with other agencies within the DHHS (Institute of Medicine, 2001b).
While applied health services research has not been the focus of NIH activities, quality-related health services research is conducted within each of the Institutes. For example, research to develop performance measures for care of depression emanates from the National Institute of Mental Health, while research to develop performance measures for cancer care is supported by the National Cancer Institute (NCI), and for Alzheimer’s Disease by the National Institute on Aging. Reflecting its scientific and medical research mission, NIH focuses much of its research on evaluating the relative effectiveness of different clinical interventions and delivery arrangements in producing desired outcomes; developing clinical data to lead to the development of treatment guidelines; and improving public access to medical and clinical information, such as the results of clinical trials. Similar to the TRIP initiative in AHRQ, research efforts also have focused on strategies to improve the assimilation of research findings into community practice.
NCI’s initiative on quality-of-cancer care includes identifying a core set of outcome measures for use in quality-of-care studies and strengthening the methods and empirical foundations for quality-of-care assessment. An illustrative project is the Cancer Care Outcomes and Surveillance Consortium (CanCORS)—a 5-year, $34 million cooperative study to monitor and better understand variations in receipt of quality cancer care and process–outcome relationships among large cohorts of newly diagnosed lung and colorectal cancer patients. CanCORS findings will complement qual-