Eric B. Larson discusses the Health Maintenance Organization (HMO) Research Network as a potential model for a national test bed. Many ongoing activities of these 15 linked integrated delivery systems illustrate the potential for these networks to facilitate needed two-way learning between research and healthcare systems. Finally, Michael Mustille presents the history and progress of the Council for Accountable Physician Practices (CAPP) to demonstrate how this network of multispecialty medical groups has accelerated the redesign of physician practice—improving the uptake of evidence-based approaches to care, the translation of research to practice, and the outcomes and efficiency of care.

NIH AND REENGINEERING CLINICAL RESEARCH

Stephen I. Katz, M.D., Ph.D.

National Institutes of Health


The NIH Roadmap for Medical Research was developed to increase synergy across NIH and accelerate the pace of discoveries and their translation. It was launched in order to identify major opportunities and gaps in biomedical research that the agency as a whole needed to address to have the greatest impact on the progress of medical research. Roadmap dollars represent 0.8 percent of the total NIH budget and are planned to reach $500 million by 2008. The Roadmap project is meant to address the questions that no one of the 27 different institutes or centers could address on its own but that we could address collectively. This is not a single initiative, but more than 345 individual awards were given, in FY 2005: 40 percent for basic, 40 percent for translational, and 20 percent for high-risk research.

The NIH Roadmap Strategy was to build on the paradigm of bringing basic science and discovery to clinical practice. Roadmap initiatives are grouped under three main headings: New Pathways to Discovery, Research Teams of the Future, and Reengineering the Clinical Research Enterprise. These are all initiatives that are meant to facilitate bench-to-bedside translation of research. New Pathways to Discovery addresses the fundamental issues that need to be overcome to accelerate research at the basic level. Most notable here are the molecular libraries and imaging advances that will enable high-throughput screening of molecular pathways that have been identified as of interest. Research Teams of the Future embodies the commitment of NIH to an interdisciplinary research approach and the promotion of high-risk research through Pioneer Awards.

About one-third of the Roadmap awards are in the area of Reengineering the Clinical Research Enterprise. These initiatives include the Clinical and Translational Science Awards (CTSAs) and a number of projects that are investigating the integration of clinical research networks. We have



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