Research and Service Programs in the PHS Challenges in Organization (1991) / Chapter Skim
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Methodology
Methodology
Pages 43-68
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From page 43... ...
Effectiveness of organization- Does co-administration enhance or detract from: · effectiveness of services programs; · effectiveness of research programs; · efficiency of research and service programs; coordinating overlapping programmatic research and service priorities and eliminating unwarranted duplication of research and service projects; avoiding gaps in research and service programs.
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From page 44... ...
The committee used two approaches to obtain and analyze the information pertinent to the questions being addressed: 1. categorical analyses (i.e., case studies of disease-specific research and service development and demonstration programs conducted by different agencies, which are used to analyze the effects of differences in organizational arrangements; and 2.
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From page 45... ...
It is therefore necessary that the case studies as a group represent different types of research and services programs and projects, a variety of organizational approaches, special populations, involvement of different levels of government, varied kinds of financing, and different political climates in which research and service programs have developed over time. Each of the three case studies chosen by the committee represents a number of issues with regard to stages of research and services and the linkage between federal research and service programs: 1.
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From page 46... ...
Research focuses on pharmacological interventions, and services focus on chronic, long-term care. This case study explored communication among basic scientists addressing the same area of research across institutes and agencies; it also examined the translation of clinical findings into the service delivery sector (i.e., drug development)
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From page 48... ...
, which manages the Computerized Retrieval of Information on Scientific Projects (CRISP) , a database of all PHS-funded grants.
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shows the average of all subproject awards on the grant—not the actual amount for a particular subproject. This problem weighs heavily in any analysis, since centers and program project grants constitute a sizable portion of research funds.
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The search on information dissemination programs in schizophrenia retrieved health status research grants on information processing and sensory system integration in schizophrenia. In these two instances, the committee sought other sources of information on which to base its deliberations.
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. The areas the committee found most amenable to classification were health status research and health interventions research (with the exception of health services research and research demonstrations)
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The main factor in the inadequate service programs for AD patients is the lack of a national long-term care policy in the face of a widespread disease for which the only treatment is long-term care. Co-administration of AD research and service programs does not exist at the agency level; rather, it is the Secretary of Health and Human Services who oversees agencies that support AD research and that provide social services and reimbursement for services.
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Research into substance-abusing pregnant women is a small portion of pregnancy research and of addiction research. SOURCE: National Institutes of Health CRISP system.
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. Other relevant concerns identified in the case study include stigma attached to alcohol and drug use, particularly in pregnancy; the general lack of attention to women's issues in federal research and service programs; congressional ambivalence about the mission of ADAMHA and the relative importance of federal and state program planning, insularity in federal agencies; and the decision to deal with ADM problems largely outside the primary health care arena.
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From page 55... ...
Considerable responsibility for this failure could be attributed to neglect and to conflicting priorities between biomedical research and the development of interventions. CASE STUDY OF DOPAMINE RESEARCH: SCHIZOPHRENIA AND PARKINSON'S DISEASE The role of dopamine in the etiology and treatment of both schizophrenia and Parkinson's disease has been studied for over 20 years (Figures 3-4 and 3-51.4 Health status research and health interventions research for both these diseases are well developed.
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~ Dopamino FIGURE 3~ Grants for Parkinson's disease and for dopamine research. This comparison of the growth in research grants for all dopamir~e research, all Parkin~on's disease msearch, and research on the role of dop~n~ine in Parkinson's dowse shows that research on dopamine has increased steadily since 1975.
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From page 57... ...
Co-administration is seen, to a minor degree, at the level of the director of NIMH for schizophrenia and at the level of the DEIHS Secretary for Parkinson's disease. Co-administration was not thought to be a major factor in the success of the research programs or in the relative lack of attention to service programs.
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Exceptions are relatively rare and reflect either major policy issues (such as concern about drug abuse and AIDS) or the specific concerns of key individuals in Congress or the administration.
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Health services research methodology has much to offer all three types of demonstration projects and therefore needs ties to agencies, institutes, and offices administering either research or services programs. Likewise, demonstration projects of all three types benefit from ties to health service research, which serve to strengthen the evaluation of costs and effectiveness.
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From page 60... ...
This paper discusses several paradigms for the research-services continuum in which demonstrations play an important role. The large recent increases in appropriations for demonstration programs in ADAMHA have been attributed to congressional displeasure with the declining federal role in service development that followed enactment of the block grant program.
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From page 61... ...
Although mandated by the same legislation, historical and administrative differences between the block grant programs within PHS agencies have had a direct bearing on the relationship of research and services in the respective programs. The office and personnel responsible for administering the block grants changed repeatedly in all three PHS agencies, beginning in 1982.
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From page 62... ...
Constituency Group Relations with Federal Agencies This paper discusses constituency groups and their relationships with research and service agencies in the PHS, focusing on the effects on constituency groups of federal organizational arrangements for the administration of research and services programs and the related issues of mission and leadership.~° Perceptions varied, but the interviews suggest that a consensus exists on the importance of (1) clarity of agency missions, as well as stability of program placement and leadership, and (2)
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From page 63... ...
Organizational arrangements per se, although important, were not found to influence the style of a constituency group's involvement with an agency that is, how it goes about the business of building relationships with programs and the repertoire of advocacy techniques that it uses. Linkage Mechanisms Between Research and Service Programs This paper describes and analyzes linkage between six research and service programs in federal agencies.
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From page 64... ...
Although service activities have been deemphasized since 1981, ADAMHA continues to have funding mandates for services and demonstration programs. Within the past 5 years, congressional authorization for demonstration and services programs that target specific diseases or populations has increased significantly.
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NOTES I Institute of Medicine staff report, Demonstrations and Block Grants in the Public Health Service," paper prepared for the IOM Committee on Co-Administration of Service and Research Programs of the NIH, ADAMHA, and Related Agencies, 1991; available from the National Technical Information Service,
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From page 66... ...
7. Institute of Medicine staff report, "Demonstration and Block Grants in the Public Health Service, paper prepared for the IOM Committee on Co-Administration of Service and Research Programs of the NIH, ADAMHA, and Related Agencies, 1991; available from the National Technical Information Service, Springfield, Va.
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From page 67... ...
9. Institute of Medicine staff report, "Information Dissemination in the Public Health Service," paper prepared for the IOM Committee on Co-Administration of Service and Research Programs of the NIH, ADAMHA, and Related Agencies, 1991; available from the National Technical Information Service, Springfield, Va.
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go go 15.
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