The Agency for Healthcare Research and Quality will spend $15 million looking at better ways to treat patients with 10 prioritized conditions or disease states.
The Medicare Modernization Act of 2003 tasked the AHRQ to come up with a list of priority conditions affecting Medicare, Medicaid and SCHIP patients. The federally funded agency did that earlier this year through a public "listening session" in May and from subsequent written testimony submitted to HHS.
A committee with representatives from the AHRQ, the CMS and the Food and Drug Administration and the HHS secretary picked the initial 10 study areas. These are focused primarily on conditions deemed most important to Medicare patients, according to Jean Slutsky, director of the center for outcomes and evidence at AHRQ, who will be heading the research project.
They are ischemic heart disease; cancer; chronic obstructive pulmonary disease/asthma; stroke, including control of hypertension; arthritis and nontraumatic joint disorders; diabetes; dementia, including Alzheimer's disease; pneumonia; peptic ulcer/dyspepsia; and depression and other mood disorders.
Slutsky said that as the research work continues, the list will grow to include areas of primary interest to Medicaid and SCHIP patients.
The AHRQ will seek to determine the comparative effectiveness, outcomes and appropriateness of various clinical interventions to treat patients with the conditions on the list, but will not duplicate previous research.
"There have been tons of studies under these conditions," Slutsky said. "Part of the problem is putting all that research together and coming up with the best evidence of what all that research shows. There are a huge number of questions that are important to people who either provide healthcare or are recipients of healthcare, questions that remain unanswered."
For example, Slutsky said, "There are critical questions about how certain interventions might work compared to other interventions, say a pharmaceutical intervention compared with a surgical intervention."
The work product of the AHRQ research program will come in the form of systematic reviews, not guidelines, she said, but the form and substance will depend on the question studied.
"It can turn up in an alert, general information about how to treat a patient, things to consider, (or) a physician order entry form when a pharmacist sees two drugs being prescribed together so he can call up the doc and say, 'Maybe this isn't a good combination,'" Slutsky said.
"An exciting part of the statute talks about dissemination of products of the research," she said. "We're instructed that it's disseminated in formats that are useful for a wide variety of users."
That would include healthcare information technologies such as alerts built into computerized medical record and order entry systems. "We're going to talk to the (IT) vendor and user community and find out how we can disseminate this product in a format that's useable to them," Slutsky said.
The fruits of their labors should begin to appear in about 18 months, Slutsky said. Though the authorization for the research was contained in the language of the 2003 legislation, money to carry it out was only just approved under the omnibus appropriation legislation signed by President Bush earlier this month.