Response to AHCPR on CERTs:

Sue Tolleson-Rinehart, University of North Carolina at Chapel Hill
December 17, 1998

I am the Program Coordinator of an exciting new initiative called the UNC Program on Health Outcomes (UNC PHO) here at the University of North Carolina at Chapel Hill. The PHO commenced on October 1, and is in a vigorous planning year, under the direction of William L. Roper, M.D., M.P.H.

The PHO is a multidisciplinary endeavor whose mission is to advance the development and dissemination of new knowledge, methods and interventions related to health outcomes and health care quality; and to translate scientific knowledge into strategies that can be implemented within real-world organizations and communities to achieve meaningful improvements in health and well-being. The PHO is capitalizing on, and coalescing, the extraordinary resources already extant at UNC for outcomes and quality of care research, education, and clinical application.

I am sending you this message to respond to the AHCPR's call for nomination of topics of study and ideas for implementing the proposed Centers for Education and Research on Therapeutics. May I impart these suggestions?

First, I believe that the proposed RFP would be very well served by devoting considerable thought and discussion to the infrastructure and capacity of potential CERTs. It seems to me that, regardless of the eventual topics chosen, CERTs will need to be large, flexible enterprises, capable of drawing quickly on a wide but closely connected community of collaborators, in order to provide the highest quality products.

Second, with regard to initial areas of emphasis and high priority research topics, I hope that the AHCPR will consider these two things:

1. Interpret outcomes research broadly, to include not only clinical and therapeutic outcomes, but economic and social-psychological outcomes as well. Clinical outcomes are unquestionably important, but health care quality today cannot be discussed in an economic vacuum. As an example of the importance of social-psychological variables, efforts to understand patients' "health literacy," are also essential to quality outcomes, especially in terms of reduction of drug misadventures. I believe that this emphasis on "health literacy"—people's understanding of the medicines they use—also comports very well with the FDA's mission.
2. Make provision to explore the relationship between outcomes research and health policymaking, especially with regard to such questions as the degree to which outcomes research can be synthesized, translated for, or explained to elective and appointive policymakers at State and Federal levels. Policymakers, most of whom are not scientists, must be given opportunities to understand outcomes research before they can use it to make the best policy decisions. Conversely, health researchers can benefit from a greater understanding of the constraints under which policymakers operate.

Thank you for the opportunity to express these thoughts to you. It would be my great pleasure to tell you and your colleagues more about the UNC Program on Health Outcomes.

Sue Tolleson-Rinehart, Ph.D.
Program Coordinator, UNC Program on Health Outcomes
CB # 7400, Rosenau Hall
University of North Carolina at Chapel Hill
Chapel Hill NC 27599-7400
Telephone: (919) 843-9477
Fax: (919) 966-7141
suetr@unc.edu

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