Appendix B: Topic Nomination Form

The Effective Health Care Program Stakeholder Guide

Suggesting a Topic for Effective Health Care Research

The Effective Health Care Program compares available health care tests and treatments to determine whether there are significant advantages or disadvantages with different approaches. The results of this comparative effectiveness research can help people make better decisions about what health care they want to have, and can help clinicians and health care purchasers to focus on the best tests and treatments.

To nominate a topic for research in this program, please complete this form. We need to understand important aspects of the health care service you are interested in, including to whom it applies, what benefits or harms are of greatest interest, and with what other health care services or tests you think it should be compared. Your answers to the following questions will help us phrase your suggestion as one or more research questions that could be answered through comparative effectiveness research. At the end of this form, you will also have the chance to phrase your own research question based on your answers.

Thank you for participating in the program!

To nominate a topic for research in this program, please fill in the form below as completely as possible and click on "submit" at the end. If you prefer, you may fill out the rich text format (rtf) version of the form, which can be edited in any text editing program (e.g., MS Word, Wordpad), and E-mail the completed form to effectivehealthcare@ahrq.hhs.gov, or you may print out the completed form and mail it to:

Michelle Eder
AHRQ Effective Health Care Program
c/o Scientific Resource Center at Oregon EPC
Center for Health Research
3800 N Interstate Avenue
Portland, OR 97227-1110

If you have any supporting documents you would like to include with your nomination, you can include them (if mailing), send them as additional attachments (if E-mailing), or you will be given an opportunity to upload them after submitting the online form. All topic nominations, including those submitted on paper, will appear in the public reading room.

Topic Nomination

  1. Your Nomination—Briefly describe a specific question, or set of related questions, about a health care test or treatment that this program should consider.

    • Examples:
      • For patients with low bone density, what is the comparative effectiveness of exercise versus drug therapy to treat or prevent osteoporosis?
      • For adult patients with a major depressive disorder (MDD), what are the comparative risks and benefits of older versus newer antidepressants?
      • In patients with cystic fibrosis, what is the effectiveness of recombinant human growth hormone (rhGH) in improving intermediate health outcomes, such as pulmonary function and nutritional status?


  3. Does your question include a comparison of different health care approaches? (If no, your topic will still be considered)

    2a. If yes, explain the specific technologies, devices, drugs, or interventions you would like to see compared:

    • Examples:
      • Calcium versus biphosphonates for the prevention of vertebral fractures
      • Core needle biopsy versus open surgical biopsy for diagnosing breast lesions
      • Antireflux medication versus diet and exercise for the control of acid reflux symptoms


  4. What patients or group(s) of patients does your question apply to? (Please include specific details such as age range, gender, coexisting diagnoses, and indications for therapy)

    3a. Are there subgroups of patients that your question might apply to? (For example, an ethnic group, stage or severity of a disease)

  5. Describe the health-related benefits you are interested in. (For example, improvements in patient symptoms or problems from treatment or diagnosis)

  6. Describe any health-related risks, side effects, or harms that you are concerned about.

Appropriateness for EHC Program

  1. Does your question include a health care drug, intervention, device, or technology available (or likely to be available) in the U.S.?

  2. Which priority area(s) and population(s) does this topic apply to? (Check all that apply.)

    Priority Conditions

    ___ Arthritis and nontraumatic joint disorders
    ___ Functional Limitations and disability
    ___ Cancer
    ___ Infectious diseases, including HIV/AIDS
    ___ Cardiovascular disease, including stroke and hypertension
    ___ Obesity
    ___ Dementia, including Alzheimer's Disease
    ___ Peptic ulcer disease and dyspepsia
    ___ Depression and other mental health disorders
    ___ Pregnancy, including preterm birth
    ___ Developmental delays, attention-deficit hyperactivity disorder, and autism
    ___ Pulmonary disease/asthma
    ___ Diabetes mellitus
    ___ Substance abuse

    Priority Populations

    ___ Low income groups
    ___ Minority groups
    ___ Women
    ___ Children
    ___ The elderly
    ___ Individuals with special health care needs including individuals with disabilities or who need chronic care or end-of-life care

    Federal Health Care Program

    ___ Medicaid
    ___ Medicare
    ___ State Children's Health Insurance Program (SCHIP)
    ___ Other

    Importance

  3. Describe why this topic is important.





  4. What specifically motivated you to ask this question? (For example, you are developing a clinical guideline, working with a policy with large uncertainty about the appropriate approach, costly intervention, new research you have read, items in the media you may have seen, a clinical practice dilemma you know of, etc.)

  5. Does your question represent uncertainty for clinicians and/or policymakers? (For example, variations in clinical care, controversy in what constitutes appropriate clinical care or a policy decision)

    10a. If yes, please explain:

    Potential Impact

  6. How will an answer to your research question be used or help inform decisions for you or your group?

    11a. Describe the timeframe in which an answer to your question is needed.

  7. Describe any health disparities, inequities, or impact on vulnerable populations your question applies to.

    Technical Experts and Stakeholders

  8. Are there health-care-focused, disease-focused, or patient-focused organizations or technical experts that you see as being relevant to this issue? Who do you think we should contact as we consider your nomination? This information will not influence the progress of your suggestion through the selection process, but it may be helpful to those considering your suggestion for further development.

    1. List organizations:

    2. List individual experts:

      Examples:

      • American Heart Association and American College of Cardiologists
      • Mental Health America
      • Association of American Indian Physicians
      • Depression and Related Affective Disorders Association
      • Gerontological Society of America
      • National Lipid Association
      • Nominator Information


  9. In order to help us to understand the context of your health care question, it would be helpful to know more about you. The answers you give will not influence the progress of your suggestion.

    1. Choose a description that best describes your role or perspective: (You may select more than one.)

      ___ Patient/consumer
      ___ Continuous Quality Improvement group
      ___ Physician
      ___ Health benefits plan/insurance carrier
      ___ Nurse/nurse practitioner/physician assistant
      ___ Administrator (hospital or other)
      ___ Pharmacist
      ___ Health care payer/purchaser (employer, Federal government)
      ___ Other health care professional
      ___ Health care industry (device, drug, or other manufacturer)
      ___ Professional society
      ___ Researcher
      ___ Public policymaker/legislator
      ___ Other

    2. Are you making a suggestion as an individual or on behalf of an organization?

    3. If an organization, please state the name of the organization: (optional)

    4. Your name and contact information: (optional)


    Your personal identification will not be displayed in the public reading room, nor will it influence your nomination for EHC research. It will only be used to contact you for additional information about your nomination if necessary. It is not mandatory that you provide your contact information, but it is often helpful for us to contact the nominator when we need clarification about a research question.

    Your First Name:

    Your Last Name:

    Your Title:

    Your Organization:

    Your E-mail address:
     

Current as of July 2011
Internet Citation: Appendix B: Topic Nomination Form: The Effective Health Care Program Stakeholder Guide. July 2011. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/research/findings/evidence-based-reports/stakeholderguide/appendixb.html