Strategic Plan: Children as a Priority Population
To establish the Agency for Healthcare Research and Quality (AHRQ) as one of the Nation's key public organizations for improving the quality and effectiveness of health care services to the Nation's children and adolescents.
AHRQ was created specifically to respond to the Nation's need for knowledge about the health care system. The Agency's authorizing legislation directs AHRQ "to enhance the quality, appropriateness, and effectiveness of health care services, and access to such services, through the establishment of a broad base of scientific research and through the promotion of improvements in clinical and health system practices, including the prevention of diseases and other health conditions" (Public Law 106-129).
AHRQ's authorizing legislation and AHRQ's Strategic Plan make children one of AHRQ's priority populations. AHRQ's mission for children is consistent with its overall mission: to support, conduct, and disseminate research that improves access to care and the outcomes, quality, cost, and use of health care services.
Goals and Objectives
The goals for the Agency in the area of child health address six areas:
- Contribute to new knowledge about child health services.
- Create tools and nourish talent to strengthen the knowledge base in child health services.
- Translate new knowledge into practice.
- Improve communication with stakeholders in child health.
- Include children and child health care in all AHRQ-supported research, as scientifically and ethically appropriate.
- Balance the AHRQ research portfolio to represent a broader range of children and child health care.
The first three areas follow the Agency's research cycle. The second three are specific to child health and cut across the research cycle and the Agency's three strategic goals. The rest of this strategic plan outlines these goals and their related objectives in greater detail. The strategic plan ends with an overview of partnerships, a significant element for achieving our goals in child health.
Goal 1. Contribute to new knowledge about child health services.
In order to improve health care services for the Nation's children, new research is needed to fill critical gaps in the areas of outcomes, quality, cost, use, and access. In the area of outcomes, gaps include the way child health outcomes are affected by specific clinical approaches in everyday clinical settings, as well as by variations in the organization and financing of care. Child health services research would benefit from targeted new health outcomes and cost measures. Children need quality measures for choice and for assessing quality improvement, as well as effective new quality improvement strategies. Recent expansions of children's health insurance have demonstrated the need for new measures of access, both in terms of insurance coverage and in terms of access to care for children with financial coverage. More and better measures of child health care use and its correlates would enhance the Nation's understanding of child health care. New estimating methods that take into account both short- and long-term costs would help inform public and private policymaking in the area of child health care.
Fund research that fills gaps in knowledge regarding health care structure and processes and their relationships to health and cost outcomes for children.
Strategy 1.1.1: Support outcomes research that examines the impact of specific health care interventions as well as the impact of existing, planned, or proposed variations in the organization and financing of care on child health outcomes and costs.
Support extramural development of quality measures for children to identify quality problems, foster consumer choice of health care plans and providers, and measure the success of quality improvement strategies.
Support extramural research to develop effective and feasible quality improvement strategies in child health care.
Support both intramural and extramural research that develops new knowledge on child access to care, including measures of financial access, and access to care for those with financial coverage.
Support intramural and extramural research that builds the knowledge base on children's use of health care services across a range of health/disease states and health care settings.
Support research that develops knowledge about how to translate research into practice. This research could create new information, or synthesize existing information in theoretically grounded and practically useful ways, as appropriate.
Remain up to date on needs for new knowledge.
Strategy 1.7.1: Continue to analyze specific topics (including cross-cutting areas such as settings and providers of care) in which knowledge gaps require new research efforts. For example, maintain a running synthesis of evidence report topic nominations and evidence report conclusions about gaps in knowledge.
Goal 2. Create tools and nourish talent to strengthen the knowledge base in child health services.
Recent years have witnessed advances in the quality and quantity of child health services research. Nonetheless, AHRQ and the field itself acknowledge that more is needed to build on past successes. The creation of critically needed tools such as quality measures and quality improvement strategies will arise from funded research on those topics for children (see Goal 1). In addition, health services research related to children requires research tools such as guidance on child-relevant methodological issues and new and enhanced databases for research.
Talent for child-relevant health services research must also be nourished. Our objectives—to fund new investigators, to convene investigators for information sharing, and to broaden the disciplinary base of child health services researchers—respond to the stated needs and goals of the child health services research (CHSR) community.
Create tools to strengthen the knowledge base.
Strategy 2.1.1: Support talks and papers on methodological issues and solutions in CHSR, to provide guidance to future applicants.
Strategy 2.1.2: Promote enhanced administrative databases of children's clinical services.
Build capacity in health services research in child health care issues.
Strategy 2.2.1: Enhance AHRQ training opportunities for CHSR.
Strategy 2.2.2: Support appropriate CHSR training opportunities in other agencies (e.g., NIH, HRSA).
Strategy 2.2.3: Convene child health services researchers to share knowledge and enhance researcher-to-researcher communication.
Strategy 2.2.4: Understand, and provide incentives for improvements in, CHSR curricula and settings.
Strategy 2.2.5: Broaden the disciplinary base of child health services researchers (and AHRQ applicants).
Goal 3. Translate new knowledge into practice.
Throughout the health care field, there is a well-documented and acknowledged need to ensure that the useful information that agencies such as AHRQ help create is appropriately and quickly put into practice. The continuing requests for evidence reports on child health topics, and the impressive response to the FY99 TRIP RFA, show that the same need for information exists in child health care.
Support evidence reports to synthesize existing knowledge on child health care topics.
Support evidence centers to include a focus on children in evidence reports that cover multiple populations, as appropriate.
Support rigorous research and well-evaluated demonstration projects aimed at translating knowledge into practice (e.g., through quality improvement research).
Identify and partake actively in partnerships to translate research into practice. (See the last section of this Strategic Plan.)
Disseminate results of research, including research on effective mechanisms for translating research into practice.
Goal 4. Improve communication with the child health services research stakeholder and user communities.
To support the creation of the knowledge base and tools that will be useful to children, child health care providers, and policymakers, there is no substitute for continued interaction between AHRQ staff and stakeholders and users in the child health community. The following objectives are designed to bring stakeholders and users into the Agency, ensure that Agency staff participate in policy discussions of the literature and in other forums, and build mechanisms to enhance the availability and usefulness of outside advice and knowledge.
Create and enhance mechanisms to explore users' concerns and interests in child health and health care.
Strategy 4.1.1: Convene periodically a broad range of users and stakeholders.
Strategy 4.1.2: Identify opportunities to meet individually with stakeholders.
Strategy 4.1.3: Strengthen our ability to get timely feedback from child health care stakeholders.
Strategy 4.1.4: Create a speaker series in CHSR that will attract key speakers and child health audiences to the Agency to promote an enhanced understanding of CHSR.
Participate as leaders in child health discussions nationally.
Strategy 4.2.1: Identify opportunities for participation.
Strategy 4.2.2: Accept invitations relevant to AHRQ's child health mission and vision.
Strategy 4.2.3: Participate actively.
Strategy 4.2.4: Follow up with Agency senior management to discuss Agency and personal commitments, as appropriate.
Strategy 4.2.5: Write, publish, and otherwise disseminate articles in CHSR.
Create efficient, resource-sensitive, internal mechanisms to collect, synthesize, and act on (as appropriate) CHSR users' (and potential users') concerns.
Strategy 4.3.1: Disseminate timely information internally.
Strategy 4.3.2: Respond appropriately to stakeholders' concerns.
Improve electronic and print communication of AHRQ child health activities.
Strategy 4.4.1: Revise and expand the child health pages on the AHRQ Web site.
Strategy 4.4.2: Encourage participation in the child health LISTSERV®.
Strategy 4.4.3: Develop and implement a public affairs strategy on child health.
Goal 5. Include children and child health care in AHRQ-supported research, as scientifically and ethically appropriate.
Children and child-relevant analyses are often excluded from research that could conceivably contribute to the knowledge base on important child health issues. For example, how do market forces affect the availability and quality of child health care? How does the design of insurance benefits affect costs for children's care? What are the most effective preventive and treatment strategies for children with diabetes or pain? How do mental health referral practices in primary care affect children? As a result of these omissions—typically inadvertent—we know much less about child health and health care than is desirable. Including children in research where appropriate would tap into a large, untapped pool of expertise on a range of traditional health services research topics for the benefit of children. It would also expand the knowledge base of the health services research community to include new aspects of health care.
Expand the inclusion of children and child-relevant analyses in intramural and extramural research.
Strategy 5.1.1: Develop an inclusion policy, based on appropriate feedback internally and externally.
Strategy 5.1.2: Publish the policy in the NIH Guide, and use other mechanisms to broadly publicize the policy.
Strategy 5.1.3: Develop and implement technical assistance on the inclusion policy for staff, applicants, study sections, and institutional review boards.
Strategy 5.1.4: Monitor implementation and evaluate success or failure of the inclusion policy.
Periodically analyze and discuss internally and externally the adult-child balance in the research portfolio.
Goal 6. Ensure long-term balance across the range of children and child health care, while ensuring responsiveness to short-term needs.
Although children can be grouped into the category "not little adults," they are not themselves a monolithic population. Throughout childhood, different children will experience substantial differences in health conditions and health risk factors, resulting in different health care needs. Across all goals in this strategic plan, AHRQ should strive to achieve a balance across the many aspects of child health care that affect child health. The emphasis throughout should be on personal health care services, regardless of setting. Personal health care services are primarily clinical services provided by physicians and other health care providers in offices, clinics, and homes; hospital services; and nursing home and home health services. Clinical services include screening, diagnostic, treatment, rehabilitative, and palliative interventions.
Concentrated short-term attention to address past imbalances or emerging needs should not drive out the need for balance.
Within the framework that AHRQ's research responsibility is in the realm of personal health care services, achieve balance in the research portfolio across child health topics, types of child health services, child health care settings, and the range of participants in child health and health care.
Strategy 6.1.1: Measure balance at every funding cycle, and share information with those involved in funding decisions.
Strategy 6.1.2: Measure balance periodically with the help of outside analyses, and share information with Agency staff, research community, and stakeholders as appropriate.
Strategy 6.1.3: Devise methods (e.g., requests for applications, program announcements, special emphasis notices) to address gaps.
Across the next 3 to 5 years, while the research portfolio becomes more balanced (see Objective 6.1), support research on certain special needs areas that are defined as critical and appropriate to AHRQ involvement by Agency staff, the administration, and outside advisors. Current special needs populations include adolescents, children with chronic illnesses and disabilities, low-income children, and racial and ethnic minority children experiencing disparities in health and health care.
Strategy 6.2.1: Develop an appropriate strategy to decide when and how to respond to external and internal demands for focusing on specific topics.
Strategy 6.2.2: Use appropriate mechanisms to solicit research in critical areas (e.g., special emphasis notices, RFAs).
Strategy 6.2.3: Use creative mechanisms to publicize the need for research in critical areas.
AHRQ is not able to accomplish its mission alone. Partnerships formed with the agencies within the Department of Health and Human Services, with other components of the Federal government, and with private-sector organizations will continue to play a critical role in achieving Agency goals. Partnerships take many forms and contribute to the Agency's achieving its goals at all points of the cycle of research.
- Needs assessment: AHRQ works cooperatively with many public- and private- sector organizations to identify their needs for child health services research so that Agency initiatives in child health begin and end with the user.
- Knowledge-base development: AHRQ works in partnership with the National Institutes of Health, the Centers for Disease Control and Prevention, the research divisions of the Health Resources and Services Administration, The David and Lucile Packard Foundation, the American Association of Health Plans Foundation, and other public and private research organizations to undertake projects of mutual benefit and to ensure a balanced investment in the full continuum of health research for the benefit of children.
- Translation and dissemination: Partnerships are critical to assure that the knowledge gained through research is used to improve care for children in America. AHRQ works in partnership with Federal and State policymakers involved in the State Child Health Insurance Program, Federal agencies and professional associations active in the National Asthma Education and Prevention Program, and with other national and regional initiatives, to translate new knowledge into practice and policy to improve child health care and health.
- Evaluation: Increasingly, AHRQ will partner with public- and private-sector organizations to conduct studies or projects to test implementation strategies, the applicability of research findings in different practice settings, and the quality, usefulness, and ease of use of Agency products for improving child health.