On June 30, a new government agency within the Department of Health and Human Services (HHS) called the Federal Coordinating Council for Comparative Effectiveness Research released its first report to President Obama and Congress. Authorized by the American Recovery and Reinvestment Act of 2009, the council is tasked with prioritizing and coordinating how multiple government agencies will spend the stimulus package’s $1.1 billion windfall for comparative effectiveness research (CER), which is aimed at improving healthcare outcomes in the U.S.
Of the funds, $400 million has been directed to the National Institutes of Health (NIH), $300 million to the Agency for Healthcare Research and Quality, and the remaining $400 million to the Office of the Secretary of Health and Human Services.
Patrick Conway, MD, MSc, the federal coordinating council’s executive director, is well versed in the potential impact of comparative effectiveness research on hospitalists. Just as Dr. Conway was joining the Center for Health Care Quality at Cincinnati Children’s Hospital after a fellowship at Children’s Hospital of Philadelphia, the pediatric hospitalist was named a 2007-2008 White House Fellow at HHS—the first hospitalist accepted into the program.
This research will address primary questions about which medicine is best for which patient, but also address larger issues, such as care coordination and how care is organized within the hospital and outside the hospital.
—Patrick Conway, MD, MSc, executive director, HHS’ Federal Coordinating Council for Comparative Effectiveness Research
In August 2008, he was tapped for the post of chief medical officer in the department’s Office of the Assistant Secretary for Planning and Evaluation.
Meanwhile, Dr. Conway still sees patients on weekends at Children’s National Medical Center in Washington, D.C. He recently talked with The Hospitalist about the challenges of coordinating research funding across multiple government agencies, how the Office of the Secretary’s $400 million allocation could be best spent, and what it all means for patient care.
Question: What are the biggest recommendations in the federal coordinating council’s report?
Answer: We approached this as “What unique role can the Office of the Secretary research funds address?” We identified data infrastructure as a potential primary investment. That includes things such as patient registries, distributed data networks, and claims databases.
Traditionally, the federal government has not invested in infrastructure because we have funded independent investigators on a one-question-by-one-question basis. The way I see this infusion of funds is it allows you to invest in data infrastructure that can then be used to answer literally hundreds of questions over time.
Secondly, we identified dissemination and translation, so how do we think about innovative ways to actually communicate directly to patients and physicians at the point of care? We also identified priority populations, including racial and ethnic minorities, persons with multiple chronic conditions, children, and the elderly. And lastly, we identified priority interventions, such as behavioral change, delivery systems, and prevention. So how do we decrease obesity, how do we decrease smoking rates?
Q: How will you address the challenge of coordinating research funding across multiple federal agencies?
A: I think the first step is doing the inventory [of CER], which is going to be an ongoing and iterative process. By doing that, then the council and the HHS have to attempt to avoid duplicating efforts and actually coordinate efforts across the federal government.
Honestly, I think the biggest challenge is these are extremely large, complex government programs. These are hundreds of millions of dollars going out to a huge variety of researchers, academic institutions, etc. One of the systems we’re trying to put in place is a better way to track what’s going on now, so we can actually coordinate going forward. It’s something as simple as we now have a common definition. We tag all money (e.g., CER), so we know exactly what we’re spending money on. That sounds really simple, but it’s actually never been done before. This is a relatively new area of emphasis for the federal government and for healthcare.