Thanks to the interest and dedication of the public and of pioneering researchers, our issue has finally made it to the regular announcement of research priorities of a major federal funding agency. In the announcement of the core research agenda for the Agency for Healthcare Research and Quality (AHRQ) (www.grants.nih.gov/grants/guide), one area of interest for primary care is "Improved care for the end of life." AHRQ singles out five populations as special targets for research; end-of-life health care is one. Specific research interests include advance care planning, continuity, costs and quality in different sites, severity criteria, expanded access to appropriate care, family caregiving, and decision-making.
In addition, the Quality Interagency Coordination Task Force (QuIC) has targeted end-of-life issues. The QuIC is a public-private collaborative panel designated by the President to shape the course of our national work on patient safety and error reduction. Their research agenda includes end-of-life patients as an especially vulnerable group and end-of-life care as a special target (www.quic.gov).
AHRQ has planned six "Requests for Proposals" to support work in patient safety and error reduction. The first two have been published: one for Centers of Excellence (program projects with at least a few intertwined projects) (grants.nih.gov/grants/guide) and one for Developmental Centers of Excellence (laying the groundwork for larger projects) (www.grants.nih.gov/grants/guide/rfa-files/RFA-HS-01-007.html). Each of these continues the pattern of targeting end-of-life care and our patients.
These are important strides for our field. Those who manage research funds have begun to see opportunities; at the same time, our field has developed a substantial cadre of researchers, and public and policymaker interest has grown. ABCD’s testimony to the QuIC National Summit (www.qic.gov/summit/wlynn.htm) and our other contacts in support of an agenda for research funding were important in accomplishing this much.
These will be very hard grants to get. AHRQ has very little money for its core work, and much of its funds will be earmarked for patient safety. The main players for that money are involved in reducing errors in hospitals, mainly medication errors and some errors in surgery or other interventions. Much of that field depends upon informatics and automation. The overwhelming threats to patient safety for end-of-life patients are transfers between care settings, incomplete advance planning, polypharmacy, and inadequate patient and family self-care education. These errors fit under the definitions being used, but research on them will have to make it through a study section whose main focus will be on hospitals and informatics.
Nevertheless, I would encourage researchers in end-of-life care to try to respond to these RFAs. We can’t win if we don’t play! And having some good proposals before the agency makes it more likely that future RFAs will be more readily adapted to our work. In addition, activists should remember to mention to their congressional representatives that this work is important and should be encouraged.
The first round of grants will be announced late in the summer (provided Congress passes the last budget bills in December). Stay tuned for updates on our field’s success.
<<< Previous Next >>> [ Go Up ]