[Federal Register: June 21, 2002 (Volume 67, Number 120)]
[Notices]               
[Page 42264-42265]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr21jn02-72]                         

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Agency for Healthcare Research and Quality

 
Request for Planning Ideas for Development of a Health Services 
Research Agenda for the National Children's Study

AGENCY: Agency for Healthcare Research and Quality (AHRQ), HHS.

ACTION: Notice of Request for Ideas.

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SUMMARY: AHRQ seeks recommendations on priority issues in children's 
health services for potential inclusion as topics of research in a 
planned large-scale longitudinal study of children's health outcomes. 
The goal of AHRQ's role in the study is to generate new knowledge that 
can be incorporated into practice and policy. The purpose of this 
announcement is to solicit broad input from clinical and social 
scientists, researchers, clinicians, health systems leaders and others 
regarding priority issues for research which could be addressed in this 
study. Recommendations received will be compiled and discussed at an 
expert workshop convened to discuss the role of health services 
research in this study and to plan research hypotheses and methods. 
This request for suggestions and the expert meeting are preparatory 
steps for submission of hypotheses for consideration into the National 
Children's Study.

DATES: Please submit comments on or before July 2, 2002.

ADDRESSES: Submissions should be brief (no more than three pages per 
recommendation), and may be in the form of a letter or e-mail, 
preferably with an electronic file in a standard word processing format 
on a 3\1/2\ inch floppy disk or as an e-mail attachment. Responses to 
this request should be submitted to: William Lawrence, M.D., Agency for 
Healthcare Research and Quality, 6010 Executive Blvd., Suite 300, 
Rockville, MD 20852, Phone: (301) 594-4040, Fax: (301) 594-3211, E-
mail: wlawrence@ahrq.gov.
    In order to facilitate handling of submissions, please include full 
information about the person submitting the recommendation: (a) Name, 
(b) title; (c) organization, (d) mailing address, (e) telephone number, 
and (f) e-mail address. Please do not use acronyms. Electronic 
submissions are encouraged to wlawrenc@ahrq.gov.

FOR FURTHER INFORMATION CONTACT: William Lawrence at (301) 594-4040 or 
at wlawrence@ahrq.gov. All responses will be available for public 
inspection at AHRQ's Center for Outcomes and Effectiveness Research 
weekdays between 8:30 a.m. and 5 p.m. Arrangements for reviewing the 
submissions may be made by calling (301) 594-4040.

SUPPLEMENTARY INFORMATION:

Background

    The National Children's Study (NCS) represents a unique opportunity 
to understand the impact of health services on children's health and 
development within a large-scale, longitudinal study of children. This 
study would combine AHRQ's commitment to health services research on 
one of its priority populations: children, and two of its strategic 
goals: to support improvements in health outcomes and identify 
strategies to improve access, foster appropriate use, and reduce 
unnecessary expenditures.
    Therefore, the NCS is a proposed longitudinal study of a cohort of 
approximately 100,000 children, following them from before birth 
through age 21 years old. This large-scale study seeks to examine the 
impact of physical, psychological, social, and economic environmental 
factors on children's health and development. AHRQ is seeking written 
suggestions as to the priority issues for research into children's 
health care services that should be addressed in the NCS. Issues should 
be considered priorities for this study if their impact has not been 
adequately studied in other research, if their impact can only be 
evaluated in a large study such as this, and if there is a large 
potential for impact on children's health. Supporting rationale and 
suggestions for research strategies should be included.

Nature of Recommendations

    Suggestions should address one or more of the following:
     Age group to be studied: The nature of the proposed study 
will be to follow children from birth through age 21; for some of the 
cohort, mothers may be recruited during pregnancy or even 
preconception. Thus, participants will be followed in this study 
throughout childhood and possible before birth. However, we are seeking 
recommendations for specific age ranges to be studied for priority 
issues.
     General population or priority population to be studied: 
Should health services research within the NCS be focused on the needs 
of priority populations (as defined by AHRQ: racial and ethnic 
minorities, low-income populations, people living in rural areas and 
inner-city areas, and people living with chronic illnesses and/or 
disabilities), the needs of children insured through public programs, 
or the general pediatric population?
     General health care or specific conditions: Some research 
questions require specific tracer conditions (e.g., asthma, depression, 
etc.) to adequately study, whereas other questions may be best studies 
with a broad range of health services and conditions. Specific 
conditions studied in the NCS would need to be of sufficient prevalence 
or incidence that a sufficient number of children with the condition 
could be recruited in a population sample of 100,000 children. AHRQ 
seeks recommendations for priority conditions and issues in general 
health

[[Page 42265]]

care, with rationale including the importance of the topic and 
assurance of sufficient number of children in the study to adequately 
study the priority issues.
     Environmental factors: For those exposures in the 
physical, social, and economic environment that have a detrimental 
effect on children's health and development, health services may have a 
positive effect by preventing the exposure on ameliorating the impact 
of the exposure on health. AHRQ seeks recommendations with rationale 
for priority issues concerning environmental exposures, broadly 
defined, in which health services may impact on the relationship 
between exposure and health outcomes.
     Components and structure of health services: What 
organizational and delivery components of child health care settings 
and characteristics should be examined for their impact on children's 
health outcomes? What specific processes should be studied? AHRQ seeks 
recommendations for study of a broad variety of health services, 
including not only care delivered in traditional inpatient and 
outpatient settings, but also care delivered through the community, the 
educational system, the juvenile justice system, and other venues. 
Recommendations should be given within the broad categories of mental 
health services, dental health services acute and chronic medical care 
services, services for people with disabilities, community health, 
prevention and anticipatory guidance, obstetric and perinatal services, 
and other.
     Content area of research priorities: The Institute of 
Medicine, in their 2001 report Crossing the Quality Chasm: A New Health 
System for the 21st Century, identified six critical determinants of 
quality of health services: safety, effectiveness, patient-
centeredness, timeliness, efficiency, and equity. In addition, care can 
impact on children with different needs, including: staying healthy, 
getting better, living with illness, end of life care. The framework of 
quality criteria and children's needs from the health care system form 
a matrix within which research priorities in children's health services 
can be considered. AHRQ is seeking research priorities within these 
content areas.
     Outcomes to be measured: What are the most important child 
health outcomes, long and short term, for which it would be important 
to study the relationship with structures and processes of health care 
under study?
     Methodologic issues: The study of health services within 
the NCS must take place within the constraints of the main study 
design. Within these constraints, what critical design issues need to 
be considered in a large-scale study of health services? Example issues 
in this category could include: oversampling of specific populations, 
time points for measurement, or inclusion of nested studies. Comments 
on the relative advantages or disadvantages of different methodologic 
approaches to answering study questions in priority research areas are 
also welcomed. For example, which questions can be addressed with 
observational data and which with data from intervention studies?
     Other issues in child health care services that do not fit 
into the categories above.

    Dated: June 14, 2002.
Carolyn M. Clancy,
Acting Director.
[FR Doc. 02-15788 Filed 6-20-02; 8:45 am]
BILLING CODE 4160-90-M