Building a Community of Health Services Research Training.
It has become increasingly clear that to improve health care access, cost, and quality in a meaningful way, the nation needs a critical mass of health services researchers. Individuals skilled in the methods of health care research are essential to building the knowledge base that will inform health care decision makers. In parallel, the nation needs decision makers who are familiar with research methods and are critical users of the health services research literature that can inform improved decisions. As the nation's lead Agency in generating the knowledge essential to improving quality care and understanding the challenges to health care access and costs, we have incorporated this community-building philosophy into our strategic plan. Moreover, we are capitalizing on new technologies to make information about new programs and opportunities more immediately accessible and to help fellow researchers at all levels and locations communicate and collaborate with each other.
FY 2000: A BANNER YEAR
In its 32-year history, AHRQ and its predecessor agencies have achieved an impressive track record in funding pre- and postdoctoral research training. This past fiscal year (FY 2000) was particularly notable. As of September 30, 2000, AHRQ funded more than 80 training and career development grants for a total in excess of $9 million. More than 180 students received AHRQ support, exceeding threefold the number who received funding 14 years ago when the Agency's role in research education was officially recognized by its inclusion in the National Research Service Award (NRSA) program of the National Institutes of Health (NIH). Also last year, the Agency expanded opportunities available under the NRSA program to include sponsorship of individual predoctoral fellowships for underrepresented minority students, which it is co-sponsoring with NIH (see www.ahrq.gov/fund/training/rsrchtngJitm#PFAMS). Concomitantly, the Agency expanded its support of dissertation research by 60 percent and continued its commitment to the NRSA program by supplementing the available funds.
In addition to achieving new levels of funding for training, FY 2000 was remarkable for another reason. It was the first time AHRQ invested in extramural and intramural career development efforts. Recognizing that new investigators require help in launching their careers, the Agency initiated two career development programs: one for independent scientists (K02, see www.ahrq.gov/fund/training/rsrchtngiitm#ISA) and another for mentored clinical scientists (K08, see wzvw.alzrq.gov.fund/training.rsrchtng.htm#MCSDA). Further, the Agency launched its Kerr White Visiting Scholars program, which enables outside researchers to spend time working on site at AHRQ in Rockville, MD, to gain experience with AHRQ data sets or to conduct health care research using other approaches, and to enrich the Agency's intramural research program (see www.ahrq.gov/fund/training/rsrclitng.Iztm #KWVSP).
Moreover, we now have expanded web-based materials that describe each training program that the Agency supports, lists the students currently enrolled, including their research interests and e-mail addresses, and identifies appropriate points of contact, as well as links to university sites and electronic copies of government policies and forms. Detailed information and all appropriate web address links can be found on our web page at www.akrq.gov/fitnd/training/trainix.htm. Hard copies of new announcements, application kits, brochures, and posters can be obtained by contacting our clearinghouse at 1-800-553-6847. To receive the latest news on all new programs, readers are encouraged to subscribe to AHRQ's electronic newsletter (see www.ahrq.gov/news/ahrqlist.htm).
HOW DID WE GET HERE FROM THERE?
The evolution of AHRQ's training and career development programs can be divided into three phases: an initial phase, which contributed to the rise of many of today's stars in the health services research field; a middle phase, which affirmed the Agency's role in training; and the present stage, which continues to grow and enrich the field by prioritizing research education, career development, and outreach.
Phase 1: 1968-1986
AHRQ was originally established in 1968 as the National Center for Health Services Research and Development (NCHSR&D). As the nation's newest member of the Public Health Service, the Center made a strong start in funding new investigators. By 1973, the Center was supporting as many as 40 pre- and postdoctoral research programs annually. Program emphasis shifted, however, when the Department of Health, Education and Welfare (the predecessor of the Department of Health and Human Services) called for the termination of existing programs. Although the Center continued to seek approval for training programs from the mid-1970s on, no additional funds were appropriated.
The 1970s, however, cannot be characterized entirely as a retrenchment period in government funding for health services research. In fact, it was during this period that the NRSA program--a program that became critical to AHRQ's future--was born. 
By the end of this first phase, NCHSR had already changed the nature of health services research. The list of program and fellowship grants awarded during this time reads like a Who's Who in health services research and includes, among others, Lu Ann Aday, Robert Brook, Robert Blendon, Alan Garber, Clif Gaus, Marsha Gold, Mitch Greenlick, Joel Hay, Arnold Kaluzny, Willard Manning, Michael Morrisey, Duncan Neuhauser, Charles Phelps, Thomas Rice, David Salkever, and Stephen Shortell.
Phase 2: 1986-1998
The second phase of AHRQ training efforts began modestly in 1986 with NRSA-supported funding for a few, primarily institutional postdoctoral training programs (University of Michigan, RAND, University of Pennsylvania, Howard University, UCSF-Berkeley, and Stanford), which grew over time to encompass predoctoral training as well. At present, AHRQ supports the following 24 educational centers of excellence:
* Predoctoral: Brandeis, Harvard, Yale;
* Postdoctoral: Brown, Cornell's Weill Medical College, Duke, Harvard, Harvard-Pediatric, New England Medical Center, Oregon Health Sciences Center;
* Combined: UC Berkeley and San Francisco; UC Los Angeles/RAND, Case Western Reserve, University of Chicago, Dartmouth, Johns Hopkins, University of Michigan, University of Minnesota, University of North Carolina, Northwestern, University of Pennsylvania, University of Rochester, Stanford University, University of Wisconsin.
For additional information on these programs, see www.ahrq.gov/fund/training/rsrchtng.htm#ITA).
In 1989, the NCHSR was renamed the Agency for Health Care Policy and Research (AHCPR). AHCPR expanded the commitment to research education by allocating $500,000 annually to dissertation grants. Additionally, AHCPR began to stimulate minority undergraduate interest in health services research and health policy. The Agency provided support to Harvard University for a Summer Institute for Minority Undergraduate Students and to the Association of American Medical Colleges for a Health Services Research Institute for Minority Faculty.
Also during this middle phase, AHCPR reached another significant milestone in training program efforts: its share of NRSA funds increased substantially from 0.5 percent to 1.0 percent of NIH's allocation.  Toward the end of this period, the Agency fostered greater opportunities for interaction among trainees and began seed support for an annual meeting of its NRSA trainees, in conjunction with those supported by the Health Resources and Services Administration.
Phase 3: 1998 and the Future
As part of the Agency's reauthorization in 1999, AHCPR was renamed AHRQ. Its training and career development today are direct outgrowths of two key events: release of an Institute of Medicine (IOM) report on work force and educational issues, and a needs assessment undertaken by the Agency in 1999. Both inspired the development of new programs and a series of activities designed to build a community among students and faculty across educational institutions. This new initiative is comprised of several components designed to support the development of a strong research infrastructure, provide an identity and visibility for the profession, and promote greater cohesion and integration across training programs.
The IOM Report. Charged with assessing training and work force issues, the IOM Study Committee reported in 1995 that it "became concerned that those in doctoral programs were not being adequately prepared for the 'real world' (or worlds) of health services research" (IOM Study Committee 1995). Further, the Committee concluded that to meet the new demands of a changing health care system, seed money was needed for programs that NRSA did not underwrite (e.g., curriculum development, partnership formation with non-academic organizations).  The report also emphasized the need to invest educational support in new and emerging areas of research, as well as areas in high demand.
In response to the report, the Agency issued two new grant announcements in 1997, the NRSA institutional training program noted previously, and the Innovative Incentive Award program providing seed money for institutions to develop innovative curricula, form new training partnerships, and provide other types of novel approaches to education (see www.ahrq.gov/fund/training/rsrchtng.htm#TIIA). Funding of these programs began in 1998.
The Needs Assessment. Through a series of focus groups with NRSA program directors and faculty, trainees, and prospective employers conducted in 1999, the Agency learned that there was a need to provide greater financial support, foster the career development of young investigators, assist programs with recruitment, and enhance program visibility and integration.
Responding immediately to the call for greater financial support, the Agency has now increased funding for dissertation research, initiated fellowships for predoctoral underrepresented minority students, created career development opportunities for new investigators, and provided enhanced coverage for training-related expenses designed to build a community among trainees in the programs. These latter funds are being used for a variety of activities, including the support of visiting scholars and student travel opportunities and the creation of an expanded set of web-based and printed materials.
In addition, Agency staff members are now fostering the building of a community across training programs and trainees such as those in economics, sociology, nursing, pharmacy, anthropology, industrial engineering, statistics, and political science, as well as clinical training programs. Further, we have now expanded the annual meeting of NRSA trainees in scope to allow more students to present ongoing research and obtain feedback from faculty. To provide programs the opportunity to share experiences pertaining to new and emerging issues, the Agency also has convened annual meetings of training program directors. Among recent meeting topics were training in the responsible conduct of research, approaches to education, the administration of grant programs, ongoing and planned evaluation efforts, and use of Health Care Financing Administration data.
The Agency is also committed to providing assistance with outreach and recruitment. For example, the staff created a series of e-mail groups and LISTSERVs[R] to facilitate broad dissemination, particularly to underrepresented minorities and institutions, and to provide faculty and students with important Agency announcements and employment and research opportunities. Interested individuals can get placed on one of these e-mail groups or contribute materials to be shared with one another by sending the information and their Internet address to email@example.com.
TOWARD CRITICAL MASS
Today, AHRQ is poised to expand its Building a Community efforts. Focusing on outreach, the Agency will begin programs to provide support for infrastructure development in institutions that serve large populations of underserved minorities or are located in geographic areas that have historically low aggregate success rates for research grant awards from AHRQ. Recognizing the need for continuing education, AHRQ is also examining short-term and mid-career training opportunities. Finally, AHRQ will continue to require training in the ethical conduct of research and make available innovative models and curricula in this, as well as other important areas. By tapping into the talent segment of our pipeline, these community-building efforts will help us achieve the critical mass needed to improve all aspects of health care quality and cost, use, and access.
Francis D. Chesley, M.D. is Director of the Office of Research Review, Education and Policy (ORREP) within the Agency for Healthcare Research and Quality (AHRQ). Karen A. Rudzinski, Ph.D. is Director, Division of Research Education (ORREP).John M. Eisenberg, M.D. is the Director of AHRQ.
(1.) Initiated in 1974 to ensure adequate numbers of scientists, the NRSA program would eventually become the principal source of AHRQs institutional program training grants (T series) and individual fellowship (F series) awards by the mid-1980s. For an interesting summary of NRSA's impact in the area of primary care research, see Steiner (2000).
(2.) For a complete analysis on the graduate and postgraduate training of life scientists during the years 1968 through 1998, see Committee on Dimensions, Causes and Implications of Recent Trends in the Careers of Life Scientists (1998).
(3.) Education and training issues continue to be of concern within the community. As this article goes to publication, several reports are also pending publication, including one each from the Health Resources and Services Administration, the National Institutes of Health, and the National Research Council.
Steiner, J. F. 2000. "Program Directors' Perspectives on Federally Funded Fellowship Training in Primary Care Research." Academic Medicine 75 (1).
Committee on Dimensions, Causes and Implications of Recent Trends in the Careers of Life Scientists. 1998. Trends in the Early Careers of Life Scientists. Washington, DC: National Academy Press.
IOM Study Committee. 1995. Health Services Research: Work Force and Educational Issues. Committee on Health Services Research: Training and Work Force Issues, p. 7. Washington, DC: National Academy Press.
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|Title Annotation:||Agency for Healthcare Research and Quality|
|Author:||Chesley, Francis D.; Rudzinski, Karen A.; Eisenberg, John M.|
|Publication:||Health Services Research|
|Date:||Dec 1, 2000|
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