11296 Federal Register / Vol. 66, No. 37 / Friday, February 23, 2001 / Notices

involving individual Federal Reserve

System employees.

2. Any items carried forward from a

previously announced meeting.

CONTACT PERSON FOR MORE INFORMATION:

Lynn S. Fox, Assistant to the Board;

202–452–3204.

SUPPLEMENTARY INFORMATION: You may

call 202–452–3206 beginning at

approximately 5 p.m. two business days

before the meeting for a recorded

announcement of bank and bank

holding company applications

scheduled for the meeting; or you may

contact the Board’s Web site at http://

www.federalreserve.gov for an

electronic announcement that not only

lists applications, but also indicates

procedural and other information about

the meeting.

Dated: February 21, 2001.

Robert deV. Frierson,

Associate Secretary of the Board.

[FR Doc. 01–4615 Filed 2–21–01; 10:37 am]

BILLING CODE 6210–01–P

DEPARTMENT OF HEALTH AND

HUMAN SERVICES

Agency for Healthcare Research and

Quality

Request for Planning Ideas for the

Development of the Children’s Health

Outcomes Initiative

AGENCY: Agency for Healthcare Research

and Quality (AHRQ), DHHS.

ACTION: Notice.

SUMMARY: AHRQ is exploring the

feasibility of leading a significant

research initiative (Initiative) that will

examine the relationships between care

management processes (including

health systems and clinical care) and

children’s health outcomes to produce

information that can be incorporated

into practice and policy. Consistent

with research previously funded by

AHRQ, outcomes are defined as

important dimensions of health

attributable to health care, including

health perceptions, ability to function,

and satisfaction with care. Interventions

of interest are broadly defined to

include both clinical interventions,

organizational characteristics and

strategies, and the intersection or

combination of both. The purpose of

this announcement is to solicit broad

input from clinical and social scientists,

researchers, clinicians, health systems

leaders and others regarding priorities

for focusing the Initiative.

Recommendations received will be

compiled and discussed at an expert

meeting convened to discuss the

initiative and plan a possible research

strategy. This request for suggestions

and the expert meeting are preparatory

steps of the Initiative, which may lead

to a study (or family of studies)

commencing in FY 2002.

Nature of Recommendations

AHRQ requests written suggestions as

to the priority issues in children’s

health care that the Initiative should

address. Issues should be considered

priorities because their impact has not

been adequately studied in other

research or because their impact can

only be evaluated in a large study such

as this. Supporting rationale and

suggestions for research strategies

should be included. Suggestions should

address one or more of the following

categories:

• Age of population to be studied:

Child health includes the health care

needs of infants, preschoolers, schoolage children, and adolescents. Since

their needs vary, should the Initiative

focus on a particular group or the entire

spectrum?

• General population or priority

populations to be studied: Should the

Initiative focus exclusively 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, and people

living with chronic illnesses and/or

disabilities), the needs of children

insured through public programs, or the

general pediatric population?

• General health or tracer conditions

to be studied: One approach used to

assess care management in adult

populations has involved the use of

selected ‘‘tracer’’ or sentinel conditions

(e.g., diabetes) to derive inferences

about overall health system

performance. (Kessner DM, Kalk CE,

Singer J. Assessing health quality—the

case for tracers. The New England

Journal of Medicine. 1973;288(4): 189–

194.) This strategy may or may not be

suitable for children. AHRQ seeks input

on the question: Should general health

or tracer conditions be used to evaluate

the health care organization’s impact on

child health status? If tracer conditions

should be the focus, which conditions

(physical, mental or behavioral) should

be examined? Examples of experience

from research or clinical improvement

programs would be particularly helpful.

• Structures of the health care system

to be studied: What organizational and

delivery components of typical child

health care settings and characteristics

should be examined for their impact on

children’s health outcomes? Beyond the

evolution of managed care

arrangements, there is far less

understood about practice settings likely

to influence the content of care.

• Clinical processes of care: An

important challenge for this Initiative is

establishing priorities for clinical

conditions or interventions to be

assessed. When assessing clinical

processes of care, should the focusing

theme be ‘‘tracer’’ conditions (e.g., acute

or chronic medical conditions, behavior

problems, risk factors for adult disease,

etc.) and the clinical processes that

effect theses conditions, or should the

focusing theme be generic clinical

processes (e.g., anticipatory guidance,

specialty care, pediatric rehabilitation,

etc.) and their impact on broader health

outcomes, or should it be a combination

of the two? Criteria for selecting priority

topics would also be most welcomed.

For example, conditions for which

current evidence is exceeded by

increasing need (e.g., obesity) are of

particular interest, as are clinical

processes that are broadly applied but

for which there is little evidence (e.g.,

anticipatory guidance), as well as

conditions relevant to children with

special health care needs, such as

rehabilitative services.

• Outcomes to be measured: What

might be the most salient child health

outcomes, long and short term, for

which it would be important to

elucidate the relationship with the

structures and processes of health care

under study?

• Methodologic issues: There are a

number of study designs that are

potentially suitable for this effort,

including a multi-center study with a

single protocol and coordinating center;

centers of excellence with specific

themes; a follow-back component added

to an existing data collection effort; or

focused individual projects that include

common outcome measures and design

features but allow local flexibility.

Comments on the relative advantages or

disadvantages to these approaches, or

other designs, are also most welcomed.

• Other issues in child health care

that do not fit into the categories above.

DATES: Submit comments on or before

March 26, 2001.

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 31⁄2 floppy

disk or as an attachment. Responses to

this request should be submitted to:

Howard Bauchner, MD, Scholar in

Residence, Agency for Healthcare

Research and Quality, 6010 Executive

Boulevard, Suite 201, Rockville, MD

Federal Register / Vol. 66, No. 37 / Friday, February 23, 2001 / Notices 11297

20852, Phone: 301/594–5420, Email

address: HBauchne@AHRQ.gov.

In order to facilitate the 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 HBauchne@AHRQ.gov.

FOR FURTHER INFORMATION CONTACT:

Howard Bauchner (301) 594–5420. 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) 594–5420.

SUPPLEMENTARY INFORMATION:

Background

Under authorization of Title IX of the

Public Health Service Act (42 U.S.C.

299–299c–7) as amended by Public Law

106–129 (1999), the Agency for

Healthcare Research and Quality

(formerly the Agency for Health Care

Policy and Research) is charged with

enhancing the quality, appropriateness,

and effectiveness of health care services

and access to such services. AHRQ

accomplishes these goals through

scientific research; promotion of

improvements in clinical and health

systems practices including the

prevention of diseases and other health

conditions; and improvements in the

organization, financing and delivery of

health care services. Section 1142 of the

Social Security Act (42 USC 1320b–12)

enhances and elaborates on AHRQ’s

program of outcomes and effectiveness

research which constitutes a major

portion of AHRQ’s health services

research agenda.

This Initiative 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.

Priority Populations

AHRQ has made a commitment to

focus its health services research on

certain priority populations: racial and

ethnic minorities, women, children, the

elderly, low-income populations, people

living in rural areas and inner-city, and

people living with chronic illnesses

and/or disabilities. These are all groups

for whom public policy struggles to find

effective solutions to improve health

care. Health services research has

consistently documented the persistent,

and at times great, disparities in health

status and access to appropriate health

care services for certain groups, notably

racial and ethnic minorities and low

income families and children. Despite

the dramatic changes occurring in the

organization and financing of children’s

health services, the knowledge base for

guiding these changes or assessing their

impact is less well developed than that

for adults. Health care issues that exist

for people with chronic illnesses and

disabilities also require attention.

Health services research should do a

better job of bringing science-based

information to bear on these disparities

so that the health of these groups is

enhanced.

Strategic Goals

AHRQ has enunciated three strategic

goals which will contribute to

improving the quality of health care for

all Americans. These goals are to (1)

support improvements in health

outcomes; (2) strengthen quality

measurement and improvement; and (3)

identify strategies to improve access,

foster appropriate use, and reduce

unnecessary expenditures. This

Initiative would focus on the first and

third.

(1) Support Improvements in Health

Outcomes

The field of health outcomes research

studies the end results of the structure

and processes of health care on the

health and well-being of patients and

populations. (Institute of Medicine,

1996.) A unique characteristic of this

research is the incorporation of the

consumer’s or patient’s perspective in

the assessment of effectiveness.

Policymakers in the public and private

sectors are also concerned with the end

results of their investments in health

care, whether at the individual,

community, or population level.

A high priority for AHRQ’s outcomes

research will be conditions that are

common, expensive, and/or for which

significant variations in subpopulations,

practice or opportunities for

improvement have been demonstrated.

Also of importance for research will be

the type of delivery system or processes

by which care is provided and their

effects on outcomes, as well as, research

on clinical preventive services that lead

to the prevention of premature death

and disability in the United States.

The outcomes and effectiveness

research program grew out of the

awareness of significant unexplained

variations in clinical practice and the

inadequacy of scientific evidence to

support many common treatments and

procedures. Outcomes and effectiveness

research encompasses three main areas

of emphasis for the prevention,

diagnosis, treatment, and management

of illness: (1) Determination of the

clinical interventions that are most

effective, cost effective, and appropriate;

(2) development of methods and data to

advance effectiveness research; and (3)

dissemination and evaluation of the

impact of research findings on clinical

practice and outcomes. Other distinctive

characteristics of outcomes and

effectiveness research include its multidisciplinary nature; use of a variety of

research designs (e.g., observational

studies, prospective trials, databases

studies) and analytical methods (e.g.,

decision analysis, utility analysis, and

cost-effectiveness analysis);

incorporation of both objective and

subjective measures of outcomes; and

emphasis on policy relevance.

(3) Identify Strategies To Improve

Access, Foster Appropriate Use, and

Reduce Unnecessary Expenditures.

Adequate access to health care

services continues to be a challenge for

many Americans. This is particularly so

for the poor, the uninsured, members of

minority groups, rural residents, and

other vulnerable populations. In

addition, the changing organization and

financing of care has raised new

questions about access to a range of

health services, including emergency

and specialty care. At the same time,

examples of inappropriate use of care,

including overutilization and misuse of

services, continue to be documented.

The increasing portion of our Nation’s

resources devoted to health care

expenditures remains a concern, with

some indicators suggesting that the rate

of increase may accelerate once again.

The continued growth in public

spending for Medicare and Medicaid, in

particular, raises important questions

about the care delivered to the elderly,

poor, and people with disabilities.

Together, these factors require concerted

attention to the determinants of access,

use, and expenditures as well as

effective strategies to improve access,

contain costs, and assure appropriate

and timely use of effective services.

Dated: February 15, 2001.

John M. Eisenberg,

Director.

[FR Doc. 01–4530 Filed 2–22–01; 8:45 am]

BILLING CODE 4160–90–M