Lost in translation? Reflections on the role of research in improving health care for children

While the budget of the National Institutes of Health (NIH) has grown to double its 1993 level, growing understanding of the chasm between the "health care we have and the health care we could have" has led to a stronger focus on the need to translate research into practice. Children's health care has much to gain from this new emphasis; however, the unique features of children's health, health services, and the history of funding for child health research are limiting our ability to make rapid progress.     

卫生研发活动经费流向调查指标与监测体系

在提高卫生研发活动资源配置效率日益成为全球卫生科技发展热点的情况下,掌握研发活动经费流向情况是改善资源配置效率的重要前提。以往关于卫生研发经费流向情况的信息十分缺乏,系统地追踪全球卫生研发经费流向情况是一个长期的目标。本就卫生研发活动经费调查在世界范围内所进行的情况,以及实施调查涉及的概念、分类指标进行概述。同时,就我国卫生研发经费调查的现状进行分析,并对建立我国卫生研发活动监测体系给予政策建议。     

Rural and remote health research: Does the investment match the need?

Objective

To determine the percentage of research projects funded by the National Health and Medical Research Council in the period 2000–2014 that aimed specifically to deliver health benefits to Australians living in rural and remote areas and to estimate the proportion of total funding this represented in 2005–2014.

Design

This is a retrospective analysis of publicly available datasets.

Setting

National Health and Medical Research Council Rural and Remote Health Research 2000–2014.

Outcome measures

‘Australian Rural Health Research’ was defined as: research that focussed on rural or remote Australia; that related to the National Health and Medical Research Council's research categories other than Basic Science; and aimed specifically to improve the health of Australians living in rural and remote areas. Grants meeting the inclusion criteria were grouped according to the National Health and Medical Research Council's categories and potential benefit. Funding totals were aggregated and compared to the total funding and Indigenous funding for the period 2005–2014.

Results

Of the 16 651 National Health and Medical Research Council‐funded projects, 185 (1.1%) that commenced funding during the period 2000–2014 were defined as ‘Australian Rural Health Research’. The funding for Australian Rural Health Research increased from 1.0% of the total in 2005 to 2.4% in 2014. A summary of the funding according to the National Health and Medical Research Council's research categories and potential benefit is presented.

Conclusion

Addressing the health inequality experienced by rural and remote Australians is a stated aim of the Australian Government. While National Health and Medical Research Council funding for rural health research has increased over the past decade, at 2.4% by value, it appears very low given the extent of the health status and health service deficits faced by the 30% who live in rural Australia.     

Federal Sponsorship of Cost-Effectiveness and Related Research in Health Care: 1997–2001

OBJECTIVES: To describe recent federal sponsorship of cost-effectiveness and related health economics research to provide insight into the functioning of existing research support systems and assess the roles of federal health agencies. METHODS: Using the PubMed database, we identified cost-effectiveness and related publications citing support from a US government entity and published during the period of 1997 through 2001, and audited them for information on funding sources, study type, and content focus. RESULTS: Five Department of Health and Human Services agencies and centers and the Veterans Administration are cited as funders in 74% of 520 federally supported health economics publications we identified. Three-fourths of federally supported publications address five areas of high disease burden: infections, cancer, HIV/AIDS, cardiovascular disease, and substance abuse. Other high burden diseases, including mental health, diabetes, and injuries, receive less attention. Federal support of health economics studies of health education and care delivery-intervention types underexamined in the field-is relatively strong but most often focuses on substance abuse or mental health services. Each of the top federal funders has a distinct funding pattern, but there are substantial areas of overlap within which we could not identify content domains specific to one funder or another. CONCLUSIONS: Federal support of health economics research has paralleled growth in the field. Federal funders support projects consistent with their mission and focus on high-burden disease areas. However, overlapping funding areas, ambiguity concerning agency interests within overlapping content areas, and gaps in some disease and intervention areas suggest that the coordination of health economics research funding could be improved.     

Treading Water: The No-Growth Investment in Health Services Research

There is a “perfect storm” brewing in the American healthcare system. Healthcare spending has grown faster than our economy for many years and is projected to double in as little as 10 years. In spite of what we spend on healthcare, research tells us that we only receive appropriate care half the time. We are simply not getting what we are paying for. Health services research provides the data and the evidence needed to make better decisions, design healthcare benefits, and develop effective policies to optimize healthcare financing, facilitate access to healthcare services, and improve healthcare outcomes. Despite what we know and what we can learn from health services research, federal funding for this important field continues to erode. This article provides a primer on the federal budget process and summarizes findings from the Federal Funding for Health Services Research 2007.Health services research (HSR) explores healthcare costs, quality, and access and seeks ways to improve healthcare delivery, safety, availability, and affordability. HSR has been defined as a “multidisciplinary field of scientific investigation that studies how social factors, financing systems, organizational structures and processes, health technologies, and personal behaviors affect access to healthcare, the quality and cost of healthcare, and ultimately our health and well-being.”1 In particular, HSR identifies what treatments work best when, for whom, and at what sites of service; it evaluates how best to finance healthcare and control spending; it helps inform healthcare benefit design; it translates the innovations from basic bench science into medical practice, allowing providers, health plans, and patients to make more informed health choices. HSR is the link between research and patient care.Since 2003, the Coalition for Health Services Research (coalition) has been tracking the federal government''s investment in HSR by collecting budgetary data from federal agencies that principally fund HSR. The coalition has been collecting annual budgetary data from the federal agencies that fund HSR. In the past 5 years, we have found that despite what we can learn from HSR, there has been an erosion of federal funding for this field, in part because of competing federal priorities, a constrained fiscal climate, and polarizing partisan politics. These trends have likely hindered the ability of the researchers to examine the healthcare system and identify innovative and effective solutions. If left unchecked, the declining investment in HSR may have further implications for the study of health and patient care in the future.This article provides a primer on the federal budget process and summarizes findings from Federal Funding for Health Services Research 2007, the fifth annual report of HSR expenditures.2Federal agencies have not developed or adopted a uniform definition for HSR or standard categories for collecting and reporting data about reimbursement and funding methodologies, health disparities, patient safety, and chronic disease management. Therefore, questions remain about the breadth and scope of activities included in the funding totals presented in this article. Investments in what any one agency has self-reported as “health services research” may not be equivalent to what is reported by another agency. For example, budget numbers can reflect entire agency budgets, including overhead costs or a rough estimate of dollars spent on HSR. Nevertheless, our data offer the best available estimate on the federal government''s investment in this area.     

Historical and current policy efforts to eliminate racial and ethnic health disparities in the United States: future opportunities for public health education research

In the summer of 2005, the Society for Public Health Education convened a meeting, Health Disparities and Social Inequities, with the task of setting the minority health disparities research agenda for public health educators. The article provides a history of minority health efforts beginning with the Negro Health Improvement Week in 1915 and an overview of National Institutes of Health's (NIH) current 5-year strategic research plan to eliminate health disparities. The plan's goals represent a significant investment in minority health research and the emergence of NIH as the leading federal agency funding health disparity research. Understanding the history of minority health efforts and current health disparity research offers a perspective that will help guide public health educators in reaching the Healthy People 2010 goal of eliminating racial and ethnic health disparities.     

The Art and Science of Integrating Undoing Racism with CBPR: Challenges of Pursuing NIH Funding to Investigate Cancer Care and Racial Equity

In this nation, the unequal burden of disease among People of Color has been well documented. One starting point to eliminating health disparities is recognizing the existence of inequities in health care delivery and identifying the complexities of how institutional racism may operate within the health care system. In this paper, we explore the integration of community-based participatory research (CBPR) principles with an Undoing Racism process to conceptualize, design, apply for, and secure National Institutes of Health (NIH) funding to investigate the complexities of racial equity in the system of breast cancer care. Additionally, we describe the sequence of activities and “necessary conflicts” managed by our Health Disparities Collaborative to design and submit an application for NIH funding. This process of integrating CBPR principles with anti-racist community organizing presented unique challenges that were negotiated only by creating a strong foundation of trusting relationships that viewed conflict as being necessary. The process of developing a successful NIH grant proposal illustrated a variety of important lessons associated with the concepts of cultural humility and cultural safety. For successfully conducting CBPR, major challenges have included: assembling and mobilizing a partnership; the difficulty of establishing a shared vision and purpose for the group; the problem of maintaining trust; and the willingness to address differences in institutional cultures. Expectation, acceptance and negotiation of conflict were essential in the process of developing, preparing and submitting our NIH application. Central to negotiating these and other challenges has been the utilization of a CBPR approach. Yonas and Eng are with the Department of Health Behavior and Health Education, School of Public Health, University of North Carolina, Chapel Hill, NC, USA; Jones and DuBose are with the Greensboro Health Disparities Collaborative, The Partnership Project, Greensboro, NC, USA; Vines and White are with the Program on Ethnicity, Culture, and Health Outcomes, University of North Carolina, Chapel Hill, NC, USA; Aronson is with the Department of Public Health Education, University of North Carolina, Greensboro, NC, USA; Griffith is with the Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, MI, USA; Vines is with the Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA.     

Funding for rural health research from the Australian Research Council: A missed opportunity?

Objective:  To determine the number of projects, and level of funding, for rural health research from the Australian Research Council (ARC).
Design:  Analyses of ARC searchable datasets of completed, and new and ongoing projects from 2001 to 2008.
Main outcome measures:  Number of rural health research projects as a proportion of total funding; level of funding for rural health research projects as a proportion of total funding.
Results:  Only 46 of 6498 ARC completed projects were classified as rural health research projects. This represents 0.7% of the total number of projects, and 0.39% of the total funding allocated. Only 25 of 4659 ARC new and ongoing projects were classified as rural health research projects. This represents 0.54% of the total number of projects, and 0.27% of the total funding allocated. None of the 832 completed fellowships were classified as rural health. Only five (0.52%) of the 953 new and ongoing fellowships were classified as rural health.
Conclusions:  The level of under-funding for rural health research could be partially addressed by directing applications towards the ARC, in addition to the National Health and Medical Research Council. With a few exceptions, rural health researchers are not yet competitive in the national funding arena.     

Pearl Kendrick, Grace Eldering, and the Pertussis Vaccine

In light of the reemergence of pertussis (whooping cough), the pioneering research of Pearl Kendrick and Grace Eldering is worth revisiting. In the 1930s, working in the Michigan Department of Health laboratory in Grand Rapids, Michigan, USA, they began researching a pertussis vaccine. Their research offers an instructive case study of the creative public health research performed in state health department laboratories during the interwar years. State department of health laboratory directors actively promoted research by supporting advanced education; making facilities and funding available for individual projects; and, when possible, procuring new facilities. Using Michigan Department of Health resources and local and federal funding, Kendrick and Eldering developed standardized diagnostic tools; modified and improved extant vaccines; conducted the first successful, large-scale, controlled clinical trial of pertussis vaccine; and participated in international efforts to standardize and disseminate the vaccine. Their model may again offer a promising avenue for groundbreaking research.     

Reporting guidelines for implementation and operational research

In public health, implementation research is done to improve access to interventions that have been shown to work but have not reached many of the people who could benefit from them. Researchers identify practical problems facing public health programmes and aim to find solutions that improve health outcomes. In operational research, routinely-collected programme data are used to uncover ways of delivering more effective, efficient and equitable health care. As implementation research can address many types of questions, many research designs may be appropriate. Existing reporting guidelines partially cover the methods used in implementation and operational research, so we ran a consultation through the World Health Organization (WHO), the Alliance for Health Policy & Systems Research (AHPSR) and the Special Programme for Research and Training in Tropical Diseases (TDR) and developed guidelines to facilitate the funding, conduct, review and publishing of such studies. Our intention is to provide a practical reference for funders, researchers, policymakers, implementers, reviewers and editors working with implementation and operational research. This is an evolving field, so we plan to monitor the use of these guidelines and develop future versions as required.     

Health services research and development in practice: an Australian experience

While there is a growing literature on how health services research can inform health policy decisions, the practical challenge is for health services researchers to develop an effective interface with health policy-making processes and to produce outputs that lead to outcomes. The experience of the Centre for Health Service Development at the University of Wollongong, Australia, is used to illustrate the issues so commonly described in the literature and to reflect on our experience of trying to remain viable while producing relevant and valid research. A case study in a specific policy area - namely, the development of case-mix classifications and information systems to inform policy and funding in the subacute and non-acute hospital and community care sectors - is used as a practical example of the research-policy interface.     

Help with your research? Sources of information and support

High quality research is essential to the provision of excellent health care in both primary and hospital settings. Midwives, health visitors, other community practitioners and allied health professionals should be encouraged to initiate and participate in research. No one should undertake research in isolation. Those who are novices should make sure that they are part of a team of more experienced researchers from whom they can learn and develop their own research skills. The National Institute for Health Research provides research training programmes, research funding and infrastructure to support researchers. The latter includes RDInfo, a free resource for all health and social care researchers in the UK. It provides comprehensive information on available research funding and training as well as individualised referrals for research advice.     

The women's health research coalition: a new advocacy network

The Society for the Advancement of Women's Health Research is a nonprofit, nonpartisan organization committed to improving the health of women through research. The Society was founded in 1990 to bring national attention to the problem of the exclusion of women from clinical trials and the need for greater federal funding for diseases and conditions prevalent in and unique to women. Today, the Society works closely with members of the public and private sectors and academic institutions to promote a women's health research agenda. The Society seeks both to shape public policy and improve public and professional education. The Journal of Women's Health is the official publication of the Society. We welcome your views. Contact us by fax at (202) 833-3472, or visit our website at http://www.womens-health.org/.     

儿少卫生与妇幼保健学科领域科学研究趋势及热点

为总结中国共产党十八大以来在国家自然基金的支持下,儿少卫生与妇幼保健学科的科学研究发展趋势和热点问题。文章梳理了2012—2021年国家自然科学基金(National Natural Science Foundation of China,NSFC)对儿少卫生(原申请代码H2606,现申请代码H3006)和妇幼保健(原申请代码H2605,现申请代码H3005)2个领域资助的常规项目数和项目内容。结果显示项目数有所增加,形成了相对稳定资助规模。根据儿童少年和妇女健康的特殊健康需要,形成了学科整体研究趋势和学科研究热点,推动了中国儿童、妇女健康研究领域的发展水平,并受益于中国的儿童、青少年及妇女健康。     

Peer support in type 2 diabetes: a randomised controlled trial in primary care with parallel economic and qualitative analyses: pilot study and protocol

Background

General practitioners and other primary health care professionals are often the first point of contact for patients requiring health care. Identifying, understanding and linking current evidence to best practice can be challenging and requires at least a basic understanding of research principles and methodologies. However, not all primary health care professionals are trained in research or have research experience. With the aim of enhancing research skills and developing a research culture in primary health care, University Departments of General Practice and Rural Health have been supported since 2000 by the Australian Government funded 'Primary Health Care Research Evaluation and Development (PHCRED) Strategy'. A small grant funding scheme to support primary health care practitioners was implemented through the PHCRED program at Flinders University in South Australia between 2002 and 2005. The scheme incorporated academic mentors and three types of funding support: bursaries, writing grants and research fellowships. This article describes outcomes of the funding scheme and contributes to the debate surrounding the effectiveness of funding schemes as a means of building research capacity.

Methods

Funding recipients who had completed their research were invited to participate in a semi-structured 40-minute telephone interview. Feedback was sought on acquisition of research skills, publication outcomes, development of research capacity, confidence and interest in research, and perception of research. Data were also collected on demographics, research topics, and time needed to complete planned activities.

Results

The funding scheme supported 24 bursaries, 11 writing grants, and three research fellows. Nearly half (47%) of all grant recipients were allied health professionals, followed by general practitioners (21%). The majority (70%) were novice and early career researchers. Eighty-nine percent of the grant recipients were interviewed. Capacity, confidence, and level of research skills in ten core areas were generally considered to have improved as a result of the award. More than half (53%) had presented their research and 32% had published or submitted an article in a peer-reviewed journal.

Conclusion

A small grant and mentoring scheme through a University Department can effectively enhance research skills, confidence, output, and interest in research of primary health care practitioners.     

Federal Expenditures on Maternal and Child Health in the United States

The goals of this study are to estimate federal maternal and child health (MCH) expenditures and identify their sources. This analysis is intended to provide a broad view of MCH funding appropriations and a basis for discussion of whether funds could be better utilized for the benefit of the population served. Data on federal maternal and child health expenditures for fiscal year (FY) 2006 were derived from examining federal legislation, department/agency budgets, and various web-based program documents posted by federal agencies. Based on selected criteria, we identified programs targeting children under 21 or pregnant/parenting women within the United States. The funding levels of agency programs for maternal and child health activities were determined and the programs briefly summarized. The identifiable funding for maternal and child health programs in FY 2006 approached $57.5 billion dollars. Funding sources for maternal and child health were concentrated within the U.S. Department of Health and Human Services, but spread across several different agencies within the department and in the Departments of Defense, Education, Agriculture, Housing and Urban Development, and the Environmental Protection Agency. Multiple agencies and offices often funded related activities, without evidence of a common underlying strategy. Federal maternal and child health funding mechanisms may lead to a fragmentation in maternal and child health activities. The funding and service delivery apparatus would benefit from an integrative MCH infrastructure approach to pediatric research, service delivery, and data collection/access that incorporates life-course and social/environmental determinants perspectives.     

Rethinking health research capacity strengthening

Health research capacity strengthening (HRCS) is a strategy implemented worldwide to improve the ability of developing countries to tackle the persistent and disproportionate burdens of disease they face. Drawing on a review of existing HRCS literature and our experiences over the course of an HRCS project in Vietnam, we summarise major challenges to the HRCS enterprise at the interpersonal, institutional and macro levels. While over the course of several decades of HRCS initiatives many of these challenges have been well documented, we highlight several considerations that remain underarticulated. We advance critical considerations of the HRCS enterprise by discussing (1) how the organisation of US public health funding shapes the ecology of knowledge production in low- and middle-income country contexts, (2) the barriers US researchers face to effectively collaborate in capacity strengthening for research-to-policy translation, and (3) the potential for unintentional negative consequences if HRCS efforts are not sufficiently reflexive about the limitations of dominant paradigms in public health research and intervention.     

Research in support of health systems transformation in South Africa: the experience of the Centre for Health Policy

We describe the role and experience of the Centre for Health Policy (CHP), a university-based research unit established in 1987, in influencing and supporting health systems transformation in South Africa over two decades. During 2010, we analyzed relevant documents and conducted interviews with 25 key informants. CHP's research has contributed directly to health policy development and implementation while also changing the way government understood or approached policy issues. Key success factors for policy influence are: research quality and trustworthiness, strategic alliances and networking, and capacity building. CHP's challenges include identifying new funding sources and sustaining a high public profile. The lessons for other countries are to: conduct good quality, relevant research based on strong ethical values; build and maintain open and honest relationships with government; recognize and adapt to changes in the policy environment; develop capacity as part of a continuous programme; and seek core funding that ensures research independence and public accountability.     

How much are we spending? The estimation of research expenditures on cardiovascular disease in Canada

ABSTRACT: BACKGROUND: Cardiovascular disease (CVD) is a leading cause of death in Canada and is a priority area for medical research. The research funding landscape in Canada has changed quite a bit over the last few decades, as have funding levels. Our objective was to estimate the magnitude of expenditure on CVD research for the public and charitable (not-for profit) sectors in Canada between 1975 and 2005. METHODS: To estimate research expenditures for the public and charitable sectors, we compiled a complete list of granting agencies in Canada, contacted each agency and the Canadian Institutes of Health Research (CIHR), and extracted data from the organizations' annual reports and the Reference Lists of health research in Canada. Two independent reviewers scanned all grant and fellowship/scholarship titles (and summary/key words, when available) of all research projects funded to determine their inclusion in our analysis; only grants and fellowships/scholarships that focused heart and peripheral vascular diseases were selected. RESULTS: Public/charitable sector funding increased 7.5 times, from close to $13 million (in constant dollars) in 1975 to almost $96 million (in constant dollars) in 2005 (base year). The Medical Research Council of Canada (MRCC)/CIHR and the Heart & Stroke Foundation of Canada have been the main founders of this type of research during our analysis period; the Alberta Heritage Foundation for Medical Research and the Fonds de la recherche en sante du Quebec have played major roles at the provincial level. The Indirect Costs Research Program and Canada Foundation for Innovation have played major roles in terms of funding in the last years of our analysis. CONCLUSION: Public/charitable-funded research expenditures devoted to CVD have increased substantially over the last three decades. By international standards, the evidence suggests Canada spends less on health-related research than the UK and the US, at least in absolute terms. However, this may not be too problematic as Canada is likely to free-ride from research undertaken elsewhere. Understanding these past trends in research funding may provide decision makers with important information for planning future research efforts. Future work in this area should include the use of our coding methods to obtain estimates of funded research for other diseases in Canada.