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Letter From the Director: Advancing AHRQ’s Mission

As stewards of taxpayer funds, ������Ƶmust deliver results that matter to the public. Today, I’m pleased to announce that ������Ƶis moving toward a strategy that aligns our priorities and funding approaches to fulfill this commitment. Through this strategy, we will leverage the missions of each Center to fund the most meritorious research, address urgent health needs, and sustain a robust health services research workforce, as we adhere to the President’s priorities and those of his administration.

A central pillar of this approach is balancing scientific opportunity with AHRQ’s mission of enhancing the quality, appropriateness, and effectiveness of health services and access to such services, through scientific research and the promotion of improvements in clinical and health system practices, including the prevention of diseases and other health conditions. ������Ƶis sharpening its focus on the prevention and care of chronic health issues that affect Americans, including chronic childhood diseases and nutrition-related problems such as obesity. We are also prioritizing next-generation tools such as artificial intelligence and alternative testing models, as we continue to rely heavily on real-world data in our efforts.

������Ƶwill expand support for replication studies when appropriate and strengthen our capacity to advance groundbreaking quality, effectiveness, and prevention research. At the same time, ������Ƶremains dedicated to fostering open, competitive, and accountable science and supporting investigators as they pursue innovative, and sometimes controversial, questions grounded in rigorous methodology.

A core function of ������Ƶand its Centers is to assess scientific merit within the context of AHRQ’s broader strategic goals and administration priorities and develop appropriate research funding plans accordingly. In an environment where ������Ƶreceives more meritorious applications than it can fund, this review process is increasingly critical. To that end, ������Ƶwill make funding decisions that reflect administration and agency priorities, scientific opportunity, program balance, workforce needs, and other core principles that will be consistently applied across the agency.

Taxpayer dollars are a finite resource, entrusted to ������Ƶofficials to invest in the nation’s future. By transparently establishing priorities and aligning our goals, we aim to demonstrate to the American public that we take this commitment seriously—and that we are doing all we can to honor their trust.

Roger D. Klein, M.D., J.D.
Director, AHRQ

AHRQ’s Research Priorities

This document has been prepared in furtherance of the ������ƵDirector’s responsibility to carry out AHRQ’s mission, duties, and statutory responsibilities. See 42 U.S.C. § 299 et sec. Please note that this is not an exhaustive list of all agency priorities. This document is intended to clarify specific issues that currently require additional guidance. ������Ƶcontinues to support projects across the spectrum of health services research. Through executive orders, including those on Gold-Standard Science and the   (PDF, 3.8 MB), the President has directed HHS to close critical research gaps and guide efforts to better combat chronic disease in America and improve the health of all Americans through gold-standard science. To meet these requirements and fulfill our mission, ������Ƶis prioritizing research in the following areas:

Patient Safety

Making healthcare delivery safer and more effective for all Americans will continue to be an important part of AHRQ’s core function. Important areas of research include medical and hospital errors, including the development of performance measures, medication safety, and improving diagnosis with a focus on uncovering and implementing changes that can benefit large numbers of patients in significant ways or profoundly and substantially benefit smaller patient groups.

Preventing Antibiotic Resistance

Antibiotic resistance is a major health problem, with overuse and misuse of antibiotics as a prime driver. The development of strategies to encourage appropriate antibiotic use, including in children, is a fundamental challenge of the 21st century. ������Ƶwill continue to play a lead role in this area.

Telehealth

During the COVID-19 pandemic, telehealth emerged as an important tool in providing medical care to infectious or potentially infectious patients. Although the pandemic has receded, the utility of the appropriate use of telehealth remains. Telehealth can potentially provide needed care for patients with reduced access such as those in rural areas or individuals with poor mobility and for providers for which there is a limited or inadequate supply or geographic concentration such as certain specialty medical care, genetic counselors, and mental health counselors. ������Ƶis interested in defining appropriate and cost-effective uses of telehealth to improve patient outcomes.

Overmedication of Children

The numbers of children treated with psychoactive medications to treat putative anxiety, depression, for behavioral problems and more severe forms of mental illness, and attention deficit hyperactivity disorder (ADHD) has proliferated in recent years. ������Ƶis interested in better understanding the quality, frequency, and accuracy of psychological diagnoses in children, the impact of these diagnoses on long-term health, psychological and financial outcomes, and the appropriate use of psychotropic medications for treatment.

The Use of Digital Health Tools To Improve Health

������Ƶis interested in understanding the best uses of digital health tools for prevention of disease and to monitor and improve health status with the goal of improving health outcomes.

Long COVID

Long COVID refers to a range of symptoms and conditions that occur at least 3 months after SARS-CoV-2 infection. Symptoms may improve, worsen, remain ongoing, or reemerge after time. Understanding and treatment of Long COVID is in its infancy. ������Ƶhas a keen interest in understanding the demographics, features, and care of Long COVID patients, the effectiveness of treatment, and potential associations with Long COVID symptoms, severity, duration or etiology.

Training Future Health Services Researchers

������Ƶtraining programs should focus on training future health services researchers to maximize patient health outcomes in the 21st century. Programs should allow trainees to design and conduct the highest quality scientific studies. Importantly, these programs should be based on merit, follow civil rights law, and not discriminate against anyone. The institutions we support must also uphold safe, equal, and healthy working and learning conditions conducive to high-quality research and free inquiry.

Replication and Reproducibility

Replicable, reproducible, and generalizable research must serve as the basis for truth in biomedical science, including health services research. The “publish or perish” culture favors the promotion of only favorable results, and replication work is little valued or rewarded. ������Ƶis prioritizing research that produces robust, reproducible results that could have significant impacts on large numbers of patients or the potential for substantial improvement among smaller cohorts. To the extent feasible and appropriate, we are exploring various mechanisms to support scientists focused on replication work, to publish negative findings, and to elevate replication research.

Real-World Data Platform

������Ƶhas several unique surveys and databases that track health utilization, cost, longitudinal hospital care, encounters, insurance coverage, and more and will be working to integrate and link these data with other real world data sources consistent with a deep respect for individual privacy rights and with AHRQ’s statutory confidentiality protections. This integrative approach to data management will provide advanced computational analysis resources for investigators across a broad range of health services areas, from financial research and access, to quality, to care of patients with neurodevelopmental disorders and chronic diseases.

Artificial Intelligence

Artificial intelligence breakthroughs provide exciting new possibilities for science and medicine, but require careful, rigorous research to validate them to fulfill their promise. ������Ƶwill seek to enhance transparency in AI models, develop appropriate replication standards for AI use in health services research, and expedite the research, development, and translation of AI discoveries to benefit patients. ������Ƶwill consider strategic architecture, high-impact AI use cases, new opportunities to use AI for evidence reviews and agency operations, and best practices for validating AI in healthcare delivery.

Nutrition

������Ƶwill champion initiatives rigorously exploring the role of diet in causing common chronic conditions and the identification and outcomes from healthy diets that can prevent and better manage these conditions. We will prioritize projects focusing on the role of maternal and infant dietary exposures on health outcomes across the lifespan. ������Ƶwill also work to initiate long-term studies to understand the impacts of certain foods and diets on obesity and insulin resistance in children.

Furthering Our Understanding of Autism

������Ƶis supporting initiatives to understand the treatment and care needs of the broad spectrum of people with autism. Activities supported will include creating new data resources and integrating existing data resources into state-of-the-art analyses on the care, quality, scope, potential etiologies, and costs of treatment for patients with autism. The program aims to develop knowledge to improve health outcomes for people on the autism spectrum.

Alternative Study Methods

������Ƶis interested in the development of alternative, innovative study methods across its spectrum of research. Particularly desirable are methods intended to achieve practical results with the potential for substantive impacts at reasonable costs. For example, ������Ƶhas robust programs for developing evidence of the effectiveness of treatments or other interventions. However, evidence reviews are typically expensive, time consuming, and difficult to update, particularly in a timely manner. ������Ƶis therefore interested in new methodologies that can produce practical, useful information rapidly, and which can be readily updated to meet current needs.

Promoting Research Focused on Scientifically Valid, Measurable Health Outcomes

������Ƶwill continue to support research that advances the health of all Americans, regardless of their age, race, ethnicity, sex, or other characteristics. To conduct meaningful health services research, researchers must consider both individual and external factors that influence health outcomes, guided by the needs of the specific research question. Some relevant personal characteristics may include demographic indicators such as race and sex, while some contextual factors, like environmental exposures and socioeconomic conditions (e.g., poverty), may also be scientifically significant. Any distinctions made in study design must be directly relevant to the health outcomes under investigation. ������Ƶwill support scientifically rigorous research that considers these factors when they are scientifically justified and aligned with the study’s objectives. The preceding notwithstanding, ������Ƶwill comply with all applicable law.

In contrast to research that considers race or ethnicity when scientifically justified (described in the paragraph above), research based on ideologies that promote differential treatment of people based on race or ethnicity, or relies on poorly defined concepts or on unfalsifiable theories, does not follow the principles of gold-standard science. Investigators must employ specific and measurable concepts in health disparities research. ������Ƶwill support scientifically rigorous research programs that explore such causes as one reason among many for poor health outcomes for Americans.

������Ƶwill not support research that gratuitously or inordinately includes or focuses on such information without demonstration of relevance, need and addressability. Such studies often fall within the realm of social policy research and divert resources away from projects that advance the health, outcomes, and longevity of all Americans, including minority populations. ������Ƶwill always prioritize gold-standard science.

Broad or subjective claims—such as attributing worse health outcomes in a particular population to poorly measured factors like systemic racism—should not be presented as established background facts without clearly defining measurable variables that are part of the research question.

Relatedly, research involving participant volunteers should be based on relevant and appropriate population descriptors and categories that use precise language to define participant attributes, comparator group attributes, and to whom the study findings apply. Research based on overly broad and scientifically imprecise goals is of low value and off-mission.

Shifting to Solution-Oriented Approaches in Health Disparities Research

������Ƶhas invested substantially in health disparities research, focusing mainly on identifying and documenting worse health outcomes for minority populations. The field has made significant progress in mapping the breadth and depth of differences in health outcomes across populations, but this research has often not been translated into measurable improved health for minority populations.

Going forward, ������Ƶwill prioritize research that goes beyond measuring health disparities to focusing on solution-oriented approaches. This includes actively testing, advancing, scaling, and implementing innovative evidence-based interventions and treatments that address poor health outcomes.

Ensuring Evidence-Based Health Care for Children and Teenagers Identifying as Transgender

The state of the scientific literature regarding optimal care and support approaches for children and teenagers identifying as transgender and those diagnosed with gender dysphoria is described in the recent  (PDF, 7 MB). In accordance with these data, there are clearly more promising avenues of research that can be taken to improve the health of these populations than to conduct studies that involve the use of puberty suppression, hormone therapy, or surgical intervention to treat gender dysphoria, gender identity disorder, or gender incongruence in minors. Research that describes the extent of this serious societal health problem, as well as incentives and other misaligned factors that encourage its propagation and persistence, may be helpful, especially if paired with solutions for ending these harmful, unfortunate practices. In addition, research that aims to identify and treat the harms these therapies and procedures have potentially caused to minors diagnosed with gender dysphoria, gender identity disorder, or gender incongruence, and how to best address the needs of these individuals so that they may live long, healthy lives is more promising.