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Research Questions

  1. What are the breadth and focus of federal agency research portfolios in HSR and PCR?
  2. What is the overlap among agency research portfolios and the coordination that occurs among federal agencies funding HSR and PCR?
  3. What are the impacts of federally funded HSR and PCR and the challenges to assessing and achieving impact?
  4. What are the gaps in federally funded HSR and PCR and approaches to prioritizing gaps?
  5. What are options for improving the outcomes, value, and impact of future federally funded HSR and PCR?

This report presents the results of a congressionally mandated, independent assessment of federally funded health services research (HSR) and primary care research (PCR) spanning the U.S. Department of Health and Human Services (HHS) and U.S. Department of Veterans Affairs (VA) from FYs 2012 to 2018. Through technical expert panels, stakeholder interviews, and a systematic environmental scan of research grants and contracts funded by HHS and the VA, the authors characterize the distinct contributions of agencies in these departments to the federal HSR and PCR enterprise. The authors also identify opportunities to improve detection and coordination of overlap in agency research portfolios, the impacts of HSR and PCR and how they cumulate across research portfolios, and gaps in research funding, methods, and dissemination. The authors offer recommendations to maximize the outcomes and value of future investments in federal HSR and PCR to better guide and serve the needs of a complex and rapidly changing U.S. health care system.

Key Findings

The HSR and PCR portfolios of agencies have distinct focus areas based on their individual congressional authorizations, missions, and operational needs

  • Stakeholders noted the Agency for Healthcare Research Quality's distinct focus on health care system outcomes, synthesis of evidence, and dissemination of innovations across settings and populations.
  • HSR and PCR portfolios of other agencies tend to be organized around specific diseases, body systems, populations, or settings.

Research funded by agencies on similar topics is mostly complementary, but potential overlaps in research portfolios need to be more proactively identified

  • Stakeholders generally viewed research funded by agencies on similar topics to address different facets of a topic or combine resources on an underfunded topic.
  • Stakeholders considered agencies to be adept at coordination once they recognize overlaps in portfolios. However, discovery of overlaps was described as "sporadic" or "accidental."

Federally funded HSR and PCR have a wide range of impacts that are often cumulative across research portfolios

  • Impacts ranged from scientific and professional knowledge to changes in health care systems and services, policies, and patient and societal outcomes.

The variety of gaps in HSR and PCR reflect the challenge of improving U.S. health care, which requires new research approaches and strategies to prioritize research efforts

  • Many research gaps are driven by the complexity and pace of health care change.
  • General gaps include producing timely results for improving health care delivery, developing methods to examine complex dynamics of health care change, communicating results to guide implementation, and using theory to connect findings and advance knowledge on health care improvement.


Cross-cutting recommendations for federally funded HSR and PCR include suggestions for improving the relevance and timeliness of research, dissemination of actionable and findable results, and interagency prioritization and coordination of research

  • Create funding mechanisms that support more rapid, engaged research approaches.
  • Expand funding for mixed qualitative and quantitative methods suited to generating evidence on implementation of change in complex health systems.
  • Create funding mechanisms that support innovative high-risk, high-reward research.
  • Train and assist researchers in effectively communicating results in formats readily usable by health care delivery stakeholders.
  • Fund research to identify the most-effective channels to communicate research results for different audiences and users.
  • Require researchers to consider implementation issues early in study design and explicitly apply theories of change.
  • Expand funding for the synthesis of evidence across research projects.
  • Initiate a strategic planning process across federal agencies to prioritize HSR investments.
  • Establish a review process and data systems to proactively identify potential overlaps across agency research portfolios.
  • Maintain the Agency for Healthcare Research and Quality as an independent agency within HHS to serve as the funded hub of federal HSR to ensure its unique and central role.

PCR-specific recommendations include the following

  • Initiate a strategic planning process across federal agencies specifically to prioritize PCR investments.
  • Establish a review process to proactively identify potential overlaps across agency research portfolios, focused on maximizing limited federal funding available for PCR.
  • Provide targeted funding for a hub for federal PCR to adequately support research on core functions of primary care and to coordinate PCR across federal agencies.

Research conducted by

This research was funded by the Agency for Healthcare Research and Quality and conducted by the Payment, Cost, and Coverage Program within RAND Health Care.

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