Research

The healthcare landscape is constantly evolving as healthcare research initiatives aim to enhance the understanding of the human body, advance medical technologies, and improve treatment options. This section will highlight three current and ongoing healthcare research initiatives.

EvidenceNow

The Agency for Healthcare Research and Quality, AHRQ, has a current grant initiative called EvidenceNow. This initiative targets small to medium primary care practices nationwide. Evidence is used to help improve the populations Heart Health.

How does this work?

EvidenceNow works with 7 regional cooperatives. These cooperatives are composed of public and private health partnerships as well as multidisciplinary teams. They can be found within 12 states. According to the AHRQ, “the cooperatives designed interventions to expand primary care practices’ capacity to use evidence to improve the care they provide, including heart health care.” The cooperative offers services to the practices that include onsite practice facilitation and coaching, expert consultation, shared learning collaboratives, electronic health record support, and data feedback and benchmarking.

You can find out more about the cooperatives here:

Midwest Cooperative
Principal Investigator: Abel Kho, M.D.
Serving: Tri-State Chicago area of Wisconsin, Illinois, and Indiana
Profile: Information about the Midwest cooperative (PDF Version, 1.0 MB)
Learn about the Midwest cooperative's organizational structure on the ESCALATES Web site .
New York City Cooperative
Principal Investigator: Donna Shelley, M.D.
Serving: New York City
Profile: Information about the NYC cooperative (PDF Version, 1.0 MB)
Learn about the New York City cooperative's organizational structure on the ESCALATES Web site .
North Carolina Cooperative
Principal Investigator: Samuel Cykert, M.D.
Serving: North Carolina
Profile: Information about the North Carolina cooperative (PDF Version, 1.0 MB)
Learn about the North Carolina cooperative's organizational structure on the ESCALATES Web site .
Northwest Cooperative
Principal Investigator: Michael Parchman, M.D.
Serving: Washington, Oregon, and Idaho
Profile: Information about the Northwest cooperative (PDF Version, 1.0 MB)
Learn about the Northwest cooperative's organizational structure on the ESCALATES Web site .
Oklahoma Cooperative
Principal Investigator: Daniel Duffy, M.D.
Serving: Oklahoma
Profile: Information about the Oklahoma cooperative (PDF Version, 1.1 MB)
Learn about the Oklahoma cooperative's organizational structure on the ESCALATES Web site .
Southwest Cooperative
Principal Investigator: W. Perry Dickinson, M.D.
Serving: Colorado and New Mexico
Profile: Information about the Southwest cooperative (PDF Version, 5.3 MB)
Learn about the Southwest cooperative's organizational structure on the ESCALATES Web site .
Virginia Cooperative
Principal Investigator: Anton Kuzel, M.D.
Serving: Virginia
Profile: Information about the Virginia cooperative (PDF Version, 1.0 MB)
Learn about the Virginia cooperative's organizational structure on the ESCALATES Web site .
Comparison of Cooperatives
Various Ways to Organize a Practice Extension Service – Seven Approaches on the ESCALATES Website .

According to the AHRQ, “The ability to integrate and implement new discoveries into patient care creates a stronger, more effective health care system. But not all discoveries are equal. We turn to evidence to understand what works and how best to integrate effective approaches and treatments into patient care.” This brought forth the research and results that helped launch the initiative.

Impacts to the Stakeholders:

The facilities and providers are seeing a positive impact on their patient’s health. According to AHRQ, “Ten participating EvidenceNOW primary care practices and providers have been selected as 2018 Million Hearts® Hypertension Control Champions.” Many of these practices service the underserved populations. Primary Care clinics face obstacles trying to juggle and successfully integrate numerous projects and government mandated programs. This makes being part of this initiative another challenge. According to Sweeney, et al, “Engaging primary care practices in initiatives designed to enhance quality, reduce costs and promote safety is challenging as practices are already participating in numerous projects and mandated programs designed to improve care delivery and quality.” Patients are also impacted by the initiative as their care changes. They now partake in the ABCS of cardiovascular disease prevention. They are aspirin in high-risk individuals, blood pressure control, cholesterol management, and smoking cessation.

Find out more here: https://www.ahrq.gov/evidencenow/about/index.html

The BRAIN Initiative

The National Institutes of Health (NIH) has an ongoing research initiative called the BRAIN Initiative, which stands for Brain Research through Advancing Innovative Neurotechnologies. Developing over a decade long period beginning in FY2016, the aim of the BRAIN Initiative according to the NIH is to “focus on the development and use of tools for acquiring fundamental insight about how the nervous system functions in health and disease.”

Why was the BRAIN Initiative created?

Because the human brain is incredibly complex, the main causes of a significant number of neurological and psychiatric conditions remains unknown and treating these conditions can therefore prove to be difficult. The NIH states that "neuroscience has advanced to the level that we can envision a comprehensive understanding of the brain in action, spanning molecules, cells, circuits, systems, and behavior." Using advanced medical technologies to provide detailed images of the human brain, researchers will be able to map out the structure of the brain down to the individual cell level. Having a detailed understanding of the human brain will allow medical professionals to better treat its disorders, such as Alzheimer’s disease, Parkinson’s disease, depression, schizophrenia, and traumatic brain injuries.

The NIH outlines seven major goals of the BRAIN Initiative, including:

Discovering diversity: Identify and provide experimental access to the different brain cell types to determine their roles in health and disease
Maps at multiple scales: Generate circuit diagrams that vary in resolution from synapses to the whole brain
The brain in action: Produce a dynamic picture of the functioning brain by developing and applying improved methods for large-scale monitoring of neural activity
Demonstrating causality: Link brain activity to behavior with precise interventional tools that change neural circuit dynamics
Identifying fundamental principles: Produce conceptual foundations for understanding the biological basis of mental processes through development of new theoretical and data analysis tools
Advancing human neuroscience: Develop innovative technologies to understand the human brain and treat its disorders; create and support integrated human brain research networks
From BRAIN Initiative to the brain: Integrate new technological and conceptual approaches produced in Goals #1-6 to discover how dynamic patterns of neural activity are transformed into cognition, emotion, perception, and action in health and disease

Impacts to the Stakeholders:

The impacts to stakeholders that the BRAIN Initiative will have are speculative since the project is newer and ongoing. Insurance providers are expected to see a significant impact as the treatments for previously difficult to treat neurological and psychiatric disorders improves. For instance, the NIH states that "the cost of caring for individuals with Alzheimer's (numbering over 5 million people) is over $200 billion per year, including $150 billion from Medicare and Medicaid. With a better understanding of how these disorders work and how to treat them (researchers hope to be able reverse symptoms or even cure disorders altogether) in a more effective manner, the cost of care is projected to decline. For patients, the discovery of genetic risk factors for neurological and psychiatric disorders will allow them to take their health into their own hands and actively work to prevent the development of these disorders. Providers will be impacted as the course of treatment for brain disorders changes and imaging technologies advance.

Find out more here: https://braininitiative.nih.gov/about/overview

The HEAL Initiative

The NIH also oversees another research initiative named the HEAL Initiative, which stands for Helping to End Addiction Long-term. Started in 2018, the aim of the HEAL Initiative is to "provide scientific solutions to the opioid crisis and offer new hope for individuals, families, and communities."

Why was the HEAL Initiative created?

The US is in a current opioid public health crisis. According to the NIH, "more than 47,000 Americans died of opioid overdose in 2017, and more than 2 million Americans live with addiction to opioids." The NIH recognizes that treatment options for opioid addiction is not adequate, and patients with chronic pain lack safe and effective non-opioid to treat their pain. In order to stem the opioid epidemic, preventative and therapeutic interventions for opioid use disorder (OUD), and new, non-opioid medications for the treatment of chronic pain, must be developed.

The NIH outlines six major goals of the HEAL Initiative, including:

Translation of research to practice for the treatment of opioid addiction: Use implementation studies to test the integration of evidence-based interventions in an array of settings
New strategies to prevent and treat opioid addiction: Support research to develop new or improved prevention and treatment strategies for opioid addiction
Enhanced outcomes for infants and children exposed to opioids: Support research to address the medical and social needs of infants and children affected by opioid use disorder
Novel medication options for opioid use disorder and overdose: support the development of new medications to treat all aspects of the opioid addiction cycle
Clinical research in pain management: Support new clinical trial programs and the expansion of existing programs to evaluate innovative therapies for pain management
Preclinical and translational research in pain management: Accelerate the discovery and preclinical development of new medications and devices to treat pain

Impacts to the Stakeholders:

The developments created through the HEAL initiative will have major impacts on stakeholders. For instance, expanded access to naloxone, provider education, and expanding medication-assisted treatment for opioid addiction will all affect the course and standard of care for opioid addiction (Sultz & Young, 2018). Providers will also have to undergo a cultural shift towards prescribing less opioid medications for pain management, as has been the norm for the last couple decades. The HEAL initiative will impact the government as new legislation is passed to help deal with the opioid crisis. Improved patient education can help patients recognize the beginning stages of opioid use disorder before it progresses. Furthermore, the NIH states that "biological signatures to predict which patients are at risk for developing chronic pain will guide precision medicine approaches to reduce patient transition to chronic pain."

Find out more here: https://heal.nih.gov/

Resources

“About EvidenceNOW: Background and Stories from the Field.” AHRQ, https://www.ahrq.gov/evidencenow/about/index.html.

NIH. (2014, June 5). BRAIN 2025 report. Retrieved from https://braininitiative.nih.gov/strategic-planning/brain-2025-report

NIH. (2019, October 25). NIH HEAL initiative research plan . Retrieved from https://heal.nih.gov/about/research-plan

Sultz, H. A., & Young, K. M. (2018). Health care USA: Understanding its organization and delivery. Burlington, MA: Jones & Bartlett Learning.

Sweeney, S. M., Hall, J. D., Ono, S. S., Gordon, L., Cameron, D., Hemler, J., … Cohen, D. J. (2018). Recruiting Practices for Change Initiatives Is Hard: Findings From EvidenceNOW. American journal of medical quality : the official journal of the American College of Medical Quality, 33(3), 246–252. doi:10.1177/1062860617728791