Funding Opportunities in KnowledgeTranslation: Review of the AHRQ’s‘‘Translating Research into Practice’’Initiatives, Competing Funding Agencies,and Strategies for SuccessMichael Handrigan, MD, Jean Slutsky, PA, MSPH

AbstractThe Agency for Healthcare Research and Quality actively funds and conducts research to improve healthcare for all Americans. This article is intended to provide a brief overview of Agency for HealthcareResearch and Quality activities in knowledge translation and to accompany the presentation given onMay 15, 2007, to the Academic Emergency Medicine Consensus Conference, ‘‘Knowledge Translation inEmergency Medicine: Establishing a Research Agenda and Guide Map for Evidence Uptake.’’

ACADEMIC EMERGENCY MEDICINE 2007; 14:965–967 ª 2007 by the Society for Academic EmergencyMedicine

Keywords: knowledge translation, evidence, clinical practice

As Yogi Berra once said, ‘‘The future ain’t what itused to be.’’ Or is it? In 1966, the National Acad-emy of Sciences Committee on Trauma issued a

landmark report on the state of emergency services inthe United States entitled Accidental Death and Disability:The Neglected Disease of Modern Society.1 This report iswidely considered the nidus of an effort that would even-tually lead to the formal recognition by the AmericanMedical Association of emergency medicine (EM) as amedical specialty. In this historic 1966 report, the com-mittee issued the following call to arms: ‘‘One of the seri-ous problems today in both the lay and the professionalareas of responsibility for total care is the broad gap be-tween knowledge and its application.’’1 In the 40 yearssince, the scientific basis and practice of EM have pro-gressed enormously, and yet in 2001, the Institute of

From the Agency for Healthcare Research and Quality (MH, JS),

Washington, DC.

Received July 18, 2007; accepted July 19, 2007.

Presented at the 2007 Academic Emergency Medicine Consensus

Conference, ‘‘Knowledge Translation in Emergency Medicine:

Establishing a Research Agenda and Guide Map for Evidence

Uptake,’’ Chicago, IL, May 15, 2007.

The views expressed in this paper are those of the authors and

do not necessarily reflect the official position of the U.S. Depart-

ment of Health and Human Services.

Contact for correspondence and reprints: Michael Handrigan,

MD; e-mail: michael.handrigan@ahrq.hhs.gov.

ª 2007 by the Society for Academic Emergency Medicine

doi: 10.1197/j.aem.2007.07.007

Medicine issued a report entitled Crossing the QualityChasm: A New Health System for the 21st Century, inwhich the authors identified ‘‘a health care system thatfrequently falls short in its ability to translate knowledgeinto practice.’’2

To some extent, EM and hospital emergency depart-ments (EDs) have been victims of their own success. Inits 1966 report, the National Academy of Sciences Com-mittee on Trauma declared that ‘‘Society now looks tothe hospital emergency department as a community cen-ter for outpatient care. More than two-thirds of the40,000,000 ‘emergency room’ visits in 1966 cannot be clas-sified as emergencies.and most such services operate at afinancial loss.’’1 The specialty of EM developed in responseto an increasingly overburdened system of medical caredelivery and the recognition that a successful responsewould require unique and specialized services, training,and infrastructure. EDs have consequently been trans-formed into highly efficient and effective centers of emer-gent, urgent, and ambulatory patient care. Nonetheless, anew landmark report issued by the Institute of Medicine in2006 entitled Hospital-Based Emergency Care: At theBreaking Point describes the modern ED as a refuge forthe uninsured, a valuable practice asset, a one-stop shopfor the patient, and a relief valve for the hospital,3 a rathersimilar state of affairs to that described in 1966. One couldargue that the transformation in ED patient care servicessuccessfully met the stated 1960s requirements but wassimply not sufficient to keep up with U.S. populationgrowth, accelerating demand for ED services, and an

ISSN 1069-6563

PII ISSN 1069-6563583 965

966 Handrigan and Slutsky � FUNDING OPPORTUNITIES IN KT

ever-increasing reliance on the ED as a relief valve. In viewof the likely increase of underinsured and uninsuredAmericans, and an anticipated surge in Medicare enroll-ees, it is very unlikely that the next 40 years will see achange in the dynamics of escalating demand on the EMinfrastructure than was seen in the previous 40 years, orindeed in the decades that preceded that.

Ideally, well-crafted research and the objective and ex-plicit analysis of the resulting scientific evidence woulddirectly lead to consistent and sustainable improvementsin clinical practice. However, as the past four decadeshave proven, the real dilemmas in health care are oftenlarger than the simpler issues of what works and whatdoes not. In reality, evidence alone rarely leads to im-provements in practice or changes in policy.4 Conflictsurrounding health care policy often occurs as a resultof ancillary considerations such as the values, prefer-ences, and circumstances of individuals and the commu-nities that a particular policy change will affect.5 Thismay represent the true challenge in responding totoday’s crisis in health care. Research efforts in healthservices should encourage the consistent application ofscientifically rigorous evidence at all levels of medical de-cision-making and at the same time be responsive to thecommunity of users who need information for makingappropriate decisions concerning that evidence.5,6 Treat-ment decisions and resource utilization must be sup-ported by best evidence, and that evidence must bemade readily available and understandable to decision-makers.7

The need for systematic change in the process of trans-lating evidence into clinical practice was recognizedin Section 1013 of the Medicare Prescription Drug,Improvement, and Modernization Act of 2003, which au-thorized research, demonstrations, and evaluations toimprove the quality, effectiveness, and efficiency of thefederally administered health care programs, namely,Medicare, Medicaid, and the State Children’s Health In-surance Program. This legislation authorized the Agencyfor Healthcare Research and Quality (AHRQ) to developstate-of-the-art information about the effectiveness ofinterventions with input from the public and fromstakeholders and to conduct and support research witha focus on outcomes, comparative clinical effectiveness,and appropriateness of pharmaceuticals, devices, andhealth care services. Information concerning AHRQ re-search authorized under Section 1013 of the MedicarePrescription Drug, Improvement, and ModernizationAct can be found at http://effectivehealthcare.ahrq.gov/aboutUs/index.cfm.

In keeping with the mission of AHRQ to improve thequality, safety, efficiency, and effectiveness of healthcare for all Americans, AHRQ funds and conducts re-search on issues important to clinical, health system,and policy decision-makers and aims to close the gap be-tween evidence and practice while nurturing the nextgeneration of health services researchers. Historically,AHRQ has been at the forefront of a national effort to im-prove the process of translating research knowledge intoclinical practice. In 1999, AHRQ launched a two-phasegrant program entitled Translating Research into Practice(TRIP I and TRIP II). These grants were intended to pro-vide sound research data from the evaluation of inter-

ventions designed to improve outcomes, quality,effectiveness, efficiency, and cost-effectiveness of healthcare and to demonstrate that the translation of knowl-edge into clinical practice can lead to measurable andsustainable improvements in health care.8 Specifically,TRIP I was intended to develop new knowledge aboutapproaches that are effective and cost-effective in pro-moting the use of research evidence in clinical settingsand lead to improved health care practice and sustainedpractitioner behavior change. TRIP II was intended todevelop strategies for translating research into practicethrough the development of partnerships between re-searchers and health care systems and organizations. In2004, TRIP investigators were surveyed concerning theirexperiences with respect to barriers to knowledge trans-lation and implementation. An evaluation of the identi-fied barriers revealed that ‘‘The research base is stillinadequate to guide policymakers, administrators, andclinicians in the optimal approaches for translating re-search into practice across the broad range of clinicalconditions and practice settings.’’9 These findings mayreflect the same issues that have persisted since the1966 Academy of Science report, in that the pathwayfrom generation of evidence to its application is nottransparent, value free, or universally accepted.10

It is generally accepted that translating research intopractice is the key to creating sustainable improvementsin health outcomes. To this end, AHRQ remains a dedi-cated science partner in the advancement of investi-gations that concentrate on user-identified gaps inknowledge and decrease disparities in health care. Aninterest in funding opportunities via AHRQ should beginwith a clear understanding of the AHRQ researchagenda, which can be found at http://www.ahrq.gov/fund/ragendix.htm. The Internet is the funding gateway.It allows investigators to keep abreast of research prior-ities and open solicitations. Investigators are stronglyencouraged to visit the AHRQ Web page (http://www.ahrq.gov/) and to take advantage of postings that de-scribe all current solicited Funding Opportunity An-nouncements and Program Announcements, as well asa broad spectrum of Unsolicited Research Opportunities.Additionally, investigators interested in applying for anyopportunity should review the National Institutes ofHealth Guide for Grants (http://grants1.nih.gov/grants/guide/index.html and http://www.grants.gov).

CONCLUSIONS

The amount of biomedical research has outstripped theclinician’s ability to assimilate diverse findings to guidereal-world clinical decisions. Research is essential to as-sess and improve the process of integrating diverse bod-ies of evidence to answer questions critical to effectivepatient care. EM is cutting edge and innovative and re-mains a de facto safety net; thus, the role of EM in healthservices research and translating research into practicebrings a unique perspective and a natural forum for link-ing evidence to action.

Understanding how to make clinical practice moreeffective, in part, relies on appreciation of the organi-zational, systems, and clinical environment. Even whenthe evidence base is strong, getting the findings to the

ACAD EMERG MED � November 2007, Vol. 14, No. 11 � www.aemj.org 967

point of care can be difficult. EM is a cornerstone in theU.S. health care system. Its practitioners can and shouldplay an important role in knowledge generation andknowledge translation, both as researchers and as imple-menters.

References

1. National Academy of Sciences and National ResearchCouncil. Accidental Death and Disability: The Ne-glected Disease of Modern Society. Washington,DC: National Academy of Sciences, 1966.

2. Institute of Medicine and Committee on Quality ofHealth Care in America. Crossing the Quality Chasm:A New Health System for the 21st Century. Washing-ton, DC: National Academy Press, 2001.

3. Institute of Medicine and Committee on the Future ofEmergency Care in the U.S. Health System. HospitalBased Emergency Care: At the Breaking Point. Wash-ington, DC: National Academy Press, 2006.

4. Bero LA, Grilli R, Grimshaw JM, Harvey E, OxmanAD, Thomson MA. Closing the gap between researchand practice: an overview of systematic reviews ofinterventions to promote the implementation of

research findings. The Cochrane Effective Practiceand Organization of Care Review Group. BMJ.1998; 317:465–8.

5. Atkins D, Siegel J, Slutsky J. Making policy when theevidence is in dispute. Health Aff (Millwood). 2005;24:102–13.

6. Slutsky JR, Clancy CM. The Agency for HealthcareResearch and Quality’s Effective Health Care Pro-gram: creating a dynamic system for discoveringand reporting what works in health care. Am J MedQual. 2005; 20:358–60.

7. Atkins D, Fink K, Slutsky J. Better information for bet-ter health care: the Evidence-based Practice Centerprogram and the Agency for Healthcare Researchand Quality. Ann Intern Med. 2005; 142:1035–41.

8. Farquhar CM, Stryer D, Slutsky J. Translating re-search into practice: the future ahead. Int J QualHealth Care. 2002; 14:233–49.

9. Feifer C, Fifield J, Ornstein S, et al. From researchto daily clinical practice: what are the challengesin ‘‘translation’’? Jt Comm J Qual Saf. 2004; 30:235–45.

10. Col NF. Challenges in translating research into prac-tice. J Womens Health (Larchmt). 2005; 14:87–95.