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Sally T. Hillsman,
Footnotes readers have watched the saga leading to President Obama’s March 2010 signing of the Patient Protection and Affordable Care Act (PPACA) that establishes the historic Public Law 111-148. Less commonly known are provisions in the law affecting biomedical and social science research that have significant implications for the future role of sociologists in improving the health of Americans. The new healthcare law emphasizes evaluation, data collection and analysis, and health/healthcare disparities as integral parts of its wide-ranging efforts to prevent disease and promote healthy behavior.
Of particular interest to sociologists, the act creates an independent nonprofit center supported by a U.S. Treasury Department trust fund to conduct and fund comparative effectiveness research (CER) on treatments. This will include the synthesis and dissemination of research findings on "the manner in which diseases, disorders, and other health conditions can effectively and appropriately be prevented, diagnosed, treated, monitored and managed."
CER will be conducted by the Patient-Centered Outcomes Research Institute (PORI) to identify research priorities and pursue a peer-reviewed research agenda. PORI will prohibit the use of data from original research in work-for-hire contracts with individuals or entities that have a financial interest in the results (unless approved by PORI under a data-use agreement). The law directs the Office of Communication and Knowledge Transfer at the Agency for Healthcare Research and Quality (AHRQ) to broadly disseminate research findings published by PORI and other government-funded research relevant to CER. While CER findings may not be used to determine Medicare coverage, they can be considered by the Centers for Medicare & Medicaid Services after public comment and the consideration of effects on subpopulations for which the findings may have limited validity.
The PPACA authorizes grants to study current gaps and research-based improvements needed in existing measures of healthcare quality for use in government health programs. This includes grants to help the government establish an effective framework to collect and aggregate consistent data on healthcare quality as well as publicly report on efficacy data and data on the level of resources used by various therapies in healthcare delivery.
The new law also directs the Center for Quality Improvement and Patient Safety of AHRQ to conduct or fund activities to identify best practices in the delivery of healthcare services. In addition, it authorizes funding research on the development of tools to facilitate adoption of best practices that improve the quality, safety, and efficiency of healthcare delivery services.
The PPACA elevates the status of the NIH’s National Center on Minority Health and Health Disparities to a National Institute on Minority Health and Health Disparities, and makes its Centers of Excellence eligible to receive endowments. The new Institute Director is required to plan, coordinate, review, and evaluate research funded by the other NIH institutes and centers that impacts minority health. The law also elevates the Office of Minority Health by transferring it to the Office of the Secretary of the Department of Health and Human Services (HHS).
The new law also elevates the status of the Office of Research on Women’s Health by having it report directly to the NIH Director. The law also establishes an Office on Women’s Health within each of the following Offices: HHS Secretary, Director of the Centers for Disease Control and Prevention (CDC), AHRQ Director, Administrator of the Health Resources and Services Administration, and the Commissioner of the Food and Drug Administration.
The PPACA requires the President to appoint the Surgeon General as chair of a new National Prevention, Health Promotion and Public Health Council that is authorized to develop a comprehensive national strategy. The law requires the HHS Secretary and the Comptroller General to periodically review and assess every federal disease prevention and health promotion initiative, program, and agency. And it requires the Preventive Services Task Force to review scientific evidence on the efficacy and appropriateness of prevention services to develop recommendations.
The law requires the CDC to convene an independent Community Preventive Services Task Force to review scientific evidence on the effectiveness of community preventive interventions in order to develop recommendations for individuals, service organizations and other policy makers. The new law requires the CDC to implement a national science-based media campaign on health promotion and disease prevention.
The law requires the CDC to award grants to state and local governmental agencies and community-based organizations to implement, evaluate, and disseminate evidence-based community preventive health activities. Similarly, the HHS Secretary is also required evaluate community-based prevention and wellness programs that focus on Medicare beneficiaries.
PPACA requires the CDC to fund research on public health services and systems, including a requirement that all federal healthcare or public health program surveys collect specific demographic data regarding health disparities. The National Coordinator for Health Information Technology is required to develop national standards for managing health data and ensuring interoperability and security of data systems. The CDC is also required to provide employers with resources necessary to evaluate employer-based health and wellness programs and to build evaluation capacity among workplace staff as a basis for allowing the HHS Secretary to determine whether federal health and wellness initiatives are effective
As the new health law implements changes in the social infrastructure affecting Americans’ health, it also makes more pronounced the fundamental role of social scientists in the design, implementation, and evaluation of programs and data collection strategies. Basic biomedical and other health researchers have slowly come to recognize the fundamental role of social science research in efforts to improve the health of populations and subgroups. PPACA moves this process a step further with its emphasis on disease prevention, greater access to health screenings and preventive care, and the promotion of a "health friendly ecology" through federal funds for projects and infrastructure that facilitate exercise. The new law presages changes in the social structure of health and well-being as well as changes in the delivery of medical care. It also presages the enhanced importance of sociological research.
Sally T. Hillsman is the Executive Officer of ASA.
She can be reached by email at firstname.lastname@example.org.