The Agency for Healthcare Research and Quality (AHRQ) today announced new support for assessing and improving the U.S. health care system's capacity to respond to possible incidents of bioterrorism. This $5 million initiative, focusing on clinical preparedness of health care providers and health care systems, is part of a broad effort by the U.S. Department of Health and Human Services and other federal agencies against bioterrorism.

The initiative will examine the clinical training and ability of front- line medical staff, including primary care providers, emergency departments, and hospitals, to detect and respond to a bioterrorist threat. This initiative also will focus on research on the use of information and decision support systems to enhance clinical preparedness in the event of a bioterrorist threat and will assess and improve linkages between the health system, local and state public health departments, and emergency preparedness units.

AHRQ Director John M. Eisenberg, M.D., said, "A bioterrorist event could pose unprecedented challenges to our health care system. This research will help clinicians, hospitals, and other parts of the health care system detect and respond more quickly in the event of a bioterrorist incident. We need to think about how we would handle the unthinkable."

AHRQ will use several mechanisms to accomplish these goals, including research contracts, evidence reports, primary care practice-based research networks, and integrated delivery system research networks. Components of AHRQ's comprehensive anti-bioterrorism portfolio include:

Bioterrorism Response Contracts and Topic Assignments

These contracts are part of a concerted strategy to examine the clinical preparedness of key medical staff in responding to potential bioterrorist threats:

* Bioterrorism: Automated Decision Support and Clinical Data Collection. Principal investigator: Michael Shannon, M.D. Children's Hospital, Harvard University. Total projected funding: $749,917. Funding period: 9/29/00-3/31/02. This project will develop a prototype database and Web site to give clinicians the opportunity to report suspicious trends of possible bioterrorist events. It also will develop four prototypes for decision support systems for clinicians to give them "just-in-time" information and advice on appropriate response.

* Using Information Technology to Improve Clinical Preparedness for Bioterrorism. Principal investigator: Michael Wagner, M.D., Ph.D. MPC Corporation, University of Pittsburgh, and Carnegie Mellon University. Total projected funding: $1,020,652. Funding period: 9/29/00-3/31/02. This project will evaluate the ability of existing data systems and information technology to support earlier detection of and response to a bioterrorist event.

* Innovative Approaches to Training Clinicians for Bioterrorist Attacks. Principal investigator: Kathleen Lohr, Ph.D. Research Triangle Institute, University of North Carolina. Total projected funding: $600,000. Funding period: 9/29/00-3/31/02. This project -- which includes an advisory committee of clinicians, medical educators, health systems leaders, and others -- will develop two prototype approaches for training clinicians to recognize and respond appropriately to a possible bioterrorist attack.

* Understanding Needs for Health System Preparedness and Capacity for Bioterrorist Attacks. Principal investigator: Sue Losch, R.N., B.S.N.C. Booz-Allen & Hamilton, University of Maryland, and Emory University. Total projected funding: $559,031. Funding period: 9/29/00-3/31/02. This project will assess the current capacity of hospitals and health systems to respond to a bioterrorist attack. It also will describe opportunities to improve existing clinical preparedness programs, develop model plans for hospitals and health systems, and develop innovative approaches to increasing hospital system capacity to support medical response.

* Innovative Approaches to Training Clinicians for Bioterrorist Attacks. Principal investigator: Thomas Terndrup, M.D. University of Alabama at Birmingham. Total projected funding: $500,000. Funding period: 9/29/00-3/31/02. This project will develop innovative approaches to training clinicians for bioterrorist attacks and creative methods for evaluating the effectiveness of those approaches. Such approaches will be applicable on a broad scale and be adapted to the information needs and current challenges confronting busy clinicians.

* Establishing Effective System Linkages for Bioterrorism: Medical Care, Public Health, and Emergency Preparedness. Principal investigator: Jerry Hauer, M.H.S. Science Applications International, George Washington University, Johns Hopkins University, and the Joint Commission on the Accreditation of Healthcare Organizations. Total projected funding: $499,843. Funding period: 9/29/00-3/31/02. This project will assess and improve linkages between the medical care, public health, and emergency preparedness systems to improve detection of and response to a bioterrorist event.

Projects at Evidence-based Practice Centers

AHRQ currently funds research at 12 Evidence-based Practice Centers (EPCs) in the United States and Canada. These EPCs systematically review and analyze all relevant scientific literature on assigned clinical care topics, produce evidence reports and technology assessments, conduct research on methodologies and the effectiveness of their implementation, and participate in technical assistance activities. The following EPC projects have a specific focus on bioterrorism:

* Bioterrorism: Training for Rare Public Health Events. Principal investigator: Christina Catlett, M.D., and Trish Perl, M.D. Johns Hopkins University. Total projected funding: $250,000. Funding period: 11/1/00-4/30/02. This evidence report will assess the available research for training providers for rare public health events, such as a bioterrorist attack.

* Role of Decision Support Systems in Disease Management Following a Bioterrorist Event. Principal investigator: Douglas K. Owens, M.D., M.S. University of California at San Francisco and Stanford University. Total projected funding: $400,000. Funding period: 9/29/00-9/28/02. This evidence report will address the role of decision support systems in the rapid diagnosis and management of disease resulting from a bioterrorist event.

Projects at Primary Care Practice-Based Research Networks

AHRQ recently funded 19 Primary Care Practice-Based Research Networks (PBRNs) nationwide. PBRNs are groups of ambulatory practices devoted principally to patient care, but which are affiliated with each other to investigate questions related to community-based practice. These PBRNs will explore the role of primary care providers in clinical preparedness for a bioterrorist event:

* National Network for Family Practice and Primary Care Research. Principal investigator: Herbert F. Young, M.D. American Academy of Family Physicians (AAFP). Total projected funding: $121,388. Funding period : 9/30/00-9/29/01. This national network developed by the AAFP, which includes 110 clinicians from practices in 34 states and four Canadian provinces, will explore the adequacy of linkages of providers' offices with public health and emergency preparedness agencies.

* ResNet. Principal investigator: William M. Tierney, M.D. Indiana University Medical Group-Primary Care. Total projected funding: $134,008. Funding period: 9/30/00-9/29/01. This network at Wishard Health Services and the primary care practices of the Indiana University School of Medicine will focus on the use of information technology to connect primary care providers to emergency preparedness and public health personnel.

* UCSF/Stanford Collaborative Research Network. Principal investigator: Mary S. Croughan-Minihane, Ph.D. University of California at San Francisco. Total projected funding: $132,750. Funding period: 9/30/00-9/29/01. The Collaborative Research Network, a network of 600 primary care physician practices in Northern and Central California with a large underserved urban patient population, will conduct research on clinicians' preparedness for a biotterrorist event.

Integrated Delivery System Research Network Projects

AHRQ also recently funded an Integrated Delivery System Research Network (IDSRN), which is a new model of field-based research designed to link the nation's top researchers with some of its largest health care systems to conduct fast-track research on cutting-edge issues. The IDSRN will explore the role of integrated delivery systems in clinical preparedness for a bioterrorist event:

* Integrated Delivery Systems and Clinical Preparedness for Bioterrorism. Principal investigator: Alvin Mushlin, M.D. Weill Medical College, Cornell University. Total projected funding: $249,973. Funding period: 9/25/00-9/24/01. The Weill Medical College Network -- which includes the University Hospital of Columbia and Cornell, the Joseph L. Mailman School of Public Health of Columbia University, North Shore University Hospital, Memorial Sloan-Kettering Cancer Center, Health Watch, and members of the New York Presbyterian Healthcare System -- will examine hospital and delivery system capacity to respond to a bioterrorist event and will identify current linkage capabilities of integrated delivery systems with the local public health infrastructure.

Conference Support Grant