Report on NIH Collaborations with Other HHS Agencies for FY 2011
Background
Section 403A [283a] (a), Annual Reporting to Increase Interagency Collaboration and Coordination, was added to the Public Health Service Act by Section 104 of the National Institutes of Health (NIH) Reform Act of 2006, and requires that the NIH Director forward to the Health and Human Services (HHS) Secretary an annual report on NIH’s collaborations with other HHS Agencies
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This, our fifth report to the Secretary, covers FY 2011.
The NIH’s collaborative efforts with other HHS agencies are a critical component of the HHS mission to protect the health of all Americans and provide essential human services, especially for those who are least able to help themselves. As the Nation’s leading biomedical and behavioral research institution, NIH is dedicated to the pursuit of fundamental scientific knowledge about living systems and the application of that knowledge to improve people’s health and reduce the burden of disease. Our collaborations with other HHS agencies promote the translation of NIH’s research to community health practice, coordinate a range of health programs and policies, enable better tracking of patient safety initiatives, and optimize agency efforts to reduce health disparities, thereby providing a healthier population, resulting in increased social and economic benefits.
Scope of Report
In FY 2011, NIH collaborated with HHS operating divisions on 574 activities: 395 activities that did not require NIH funding and 179 activities funded with contributions from NIH totaling $397,520,434.
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Of these activities, 77 are new for FY 2011.
Navigating the Report
This year, the full report can be easily viewed electronically through the NIH Research Portfolio Online Reporting Tools (RePORT) Web site located at
http://report.nih.gov/reports.aspx. A complete listing of individual collaborations is in Table 1 of the report, with each collaboration designated a category based on the nature of the activity. These categories include: Committee/Workgroup, Database, Disease Registry, Health Survey, Information Clearinghouse, Meeting/Workshop, Public Education Campaign, Research Initiative, and Training Initiative (Chart 1). In addition, the alignments with HHS strategic priorities and NIH strategic priorities, as well as the full details for each activity, can be viewed by clicking on the icon next to the Details column of each activity.
Overview
NIH continues to invest heavily in a spectrum of activities with other HHS agencies, as evident in the individual collaborations listed in Table 1. For those collaborations that did not involve NIH funding (labeled “non-funded” in (Chart 2), more than half relied on NIH’s intellectual input, typically in the form of committees or meetings. NIH’s funding contributions with each HHS operating division can be found in Chart 3 and shows the majority of collaborations were with the Centers for Disease Control and Prevention (CDC, $227,952,902), the Food and Drug Administration (FDA, $123,468,932), and the Centers for Medicare and Medicaid Services (CMS, $63,650,687). Most collaborations involving funding from NIH were for research initiatives, which made up 63 percent of all funded activities (126 funded collaborative research initiatives for a total of $250 million).
New Collaborations for FY 2011
Behavioral Health
In FY 2011, NIH and other HHS agencies undertook 77 new collaborative activities to address pervasive health issues for the Nation. This year brought a renewed focus on behavioral and social processes that may influence health outcomes and mitigate health risk factors. This focus is exemplified by the creation of the HHS Behavioral Health Coordinating Committee (BHCC), charged with coordinating behavioral health activities across HHS. The BHCC includes five subcommittees to address early intervention, prescription drug abuse, teenage drinking, integrating behavioral health care with primary care, and behavioral health communications. As an example of activities undertaken by the BHCC, the prescription drug abuse subcommittee has catalogued the main sources of data to measure the availability and success of treatment services. Other collaborations involving behavioral or social interventions include the development of a three-year Twelve Cities Project to implement behavioral interventions to help reduce HIV infections in areas of the country with the highest prevalence of the disease. The program is also linking those with the disease to care and treatment. The Autism Quality Measure Development Subgroup is looking at ways to develop, and electronically share, clinical quality measures of behavioral health in children with autism. Once developed, this centralized data will facilitate research efforts on autism disorders.
Addressing trauma presents a further need to bring experts in the behavioral and social sciences together. NIH participates in several multi-agency collaborations, including an affiliation with the Board of Scientific Counselors for the CDC’s National Center for Injury Prevention and Control to mitigate trauma brought about by abuse and neglect in older adults. NIH invested $225,000 in the Development of Quality Measures for Post-Traumatic Stress Disorder (PTSD) that proposes to develop a set of at least four validated quality measures for the treatment of PTSD to be implemented by State Medicaid programs.
Alzheimer’s Disease
Given the rapidly increasing prevalence of Alzheimer’s Disease, this year saw the creation of an interagency group implementing The National Alzheimer’s Project Act. This group is working across agencies to address Alzheimer’s Disease and related dementias in the hopes of offering preventative and effective treatments by 2025. Along with expanding support for those suffering from Alzheimer’s and their families, the Act makes provisions for optimizing the quality of care and its efficiency, enhancing public awareness, and better tracking the progression of the disease and its improvements.
International Efforts
New international efforts in FY 2011 include a collaboration addressing the Health Burden from Indoor Air Pollution on Women and Children in Developing Countries. Inefficient cooking stoves in the developing world contribute to 2 million deaths a year, with women and children at greatest risk for adverse health effects. This global effort is working to find a cost-effective and efficient means to replace these biomass-fueled stoves with clean, affordable, fuel efficient stoves, thereby reducing the incidence of pneumonia, lung cancer, and chronic obstructive pulmonary disease now associated with their use—the same disease risks occurring in smokers.
Presently there are no worldwide standards on the amount of Vitamin D needed to maintain a healthy level and ward off deficiency. Vitamin D helps our body absorb calcium, which is necessary to promote healthy bones and cell growth and helps the body’s immune system function. A deficiency has also been linked to many cancers, high blood pressure, heart disease, diabetes, depression, and autoimmune diseases. NIH is investing $474,900 in a global effort working to standardize measurement for Vitamin D intake through the Vitamin D Standardization Program, thereby providing use in global health surveys as a way to detect and treat deficient populations.
Ongoing Collaborative Efforts
Enhancing Health and Well-Being
To pursue its mission to provide effective health and human services, the Department explores many avenues toward reforming health care, and providing preventive measures and better treatments. NIH contributes to numerous collaborative efforts designed to reach these goals. These collaborations include more than 70 prevention efforts across HHS Agencies, including prevention against lead poisoning, HIV and STDs, Avian Influenza, underage drinking, elder abuse, and suicide. Significant investments are also being made to improve the standard of care. For example, the Oral Health and Cancer Care Education Campaign series works to engage health professionals and patients in the steps to take during and after cancer treatment to reduce painful side effects.
The Affordable Care Act (ACA) provides that CMS look to a transformative and more modern health care delivery system. Many of their activities in pursuit of this goal are collaborative efforts with the NIH. The Innovation Center is supporting efforts to devise ways of providing better health care, better health, and lower costs. Collaborative efforts are under way to find innovative payment and service delivery models to reduce program expenditures under Medicare, Medicaid, and the Children’s Health Insurance Plan (CHIP) programs without reducing care. The CMS-NIH Data Access Committee is looking at ways to link data and outcomes in NIH-supported trials to CMS data. Examples of studies in which these linkages have occurred include the Framingham and Jackson Heart Studies, Atherosclerosis Risk in Communities, and the Women’s Health Initiative. The NIH is also working with CMS in its effort to develop a standardized form that can be used to collect clinical information when patients are discharged from different care settings, as well as creating and updating the RxTerms prescription drug database used to support CMS post-acute care assessment tool (CARE).
NIH contributed $600,000 to the Medical Expenditures Panel Survey (MEPS). This large-scale set of surveys of families and individuals, medical providers, and employers is the most complete source of health care cost data and use of health care insurance coverage issues from across the United States.
Underage drinking is an issue of epidemic proportion for the Nation. Over 70 percent of children say that parents are the leading influence in their decision to drink or not drink, and 40 percent say they have tried it by the time they reach eighth grade. The Substance Abuse and Mental Health Services Administration (SAMHSA) and NIH have developed a campaign for parents on the importance of talking early and often with their children about underage drinking. Across HHS Agencies there is participation in collaborative developments for an open National Drug Control Policy that will focus on issues of prevention, health care delivery, justice systems, and military veterans and their families in developing performance and accountability measures.
The Department’s efforts are global as well. More than $3 million in NIH funding went towards The Medical Education Partnership Initiative (MEPI). This NIH/CDC/Health Resources and Services Administration (HRSA) partnership supports foreign institutions in Sub-Saharan African countries that receive support from the President’s Emergency Plan for AIDS Relief (PEPFAR) to develop or enhance models of medical education. NIH also continues to support PEPFAR, whose goal it is to increase the number of new health care workers by 140,000, strengthen medical education systems in the countries in which they exist, and build clinical and research capacity in Africa as part of a retention strategy for faculty of medical schools and clinical professors. The AIDS International Training and Research Program (AITRP) is helping to build multidisciplinary biomedical research programs that address the prevention, care, and treatment of HIV-related conditions in adults and children in the low- and middle-income countries of Zambia, Cote d’Ivoire, Vietnam, Tanzania, and South Africa.
Diabetes Care and Prevention
NIH has always worked closely with agencies across the Department to address the most pressing health care challenges for the Nation. For example, the National Diabetes Information Clearinghouse (NDIC) reports that diabetes related costs for the Nation in 2007 was $174 billion and more than 25 million people of all ages are affected. Each year 18.8 million people are diagnosed with diabetes, however 7 million go undiagnosed. Considering the impact of this disease, NIH and other agencies have several long-standing collaborations, some spanning more than 40 years.
NIH, the Indian Health Service (IHS), and the Pima Indians living in Arizona’s Gila River Indian Community (GRIC) have worked together to fight diabetes mellitus and its related complications, including obesity, since 1965. The Pima community, largely homogeneous and located in the GRIC for thousands of years, has one of the highest prevalence rates of type 2 diabetes. A genetic predisposition and a shift in diet from agricultural to one of eating more processed foods are believed to influence this high rate of diabetes. Studying the relationship between the Pima Community and type 2 diabetes helps researchers understand the genetic path and environmental influences of diabetes, as well as new approaches toward treatments for obesity and kidney disease. Today the Community’s continued participation includes genetic studies to determine biomarkers for early indicators of the disease and prevention, treatments including diet and exercise lifestyle changes to help maintain a healthy weight, and utilizing their community health related cultural education programs.
NIH continues to support the Diabetes Prevention Program, started in 1994, with an investment of more than $10 million in FY 2011. This long-term outcomes study in collaboration with IHS and the CDC has shown that diet and exercise or the diabetes medication, metformin, can delay the onset of diabetes by 10 years.
Other long-standing NIH diabetes collaborations with the CDC include the Action to Control Cardiovascular Risk in Diabetes Follow-On Study (ACCORDION). ACCORDION is designed to gain understanding of why people with type 2 diabetes are at a higher risk for cardiovascular (CVD) events, and to discover ways to decrease the number of heart attacks and strokes associated with diabetes. High risk patients are seen in 76 clinics across the U.S. and Canada. The National Diabetes Education Program (NDEP) involves 200 State, Federal, and local level partners working to improve treatment outcomes for people with diabetes. A Web-based program, the NDEP is a resource that delivers evidence-based information on diabetes and provides resources on treatments and prevention to help reduce the morbidity and mortality associated with diabetes. The Environmental Determinants of Diabetes in the Young (TEDDY), an international consortium study that began in 2002 and will continue through 2017, is working to identify infectious agents, dietary factors, or other environmental factors that trigger type 1 diabetes in genetically susceptible children and adolescents.
Two additional long-standing NIH/CDC projects, Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) and the SEARCH for Diabetes in Youth project, are multi-centered studies directed toward infants, adolescents, and youth, which are helping improve our understanding of the causes and treatments of diabetes, along with examining the safety and efficacy of treatments. SEARCH, with more than 20,000 study participants from all racial and ethnic backgrounds was launched in FY 2000 and is expected to continue through 2015. This comprehensive national study provided the first national data on incidence and prevalence of diabetes in different populations under 20 years of age. The NIH has combined its resources and activities and with a 2011 investment of more than $2 million continues to support
We Can!
, a national movement disseminating strategies, tools, and resources to help children 8-13 years old maintain a healthy weight.
With more than 200,000 people under the age of 20 diagnosed with type 1 diabetes each year, the Clinical Islet Transplantation Consortium, ongoing since 2004, is a NIH/FDA/CMS collaboration that is studying the efficacy of islet transplantations. The study consists of a network of 11 national and international study centers, as well as a central data coordination center, and focuses on improving the safety and long-term success for the methods used in transplanting islets (insulin-producing cells in the pancreas) in patients whose own islets have been destroyed by the autoimmune process associated with type 1 diabetes.
Harnessing New Technologies to Advance Public Health
The revolution in technologies used to understand biological processes is providing invaluable insights into many areas of public health. NIH is working collaboratively across the Department, especially with the FDA and CDC, to ensure that these new insights—which in turn lead to new diagnostics, treatments and better prevention—are being applied and utilized. For example, thanks to new technology, genetic variants associated with disease are being identified at a stunning rate, laying the groundwork for new diagnostic tools and novel treatments. The Genetic and Rare Disease Information Center (GARD) provides access to free, current, and reliable information about rare and genetic diseases to patients, health care providers, researchers, and the public. Induced Pluripotent Stem Cells (iPSC), in which adult cells (such as skin cells) are converted first to pluripotent stem cells and then to other types of cells (such as neurons), are another example of revolutionary technology applied to better understand disease processes, and their treatment and prevention. Already this technology is being used to discover possible treatments for conditions such as Parkinson’s or other brain conditions, sickle cell anemia or other blood diseases, and vision loss or other eye diseases. NIH and the FDA held their first joint workshop on stem cells which addressed the challenges researchers face in using old and new stem cell lines and the reprogramming of iPSC cells. A second workshop is scheduled to take place in the summer of 2012.
Conclusions
NIH appreciates the opportunity to report on its multifaceted collaborations within the Department. As our FY 2011 report illustrates, many of our collaborations have been ongoing for decades; however, NIH continues to form new collaborations when emerging issues and needs arise. With more than 70 new activities started in FY 2011, NIH is poised to continue its myriad of collaborative efforts across the Department on issues relevant to the Nation’s health needs. Activities will continue, for example, to create electronic records and biometric databases, identify cross-cutting strategies to reduce alcohol and drug use and abuse among our youth, and develop evidence-based screening tools for prevention and treatment of diseases and conditions for a healthier Nation (Table 1). These efforts together will continue moving the Department towards the realization of its mission, delivering the best health care available to the Nation.
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The collaborating HHS agencies, also referred to as HHS operating divisions in this report, include the Administration for Children and Families (ACF), Agency for Healthcare Research and Quality (AHRQ), Administration on Aging (AoA), Agency for Toxic Substances & Disease Registry (ATSDR), Centers for Disease Control and Prevention (CDC), Centers for Medicare and Medicaid Services (CMS), Food and Drug Administration (FDA), Health Resources and Services Administration (HRSA), Indian Health Service (IHS), Office of the Secretary/HHS (OS), Office of the Surgeon General (OSG), and Substance Abuse and Mental Health Services Administration (SAMHSA).
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Funding levels reported in the fiscal year 2011 Inter-Agency Collaborations Reporting System (CRS) may not be consistent with funding levels reported under the Estimates of Funding for Various Research, Condition, and Disease Categories (RCDC) at the NIH Office of Budget Web site at http://report.nih.gov/categorical_spending.aspx. The current process, implemented in 2008 through the RCDC system, uses sophisticated text data mining (categorizing and clustering using words and multiword phrases) in conjunction with NIH-wide definitions used to match projects to categories. RCDC use of data mining improves consistency and eliminates the wide variability in defining the research categories reported. The definitions are a list of terms and concepts selected by NIH scientific experts to define a research category. The research category levels represent the NIH’s best estimates based on the category definitions.