Measuring Researching and Monitoring the Quality of Health Care - National Institutes Of Health

The NIH, which began as a one-room laboratory in 1887, is the world's premier medical research center. NIH conducts research in its own facilities and supports research in universities, medical schools, and hospitals throughout and outside the United States. NIH trains research scientists and other investigators and serves to communicate medical and health information to professional and consumer audiences.

Part of the U.S. Public Health Service, NIH is composed of twenty-seven centers and institutes and is housed in more than seventy-five buildings on a three-hundred-acre campus in Bethesda, Maryland. Among the better-known centers and institutes are the National Cancer Institute, National Human Genome Research Institute, National Institute of Mental Health, and the newer National Center for Complementary and Alternative Medicine. Figure 4.5 is an organizational chart of the NIH and shows all of its centers and institutes.

Patients arrive at the NIH Warren Grant Magnuson Clinical Center in Bethesda, Maryland, to participate in clinical research trials. About seven thousand patients per year are treated as inpatients here, and an additional seventy-two thousand receive outpatient treatment. The National Library of Medicine—which produces the Index Medicus, a monthly listing of articles from the world's top medical journals, and maintains MEDLINE, a comprehensive medical bibliographic database—is in the NIH Lister Hill Center.

The NIH budget has increased from about $300 per year in 1887 to $13.7 billion in 1998 and will reach nearly $29 billion in fiscal year 2005. NIH works to achieve its ambitious research objectives of "acquiring new knowledge to help prevent, detect, diagnose, and treat disease and disability, from the rarest genetic disorder to the common cold" by investing in promising biomedical research. NIH makes grants and contracts to support research and training in every state in the country, at more than two thousand institutions.

Establishing Research Priorities

By law, all twenty-seven institutes of the NIH must be funded, and each institute must allocate its funding to specific areas and aspects of research within its domain. About half of each institute's budget is dedicated to supporting the best research proposals presented, in terms of their potential to contribute to advances that will combat the diseases the institute is charged with researching. Some of the other criteria used to determine research priorities include:

• Public health need—The NIH responds to health problems and diseases based on their incidence (the rate of development of a disease in a group during a given period of time), severity, and the costs associated with them. Examples of other measures used to weigh and assess need are the mortality rate (the number of deaths caused by the disease), the morbidity rate (the degree of disability caused by the disease), the economic and social consequences of the disease, and whether rapid action is required to control the spread of the disease.
• Rigorous peer review—Proposals are scrutinized by accomplished researchers to determine their potential to return on the investment of resources.
• Flexibility and expansiveness—NIH experience has demonstrated that important findings for commonly occurring diseases may come from research about rarer ones. NIH attempts to fund the broadest possible array of research opportunities to stimulate creative solutions to pressing problems.
• Commitment to human resources and technology—NIH invests in people, equipment, and even some construction projects in the pursuit of scientific advancements.

Since not even the most gifted scientists can accurately predict the next critical discovery or stride in biomedical research, NIH must analyze each research opportunity in terms of competition for the same resources, public interests, scientific merit, and the potential to build upon current knowledge. Figure 4.6 shows all of the stakeholders whose interests and opinions are considered when NIH resource allocation and grant funding decisions are made.

NIH Achievements

As of 2004, NIH supports about one thousand principal investigators—researchers directing projects—and forty-five thousand trainees at academic institutions and research laboratories across the United States. The NIH recruits and attracts the most capable research scientists in the world. In fact, 104 scientists who conducted NIH research or were supported by NIH grants have received Nobel Prizes. Five Nobel winners made their prize-winning discoveries in NIH laboratories.

FIGURE 4.5

FIGURE 4.6

Equally important, NIH research has contributed to great improvements in the health of the nation. Examples of past achievements credited to NIH effort include:

• U.S. deaths from cardiovascular disease—heart disease and stroke—were reduced significantly between 1975 and 2000, with heart disease deaths declining by 40% and stroke deaths by 51%.
• The number of AIDS-related deaths fell by about 70% between 1995 and 2001.
• Better detection and treatment increased the five-year survival rates for persons with cancer to 60%.
• Effective medication was explored to enable the estimated nineteen million Americans suffering from depression to regain quality of life.
• Immunization against a host of infectious diseases has markedly reduced deaths and disability among children and adults.
• Gene therapy, performed by NIH researchers for the first time in 1990, promises to produce more effective screening for genetic disorders and gene therapies for cancer and other diseases.

During 2004 NIH scientists initiated and expanded the scope of its medical research and reported significant findings resulting from new and ongoing research projects. Some of these important initiatives and findings were:

• The sequencing of the human genome set a new course for developing ways to diagnose and treat diseases such as cancer, Parkinson's disease and Alzheimer's disease, as well as rare diseases.
• In response to the anthrax attacks of 2001, the NIH launched and intensified research to prevent, detect, diagnose, and treat diseases caused by potential bioterrorism agents.
• Researchers aggressively pursued ways to make effective vaccines for deadly diseases like HIV/AIDS, tuberculosis, malaria, and potential agents of bioterrorism.
• New and improved imaging techniques enabled scientists to painlessly look inside the body and detect disease in its earliest stages when it is often most effectively treated.
• New, more precise ways to treat cancer are emerging, such as drugs that zero in on abnormal proteins in cancer cells.
• Novel research methods are being developed that can identify the causes of outbreaks, such as Severe Acute Respiratory Syndrome (SARS), in weeks rather than months or years.
• Persons at risk for developing type 2 diabetes can sharply reduce their risk by losing 5 to 7% of their body weight and exercising for thirty minutes every day.
• A vaccine that protects children ages two to five from typhoid fever was developed and tested. Typhoid fever strikes about sixteen million people per year worldwide and six hundred thousand die from it.