Commentary on the American Heart Association's Pharmaceutical Roundtable-Spina Outcomes Center papers.

Despite the critical role that health services and outcomes research should play in efforts to improve the quality of health care and address the unsustainable escalation in costs, federal support of these efforts has been complicated. Health services research has played a poor cousin to funding of traditional bench and clinical research; whereas the National Institute of Health’s 20041 roadmap emphasized translational research as a focus, and outcomes research as one avenue to achieve results, substantial funding has not followed. The Agency for Healthcare Research and Quality (AHRQ) has been the principal source of funding for investigators seeking support. Although the AHRQ received considerable increases in funding as part of the American Recovery and Reinvestment Act of 2009 and the Patient Protection and Affordable Care Act (PPACA), its history identifies the risk of infusing politics into science.2 The recent debate of the role of comparative effectiveness research and the funding and delivery of care3 has an eerie echo of the AHRQ’s (then AHCPR) near-death experience after publication of research it funded on outcomes of lumbar fusion.4 It is in this context that two articles published in Circulation: Cardiovascular Quality and Outcomes are important milestones in efforts to diversify the support of research aimed at improving the delivery of health care.