Word doc of the topic nomination form on this Webpage:

Submit your suggestion

Please fill in this form as completely as possible and email the completed form to , or you may print the completed form and mail it to:

Kara Winchell, M.A.
AHRQ Effective Health Care Program
c/o Portland VA Medical Center (R&D 71)
3710 SW U.S. Veterans Hospital Road
Portland, OR 97239

If you have any supporting documents you would like to include with your nomination send them as additional attachments (if emailing), or include them (if mailing).

You are not required to provide your name or affiliations. We will use your contact information only to get in touch with you if we have questions about your suggestion. Theinformationin the nomination form (except personal identification information) will be posted for others to view in the Read Suggested Topics for Research.

Topic Suggestion

1. Describe your topic

Please provide the following information about your topic suggestion:

  • What is the issue or question? Some examples include: For adult patients with a major depressive disorder (MDD), what are the comparative risks and benefits of older versus newer antidepressants? Are interventions for treating adults with MDD used in specialty care settings effective in primary care settings? What strategies will promote uptake of screening for depression?
  • Identify the population of interest, including details such as age range, gender, coexisting diagnoses, and reasons for therapy.
  • Identify the interventions (treatments, tests, or strategies) that you want to know more about, and what are the appropriate comparisons.
  • Identify the important outcomes (health related benefits and harms) in which you are interested, such as improvements in symptoms or problems with diagnosis.

Importance of Suggested Topic

2. Describe why this topic is important

3. Tell us why you are suggesting this topic

Tell us if you have a target date for answering your question and whether you are under a specific timeline.

Target date (month/day/year):

Impact of a New Evidence Report

4. Describe what you are doing currently and what you are hoping will change because of a new evidence report.

For example: How will an evidence report help improve practice? Is it unclear what the most beneficial treatments are? Is there an evidence gap? Is there variation in current practice? Is there a difference between current practice and recent studies? Is it unclear how to implement the health care program or how to best deliver the service?

5. How will you or your group use the information from a new evidence report?

For example: Are you developing a guideline or policy or implementing a new practice? Explain how you or your group will use a new evidence report to inform your decisions and influence practice.

6. How would you or your group plan to disseminate information from the report? Who would you plan to disseminate it to?

Other Stakeholders Who Could Use a New Evidence Report

The EHC Program appreciates opportunities to collaborate with other organizations that can use or implement evidence report findings, whether through practice guidelines, decision support, education, policies, or new research. Example types of organizations include: patient advocacy organizations, clinical professional societies, health care organizations, and Federal, State, or local agencies.

7. Do you know of organizations that could use an evidence report to change clinical practice? Are you a part of, or have you been in contact with, any organizations that might implement the research findings of an evidence report?

Information About You

To help us understand the context of your topic suggestion, it would be helpful to know more about you. The answers you give will not influence the progress of your suggestion.

Provide a description of your role or perspective (e.g., patient/consumer, physician, professional society, administrator):

Please tell us how you heard about the Effective Health Care Program

(Optional) Your name and contact information
Your personal information will not be displayed on the EHC Program Web site, nor will it influence your suggestion for a new evidence report by the EHC Program. It will only be used to contact you for additional information about your suggestion, if necessary. It is not mandatory that you provide your contact information, but it is often helpful for us to contact the person who submitted the suggestion, when we need help clarifying a research question.

First and Last name:

Title:

Email address:

If you are you making a suggestion on behalf of an organization, please state the name of the organization:

Would you be willing to partner with another organization to develop policy, program, guidelines, or dissemination and implementation materials? (yes/no)

May we contact you if we have questions about your nomination? (yes/no)