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AHRQ Annual Report on Research and Management, FY 2003

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Part 1. AHRQ Activities and Accomplishments, FY 2003

Chapter 1. Health Care in America

The overall health of people living in the United States has improved dramatically over the last century. In the last decade alone, the Nation has seen significant reductions in infant mortality, great improvement in the rate of childhood vaccinations, declining substance abuse, fewer people dying from heart disease, and promising new cancer treatments.

Most Americans are never very far from medical help, and emerging health information technologies could bring care, and the best possible science to enhance that care, even closer. Indeed, people come from all over the world to share in the benefits of the U.S. health care system.

Despite the remarkable strides we have made in the past few years, there are many problems and challenges associated with the U.S. health care system. For example:

  • Health care costs continue to rise. According to the most recent annual data available from the Medical Expenditure Panel Survey (MEPS), expenditures for health care services to the U.S. community population totaled $726 billion in 2001, an increase of 15.7 percent over 2000.
  • Average health insurance premiums in 2001 were $2,889 for single coverage and $7,509 for family coverage, representing increases of 8.8 percent and 10.9 percent, respectively, over 2000. This continued a trend of increasing premiums each year since 1996.
  • Access to health care continues to be a problem for many Americans. In 2001, 31.3 million Americans under age 65 were uninsured for the entire year, and another 30.6 million were uninsured for some part of the year. Over the first half of 2002, 45.9 million Americans under age 65 lacked health insurance, representing 18.5 percent of the nonelderly population. In addition, according to the 2000 MEPS, 18 percent of the U.S. community population does not have a usual source of health care.
  • In 2002, 12 percent of infants were born preterm, and 7.8 percent were born with low birthweight. Since the mid-1980s, rates of preterm birth and low and very low birthweight have increased. In addition, the rate of decrease in the infant mortality rate has slowed in recent years (one-tenth of a percentage point per year for 1998-2001).
  • Recent studies have raised questions about differences in care provided to different populations, including women, children, racial/ethnic minorities, the elderly, and people with chronic conditions. By the year 2050, it is estimated that nearly one in two Americans will be a member of a racial or ethnic minority group. These demographic changes have different implications for communities across the Nation and the systems of care that are in place and available to serve the residents.
  • Gaps in income between the richest and poorest households in America are widening. People of lower socioeconomic status face many barriers to obtaining timely and high-quality health care.
  • Access to care continues to be a problem for some Americans, and different patient groups experience the impact of barriers to care differently. For example, transportation to providers may pose the greatest problem for the rural elderly or disabled, while working adults may only be able to get care in the evenings and on weekends. These and other obstacles—such as difficulty in obtaining referrals to specialty care—can lead people to delay needed care or seek care in inappropriate settings, such as the hospital emergency room.
  • The United States, like all developed nations, is facing demographic challenges attributable to the successes of biomedicine—that is, the aging of the population and growing burden of illness attributable to chronic conditions, such as heart disease, diabetes, high blood pressure, and cancer. By the year 2020, an estimated 16 percent of the U.S. population will be age 65 or older, posing a significant challenge for the U.S. health care system. For example, experts have predicted that Medicare and Medicaid expenditures for long-term care will double over the 4-year period 2001 to 2005.
  • Over the past 40 years, the prevalence of obesity among adults in the United States has increased from 13 percent to 27 percent. Obesity is associated with many significant health problems, including high blood pressure, diabetes, heart disease, decreased quality of life, and premature death.
  • Obesity in children is on the rise as well. The percentage of children who were obese or overweight increased significantly and steadily from 1986 to 1998. By 1998, the prevalence of obesity/overweight had risen to 22 percent among black and Hispanic children and 12.3 percent among non-Hispanic white children.

New Director Appointed for AHRQ

Carolyn M. Clancy, M.D., a general internist and health services researcher, was named permanent director of AHRQ in February 2003. She had served as acting director of the Agency since March 2002 and, before that, as director of AHRQ's Center for Outcomes and Effectiveness Research.

Dr. Clancy holds an academic appointment at George Washington University School of Medicine, and she serves as Senior Associate Editor of the journal, Health Services Research. Her major research interests include women's health, primary care, access to care, and the impact of financial incentives on physicians' decisions.

Dr. Clancy has been with the Agency since 1990 and has also served as director of AHRQ's Center for Primary Care Research.

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AHRQ: Working to Improve Health Care in America

The Agency for Healthcare Research and Quality (AHRQ) is one of 13 agencies of the Department of Health and Human Services. AHRQ has a leadership role in finding answers to difficult questions about the Nation's health care system. The products developed by the Agency include the scientific evidence that supports decisionmaking to improve health care, as well as tools to assist in improving quality and reducing costs. AHRQ's focus is on getting research results into the hands of those who can put it to practical use as rapidly as possible. As advances in information and communications technology make it feasible to deliver the best possible evidence to the point of care, the role of evidence-based information in improving the quality, safety, efficiency, and effectiveness of health care for all Americans will become even more essential.

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Role and Mission of AHRQ

AHRQ's mission is to improve the quality, safety, efficiency, and effectiveness of health care for all Americans.

AHRQ promotes improvements in health care quality by conducting and supporting health services research that results in scientific evidence regarding all aspects of health care. Health services research addresses factors related to the organization, delivery, financing, and use of health care services; patient and provider behavior; quality and patient safety; outcomes and effectiveness; access to care; and cost. Health services researchers evaluate both clinical services and the system in which these services are provided.

Findings from health services research provide answers to real-world questions about health care. AHRQ's goal is to foster research that helps the Nation's health care system provide access to high quality, cost-effective services; to be accountable and responsive to consumers and purchasers; and to improve health status and quality of life for all Americans. An essential outgrowth of this goal is assuring that research findings are ready for use by health care decisionmakers, including policymakers, private-sector leaders, providers, clinicians, and patients/consumers.

To meet these challenges, the Agency has established a broad base of expertise in scientific research. The findings from AHRQ-supported research promote improvements in clinical and health system practices, including the prevention of diseases and other health conditions.

AHRQ's Role in the Research Arena

AHRQ's health services research complements the biomedical research of the National Institutes of Health by helping clinicians, patients, health care institutions, and policymakers make choices about what works best, for whom, when, and at what cost.

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AHRQ's Customers

Findings from the research conducted and supported by AHRQ help clinicians, policymakers, and patients, as well as purchasers and systems managers. For example:

Physicians and other health care providers
  • Findings from AHRQ research help practitioners diagnose and treat patients more effectively. A computerized clinical information system developed with AHRQ support is now being used to help clinicians determine the most appropriate timing for giving antibiotics to surgical patients.
  • AHRQ's Web M&M, an online journal and forum on patient safety and quality, helps physicians and other clinicians learn more about, and ultimately improve, patient safety. The site features expert analysis of medical errors reported anonymously by readers, interactive learning modules, and forums for online discussion. Each month, five interesting cases involving medical errors and patient safety problems are posted—one each in medicine, surgery/anesthesiology, obstetrics-gynecology, pediatrics, and other fields—along with commentaries from distinguished experts and a forum for readers' comments.
  • AHRQ's National Guideline Clearinghouse™ provides clinicians, health plans, health care delivery systems, and purchasers a free, Web-based mechanism for obtaining objective, detailed information on clinical practice guidelines.

AHRQ Has Materials to Help Patients Make Decisions About Preventive Services

AHRQ, through its Put Prevention Into Practice (PPIP) program, makes available materials to increase the appropriate use of clinical preventive services, such as screening tests, chemoprevention (the use of medications to prevent disease), and counseling. PPIP is based on evidence-based recommendations from the U.S. Preventive Services Task Force.

PPIP consumer materials, which are available from AHRQ, include checklists for men and women and pocket guides for older adults and children.

  • Men: Stay Healthy at Any Age and Women: Stay Healthy at Any Age. These checklists are designed for patients to take along on visits to health care providers to make it easier to talk about screening tests. The checklists include recommendations about cholesterol checks and tests for high blood pressure, cancer, diabetes, depression, and sexually transmitted diseases.
  • Pocket Guide to Staying Healthy at 50+. The guide includes tips and recommendations on good health habits, screening tests, and immunizations for older Americans. It provides easy-to-use charts to track personal health information and includes questions to ask health care providers, as well as resources for more information.
  • Pocket Guide to Good Health for Children. Designed for parents to help them keep their children healthy. It provides tips for asking the right questions during medical visits and information on recommended immunizations, developmental milestones, good nutrition, suggestions for injury prevention, and other important topics.
Public policymakers and other health officials:
  • AHRQ provides information and technical assistance to State and local policymakers through user-driven workshops on topics that include improving care delivered to children served by State agencies and developing strategies to reduce health disparities.
  • Data from AHRQ surveys, including MEPS and the Healthcare Cost and Utilization Project (HCUP), provide policymakers and others with the information they need to craft policies, clinical guidelines, legislation, and other materials that affect how health care is delivered and paid for in the United States. Both MEPS and HCUP are discussed in detail in Chapter 6 of this report.

Responding to Bioterrorism

AHRQ has a substantial investment in research related to bioterrorism preparedness and response. For example:

  • Researchers at Weill Medical College of Cornell University have designed a new computer model to help hospitals and health systems plan antibiotic dispensing and vaccination campaigns to respond to bioterrorism or large-scale natural disease outbreaks. The model was developed by AHRQ-funded researchers after testing a variety of patient triage and drug-dispensing plans. Now, for the first time, hospital planners can estimate the number and type of staff needed to vaccinate an entire community in an efficient and timely fashion.
  • AHRQ-funded researchers at the University of Alabama at Birmingham and Research Triangle Institute have developed training modules to teach health professionals how to respond to varied biological agents, including pathogens rarely seen in the United States. The Web site covers anthrax, smallpox, botulism, tularemia, viral hemorrhagic fever, and plagues and has modules designed for ER practitioners, radiologists, pathologists, and infection control specialists. This site was up and running just 1 week after the anthrax attacks in October 2001, and it was developed specifically to respond to clinicians' needs.
Patients and consumers:
  • AHRQ's research assists people in getting objective information on how to choose health plans, doctors, and hospitals based on their experience and performance.
  • Personal health guides developed by AHRQ help individuals keep track of their preventive care and other health services they receive.

Chronic Disease Self-Management

Improving chronic illness care is one of the top challenges for health care in the 21st century. Patients who co-manage their chronic illnesses have better outcomes than those who are less involved in their own care.

A successful bilingual chronic disease self-management program called "Living with Chronic Illness: How to Overcome Your Symptoms Through Self-Management," has been implemented in San Antonio, TX. It is the result of a research study cosponsored by AHRQ and the State of California.

The San Antonio program is offered in English and Spanish through the Texas Diabetes Institute. It was developed through a 5-year research study conducted by Researchers at Stanford University. During the first year the course was offered, more than 130 patients participated in nine classes, including four classes in Spanish.

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