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Testimony on the President's Fiscal Year 2002 Budget Request for AHRQ


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John M. Eisenberg, M.D., Director, AHRQ

Before the House Subcommittee on Labor-Health and Human Services-Education Appropriations

Accompanied by, Ms. Rita Koch, Chief, Office of Management, Division of Financial Management; Dennis P. Williams, Deputy Assistant Secretary, Office of Budget, Department of Health and Human Services


Contents

Introduction
Translating Research into Practice
Fiscal Year 2002 Request
Investigator-Initiated Research
The National Healthcare Quality Report
Patient Safety Data Development
The National Healthcare Disparities Report
Medical Expenditure Panel Survey
Conclusion

Introduction

Mr. Chairman and Members of the Committee, I am pleased to be here today to present the President's Fiscal Year 2002 budget request for the Agency for Healthcare Research and Quality (AHRQ).

The mission of the Agency for Healthcare Research and Quality (AHRQ) is to support, conduct, and disseminate research that improves access to and outcomes and quality of health care services. Our mission, to which the Committee has provided guidance, is driven by the needs of the users of our research—patients, clinicians, health system leaders, and policymakers. The primary focus of our mission is to ensure that the research that we support gets translated into practice so that it can actually help improve people's lives.

As one of the 13 agencies of the Department of Health and Human Services (HHS), AHRQ often collaborates with the other HHS agencies, particularly the National Institutes of Health (NIH) and the Centers for Disease Control and Prevention (CDC). AHRQ's health services research complements the biomedical research of the NIH by helping clinicians, patients, and health care institutions make choices about what treatments work best, for whom, when, and at what cost.

AHRQ-sponsored research that has shown that even when treatments are known to be effective many people who could benefit are not getting them. For example, beta blocker medication, given after heart attacks, can reduce mortality. Yet our research showed that many eligible patients were not getting this treatment. AHRQ researchers have developed a tool to help doctors know which patients with suspected heart attacks will benefit from beta blocker treatment.

The products of the Agency include the scientific evidence that supports decisionmaking to improve health care, as well as tools that assist in efforts to improve quality and reduce costs. Our focus is on getting research results in the hands of those who can put it to practical use. We have geared our research agenda toward achieving this goal. I would like to provide the committee with some examples of how our research has improved health care for people and how the Agency has fashioned its budget priorities to do an even better job of meeting this challenge through the Fiscal Year 2002 request.

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Translating Research into Practice

Translating research into practice focuses on closing the gap between what we know and what we do. By doing so, we can help both practitioners and consumers alike. For example, we supported the development of the Consumer Assessment of Health Plans (CAHPS®), which helps consumers decide which health plan that is offered to them best meets their health care needs. The CAHPS® makes information on the quality of health care available to approximately 100 million consumers. It is being used by 20 States, 10 employer groups, a wide range of health plans, and the Ford Motor Company. The Health Care Financing Administration (HCFA) has also used CAHPS® to help Medicare beneficiaries choose health plans.

Our research has also been used to improve clinical practice. AHRQ funded a grant that enabled researchers at the Massachusetts General Hospital to study screening for prostate cancer, specifically the prostate-specific antigen (PSA) test. The findings from this study were subsequently used by the U.S. Preventive Services Task Force (an independent panel of preventive health experts charged with evaluating the scientific evidence for the effectiveness of a range of clinical preventive services) in developing clinical recommendations for the PSA test. The Task Force's recommendations are published in the Guide to Clinical Preventive Services, which is often used by professional societies in developing clinical guidelines. The USPSTF recently released it's first set of recommendations for this year, which include screening for chlamydia, cholesterol, skin cancer, and bacterial vaginosis.

Another example of how our research is being used, is a recently developed aid designed for State and local policymakers, program directors and their staffs, consumer advocates, and other audiences, known as the Child Health Toolbox. The Toolbox, provides information on how to measure the quality of care provided to children in programs such as Medicaid, the State Children's Health Insurance Program (SCHIP), and Title V maternal and child health programs. It also provides guidance on modifying existing quality measures or designing new measures to evaluate a specific state initiative. The Toolbox is accessible through AHRQ's Web site.

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Fiscal Year 2002 Request

For Fiscal Year 2002, we are requesting $306 million, an increase of $36 million above Fiscal Year 2001. The increase will enable us to focus on five priority areas:

In each of these areas we will continue our goal of sponsoring research that investigates ways to improve the quality, outcomes and cost of care, and translating research into practice.

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Investigator-Initiated Research

In its publication Crossing the Quality Chasm: A New Health System for the 21st Century, the Institute of Medicine (IOM) of the National Academy of Sciences recently reported that the Nation's healthcare system is "plagued by a serious quality gap." The report serves as a warning that the current design of the healthcare system has created fragmentation, which is eroding away at the quality of care patients receive. Among the recommendations of the report are that scientific evidence be more accessible and useful to providers and patients.

In Fiscal Year 2002, AHRQ will continue its efforts to support, conduct, and disseminate research that improves quality. Many of these efforts address some of the concerns raised in the IOM report. We are requesting a $16 million increase to support research and training grants for universities and other institutions throughout the country. Such research serves as the foundation or the scientific evidence for helping providers and policymakers improve the Nation's health care system. It represents the Agency's investment for future advances upon which the applied research of the future will be built.

Early AHRQ-supported research by Dr. Lucian Leape and others at Harvard University demonstrated that "errors in care are prevalent and often preventable." This early research provided the basis for the current patient safety initiatives.

The Fiscal Year 2002 request includes an increase of $16 million to fund research and training grants that cover three broad areas of health services research:

  1. Improving patient-centered health care. For this to occur, both technical care and interpersonal interactions must be centered around the needs and preferences of individual patients—and research has shown that this approach yields better outcomes. As a result, health ervices research should be able to do more to identify and disseminate information about the factors that create an ideal environment for patient-centered care.
  2. Structuring, financing, and managing high-quality, efficient care delivery systems. To improve the quality and efficiency of that care, providers, purchasers and policy-makers need knowledge about how these systems operate and how different financial and organizational arrangements affect health care.
  3. Informing those who make health care decisions—from patients to policymakers—on ways to implement the lessons learned from research that informs their decisionmaking. This will attempt to answer important questions about how to translate research findings into improvements for patients and consumers, clinicians and health care delivery systems, and policy makers.

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The National Healthcare Quality Report

In 1999, the Agency was directed through its reauthorization to develop a National Healthcare Report (NQR) on the quality of health care in the United States beginning in Fiscal Year 2003. AHRQ has already begun to develop a framework for the annual report. In Fiscal Year 2002 we are requesting $2 million to enhance our databases to provide information on the health care disparities, chronic conditions in subpopulations (e.g., children), medical errors, and the quality of emergency room services. The funds will also support the acquisition of relevant data and analysis, assessment and development of quality measures for ongoing improvement of the report, and the design of NQR reporting products.

The NQR will be the first national report that provides trends on the state of health care quality in America. The report will incorporate databases from the private sector, such as those emerging from the Joint Commission on Accreditation of Healthcare Organizations on core measures of hospital performance, which will provide a broader picture of American health care delivery. This will allow the Nation for the first time to know whether quality is getting better or worse and in which areas, analogous to how we gauge the state of the economy by the leading economic indicators.

This integration of private-sector data will facilitate the ability to take a finer cut at the quality picture and provide State and system-level policymakers the ability to "drill down" from the national picture to their local health care community. The NQR will help raise public awareness about the quality of care challenges facing the health care system.

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Patient Safety Data Development

AHRQ received $50 million this fiscal year to address the serious issue of medical errors, which the Institute of Medicine estimates could cause as many as 98,000 deaths per year. As a result, AHRQ is supporting fundamental research on patient safety, determining the best approaches to reporting systems, training researchers in the area of patient safety, developing patient safety tools, and helping to translate effective approaches into practice.

One important step toward improving patient safety is to have a reporting infrastructure in place that helps identify where gaps in safety or certain patterns might exist in the healthcare system. The Fiscal Year 2002 request includes an increase of $3 million to enable AHRQ to work with CDC, FDA, and HCFA and others in developing a common vocabulary to link existing patient safety reporting systems and to assist those who are developing such systems.

This effort will streamline the process of reporting through the integration of these systems. This is intended to reduce the burden on individual doctors, nurses, hospitals, and others who are presently required to report this data, often to multiple agencies about a single event. Also, this will make better use of the data that are collected by creating more effective mechanisms for sharing that information across agencies and for feeding that information back to clinicians and facilities.

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The National Healthcare Disparities Report

Finally, in Fiscal Year 2002 the Agency requests an increase of $1 million to carry out the directive in the Agency's reauthorization legislation that calls for the development of a National Healthcare Disparities Report. Disparities in health care have been documented repeatedly over the last few decades across a broad range of medical conditions. For example, the Agency supported research on access to cancer care, which showed that minority patients were more likely to be diagnosed at advanced stages of the disease than whites, receive suboptimal cancer treatment, and have lower survival rates. Understanding where disparities exist will help the Agency better direct its research and help close these gaps.

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Medical Expenditure Panel Survey

AHRQ's Medical Expenditure Panel Survey (MEPS) has been a useful resource for decisionmakers since 1977. MEPS collects detailed information regarding the use and payment for health care services from a nationally representative sample of Americans. In addition to the $3 million in MEPS enhancements for the National Quality Report and the National Disparities Report, we are requesting $4.6 million for increased sample size for both the household and medical provider components of the survey, and for improvement in computer programs.

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Conclusion

Mr. Chairman, AHRQ is proposing a comprehensive plan that addresses key issues of importance in health care quality. I want to thank the Committee for giving me the opportunity to present the President's budget request of $306 million for AHRQ in Fiscal Year 2002. Thank you.

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Current as of May 2001

 

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