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Justification of Budget Estimates for Appropriations
Committees, Fiscal Year 2002
The mission of the AHRQ is to support, conduct, and disseminate research that improves the outcomes, quality, access to, and cost and utilization of health care services. This mission also encompasses understanding and improving the safety of patient care. The products of the Agency include knowledge that supports decisionmaking to improve health care, as well as tools based upon research that can help improve quality and reduce costs.
To fulfill this mission, AHRQ works to foster health care research that helps the American health care system provide access to high-quality, cost-effective services; to be accountable and responsive to patients, consumers, and purchasers; and to improve health status and quality of life. There are three overarching goals that the Agency uses to frame its activities:
- Support Improvements in Health Outcomes.
- Strengthen Quality Measurement and Improvement.
- Identify Strategies To Improve Access, Foster Appropriate Use, and Reduce Unnecessary Expenditures.
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Research that Begins and Ends with the User
Since its publication in December 1998, the Agency's strategic plan has been the driving force behind program and budget development. An integral part of assuring that the Agency meets the goals laid out in the plan is to ensure that the activities and projects are developed in response to user input and demand. To that end, AHRQ has continued its commitment to external consultation over the last 12 months. Several expert meetings were held on topics as far ranging as:
- Long-term care.
- The role of information technology in health care.
- The research information needs of integrated delivery systems.
In addition, during its three meetings yearly, the Agency's National Advisory Council has focused on the priorities articulated in the plan, allowing substantial guidance from the Council to be reflected in the projects proposed in this budget submission.
The Agency continues to focus on three main audiences for its work and products. These include:
- Clinicians and patients.
- Institutions, plans, purchasers, and other providers.
- Policymakers in all sectors (e.g., Federal, State and local governments, voluntary associations, international organizations, and foundations).
All of these customers require evidence-based information to inform health-related decisions. These customers influence decisionmaking in three different levels:
- Clinical Decisions: Information derived from research is used every day by clinicians, consumers, patients, and health care institutions to make choices about what works, for whom, when, and at what cost.
- Health Care System Decisions: Health plan and system administrators, as well as policymakers and leaders of other organizations, are confronted daily by choices on how to improve the health care system's ability to provide access to and deliver safe, high-quality, high-value care. Purchasers need information to select health plans and providers that offer value—that is, they are of high quality and affordable cost.
- Public Policy Decisions: Information generated by research sponsored by AHRQ is used by policymakers to expand their capability to monitor and evaluate the impact of system changes on outcomes, quality, access, cost, and use of health care and to devise policies designed to improve the performance of the system. These decisions include those made by Federal, State, and local policymakers and those that affect the entire population or certain segments of the public.
Technology Assessment and Cost-Effectiveness Studies
As part of AHRQ's User Liaison Program (ULP), attendees are now asked to provide research suggestions relating to AHRQ's mission. The following suggestions, relating to technology assessments alone, are a small selection of those that emerged from a July 12th ULP meeting:
- Autologous Bone Marrow Transplant (ABMT).
- Alzheimer's tracking devices.
- Apnea monitors.
- Assistive communications devices.
- Bottle baby teeth correction.
- Depoprovera injections for sexual aggression.
- Digital hearing aids.
- Durable Medical Equipment older than 21 years.
- Liver transplantation for patients on Methadone.
- Multi-visceral organ transplantation.
- Phrenic nerve stimulators.
- Prophylactic mastectomy.
- Therapeutic apheresis for lipid reduction.
- Ultrasound therapy for bone healing.
- Vagal nerve stimulators for chronic/acute seizures.
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The AHRQ Portfolio: A Pipeline of Investment
As described in prior years, AHRQ funds research which spans a continuum—or pipeline—of activities (Figure 1, 27 KB). The pipeline begins with the funding of new research that answers important questions about what works in American health care (New Knowledge on Priority Health Issues). This is the essential knowledge base that investigators create and that enables us to understand the determinants of the outcomes,
quality, and costs of care, and to identify instances when care falls short of achieving its intended outcomes. An important contribution of this fundamental investment is the advancement of:
- The methods used in research, such as methods to quantify costs and benefits.
- Strategies to reliably synthesize existing literature.
- New approaches to capture health information from children and adolescents.
In addition, it includes fundamental research to understand why errors occur in health care and how to prevent them will help us improve patient safety in the future.
The second section of the pipeline is the creation of tools to apply the knowledge gained in the first investment (New Tools and Talent for a New Century). Here, the work of researchers is more applied and translates new knowledge into instruments for measurement, databases, informatics, and other applications that can be used to improve care. The Medical Expenditure Panel Survey is a key example of this type of investment. In addition, the Agency has expanded training opportunities for young scholars and increased the number of evidence reports commissioned.
The final section of the pipeline (Translating Research Into Practice—TRIP) is where these two investments come together to enable research and demonstrations that translate the knowledge and tools from funded research into measurable improvements in the care Americans receive. Activities in support of this part of the pipeline continue to be a major program priority for the Agency and have expanded in the last year to include an important focus on overcoming the existing racial and ethnic disparities in care.
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How AHRQ's Research Helps People
Across the Nation, people are making better-informed health care decisions and are receiving higher quality care thanks to AHRQ-supported research. Select for just a few of the ways that AHRQ research is used to improve the day-to-day functioning of health care in the United States. These instances demonstrate how AHRQ's research helps people and highlight the kind of research that will be enhanced at the Fiscal Year 2002 request level. AHRQ believes that the work of research is not completed with the publication of findings in a research journal.
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Fiscal Year 2002 Priorities: A Summary
The Fiscal Year 2002 request focuses on continuing the Agency's existing AHRQ programs at a level in accordance with their importance to improving
health care for the Nation.
I—Research and Training Grants + $16,063,000
This first section provides $16.1 million in Fiscal Year 2002 to allow AHRQ to fund research and training grants. There is no better way to increase the breadth and productivity of research approaches than to actively support and encourage innovative, peer-reviewed investigator-initiated research. This strategy has been fundamental in the success of the Nation's biomedical research and is just as important in research on health care quality, outcomes, cost, use and access. In advertising the funds available for investigator-initiated research, AHRQ will stress the need for applications that cover at least one of three broad areas of health services research:
- Improving patient-centered health care.
- Designing and evaluating models for health system change.
- Informing those who make health care decisions—from patients to policymakers—on how to implement the lessons learned from research.
Select for more detail.
II—The National Healthcare Quality Report + $4,000,000
The Fiscal Year 2002 request includes $4 million for continued internal and external development of the National Healthcare Quality Report (NQR). This investment will support the acquisition of:
- Relevant non-federal data for the report, data processing and analysis for the first NQR.
- Assessment and development of quality measures for the ongoing improvement of the report.
- Design of NQR reporting products.
In addition, these funds will be applied to enhancements of data-collection efforts at the Agency. These data-collection enhancements foster the development of information on health care disparities, chronic conditions in specific populations (e.g., children), medical errors, the quality of emergency department services, and the receipt of needed services. Of the $4 million, $2 million will be used for MEPS.
Select for more detail.
III—Patient Safety Data Development + $3,000,000
In the wake of the Institute of Medicine report, To Err Is Human, many organizations, particularly States, are considering developing medical error data-collection systems. The Fiscal Year 2002 request includes $3 million to enable AHRQ to work with Centers for Disease Control and Prevention (CDC), Food and Drug Administration (FDA), and Health Care Financing Administration (HCFA) in developing a common vocabulary to link existing patient safety reporting systems and to assist those who are developing such systems.
The Agency received $50 million in Fiscal Year 2001 to:
- Develop an integrated set of activities to design and test best practices for reducing medical errors in multiple settings of care.
- Develop the science base to inform these efforts, as well as to improve provider training in the reduction of errors.
- Capitalize on the advances in information technology to translate proven effective strategies into widespread practice.
- Build the capacity to further reduce errors in the future.
These activities will be ongoing in Fiscal Year 2002 in addition to the work supported by the Fiscal Year 2002 increase of $3,000,000. Select for more detail.
IV—Information Technology + $3,000,000
AHRQ requests $3 million in order to meet the requirements of several new laws and directives focusing on information technology, particularly the Workforce Investment Act of 1998, the Government Paperwork Elimination Act, and the AHRQ IT Disaster Recovery program. Select for more information.
V—The National Healthcare Disparities Report + $2,000,000
For Fiscal Year 2002, the Agency requests $2 million to fund the immense work necessary to compose the National Healthcare Disparities Report, as mandated in AHRQ's reauthorization. This project will use data from numerous sources and will require AHRQ to participate in substantial data acquisition, measurement analysis and data processing to produce the type of high-quality product that is typical of AHRQ and is expected by Congress. One million dollars will be set aside for this work.
The remaining $1 million will be provided to MEPS to support enhancements, in particular to permit analyses by race/ethnicity and socioeconomic status, which will provide data for the report. Select for more information.
VI—Research Management + $3,736,000
In Fiscal Year 2002 AHRQ requests $3.7 million for research management costs. The largest portion of this increase, $2.0 million, is needed for an increase in General Services Administration (GSA) rental costs. The remaining $1.7 million will provide for current services including annualization of the Fiscal Year 2001 pay raise, the Fiscal Year 2002 pay raise, an extra day of pay, and inflation. Select for discussion.
VII—The Medical Expenditure Panel Survey (MEPS) + $7,650,000
The request also provides $48,500,000 for continued funding for the Medical Expenditure Panel Survey (MEPS), an increase of $7,650,000 from the Fiscal Year 2001 level of $40,850,000. This request consists of continuing costs of $4.65 million for Fiscal Year 2000 and Fiscal Year 2001 enhancements to the sample size and content of the MEPS Household and Medical Provider Components. In addition, this level includes $3,000,000 for enhancements to support the congressionally mandated reports described above.
Select for more detailed information on the MEPS program.
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In Fiscal Year 2002, AHRQ requests $306,245,000, an increase of $36,449,000 to come entirely from amounts designated under section 241 of the Public Health Service (PHS) Act. This section authorizes the Secretary to make funds available for evaluation activities from amounts appropriated for programs authorized under the PHS. The request reflects a concerted approach to respond to user input, needs assessment and evaluations of prior accomplishments and progress of existing programs, as well as to restore the flow of knowledge from investigator-initiated research. This request will ensure that the Agency will be able to support and conduct the research and activities needed to maintain
each segment of the research pipeline, and in particular to translate research into practice.
All of AHRQ's funding is managed and appropriated in the following three budget activities:
- Health Care Costs, Quality, and Outcomes (HCQO).
- Medical Expenditure Panel Survey (MEPS).
- Program Support.
Health Care Costs, Quality, and Outcomes (HCQO)
The purpose of the Research on Health Care Costs, Quality and Outcomes activity is to support and conduct research that improves the outcomes, quality, cost, use and accessibility of health care. Accordingly, the Agency has identified three strategic plan goals that feed into this budget activity:
- Supporting improvements in health outcomes.
- Strengthening quality measurement and improvement.
- Identifying strategies to improve access, foster appropriate use, and reduce unnecessary expenditures.
The key themes throughout all three goals are to fund new research and to translate research into practice. In addition, AHRQ also has strengthened its commitment to support research that will improve health care for vulnerable
populations. Lastly, AHRQ has enhanced specific activities that support all of our strategic goals.
For details from the justification, select Research on Health Costs, Quality, and Outcomes.
Medical Expenditure Panel Survey (MEPS)
The objectives of AHRQ's Medical Expenditure Panel Survey are to provide public and private sector decisionmakers with the ability to:
- Obtain timely national estimates of health care use and expenditures, private and public health insurance coverage, and the availability, costs and scope of private health insurance benefits among the U.S. population.
- Analyze changes in behavior as a result of market forces or policy changes (and the interaction of both) on health care use, expenditures, and insurance coverage.
- Obtain information on access to medical care, quality and satisfaction for the US population and for those with specific conditions, and for important subpopulations.
- Develop cost and savings estimates of proposed changes in policy.
- Identify the impact of changes in policy for key subgroups of the population (i.e., who benefits and who pays more).
These objectives are accomplished through the fielding of the Medical Expenditure Panel Survey. MEPS is an interrelated series of surveys that replaces the National Medical Expenditure Survey (NMES). MEPS not only updates information that was last collected more than a decade ago in fiscal year 1987, but also provides more timely data, at a lower cost per year of data, through the move to an ongoing data collection effort.
For details, select Medical Expenditure Panel Survey.
Program Support provides support for the overall direction and management of the AHRQ. This includes the formulation of policies and program objectives; and administrative management and services activities.
For details from the justification, select Program Support.
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Current as of April 2001