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Performance Budget Submission for Congressional Justification

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Commitment to Improved Health for Priority Populations

The overall health of the American people has improved over the last several decades, but not all Americans have shared equally in these improvements. Disparities persist despite improvements in health for the Nation as a whole. AHRQ research found that race and ethnicity influence a patient's chance of receiving many specific procedures and treatments. Of nine hospital procedures investigated in one study, five were significantly less common among black patients than white patients; three of the five procedures also were less common among Hispanics, and two were less common among Asian Americans.

Other AHRQ-supported studies have revealed other disparities in patient care, including the following examples.

  • Blacks are 13 percent less likely to undergo coronary angioplasty and one-third less likely to undergo bypass surgery than whites.
  • Among preschool children hospitalized for asthma, only 7 percent of black and 2 percent of Hispanic children, compared with 21 percent of white children, are prescribed routine medications to prevent future asthma-related hospitalizations.
  • The length of time between an abnormal screening mammogram and the follow-up diagnostic test to determine whether a woman has breast cancer is more than twice as long for Asian American, black, and Hispanic women as it is for white women.
  • Blacks with HIV are less likely than other people with HIV to be on antiretroviral therapy, to receive preventive medicine for pneumonia, or to be given protease inhibitors.
  • Black, Asian American, and Hispanic residents of nursing homes are far less likely than white residents to have sensory and communication aids, such as glasses and hearing aids.

We ensure that the Agency's research emphasizes the needs of priority populations who are generally underserved by the health care system and underrepresented in research. In 2001, the Agency began assembling an office dedicated to research on priority populations that will focus on children, women, minorities, the elderly and aging population, people with disabilities and/or chronic diseases, people who are terminally ill, people living in the inner city, rural residents, and low-income individuals and families.

Minority Health

AHRQ has been investigating minority health issues for more than three decades. AHRQ's investments in minority health services research have resulted in numerous findings that are helping to shed light on the disparities experienced by racial and ethnic minorities and expand what is known about the reasons for those disparities.

In FY 2001, AHRQ supported $48.4 million of research with a major emphasis on minority health. This effort includes: the Minority Research Infrastructure Support Program (M-RISP), a training program to increase the number of minority health services researchers and to expand the Nation's health workforce to be more diverse and representative of the racial and ethnic populations in America; and continuation of the Excellence Centers to Eliminate Ethnic/Racial Disparities (EXCEED) grants, a research effort that will improve the factors underlying ethnic and racial inequities in health care. Examples of findings from recent AHRQ supported research follow.

  • About one black woman in four over 55 years of age has diabetes, which is nearly twice the rate of diabetes among white women. Hispanic women are almost twice as likely to have diabetes as non-Hispanic women of similar ages.
  • Although breast cancer mortality declined 5.6 percent between 1990 and 1994, the decline was much greater among white women at 6.1 percent than among black women at 1 percent.
  • Black Medicare beneficiaries are far less likely than white beneficiaries to receive flu shots, regardless of whether they are enrolled in a managed care or fee-for service health plan—68 percent of whites versus 46 percent of blacks received flu shots.

Select for EXCEED Fact Sheet.

Women's Health

The life expectancy of U.S. women has nearly doubled in the past 100 years, from 48 in 1900 to nearly 79 in 1996, compared with a 1996 average of 73 for men. Although women have a longer life expectancy than men, they do not necessarily live those extra years in good physical and mental health. Today, the chronic conditions of heart disease, cancer, and stroke account for 63 percent of deaths among American women, and heart disease causes more than one-third of these deaths.

Disease is not the only factor that impacts women's health. Domestic violence affects millions of women and their families each year. It is the second leading cause of injuries and death among women of childbearing age. Women from all racial and ethnic groups and income levels are victims of domestic violence, and the consequences are seen in a range of medical, obstetric, gynecologic, and mental health problems. Direct health care costs associated with domestic violence are estimated to be $1.8 billion per year.

AHRQ was approached by a number of advocacy organizations and the Federal Steering Committee on Violence Against Women for assistance in developing a research-based performance standard for health care provided in the area of domestic violence. AHRQ and other HHS agencies worked together to convene a meeting of experts to develop a health services research agenda focused on the health aspects of domestic violence.

AHRQ hosted a Senior Scholar in Residence to work on projects to provide scientific information on the cost, quality, and outcomes of domestic violence intervention programs available to victims in health care settings. In addition, AHRQ is developing a report to Congress on evidence-based clinical practices used by health professionals:

  • In providing care to victims of sexual assault, including child molestation.
  • On the training of health professionals for performing medical evidentiary examinations for victims of sexual assault, elder abuse, domestic violence, and child abuse and neglect.

In FY 2002, AHRQ continues four grants begun in FY 2000 in research to evaluate health system responses to domestic violence. These studies are the first of their kind and will move us beyond studying prevalence, screening, and training to take a rigorous look at a variety of health care interventions for domestic violence and their effectiveness. Women will be evaluated over time to identify interventions that improve the health and safety of victims, predict and improve health care use, prevent and reduce the occurrence of domestic violence, and develop better techniques to identify women at risk for domestic violence.

In addition, AHRQ supports research on all aspects of health care provided to women, and we have developed a new women's health initiative that broadened the program beyond the usual problems unique to women, such as breast cancer, to include studies that examine the differences in patterns of care between men and women.

AHRQ is collaborating with the National Institutes of Health, Office of Research on Women's Health, in the Building Interdisciplinary Research Careers in Women's Health program (BIRCWH) to include a health services research component in support of the interdisciplinary focus of the programs to be developed.


Women's Health Research Findings from AHRQ-supported Studies

  • The incidence of coronary heart disease in women has increased over the past decade, yet evidence suggests that women typically receive fewer high-technology cardiac procedures than men. Before age 75, women are more likely than men to die in the hospital after a heart attack.
  • ER doctors misdiagnose about 2 percent of patients with heart attack or stable angina because they do not have chest pain or other symptoms typically associated with heart attack. When these patients are mistakenly sent home from the ER, they are twice as likely to die from their heat problems as similar patients who are admitted to the hospital.
  • Blacks and women had statistically significant lower odds of being referred for cardiac catheterization than whites and men.

Select for more on Women's Health.

Children's Health

Improving outcomes, quality, and access to health care for America's 70 million children and adolescents is a critical goal of health services research and central to the mission of AHRQ. Understanding what's needed to improve health care delivery for children and adolescents requires a special research focus.

Because children are growing and developing, their health care needs and resource use differ from adults. Unlike adults, they usually are dependent on others for access to care and determinations about the quality of care they receive. Several AHRQ-funded studies on children's health have shown the importance of experience in caring for children.

AHRQ's work in this area helps to fill the major gap that exists in evidence-based information on the health care needs of children and adolescents. Such information is essential to appropriately guide clinical and policy decisions. The need for this information has become particularly critical since the implementation of the State Child Health Insurance Program (SCHIP).

Select for information about SCHIP.

To address the scarcity of quality measures for children, AHRQ is supporting the development, testing, and implementation of the Pediatric Quality of Life measures. Also, the National Committee for Quality Assurance for HEDIS adopted the children's component of AHRQ's Consumer Assessment of Health Plan Study (CAHPS®) survey—the first time a health-plan-oriented survey of children was administered nationwide.

In FY 2001 and continuing into FY 2002, AHRQ supported child-relevant studies focused on outcomes; quality and patient safety; and cost, use, and access. Examples of these studies include:

  • Develop the first comprehensive analysis of the management of suspected child abuse in primary care practices.
  • Develop and evaluate a computerized laptop system for use in the examining room of primary care practices as an extension of an existing in-house prescribing system to improve the care of children with attention-deficit/hyperactivity disorder.
  • Establish a Developmental Center for Evaluation and Research in Patient Safety (DCERPS) in neonatal intensive care to reduce medical errors and enhance patient safety for high-risk newborns and determine how to most effectively learn from those medical errors and then communicate the information to families.
  • Determine whether the skills acquired within a simulated environment can be put into practice practices in the delivery room, and whether the practicing of these skills results in improved patient safety.
  • Investigate the impact of having a child with asthma and the burden this condition causes on the family's resources (e.g., finances, the parents' time and availability for care, and access and barriers to health care).

National Disparities Report

Disparities in health have been documented repeatedly over the last few decades across a broad range of medical conditions and for a wide range of ethnic and racial groups. These differences have been noted in health outcomes such as quality of life and mortality, processes of care such as utilization rates of certain services, quality and appropriateness of care, and the prevalence of certain conditions or diseases.

The documentation of these widespread disparities has been an important contribution of outcomes and effectiveness research and health services research. Nevertheless, these insights have only infrequently led to significant improvements in eliminating racial and ethnic health disparities—in part, because the causes of and contributing factors to these differences are inadequately understood.

Disparities persist despite improvements in health for the Nation as a whole. For example, between 1987 and 1995, mortality from ischemic heart disease decreased 20 percent for the overall population but decreased only 13 percent for blacks. As minority populations continue to increase in size and proportion, the health of these groups will increasingly affect the health of the entire Nation. Also, lessons learned from understanding and eliminating disparities and improving the health care of underserved racial and ethnic groups, as well as those of a disadvantaged socioeconomic status, will likely be applicable to the United States population as a whole.

One responsibility of Federal and State policymakers is to help ensure that all Americans have access to high-quality health care services. But sound responses from policymakers require solid information about the differences in health care delivery, and even now these data have not been systematically available. Thus, the Agency's recent reauthorization assigned it the task of preparing and publishing an annual report on prevailing disparities in health care delivery, comparing access, use and quality of health care services as they relate to racial/ethic and socioeconomic factors in priority populations.

This effort will be implemented in partnership with other Agencies to ensure synergy with existing efforts, including the Agency's National Healthcare Quality Report, Healthy People 2010, and HHS survey integration priorities. This report will begin to provide answers on a national basis to the critical questions about disparities in health care:

  • Are death rates for some inpatient procedures higher for certain racial/ethnic groups than others?
  • Are African-Americans or Hispanics less likely to receive necessary services?
  • Are people without insurance more likely to receive surgery in hospitals with high error rates?

Together, the complementary investments in the National Quality Report and the National Disparities Report will permit the development of a more complete picture of health care in America—who has access when and where, and how good that care is once received.

At present, AHRQ is working on the following:

  • Acquiring all the relevant non-Federal data for the report.
  • Data processing and analysis for the first NDR.
  • Assessment and development of quality measures for the on-going improvement of the report.
  • The design of NDR reporting products.

The extensive data development needed for this project requires new ways of partnering with public and private organizations, and new ways of collecting and disseminating data and tools that can be used in tracking disparities in care for the public at large as well as for the subgroups particularly at risk. Incorporating databases from the private sector into the National Healthcare Disparity Report will provide a more robust and in-depth picture of disparities in American health care delivery. The integration of the private-sector data requires an investment in developing the methodology that makes such integration possible. Additional resources will be applied to the acquisition of suitable data sources from the private sector.

In addition, AHRQ is convening an IOM panel to inform the development of the report. The first meeting of the IOM panel is scheduled for January 28-29, 2002.


Research Finding. Patients of various ethnic and racial groups have different attitudes toward primary care physicians. Among different Asian ethnic subgroups, Chinese and Filipino patients appeared less likely to be satisfied with their physicians, while Japanese patients were least likely to say they would recommend their doctor. Latino patients rated physicians' accessibility and technical skills less favorably than did white patients. African American patients gave physicians' use of the latest technology and of psychosocial and lifestyle health promotion a higher rating than did white patients.

These findings may represent actual differences in quality of care or variations in patient perceptions, expectations, and/or questionnaire response styles.


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Activities in Support of All Goals

Health Services Research Training

AHRQ contributes to excellence in health care delivery through research conducted by a cadre of well-trained and talented health services researchers. To maintain and nurture this vital resource, the Agency supports a variety of training and career development opportunities through individual and institutional grant programs. These include:

National Research Service Awards (NRSAs)

AHRQ supports predoctoral and postdoctoral training through the National Research Service Award (NRSA) program. AHRQ awards NRSA training grants to institutions for predoctoral and postdoctoral training (the AHRQ Institutional Training Awards) as well as individual predoctoral and postdoctoral NRSA fellowships.

Select for more on Research Training.

Dissertation Research Grants

Dissertation research funding is available for students conducting doctoral-level research on some aspect of the health care system. These grant award are often the first step toward establishment of a health services research career.

Select for Questions and Answers on dissertation research grants.

Career Awards

AHRQ began to support career development activities in FY 2000. These awards, provided to individuals embarking on a research career, allow individuals time and resources to gain experience in carrying out actual research. The intent is to provide transitional support for newly trained investigators in order to launch them on research careers. This program will nurture the next generation of health services researchers.

AHRQ supports two types of career awards:

Minority Research Infrastructure Support Program (M-RISP)

The Agency is committed to the Department's Initiative to Eliminate Racial and Ethnic Disparities in Health and the complementary Healthy People 2010 Goal to Eliminate Disparities in Health. A critical component in achieving these goals is to expand the nation's health workforce to be more diverse and representative of the racial and ethnic populations in America. This includes bringing needed diversity to the health services research workforce.

In FY 2001, AHRQ launched the Minority Research Infrastructure Support Program (M-RISP). The goals of the M-RISP program are to increase the number of minority health services researchers, and to build capacity for institutions to conduct health services research intended to improve health for racial and ethnic minorities. This support will begin to enable approximately three institutions with relatively small research programs to develop into significantly stronger health services research centers. AHRQ funded three grants for $1.2 million. The funded grants are provided below.


Minority Research Infrastructure Support Program (M-RISP)

Health Services Research in Underserved Populations (University of Texas Medical Branch). The goal is to increase this institution's ability to conduct health services research with a focus on medically underserved populations. The program will allow the university to increase the number of faculty who conduct health services research, recruit additional expert faculty, and strengthen its research capabilities.

Hawaii Minority Research Infrastructure Support Program (University of Hawaii at Manoa). The objective is to build a program at the University of Hawaii Medical School that will evaluate ethnic health disparities in the State's Asian American and Pacific Islander populations. The program also will provide mentoring and training to inexperienced researchers, facilitate collaboration between Hawaii's health care organizations, and establish a nationally recognized mentoring group to assist in the implementation of research projects.

Collaborative Minority Health Care and Quality Research (Tennessee State University). The objectives are to increase minority health care research programs at Tennessee State University and Meharry Medical College, establish collaborations with senior health services researchers at other universities, and conduct research to address racial and ethnic health care disparities.


Building Research Infrastructure & Capacity Program (BRIC)

To build research capacity in States that have not traditionally been involved in health service research, the Building Research Infrastructure & Capacity Program (BRIC) will be funded to pilot-test the feasibility of developing a program to broaden the geographic distribution of AHRQ funding and enhance the competitiveness for research funding of institutions located in States that have a low success rate for grant applications from AHRQ. Geographic regions that have received lesser amounts of AHRQ funding and have demonstrated a commitment to develop their research infrastructure will be eligible for these grants.

AHRQ funded six grants for over $1.7 million in FY 2001. These grants will stimulate sustainable improvements in capacity and/or multi-disciplinary centers supporting investigators and multiple research projects with a thematic focus. The grants are highlighted below.


Building Research Infrastructure and Capacity (BRIC)

Rutgers Center for Health Services Research (Rutgers State University of New Jersey). The center will allow researchers to build the State's expertise in health services research, including recruiting additional health services researchers to faculty positions, providing support for application development, developing a multi-use health database, and providing training, consultation, and technical assistance to State health officials and Rutgers University faculty.

Intermountain Child Health Services Research Consortium (University of Utah, Salt Lake City). The goal is to develop an infrastructure for a child health services research program with emphasis on children with special health care needs, including development of a consortium, implementation of a faculty development program in child health services research, and conduct of a study to compare a pediatric hospitalist system and traditional care on outcomes of children with special health care needs.

LSU Health Services Research Program (Louisiana State University Health Sciences Center). This project will establish the Louisiana State University (LSU) Health Services Research Program, which will function as a partnership between the university's medical school and an LSU unit that delivers health care to 1 million State residents, many of whom are uninsured and underinsured. The focus will be on translating research evidence into practice.

Intermountain BRIC Consortium (National Association of Health Data Organizations). This project will improve the infrastructure and capacity of five Building Research Infrastructure and Capacity (BRIC)-eligible States (Idaho, Montana, Nevada, Utah, and Wyoming) and enhance their ability to compete for and be awarded health services research grants. The project will produce, among other resources, standardized analytic tools, a Web-based clearinghouse and communications module, health quality indicators, and a research agenda.

Kentucky Health Services Research Development (University of Kentucky Research Foundation). The goal is to increase faculty research capability and grant-writing ability at the University of Kentucky by establishing the Kentucky HSR Development. One of the participants in this program will be a new practice-based research network, the Kentucky Ambulatory Network.

Mississippi Building Research Infrastructure and Capacity (Mississippi State University). The objective is to implement a partnership between Mississippi's child care and health care providers, Mississippi State University, and the American Academy of Pediatrics to improve health care and outcomes for underserved, low-income, and minority children in the Mississippi Delta. The researchers will develop a multidisciplinary health services research program for one of the poorest rural areas of the Nation to assess the quality of care available for these populations, identify their current health care needs, and improve quality of care.


Dissemination Activities

AHRQ promotes widespread distribution and implementation of its information and research products through a variety of dissemination methods: publication in professional journals; provider and consumer materials, media events and outreach; interviews and story placement with medical/trade press and organizations' newsletters; and articles in the popular press. AHRQ also employs public-private partnerships, direct mail, and the World Wide Web to distribute its information.

AHRQ's Web Site

Use of AHRQ's Web site continued to increase in FY 2001, with more than 22.6 million hits, compared with 18.8 million hits the previous year. User sessions also rose by almost a million visits—2.4 million, up from 1.5 million in FY 2000. Page views increased over 64 percent in FY 2001 at 8.9 million, compared with 5.4 million the previous year. Overall workload increased with 5,068 files and documents uploaded to the Web site, compared with 4,400 for FY 2000.

AHRQ handled 4,006 electronic inquiries during FY 2001 through it Web site mailbox, up from 3,500 the previous year. These inquiries included requests for:

  • Agency information products.
  • Funded research.
  • Consumer health issues and concerns.
  • Technical assistance.
  • Referrals to other resources.
  • Requests to use AHRQ electronic content on other Web sites or in electronic or print products.

The AHRQ Web site provided access to the summaries of reports issued from the Evidence-based Practice Centers and recommendations from the U.S. Preventive Services Task Force. The full text of these reports can be obtained at the National Library of Medicine, accessible through the AHRQ Web site. The Agency continued to work with the National Library of Medicine to upload evidence reports, technology assessments, and preventive services materials for clinicians on the full-text retrieval system HSTAT.

The Web site was used to provide more content on health services research issues for policymakers at the State and local level, including online learning modules relating to the State Child Health Insurance Program (SCHIP) and quality performance measures in child health programs. A new subdirectory was also developed specific to Nursing Research interests and capacity building within the nursing community for research grants and career development.

A popular feature on the Web site continued to be a "Spanish" button, Información en español, which provides translations of our consumer health and patient information materials. Many users are the Spanish-speaking public, but clinicians with large Hispanic patient populations also use these materials for their patient education efforts.

Nearly 10,900 external Web sites linked to the AHRQ Web site home page or content in the site. This included three government portals prominently featured on the AHRQ site, which in turn provided referrals to the Agency's online consumer health and patient information materials: USAgov, developed by the General Services Administration; the "healthfinder®" gateway site, developed and maintained by the Department of Health and Human Services; and MEDLINEplus, developed and maintained by the National Library of Medicine.

Based on user feedback, various audience groups came to the AHRQ site for:

Requests from outside organizations for use of electronic content from the AHRQ Web site included:

User Liaison Program

AHRQ's User Liaison Program (ULP) synthesizes and distributes research findings to local, State, and Federal policymakers so they can use it to make evidence-based decisions about health care. ULP sponsors small National and State-based workshops and telephone or Web-supported audio conferences to provide information to policymakers on the critical issues confronting them in today's changing health care marketplace. These workshops and conferences are user-driven and user-designed. ULP solicits input from legislators, executive agency staff, and local officials on policy issues where they need information and technical assistance.

In FY 2001, ULP sponsored 23 different activities—12 National workshops, 7 State-based workshops, one telephone conference, and one Web-assisted audio conference—attended by 2,376 health care policymakers from all 50 States, the District of Columbia, American Somoa, the Virgin Islands, and Guam. In FY 2000, ULP sponsored 17 events that provided training for 1,145 attendees from 50 States and the District of Columbia.

In addition, in FY 2001 and 2002 the ULP team will produce research synthesis targeted to AHRQ stakeholders, our "Research In Action" series. Their purpose is to tell where we've had impact so that other stakeholders who are less advanced can learn from what others have done. AHRQ produced three research syntheses in FY 2001 and plans an additional three for FY 2002. AHRQ's goal is to produce at least 10 each year.

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Funding Summary

Funding Summary 2001
Actual
2002
Appropriation
2003
Request
2003 Request
+/-
2002 Appropriation
Current Law
   Budget Authority
   PHS Evaluation Funds

$102,255,000
($124,130,000)

$0
($247,645,000)

$0
($194,000,000)

$0
(-$53,645,000)
Accrual Costs
   Budget Authority
   PHS Evaluation Funds

$1,230,000
($282,000)

$0
($1,526,000)

$0
($1,611,000)

$0
(+$85,000)
Proposed Law
   Budget Authority
   PHS Evaluation Funds

$103,485,000
($124,412,000)

$0
($249,171,000)

$0
($195,611,000)

$0
(-$53,560,000)
Full-Time Equivalents 253 272 272 0

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