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Performance Budget Submission for Congressional Justification

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Efficiency

Data Development

Long-term Goal: Achieve wider access to effective health care services and reduce health care costs.

Measure FY Target Result
Increase the number of partners contributing data to the HCUP databases by 5% above FY 20000 baseline

Output

2007 Increase the number of partners contributing outpatient data to the HCUP databases December 2007
2006 Increase the number of partners contributing outpatient data to the HCUP databases December 2006
2005 Increase the number of partners contributing outpatient data to the HCUP databases 39 States as data partners
2004 5% increase over FY 2000 baseline 36 States as data partners
2003 Increase the number of partners 33 States as data partners
2002 Increase the number of partners 29 States as data partners
Insurance Component tables will be available within 6 months of collection

Output

2007 6 months December 2007
2006 6 months December 2006
2005 7 months 6 months
2004 7 months 6 months
2003 7 months 7 months
MEPS Use and Demographic Files will be available 12 months after final data collection

Output

2007 11 months December 2007
2006 11 months December 2006
2005 11 months 11 months
2004 12 months 12 months
2003 15 months 15 months
Full Year Expenditure Data will be available within 12 months of end of data collection

Output

2007 12 months December 2007
2006 12 months December 2006
2005 12 months 12 months
2004 12 months 12 months
2003 18 months 18 months
Increase the number of topical areas included in the MEPS Tables Compendia

Output

2007 Add FY Insurance Tables December 2007
2006 Add State Tables December 2006
2005 Add Access Tables Completed Sep-05
2004 Add Quality Tables Completed Sep-04
Increase the number of MEPS Data Users

Output

2007 Exceed baseline standard December 2007
2006 Exceed baseline standard December 2006
2005 Meet baseline standard 11,600 HC/IC hits

16,200 Tables Compendia hits

14 active data center projects

2004 Establish baseline on:
—# of Web hits on MEPS-net IC/HC
—# of Web hits on MEPS-HC Tables Compendia
—# of data center projects worked on

Completed:
—13,101 HC/IC Net
—15,900 Tables Compendia
—10 active data center projects

Realize post-collection data processing efficiencies in cost and time following the implementation of a Windows-based CAPI process for the MEPS

Proposed Efficiency Measure
Output

2007 Establish baseline December 2007
2006 Implement CAPI process for the MEPS December 2006

Data Source: MEPS Web site; HCUP database and QI Project Officers.

Data Validation: MEPS Web site; HCUP database and QI Project Officers.

Cross Reference: Strategic goals 4/5; Healthy People 2010 goal 23.

Effectiveness

Data Development

Long-term Goal: Assure that providers and consumers/patients use beneficial and timely health care information to make informed decisions/choices.

Measure FY Target Result
By 2010, at least 5 organizations will use HCUP databases, products, or tools to improve health care quality for their constituencies by 5%, as defined by AHRQ Quality Indicators

Outcome

2007 3 new organizations will use HCUP/QIs to assess potential areas of quality improvement, and at least 2 of them will develop and implement an intervention based on the QIs December 2007
Impact will be observed in 1 new organization after the development and implementation of an intervention based on the QIs December 2007
2006 3 new organizations will use HCUP/QIs to assess potential areas of quality improvement, and at least 1 will develop and implement an intervention based on the QIs December 2006
Impact will be observed in at least 1 new organization after the development and implementation of an intervention based on the QIs December 2006
2005 2 new organizations will use HCUP/QIs to assess potential areas of quality improvement, and at least 1 will develop and implement an intervention based on the QIs 4 implementations
2004 2 new organizations will use HCUP/QIs to assess potential areas of quality improvement, and at least 1 will develop and implement an intervention based on the QIs Completed
2003 2 organizations will use HUCP/QIs to assess potential areas of quality improvement Completed
By 2008, CAHPS® data will be more easily available to the user community, and the number of consumers who use information from CAHPS® to make choices about their healthcare will increase by 20%. (Baseline FY 20022)

Outcome

2007 Produce CAHPS® questionnaire for consumer assessment of home health quality December 2007
Produce CAHPS® questionnaire for consumer assessment of assisted living quality December 2007
Produce CAHPS® questionnaire for assessments of quality of care by persons with mobility impairments December 2007
2006 Produce CAHPS® module for consumer assessment of Individual Clinician/Group Practice quality December 2006
Produce CAHPS® module for consumer assessment of Medicare prescription drug programs—MMA required December 2006
Produce CAHPS® module for cancer patients assessments of their care December 2006
2005 Produce CAHPS® questionnaire for consumer assessment of dialysis facility quality Completed
Establish baseline for number of hospitals collecting HCAHPS data Completed
1,000 Hospitals
Increase over baseline number of people with access to CAHPS® data Ongoing:
01/31/06
2004 Produce a CAHPS® questionnaire for consumer assessment of hospital quality Completed
Increase over baseline number of people with access to CAHPS® data 130 Million1
2003 Produce a CAHPS® module for consumer assessments of care received in nursing home settings Completed
Increase over baseline number of people with access to CAHPS® data 123 Million1
2002 Obtain baseline number of people with access to CAHPS® data Completed
100 Million1

Data Source: HCUP and QI Project Officers; CAHPS®; National CAHPS® Benchmarking Database (NCBD).

Data Validation: Personal communication; Tracking Medicare and Medicaid beneficiaries and NCQA accredited commercial health plan members covered by health plans that use CAHPS®.

Cross Reference: Strategic goals 3/4/5/6; Healthy People 2010 goal 23.

1.People are in plans that use CAHPS® data.

CAHPS®

The long-term goal of CAHPS® is to ensure that providers and consumers/patients use beneficial and timely health care information to make informed choices and decisions. CAHPS® has set a goal of ensuring that patient experience of care data will be more readily available to consumers by 2008 in order to help them make choices among competing providers in the marketplace on the basis of quality. By moving to create surveys for a range of providers beyond the widely used CAHPS® health plan surveys, including hospitals, nursing homes, and dialysis facilities, CAHPS® is rapidly expanding the capacity to collect data that can be utilized to make more informed choices by the purchasers who contract with and the consumers who visit these providers.

The CAHPS® program also directly addresses patient-centeredness, one of the six aims for the health care system espoused by the Institute of Medicine in its 2001 report, Crossing the Quality Chasm. Data generated by the implementation of CAHPS® surveys by the Medicare and Medicaid programs, NCQA accredited commercial health plans, and States populates several of the measures included in the annual National Healthcare Quality and Disparity Reports mandated by Congress. In addition, Medicare and other CAHPS® sponsors regularly produce public reports of CAHPS® data.

HCUP—Effectiveness

The goal of HCUP is to assure that providers and consumers/patients have access to beneficial and timely health care information to make informed decisions and choices. The examples listed below demonstrate the progress made in disseminating information used to implement interventions that make it possible to make better informed decisions and choices. The examples below demonstrate the progress made in achieving information dissemination that is being used to implement interventions aimed at making better informed decisions and choices.

2005 examples of organizations using HCUP/QIs to assess quality improvement and implement an intervention.

Two new users are Covenant and General Motors; four users implemented an intervention: Convenant, GM, University Hospital Consortium; and Dallas-Fort Worth.

  • The Wisconsin Department of Health & Family Services used the QIs to assess program performance in Medicaid-managed care programs.
  • Norton Healthcare used the Inpatient Quality Indicators and Patient Safety Indicators to produce a publicly reported quality report to improve health care quality.
  • Covenant Healthcare used the QIs to assess diabetes management for their population in Wisconsin and, based on this analysis, opened a new comprehensive Diabetes Center for Healthy Living to improve diabetes are in this region.
  • General Motors used the QIs with Michigan HCUP data to identify areas with the greatest potential for reduced hospitalizations and costs as a result of improved primary care. Based on this analysis, GM is looking to partner with others in these communities to improve care.
  • University Hospital Consortium member hospitals introduced rapid response teams in response to analysis of the AHRQ Patient Safety Indicator Failure to Rescue data. Results have demonstrated improvements in mortality with this intervention. The teams use early-detection triggers to identify those patients most at risk for mortality following the development of complications.
  • The Dallas-Fort Worth (DFW) Region use the Prevention Quality Indicators for Health Assessments for both Tarrant and Dallas Counties to prioritize health concerns in the region. Additionally, the hospitals in the DFW area use the Inpatient Quality Indicators and the Patient Safety Indicators for comparative reporting for the region to assess quality and patient safety in the region. Both sets of indicators are reviewed annually by the Dallas-Fort Worth Hospital Council-Patient Safety and Quality Committee to identify opportunities for improvements and collaborative efforts in the region. The 2005-06 improvement opportunity is focused on improving cardiac care in the region. The region shares the AHRQ Q Is through a Web portal reporting tool allowing comparison of 67 hospitals in the region.

HCUP—Efficiency

The long-term goal for efficiency is to achieve wider access to effective health care services and reduce health care costs. HCUP has set a goal that by 2010, at least 5 organizations will use HCUP databases, products, or tools to improve health care quality for their constituencies by 5 percent, as defined by AHRQ QIs. By increasing the number of organizations using HCUP and the QI tools, we support the overall program goal by expanding to add new States that will improve national and regional representation and by expanding the number of Partners that contribute ambulatory surgery and emergency department data. AHRQ added Indiana and New Hampshire to HCUP. AHRQ also added two new ambulatory surgery databases and three new emergency department databases. They were selected based on the diversity-in terms of geographic representation and population ethnicity—they bring to the project, along with data quality performance and their ability to facilitate timely processing of data. Currently, 38 statewide data organizations participate in HCUP.

Cost, Organization, and Socio-Economics Portfolio

Long-term Goal: By 2010, in at least 5 cases, public or private health care policymakers and decisionmakers will have used AHRQ findings or tools in the areas listed.

Measure FY Target Result
System and delivery improvement, payment and purchasers, and/or market forces to make decisions designed to improve quality, effectiveness, and/or efficiency of health care by 5%

Outcome

Financing, access, costs, and coverage to make decisions designed to improve the efficiency of the U.S. health care system while maintaining or improving quality, and/or improving access to care or reducing any existing disparities

Outcome

2007 Develop an evaluation of efficiency measures, including a useful applied taxonomy, an evaluation of the current published measures and a broad assessment of use December 2007
Conduct or support 15 new projects on research related to financing, access, costs, coverage, delivery, payment, purchasing of market forces that are disseminated to health care policymakers and healthcare decisionmakers December 2007
2006 Develop and enhance mechanisms to disseminate and assist with implementation of findings to health care public policymakers, systems leadership, purchasers/employers, and health services researchers December 2006
Conduct or support 15 new projects on research related to financing, access, costs, or coverage that is disseminated to health care policymakers December 2006
2005 Conduct or support 12 new projects related to system and delivery improvement, payment and purchasers, and/or market forces Completed
Conduct or support 15 new projects related to financing, access, cost, or coverage Completed
Complete a synthesis of research in a significant area or system and delivery improvement, payment and purchasers, and/or market forces Completed
Complete a synthesis of research in a significant area of financing, access, cost, or coverage Completed
2004 Develop a data warehouse and vocabulary server to process patient safety event data Completed

Data Source: Publications, intramural plans for CFACT and CDOM, grants management tracking of funded projects, and tracking of all deliverables by the IDSRN project officer.

Data Validation: The CFACT and CDOM intramural plans are maintained and reviewed by senior staff. Grants are monitored by project staff, and the IDSRN has a senior project officer.

Cross Reference: Strategic goals 1/5; Healthy People 2010 goal 17.

The Cost, Organization and Socio-Economics Portfolio implements particular sections of AHRQ's reauthorizing legislation, most particularly those that relate to:

  • Research on health care costs, efficiency, utilization, and access.
  • The ways in which health care services are organized, delivered, and financed and the interaction and impact of these factors on the quality of patient care.
  • Health care productivity, efficiency, and market forces.
  • Analysis of the MEPS and HCUP.

The mission of the portfolio is to provide public and private policymakers with the information they need to make improvements in the organization and financing of the U.S. health care system. Research conducted and supported by AHRQ has been used in the development and implementation of numerous public and private initiatives in recent years, including the design and implementation of the State Children's Health InsuranceProgramm (SCHIP), estimates of the impact of the Medicare Modernization Act on health care costs, state initiatives to address the problems of the uninsured, and private efforts to incorporate quality measures into payment schemes. AHRQ will continue to develop and disseminate this type of critical information for policymakers in 2007.

Training

Long-term Goal: By 2010, enhance capacity to conduct and translate Health Services Research.

Measure FY Target Result
Increase the number of individuals who receive career development support by 30%

Outcome

2007 Increase by 15% from FY 2004 December 2007
2006 Increase by 10% from FY 2004 December 2006
2005 Increase by 5% from FT 2004 2 new awards (Career development budget was reprogrammed in FY 2005)
2004 Support 40 career development grants 47
2003    
2002    
Improve geographic diversity by increasing the number of States by 5 that have the capacity to undertake HSR

Increase the number of institutions serving predominantly minority populations by 5 that have the capacity to undertake HSR

Output

2007 Support at least 2 new programs December 2007
2006 Issue announcements December 2006
2005 Support at least 3 institutions in new states and at least 1 new predominantly minority serving institution No new awards due to  reprogramming of FY 2005 Building Research Infrastructure and Capacity (BRIC) funds
2004 Baseline—support 6 institutions in new states and 9 predominantly minority-serving institutions Completed
2003    
2002    
Support 5 institutional programs that develop HSR curricula to address safety/quality, effectiveness, and efficiency

Output

2007 Support at least one program December 2007
2006 Issue announcements December 2006
2005 Support 1 pilot project leading to development of cultural competencies in HSR doctoral training Completed 2 projects:  small pilot feasibility study and related conference "HSR competencies for Doctoral Training"
2004    
2003    
2002    

Data Source: IMPAC II.

Data Validation: AHRQ budget data management system used to keep annual track of spending relative to budget allotment.

Cross Reference: Strategic goals 1/5; Healthy People 2010 goal 23.

The Training Portfolio's mission is to continue to foster the growth, dissemination, and translation of the field and science of HSR to achieve AHRQ's mission and address Departmental priorities geared toward the transformation of health care. Special attention will be paid to:

  • Individuals: Foster the growth of the next generation of researchers and knowledgeable users or research.
  • Diversity: Foster the institutional and individual diversity in the field of health services research.
  • Science: Foster the development of an integrated science of health services research and refine its foundation.

Throughout its research training portfolio, AHRQ seeks to address its three main research goals—focusing on enhancing efficiency, patient quality/safety, and effectiveness—as well as addressing AHRQ's priority populations.

New activities in developing the science of HSR were launched in FY 2005 with the completion of a feasibility study and related conference on the development of core competencies for doctoral training. FY 06 activities are expected to continue to impact this portfolio goal by broadly disseminating findings. Specific attention was provided to including competencies related to quality improvement and applied research training, as well as communication skills important in translating research findings to users of research, including providers and policymakers. This relates directly to AHRQ's mission to improve health care by developing researchers who are interested in and possess the necessary skills to conduct useful, applied research.

In FY 2005, new funds for career development grant support were deferred to FY 2006 due to Departmental reprogramming. However, AHRQ was able to provide support for two new awards, directly related to current Departmental and Agency priorities. These awards focus on patient safety, and primary care testing and safe use of medications within primary care practices. More new awards are expected in FY 2006 commensurate with grant budget.

Grant awards related the third goal of increasing diversity, which were deferred in FY 2005 due to Departmental budget reprogramming, are expected to be made in FY 2006. These will focus on key Departmental and Agency priorities, as well as the inclusion of priority populations.

It is anticipated that in FY 2006 and FY 2007, AHRQ will continue to support new career development and research infrastructure grants to emerging institutions, which will further the mission of AHRQ by focusing on key priorities such as patient safety, health care quality, management of multiple chronic conditions and translating research into policy and practice. In addition, AHRQ would like to initiate curricula development and short-term training grants, pending available resources, that are directed toward preparing researchers to translate research into practice through a variety of means, including the formation of partnerships between academic and nonacademic sectors. These activities would link directly with AHRQ's research portfolios and address its priority populations.

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