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Performance Plans for FY 2000 and 2001 and Performance Report for FY 1999

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Agency for Healthcare Research and Quality


Following is the Fiscal Year and 2000 2001 Performance Plan (and 1999 Performance Report) of the Agency for Healthcare Research and Quality (AHRQ, formerly the Agency for Health Care Policy and Research). The Fiscal Year 2001 President's budget request for AHCPR incorporates the annual performance plan required under the Government Performance and Results Act (GPRA). The Fiscal Year 2001 performance goals and measures are detailed in AHRQ's performance plan and are linked to both the budget and to the Strategic Plan of the Department of Health and Human Services (HHS). Select for a summary of AHRQ's Fiscal Year 2001 performance plan.

Performance targets in the plan depend partly on resource levels requested in the President's budget and could change based on congressional appropriation action.

GPRA requires that HHS plan, budget, and be accountable for program results. The intent of the Act is to improve program performance by considering performance information in decisionmaking and by involving our partners and stakeholders in accomplishing program results.


Contents

Introduction
Fiscal Year 1999 GPRA Performance Report Results: Summary
Budget Line 1—Research on Health Care Costs, Quality, and Outcomes
          Goal 1: Establish Future Research Agenda Based on User's Needs
          Fiscal Year 1999 Performance Results
          Goal 2: Make significant contributions to the effective functioning of the U.S. health care system through the creation of new knowledge
          Fiscal Year 1999 Performance Results
          Goal 3: Foster translation of new knowledge into practice by developing and providing information, products, and tools on outcomes, quality, access, cost and use of care
          Fiscal Year 1999 Performance Results
          Goal 4: Evaluate the effectiveness and impact of AHRQ research and associated activities
          Fiscal Year 1999 Performance Results
          Goal 5: Support Department-wide Initiative to Improve Health Care Quality through leadership and research
          Fiscal Year 1999 Performance Results
Budget Line 2—Medical Panel Expenditure Survey
          Goal 6: Collect current data and create data tapes and associated products on health care use and expenditures for use by public and private-sector decisionmakers and researchers
          Fiscal Year 1999 Performance Results
Budget Line 3—Program Support
          Goal 7: Support the overall direction and management of AHRQ
          Fiscal Year 1999 Performance Results
Appendix 1. Approach to Performance Measurement
Appendix 2. Changes and Improvements Over Previous Year
Appendix 3. Linkage to HHS Strategic Plan
Appendix 4. Performance Measurement Linkages with Budget, Cost Accounting, Information Technology Planning, Capital Planning and Program Evaluation
Appendix 5. Reports on Needs Assessment Activities
Appendix 6. Priority Populations Research Summaries


Introduction—Structure of the AHRQ GPRA Fiscal Year 1999 Performance Report and Fiscal Year 2000 and 2001 Annual Performance Plans

The AHRQ GPRA annual performance report and plans are aligned with the Agency's three budget lines:

  1. Research on Health Care Costs, Quality, and Outcomes.
  2. Medical Panel Expenditure Surveys.
  3. Program Support.

The first two budget lines are where Agency programs are funded. The goals associated with each of the budget lines represent core activities funded in each. The following table illustrates how the GPRA goals are aligned with the AHRQ budget lines. The cycle of research, used to structure the first four goals, is the basic framework from the Agency's strategic plan that AHRQ uses when designing and implementing its research initiatives.

What the Indicators Address GPRA Goal
Budget Line 1: Research on Health Care Costs, Quality, and Outcomes
Cycle of Research Phase 1:
Needs Assessment
GPRA Goal 1: Establish Future Research Agenda Based on User's Needs
Cycle of Research Phase 2:
Knowledge Creation
GPRA Goal 2: Make significant contributions to the effective functioning of the U.S. health care system through the creation of new knowledge
Cycle of Research Phase 3:
Translation and Dissemination
GPRA Goal 3: Foster translation of new knowledge into practice by developing and providing information, products, and tools on outcomes, quality, access, cost and use of care
Cycle of Research Phase 4:
Evaluation
GPRA Goal 4: Evaluate the effectiveness and impact of AHRQ research and associated activities
Lead role for quality initiative GPRA Goal 5: Support Department-wide Initiative to Improve Health Care Quality through leadership and research
Budget Line 2: Medical Panel Expenditure Survey
Core MEPS activities GPRA Goal 6: Collect current data and create data tapes and associated products on health care use and expenditures for use by public and private-sector decisionmakers and researchers
Budget Line 3: Program Support (Discontinued in Fiscal Year 2001 performance plan.)
Agency management activities: contracts management and the AHRQ Intranet. Goal 7: Support the overall direction and management of AHRQ

Performance Measures/Indicators

AHRQ uses a combination of process, output, and outcome indicators to present its performance information.

  • Process measures: To monitor the establishment of major new initiatives or implementation of improvements in core activities where significant resources are involved or the potential for significance of the ultimate impact is high.
  • Output measures: To record the results of research initiatives and dissemination activities essential to moving to the next step of implementation.
  • Outcome measures: To show the impact (or potential for impact) in affecting the outcomes, quality, access, cost, or use of health care.

AHRQ Performance Indicators

Indicator

Year 1

Years 3-5

Years 3-10

Phase of initiative Research initiative starts Results received Results used in health care system
Indicator type Process indicators Output indicators Outcome indicators
Indicator examples Grants funded, creation of reports, partnerships formed Publications, Web site, dissemination, research findings, reports, products available for use in health care system Results of evaluation studies, users stories, analysis of trend/other data

Crosswalk to the Budget Document

Where appropriate, the budget request is linked to the corresponding GPRA objective. In many cases, the funding for activities, such as evaluation studies or dissemination activities, are captured in the base and there will not be a corresponding description in the text.


Fiscal Year 1999 GPRA Performance Report Results: Summary

As illustrated in the following report, AHRQ has used the Government Performance and Results Act (GPRA) as part of an overall Agency strategy to assure accountability, identify opportunities for program improvement, and focus agency activities on mission critical activities. AHRQ has reached its targets for performance in Fiscal Year 1999.

Notable among these accomplishments is:

  • An intensive effort to reach out to the Agency's customers to guide program development.
  • The successful establishment of the research initiatives outlined in the Fiscal Year 1999 budget.
  • The development and active dissemination of Agency research findings and tools.
  • Concerted efforts to begin translating research into practice.
Highlights of Agency performance include the following.

User Input

Ideas for future Agency activities were solicited from the users of AHRQ research findings and tools through a targeted mailing of the Agency's strategic plan to over 100 stakeholders and customers, the publication of a "Request for Planning Ideas" in the Federal Register, and over 20 expert and user group meetings. In order to provide context for this input and use it effectively, Agency staff produced retrospective reviews of existing research in outcomes, quality, and access. The user input, combined with the summaries, provided an understanding of what has been accomplished in these areas of research including AHRQ's significant contributions. It also provided many suggestions for future Agency initiatives. AHRQ produced similar summaries for three priority population groups: children, racial and ethnic minorities, and women.

New Research Initiatives

The Agency funded 147 new grants in Fiscal Year 1999. Of the total, 107 were focused on new research initiatives for a total of $30,349,321 in funding. The grants addressed such issues as consumers use of information on quality, strengthening value-based purchasing, measuring national health care quality, health care issues of vulnerable populations including disparities in care, translating research into practice, outcomes for the elderly and chronically ill, clinical preventive services, improving the quality of children's health, and Centers for Education and Research on Therapeutics (CERTs).

Translating Research Into Practice

AHRQ had tremendous success in releasing significant research findings and disseminating them throughout the United States as illustrated by evidence of extensive press and electronic media coverage. In Fiscal Year 1999, there were 3,146 newspaper, trade press, and magazine articles (combined circulation of 253,828,363) citing the Agency. This coverage included articles in the New York Times, Wall Street Journal, Washington Post, Dallas Morning News, and Rockie Mountain News. AHRQ also received television and radio coverage on major programs including an appearance by Surgeon General David Satcher on 20/20 to discuss the AHRQ-sponsored study of race variations in referrals.

Other mechanisms used for disseminating information on the Agency and its products were also extremely successful. The award-winning AHRQ Web site had 15.5 million hits (a five-fold increase over 1997) and, in its first year of operation, the National Guideline Clearinghouse™ generated over 7 million requests for guidelines. Additionally, AHRQ leveraged outside resources through public/private and public/public partnerships for the printing and dissemination of Agency products to targeted audiences.

AHRQ products were used by Federal, State, and local policymakers, practitioners, purchasers, and/or consumers while making health care treatment, purchasing, or coverage decisions. These AHRQ products included evidence-based reports and technology assessments, the Consumer Assessment of Health Plans survey (CAHPS®), findings from Patient Outcome Research Teams studies, and analyses of data from the Healthcare Cost and Utilization Project (HCUP) and Medical Expenditure Panel Survey.

Evaluations

AHRQ used the results of a number of evaluations to better target Agency activities, improve program management, and identifying future research priorities. These include a retrospective evaluation of the Outcomes and Effectiveness research program, the results of which influenced the Translating Research Into Practice Request for Applications issued in late Fiscal Year 1999 and the design of other related Agency programs. The AHRQ State data strategy as implemented through the Healthcare Cost and Utilization Project (HCUP) was evaluated and redesigned in consultation with the state partners and researchers who use the data. Further enhancements of the data sets have been initiated based on this evaluation. Ongoing evaluations of CAHPS®, the primary care research program, and the Evidence-based Practice Centers have provided promising preliminary results that are already influencing agency programs.

Leadership of the QuIC

The operational chair of the Quality Interagency Coordination Task Force (QuIC) is the Director of AHRQ. The QuIC, which consists of representatives of the Federal agencies with health care responsibilities, made significant progress in understanding various aspects of measuring and monitoring the quality of health care. The QuIC conducted an inventory of all quality measures and risk adjustment methods used in the Federal health care system and identified gaps where further measures and methods are needed. Activities to begin filling those gaps have begun.

MEPS

Five major data files containing data from the Medical Expenditure Panel Survey (MEPS) were released for public use, and over 30 MEPS-related products were published in Fiscal Year 1999. Significant progress was made toward releasing data files within 12 months of data collection. The Agency received 20 research applications that used MEPS data as part of their design and funded five of those applications. The MEPS ongoing data collection activities continued on schedule.

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Budget Line 1—Research on Health Care Costs, Quality, and Outcomes

Funding Levels

Fiscal Year 1999: $139,314,000 (Enacted).
Fiscal Year 2000: $165,315,000 (Enacted).
Fiscal Year 2001: $206,593,000 (Fiscal Year 2001 Request).

This budget line represents the bulk of the Agency's research (extramural and intramural) portfolio. Dissemination and evaluation activities as well as the Agency's support of the Secretary's Initiative to Improve Health Care Quality are also included. The first five of the annual performance plan's six goals are used to track Agency performance in these areas.

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GPRA Goal 1: Establish Future Research Needs Based on User's Needs. (HCQO)

Strategy

In the field of health services research, the user of the information plays a critical role. If health services research is to improve the quality of health care, it must provide answers to the questions and issues that represent the barriers to improvement. AHRQ emphasizes open communication with users of its research to ensure that it is addressing important questions. Through continued emphasis on the first phase of the cycle of research, needs assessment, AHRQ will continue to assure that the Agency's research begins and ends with the user.

In the field of health services research, the user of the information plays a critical role. If health services research is to improve the quality of health care, it must provide answers to the questions and issues that represent the barriers to improvement.

Previous Successes

AHRQ has a history of consulting with the users of its research. The current program announcement that provides guidance to researchers on AHRQ's areas of interest was formed through consultations with many outside experts. A few examples include:

  • A Request for Ideas to solicit suggestions on research and other activities the Agency should undertake to best meet our strategic plan goals was published in the Federal Register on April 15, 1999.
  • The Center for Outcomes and Effectiveness Research held numerous stakeholder meetings with organizations such as PHARMA, Public Citizen Health Research Group, and the Food and Drug Administration.
  • An expert meeting was in September of 1999 to obtain stakeholder input into Agency priorities for its women's health research agenda.

Types of Indicators

Output: AHRQ is committed to tying its research agenda to the needs of the users of health services research in order to maximize the impact of Agency research on the health care system. In Fiscal Year 1999, AHRQ received input from:

  • Responses to a mailing of the Agency's strategic plan to 100+ stakeholders and customers.
  • Responses to the publication of a "Request for Planning Ideas" in the Federal Register.
  • Over 20 expert and user group meetings.
  • Consultations with peer review study section members and the National Advisory Council.

The recommendations received from these consultations were analyzed for the Agency by The Lewin Group for content and for recommendations on creating an automated data system to maintain the files (select for details).

Use of Results by AHRQ

Input received on specific issues as well as the synthetic analyses performed by the contractor were used in the program and budget development activities that the Agency undertook during the year. The result is research agendas that are informed by the real needs of the user community. The information is also being used as the basis for program development activities in Fiscal Year 2000 for important areas of study requiring preliminary work to develop a well designed initiative.

Data Issues

To provide context for reviewing the advice received from users, AHRQ reviewed and summarized major articles in the research literature pertaining to the Agency's three strategic goal areas:

  • Outcomes.
  • Quality.
  • Cost, access, and use.
The review of what has been accomplished in the field allows the Agency to assess where the user input fits into the current body of research and how best to proceed.

To synthesize the current user input from Agency constituencies, AHRQ relied on the review of individual documents related to the topics under consideration or to identify new topics of interest to the Agency. The system is currently maintained manually by the Agency Planning Officer.

Working with The Lewin Group, the Agency investigated ways of transforming the information received from the various sources into knowledge that could be aggregated and used without reading individual letters, minutes, or summaries. We learned that this information loses some of its critical meaning when aggregated.

The Agency is, therefore, creating a data management system that will electronically store the source document and have word search capability so that staff can identify relevant documents and access them efficiently from their desk top computers when performing program and budget development activities. Additionally, to ensure that the input from users is incorporated into Agency activities, a number of check points have been integrated into the planning processes where user input is explicitly identified and assessed in relation to the proposed activities.

GPRA Goal 1 Fiscal Year 1999 Results

Objective 1.1: Define direction of Fiscal Year 1999 project funding priorities, in large part, by needs assessment activities.

Indicator

Agency research agenda covering the 3 strategic research goals is developed in Fiscal Year 1999 and documented based on consultations with various groups. (The Fiscal Year 1999 reports are the first one of this type.)

Result

Appendix 5 (Reports on Needs Assessment Activities) contains reports for three of the Agency's strategic research priorities: Outcomes, Quality, and Access. A synthesis of the existing research including AHRQ's contributions to that current body of knowledge is presented with summaries of the user input the Agency received during Fiscal Year 1999. The Agency receives many more suggestions for research initiatives that it is able to implement at any one time. How the recommendations are translated into Agency programs is determined during budget and program development activities. AHRQ identifies its research priorities for the fiscal year by issuing Requests for Applications (RFA) and Program Announcements (PA). These are published in the NIH Guide and are available on the AHRQ Web site at http://www.ahrq.gov/fund/

GPRA Goal 1—Fiscal Year 2000 and 2001 Indicators

Goal 1 Objectives Fiscal Year 2000 Indicator Fiscal Year 2001 Indicator
Fiscal Year 2000 Objective 1.1: Define direction of Fiscal Year 2000 project funding priorities, in large part, by needs assessment activities. Agency research agenda in 3 strategic plan goal areas for the new Fiscal Year 2000 "closing the gap" initiatives are documented based on consultations with various groups.

Baseline: First reports produced in Fiscal Year 1999.

Fiscal Year 2001 Objective 1.1: Define direction of Fiscal Year 2001 project funding priorities, in large part, by needs assessment activities. Agency research agenda in strategic goal areas for Fiscal Year 2001 priorities (informatics, errors, and worker safety) is documented based on consultations with various groups.

Baseline: First reports produced in Fiscal Year 1999.

Budget: Commitment Base

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GPRA Goal 2: Make significant contributions to the effective functioning of the U.S. health care system through the creation of new knowledge. (HCQO)

Strategy

There are many gaps in knowledge in all areas of health care. New questions emerge as new technologies are developed, the population's demographics change, areas of inquiry previously under-emphasized take on greater importance, and research previously undertaken identifies further areas that need attention. Therefore, AHRQ will continue to focus on creating new knowledge and assessing the findings that result from completed projects. This second phase of the cycle of research, knowledge creation, identifies the opportunities for improvement from which changes in health care can be designed and implemented. AHRQ will continue to focus on developing a portfolio of peer-reviewed extramural and intramural research and will also place particular focus on the first segment of the research pipeline, "New Knowledge on Priority Health Issues."

Previous Successes

AHRQ research can be broadly categorized as being descriptive, developing tools and analytic methods, and comparing strategies and interventions to improve outcomes, quality, cost, access, and use.

Descriptive Research

AHRQ research has significantly enhanced our understanding of who get what care and when. Researchers have documented where quality or outcomes fall short of possible results, identified barriers in access, measured the costs and utilization of care, focused on the experience of care as seen by patients, and added to our understanding of the widespread nature of health disparities in America.

Examples of Descriptive Research

Analyses of MEPS data revealed that the proportion of Hispanic Americans with no usual source of care has increased dramatically over the past 20 years (30 percent in 1996, up from 20 percent in 1977), yet declines in health insurance coverage explain only one-fifth of this change.

A study on cultural impacts on asthma treatment outcomes for Mexicans and Mexican-Americans found that ethnomedical beliefs and behaviors are not related to adherence to asthma medication requirements.

Development of Tools and Analytic Methods

The second dominant aspect of the Agency's work in the last 10 years has been in the development of tools and analytic methods. These include the development of tools to systematically review and synthesize literature, instruments to measure quality and outcomes, sophisticated techniques to measure risk and severity, and methods to characterize and study the changing nature of the health care system itself.

Examples of Development of Tools and Methods

For the past three years, the Healthcare Association of New York State has produced individual performance and quality reports for each of its 200+ hospital and health system members based on the Healthcare Cost and Utilization Project Quality Indicators developed by AHRQ staff.

Measures of quality of care processes and outcomes are being developed for: acute asthma exacerbations, hip fractures, total hip replacement (primary and revision), pressure ulcer rates as nursing home outcomes, statistical measures for continuity of care, and measures for home and subacute care.

Comparative Studies

The third aspect of the Agency's work where additional emphasis has been placed in the last three years is in studies that directly compare interventions to improve care, including both clinical interventions and changes in the organization and financing of health services.

Examples of Comparative Studies

Researchers at the University of Pittsburgh are studying the relative effectiveness and cost-effectiveness of intravenous antibiotics delivered in hospitals to a regimen of oral antibiotics for treatment of pelvic inflammatory disease, a major cause of female infertility.

Preliminary results of a study comparing the use of standard feedback of performance data by Peer Review Organizations to the use of Achievable Benchmarks of Care (ABC's) indicate that ABC's are far more effective in improving physician performance.

Type of Indicators

Process and output—AHRQ uses three approaches to illustrate how it addresses its core activity of creating new knowledge. First, the reports produced for the Goal 2 indicators will provide summaries of the current state of a body of research or the AHRQ portfolio. This will enable the Agency to do the following:

  • Identify and highlight significant research findings from research funded or sponsored by AHRQ.
  • Focus its translation and dissemination activities to maximize the potential use of critical findings in the health care system.
  • Annually assess progress toward filling the gap between what we know and what we need to know about health care.

Second, coverage in major journals and/or evidence of use of research findings provided feedback to AHRQ on whether it's investing in research with the potential to have significant impact when disseminated and implemented widely. This is an initial indication of whether the research funded or sponsored by AHRQ is significant. Coverage by popular and professional media is highly competitive. AHRQ's receiving coverage is an indication that the finding has the potential for significant impact. The actual use of the finding by purchasers, professional associations, managed care organizations, and/or insurers also signals that the new knowledge has the potential to make a difference. The ultimate outcome or impact will be evaluated after the finding has been implemented over a period of time.

Third, through specify ing the number of grants that will be funded in particular areas, AHRQ is documenting its commitment to dedicating a certain level of resources in order to advance important new research initiatives. This funding represents a major portion of the new increment of funding requested annually in the budget.

Use of Results by AHRQ

The syntheses for the three populations are being used to inform the initiatives for these groups in the Agency portfolio. In the recent AHRQ reauthorization legislation, the Agency was directed to form an Office of Priority Populations. The information in these reports is being used to provide background on the types of activities that have taken place and to identify gaps that can help frame the functions of the Office.

As indicated under data issues, AHRQ uses the results of the number of media hits and stories of usage to gauge where significant levels of interest exist in Agency research findings. This interest can be leveraged to generate translation and dissemination partnerships and activities with practitioners, policymakers, purchasers, and consumers.

The statistics on number of grants funded and dollars invested in particular areas are used to determine whether the AHRQ portfolio has a significant body of work underway to begin to inform the field. They are also used in gauging the investment in these areas vs. other programs as AHRQ allocates its resources.

Data Issues

AHRQ knows it cannot collect 100 percent of the available data on the publication and use of its research findings. However, considerable effort is expended in tracking media coverage. In certain cases, when findings are of particular import or we discover that some finding seems particularly wide spread, the Agency may make a more concerted effort to evaluate the potential for impact in the health care system. Well designed studies illustrating the potential for national impact are used and will be reported under Goal 4.

Collecting data and/or anecdotes on the use of research results or tools is largely done through searches of the literature, media outlets, and Internet listings and tracking by project officers in consultation with grantees. Underscoring the commitment of the Agency to document and understand the use of its research, staff from the AHRQ Office of Health Care Information (the Research Translation Team and Public Affairs Division) have as a particular focus the tracking of documented evidence of the use. The information is captured through regular communications with partners, researchers, associations, and Federal, State, and local governments. Anecdotal information is only used when it can be verified with the actual user. Documentation of the use is sought whenever possible. AHRQ continues to look for ways to introduce efficiencies in this labor-intensive effort.

GPRA Goal 2 Fiscal Year 1999 Results

Objective 2.1: Determine the salient findings from research for three priority populations and develop plan for next steps in translation and dissemination.

Indicator

A report that synthesizes research on the major health concerns of at least three priority populations produced.

Results

Appendix 6 contains the summaries of research programs for three priority populations: children, racial and ethnic minorities, and women.

For additional information on these Agency programs or a listing of applicable grants funded in Fiscal Year 1999, please contact the following representatives:

Children's Health

Denise Dougherty, Ph.D.
Coordinator, Child Health Activities
Agency for Healthcare Research and Quality
2101 E. Jefferson St. Suite 502
Rockville, MD 20852
Phone: (301) 427-1868
E-mail: DDougher@ahrq.gov

Minority Health

Director, Minority Health Program
Agency for Healthcare Research and Quality
2101 E. Jefferson St. Suite 500
Rockville, MD 20852
Phone: (301) 427-1349


Objective 2.2: Achieve significant findings from AHRQ sponsored and conducted research.

Indicator

Findings from at least 10 AHRQ sponsored or funded research are published in major peer reviewed professional publications (New England Journal of Medicine, Journal of American Medical Association, etc.); receive national press coverage; are used in Federal or State policymaking; are used by professional associations or health plans as the basis of strategies to achieve quality; or are used to establish coverage decisions by health care purchasers, managed care organizations, or insurers, including Medicare or Medicaid.

Results

Peer Reviewed Publications Citations—AHRQ has documented over 50 citations of research sponsored by the Agency or conducted by its intramural researchers published in major peer reviewed journals during 1999. Examples or the journals include: the American Journal of Cardiology, American Journal of Epidemiology, American Journal of Hematology, American Journal of Public Health, Annals of Internal Medicine, Care Management Journals, Inquiry, Journal of General Internal Medicine, Journal of the American Geriatric Society, Journal of the American Medical Association, Medical Care, New England Journal of Medicine, and Pediatrics. This widespread coverage in major journals ensures that critical findings from Agency research is available to practitioners and policymakers. We recognize publication of findings as a FIRST step in the dissemination and use of findings in the health care system, but a critical first step that establishes the findings credibility in the field and informs potential users of the information.

National press coverage—These are conservative counts based mainly on the newspaper, trade journal and magazine clips that AHRQ receives. The actual number, which for many of the studies, includes TV/radio coverage, and for all includes mention by Internet news services, is believed to be much higher.

Examples:

  • The drug treatment for depression evidence report produced by an AHRQ Evidence-based Practice Center generated at least 211 stories.
  • The study of the relationship between hospital nurse staffing and post-surgical complications generated at least 165 stories.
  • An article from the HIV Cost and Services Utilization Study (HCSUS) on variations in access to HIV care generated at least 131 stories, including radio and television coverage.
  • A study on how managed care patients view primary care physicians generated at least 80 television, radio, newspaper, trade press stories.
  • The implementation of the National Guideline Clearinghouse™ generated at least 78 stories.
  • An AHRQ intramural research report on hospital inpatient statistics generated at least 50 stories.
  • Without a press release to alert the media, the study of race variations in referrals generated at least 30 newspaper stories including the New York Times, Washington Post, Wall Street Journal, Dallas Morning News, and Rockie Mountain News. The study was also covered on television on Good Morning America, 20/20 with an appearance by Surgeon General David Satcher, ABC News Tonight, and Fox TV News. Radio coverage included National Public Radio.

In Fiscal Year 1999, there were 3,146 newspaper, trade press, and magazine articles citing the Agency. The combined circulation of all these periodicals is 253,828,363. It is safe to say that most Americans were exposed to news about or involving AHRQ in the print media. In addition to the coverage of specific stories listed above, the following Agency programs also received print media coverage:

Program Clippings Audience Count
Evidence reports 415 36.0 Million
Smoking Cessation Guidelines 299 9.9 Million
U.S. Preventive Services Task Force 103 13.9 Million
National Guideline Clearinghouse™ 90 5.4 Million
Medical Expenditure Panel Surveys 50 2.2 Million

In the highly competitive media market, major coverage of a research project indicates its significance and increases the likelihood that the results will be noticed not only by health care practitioners, but other audiences for this information including consumers, health care purchasers, and Federal, state, and local policymakers. This type of coverage reaches audiences that do not routinely access peer review journals.

Use of research findings—AHRQ has also documented 13 cases of research findings being implemented in the health care system. (This does not include the use of reports and technology assessments completed by the AHRQ's Evidence-based Practice Centers or of the Consumer Assessment of Health Plans tool—select Objectives 3.2 and 3.3.) Examples:

  • Findings from the Pneumonia Patient Outcomes Research Team are being used by HCFA's Quality Improvement Organizations and managed care organizations to improve care for patients with community-acquired pneumonia.
  • A study contributed to the development of the "Measures of Menopause" measure, which will be included in HEDIS 2000.
  • A study on community-acquired pneumonia has been used to develop guidelines by professional organizations and hospitals.
  • Several States, including Massachusetts, Georgia, and Texas, have implemented statewide programs/treatment recommendations that are adaptations of the Schizophrenia Patient Outcome Research Teams study.
  • The Health Care Financing Administration is using research on categorizing rehabilitation patients according to their level of functioning and needed services in the development of reimbursement system for rehabilitation hospitals.
  • Research sponsored by AHRQ and data analyses from the Healthcare Cost and Utilization Project (HCUP) were used to develop indicators for the Access to Quality Health Services chapter of Healthy People 2010.
  • The Manitoba, Canada, health authorities have started using the VF-14 assessment tool to prioritize patients on waiting lists for cataract surgery.

These examples illustrate the adoption and use of Agency research findings by organizations that have impact nationally, state-wide, or through a professional organization.

Objective 2.3: Initiate Fiscal Year 1999 Research Initiatives. This objective represents the Agency's commitment to a certain level of effort that is necessary for the research initiative to succeed. The basic premise is that without a significant investment in research initiatives, there won't be enough new knowledge produced to improve the health care system.

Indicator

Funding of a minimum of 21 projects in:

  • Consumers use of information on quality (9).
  • Strengthen value-based purchasing (7).
  • Measure national health care quality (11).
  • Vulnerable populations (18).
  • Translating research into practice (11).

Results

AHRQ funded 56 grants ($16,523,715 in Fiscal Year 1999 funding) in the above categories with a minimum of 7 in each individual categories. Many of the grants fill multiple categories, for instance, many of the grants that apply to vulnerable populations also will contribute to the outcomes for the elderly and chronically ill below.

Indicator

Funding of a minimum of 17 projects in:

  • Outcomes for the elderly and chronically ill (23).
  • Clinical preventive services (5).
  • CERTs (4). (AHRQ was under a $3-million cap in spending for these grants in Fiscal Year 1999.)
  • Improving the quality of children's health (19).

Results

AHRQ funded 51 grants ($13,825,606 in Fiscal Year 1999 funding) in the above categories with a minimum of 4 in each category.

By funding grants that inform the areas of research listed above, AHRQ will develop a portfolio of research findings that will significantly inform the field in these critical areas of interest.

GPRA Goal 2—Fiscal Year 2000 and 2001 Indicators

Objective Fiscal Year 2000 Indicator Fiscal Year 2001 Indicator
Objective 2.1: Determine annually the salient findings from research in each of the three areas (outcomes; quality; and cost, access, and use) and develop plan for next steps translation and dissemination. Annual report on science advances in three research goal areas.

1. At least four major findings in each area that have potential to save significant amounts of money, improve quality, save lives or prevent physical suffering, or change the organization and delivery of health care.

2. For each finding, specific steps in translation and dissemination are identified and initiated.

3. Baseline: The first report will be published in Fiscal Year 2000.

Annual report on science advances in three research goal areas.

1. At least six major findings in each area that have potential to save significant amounts of money, improve quality, save lives or prevent physical suffering, or change the organization and delivery of health care.

2. For each finding, specific steps in translation and dissemination are identified and initiated.

3. Baseline: The first report will be published in Fiscal Year 2000.

Generate 2-3 synthesis reports on research findings and practical applications on Agency priority topics, such as priority populations and other topic themes such as Q-span.

Budget: Commitment Base.

Objective 2.2: Achieve significant findings from AHRQ sponsored and conducted research.

Findings from at least 25 AHRQ sponsored or funded research are published in major peer reviewed professional publications (New England Journal of Medicine, Journal of American Medical Association, etc.); receive national press coverage; are used in Federal or State policymaking; are used by professional associations or health plans as the basis of strategies to achieve quality; or are used to establish coverage decisions by health care purchasers, managed care organizations, or insurers, including Medicare or Medicaid.

Baseline: 50 citations in peer reviewed publications, 7 examples of major media, 7 examples of usage.

Findings from at least 40 AHRQ sponsored or funded research are published in major peer reviewed professional publications (New England Journal of Medicine, Journal of American Medical Association, etc.); receive national press coverage; are used in Federal or State policymaking; are used by professional associations or health plans as the basis of strategies to achieve quality; or are used to establish coverage decisions by health care purchasers, managed care organizations, or insurers, including Medicare or Medicaid.

Objective 2.3:

Fiscal Year 2000: Implement Fiscal Year 2000 priority (1) "New Research on Priority Health Issues"

Fiscal Year 2001: Initiate Fiscal Year 2001 Research Initiatives

Funding of a minimum of 10 projects that address gaps in knowledge about the priority problems faced by Medicare and Medicaid.

Funding of a minimum of 10 projects to address eliminating disparities in health care with particular emphasis on disparities that exist for racial and ethnic minorities.

Funding of a minimum of 20 projects in:

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