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AHRQ promotes health care quality improvement by conducting and supporting health services research that develops and presents scientific evidence regarding all aspects of health care. Health services research:
- Addresses issues of "organization, delivery, financing, utilization, patient and provider behavior, quality, outcomes, effectiveness and cost.
- Evaluates both clinical services and the system in which these services are provided.
- Provides information about the cost of care, as well as its effectiveness, outcomes, efficiency, and quality.
- Includes studies of the structure, process, and effects of health services for individuals and populations.
- Addresses both basic and applied research questions, including fundamental aspects of both individual and system behavior and the application of interventions in practice settings."1
The vision of the Agency is 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 consumers and purchasers; and, to improve health status and quality of life.
The Agency's mission is to improve the outcomes and quality of health care services, reduce its costs, improve patient safety, and broaden access to effective services. AHRQ fulfills its mission through establishing a broad base of scientific research and promoting improvements in clinical and health system practices, including the prevention of diseases and other health conditions.
1. Eisenberg JM. Health services research in a market-oriented health care system. Health Affairs, Vol. 17, No. 1:98-108, 1998.
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Overview of the Plan and Performance Report
The AHRQ Performance Plan is a companion piece to the AHRQ Strategic Plan and to the FY 2005 Budget Request. In this document, the initial FY 2005 and revised FY 2004 Performance Plans have been merged with the FY 2003 Performance Report to comply with the format developed by the Department of Health and Human Services (HHS).
The 2005 Performance Plan focuses on addressing the Agency's vision, mission and strategic goal areas of safety/quality, effectiveness, efficiency and organizational excellence. Within those goal areas, the agency aligns its 11 portfolios of work—activities grouped by categories that reflect agency investments.
1. Summary of Measures
- Overall Number of Measures: 49
- Number of Outcome Measures: 17
- Number of Output Measures: 28
- Number of Efficiency Measures: 4
- Number of Measures for which Targets Were Met: 39
- Number of measures for which Targets Were Not Met: 0
2. AHRQ FY 2003 Performance Successes & Challenges
AHRQ made significant progress this year in establish our "Portfolios of Work." These portfolios represent the groups of activities we are currently funding. They are linked to our strategic goal areas in Table 1.
Throughout this document, we maintain this structure for reporting purposes. We are in the process of refining our performance goals to better address planned activity in each portfolio. Another challenge is to provide for a better budget linkage. Our current and future efforts include the development of a software application that will map each AHRQ-funded activity to the portfolio structure. It is a work in progress, and we look forward to sharing our success as we continue on this journey.
3. AHRQ FY 2003 Performance Highlights
AHRQ conducts and sponsors research that will help improve the outcomes and quality of health care, reduce costs, address patient safety and medical errors, and broaden access to effective services. AHRQ's ability to sustain a high level of performance during FY 2003 is evidenced by how its research has ultimately been used to provide better health care delivery services. Here are some highlights of what we did in FY 2003. Information is categorized by select portfolios of work.
Quality/Safety of Patient Care Portfolio
On behalf of the HHS Patient Safety Task Force (PSTF), AHRQ signed a contract with The Keveric Company to begin the work to develop a new Patient Safety Database. The PSTF comprises AHRQ, the Centers for Disease Control and Prevention (CDC), the Centers for Medicare & Medicaid (CMS), and the Food and Drug Administation (FDA). The mission of the PSTF is to integrate existing data collection on medical errors and adverse events, to coordinate research and analysis efforts, and to collaborate on reducing the occurrence of injuries that result from medical errors. The project's goal is to reduce regulatory burden and improve communication. In phase 1, Kevric will create a Web-based reporting interface for hospital and institutional-based reporting of events to the CDC and FDA.
AHRQ launched a monthly peer-reviewed, Web-based medical journal that showcases patient safety lessons drawn from actual cases of near misses. Called AHRQ WebM&M (Morbidity and Mortality Rounds on the Web), the Web-based journal (webmm.ahrq.gov) was developed to educate health care providers about medical errors in a blame-free environment. In July of this year, 20,235 unique visitor sessions were held. A total of 3,642 copies of the spotlight cases have been downloaded. The spotlight cases include significant details accompanied by a slide set useful for instruction.
AHRQ and the American Academy of Pediatrics announced a partnership to help put valuable information about preventing medical errors into the hands of pediatricians and parents across the country. AHRQ and the AAP are working together to promote a new fact sheet called 20 Tips to Help Prevent Medical Errors in Children. It offers evidence-based, practical tips on avoiding medical errors related to prescription medicines, hospital stays, and surgery. AHRQ and AAP will distribute copies of the fact sheet to AAP's 57,000 member pediatricians, as well as to groups representing children and parents.
Medicare patients treated in the outpatient setting may suffer as many as 1.9 million drug-related injuries a year because of medical errors or adverse drug reactions not caused by errors, according to medical researchers sponsored by the Federal AHRQ and the National Institute on Aging (NIA). About 180,000 of these injuries are life-threatening or fatal, and more than half are preventable, say the researchers, who based the estimates on a study of over 30,000 Medicare enrollees followed during 1999-2000. Of note, this study was conducted in a private sector health lan with over 20 years experience providing care to medicare beneficiaries.
AHRQ has developed a new Web-based tool that can help hospitals enhance their patient safety performance by quickly detecting potential medical errors in patients who have undergone medical or surgical care. Hospitals then investigate to determine whether the problems detected were caused by potentially preventable medical errors or have some other explanations.
Improving Primary Care Patient Safety with Handheld DSS. We are currently funding two projects that are studying the use of handheld Computerized Physician Order Entry (CPOE) systems with decision support in primary care clinics. The studies are evaluating the impact of these systems on reducing medical errors and improving clinical care. They are also assessing the barriers to use of these systems and the cost-effectiveness of using this technology.
Using Handheld Technology to Reduce Errors in ADHD Care. This project is using a handheld CPOE system with decision support to reduce medical errors and improve the management of attention-deficit/hyperactivity disorder (ADHD) in children.
Impact of EpicCare on the Management of Diabetes in the Geisinger Health System. This project is using an electronic medical record system with CPOE and automated clinical reminders to improve the quality of diabetes care.
The Effect of Using Rules Technology with Provider Order Entry in Medication Error Reduction. This project is evaluating the impact of a CPOE with decision support on reducing medication errors and preventing adverse drug events. The CPOE system will trigger automatic warnings that assist providers in detecting and preventing potential adverse drug events when they are ordering medications in both the inpatient and outpatient setting. Potential problems will be identified using algorithms that link information from the laboratory, pharmacy, and medical records. They are also assessing barriers to use of CPOE, physician adherence to the recommendations, and physician satisfaction with the system.
This project is evaluating the impact of an electronic medical record system with CPOE and automated reminders on lipid management (i.e., cholesterol levels in the blood). The system integrates a patient's clinical information with recommended guidelines for lipid management, current research findings, calculates the risk of cardiovascular disease for an individual patient, and generates automatic reminders to the clinician.
Improving Quality with Outpatient Decision Support. This project is studying the impact of an electronic medical record system with CPOE and automated reminders on quality of care in outpatient clinics setting and assessing physician compliance with guidelines, reminders, and alerts. Areas being studied include chronic disease management, medication management, and the use of ancillary tests.
Impact of Electronic Prescribing on Medication Errors. This project is studying the impact of a handheld CPOE system on prescribing practices and medication error rates in an urban pediatric clinic and in the emergency department.
HIV Treatment Error Reduction Using a Genotype Database. This project is evaluating an electronic medical record system with CPOE and automated decision support that integrates an individual patient's HIV genotype information with the patient's medication information. The study will evaluate the impact of the system on the selection of antiretroviral drug medications, prescribing errors, the development of drug resistance, and overall quality of care.
The Use of Encoded Guidelines in an Electronic Medical Record System for Targeted Tuberculin Testing and Treatment of Latent Tuberculosis. This project is studying the use of a CPOE system to identify patients at increased risk for tuberculosis infection and the effectiveness of the rules and alerts in improving adherence to the screening guidelines.
Data Development Portfolio
Healthcare Cost & Utilization Project (HCUP). The HCUP vision is to increase the number of States participating in it; 33 States are HCUP partners. Four new State partners joined HCUP in FY 2003: Minnesota, Nebraska, Rhode Island, and Vermont. 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.
The number of States now participating in the State Ambulatory Surgery Databases (SASD), a second group of HCUP databases, increased from 13 in FY 2001 and 15 in FY 2002 to 18 in FY 03.
The number of States participating in the State Emergency Department Databases (SEDD) also increased, from 5 in FY 2001 and 7 in FY 2002 to 9 in FY 2003.
During the past year, AHRQ implemented a multifaceted effort to make HCUP data more accessible to researchers and other interested users. HCUP tools include:
- HCUPnet. HCUPnet (http://hcupnet.ahrq.gov/) is a free, interactive, menu-driven online service that allows easy access to national statistics and trends and selected State statistics about hospital stays. HCUPnet answers questions about conditions treated and procedures performed in hospitals for the population as a whole, as well as for subsets of the population such as children and the elderly. In addition, two new States for a total of 18 States have agreed to include their data in HCUPnet. At 6,000 plus visits a month, HCUPnet is consistently within the Top 10 resources accessed from the AHRQ Web site. The site is updated continuously throughout the year. We also update as States agree to join.
- HCUP Central Distributor. Researchers' access to HCUP data has been facilitated by the creation of a central distribution center for the State-level databases. Now researchers can go one-stop shopping instead of contacting each State on an individual basis. We have increased the number of States providing data to the Central Distributor to 18.
- HCUP fact books. Data from HCUP have been used to produce reports that answer questions on reasons Americans are hospitalized, how long they stay in the hospital, the procedures they undergo, how specific conditions are treated in hospitals, the resulting outcomes, and how hospital care for women differs from care for men. In FY 2003, a new fact book is being developed on potentially avoidable hospitalizations. This fact book will describe ambulatory care sensitive conditions—conditions that evidence suggests may have been avoided through timely and effective ambulatory care. The fact book will use graphs and tables to describe these conditions, including priority conditions such as asthma, diabetes, congestive heart failure, hypertension, and low birth weight infants. In addition, this report will assess quality from the perspective of access to health care services for select subgroups of the U.S. population: children, elderly, women, low-income, and rural residents.
Select for Figure 1 (7 KB).
Medical Expenditure Panel Survey (MEPS). The mission of AHRQ's MEPS is to serve as the Nation's primary source of information on how Americans use and pay for health care. In addition to the core survey of households, MEPS also includes surveys of medical providers and establishments to supplement the data provided by household respondents on medical expenditures and health insurance coverage. Over the last year, AHRQ has developed a number of new mechanisms to enhance the availability and usefulness of the MEPS data.
Online resources for research and policymaking. MEPS has made available two online resources that provide invaluable data and statistics for use by policymakers, researchers, and others. MEPSnet is a collection of analytical tools that operate on data from the MEPS. MEPSnet is free and publicly available on the AHRQ Web site. MEPSnet/IC (Insurance Component) has been used to help policymakers at the State level produce reports for legislators and governors on the status of employer-sponsored health insurance in their State. It also has been used to generate cost estimates and otherwise inform new health insurance proposals in States and to track the effects of past changes in State health insurance policy. MEPSnet/HC (Household Component) has been used to answer questions about health care use and spending among various population groups, health insurance coverage and who is uninsured, and how health care use varies by type of health insurance. Go to http://www.meps.ahrq.gov/mepsweb/data_stats/meps_query.jsp to access this resource.
MEPS Tables Compendium. The Compendium presents national estimates from the MEPS Household Component in tabular form. The Compendium is organized by health care topic and calendar year. A unique feature of the table's compendium is the ability to customize tables by modifying selected variables to look at particular populations of policy interest. Due to the complex survey design of MEPS, appropriate statistical tests are needed to make accurate statistical inferences. Therefore, a table of standard errors accompanies each table of estimates.
Publications. MEPS has several different series of printed reports: MEPS Research Findings, MEPS Methodology Reports, and MEPS Chartbooks. All of the reports all available free from the MEPS Clearinghouse and are available for download in both PDF and HTML format from the MEPS Web site. MEPS data are also used to prepare short Statistical Briefs released via AHRQ's Web site. In 2002 CCFS, staff prepared and disseminated a methods report, two Chartbooks, and seven Statistical Briefs.
- Adult Quality Statistical Brief 2000.
- Adult Quality Statistical Brief 2001.
- Children's Quality Statistical Brief.
- Uninsured Statistical Brief 2001.
- Uninsured Statistical Brief 96-2001.
- Priority Conditions Statistical Brief.
- Smoking Statistical Brief.
- IC Chartbook—Changes in Job Related Health Insurance, 96-99.
- Chartbook on Uninsured in America 96-2000.
- Projecting NMES Survey Data: A Framework for MEPS Projections.
How MEPS Data Are Used. In the public sector, entities such as the Office of Management and Budget, the Congressional Budget Office, the Medicare Payment Advisory Commission, the Bureau of Labor Statistics and the Treasury Department rely on MEPS data to evaluate health reform policies, the effect of tax code changes on health expenditures and tax revenue, and proposed changes in government health programs such as Medicare.
In the private sector, MEPS data are used by many private businesses, foundations, and academic institutions—such as RAND, the Heritage Foundation, Lewin-VHI, and the Urban Institute—to develop economic projections.
Researchers use MEPS data as a major resource for the health services research community at large. Since 2000, data on premium costs from the MEPS Insurance Component have been used by the Bureau of Economic Analysis to produce estimates of the Gross Domestic Product (GDP) for the Nation.
Chronic Care Management Portfolio
A team-oriented approach to testing for chlamydia increased the screening rate of sexually active 14- to 18-year-old female patients from 5 to 65 percent in a large California health maintenance organization (HMO), according to new study findings from researchers at the University of California, San Francisco, Department of Pediatrics, and Kaiser Permanente of Northern California. This screening will prevent a major portion of the incidence of infertility.
Patients recovering from a hip fracture and who had one or more abnormal vital signs, mental confusion, heart or lung problems, or couldn't eat when they were discharged from the hospital had a 360 percent greater chance of dying and a 60 percent greater chance of readmission within 60 days, according to a new study funded by AHRQ. The study, "Frequency and Impact of Active Clinical Issues and New Impairments on Hospital Discharge in Patients with Hip Fracture," was published in the January 13 issue of the Archives of Internal Medicine.
AHRQ's U.S. Preventive Services Task Force issued a number of recommendations in FY 2003. AHRQ worked with HHS to inform the Secretary's priority and initiative on preventive care.
AHRQ launched a new Quality Indicator module, the Prevention Quality Indicators—a software tool for detecting potentially avoidable hospital admissions for illnesses (e.g., diabetes) which can be effectively treated with high-quality, community-based primary care. The AHRQ Prevention Quality Indicators allows users to measure and track hospital admissions for 16 conditions using their own hospital discharge data and will provide the information needed to improve the quality of primary care for these illnesses in a community or State.
AHRQ conducted two 1-½ day regional bioterrorism and health system preparedness workshops focusing on AHRQ supported bioterrorism research findings and promising practices implemented by States, localities and health systems. Five written briefs focusing on bioterrorism issues raised in the regional workshops and during the national Web-assisted audio conferences conducted by AHRQ will be prepared.
Through AHRQ's User Liaison Program (ULP), five 90-minute Web-assisted audio conferences were conducted throughout 2003 focusing on bioterrorism and health systems preparedness. Each conference focuses on AHRQ-supported bioterrorism research findings and promising practices implemented by States, localities and health systems.
Pharmaceutical Outcomes Portfolio
Supporting research to improve the safety and effectiveness of pharmaceuticals, AHRQ's Centers for Education and Research on Therapeutics (CERTs) conduct research and provide education that will advance the optimal use of drugs, medical devices, and biological products. For example, a recent study by the Duke University center found that the percentage of patients with heart disease who report taking aspirin regularly increased from 1995 to 1999. These findings reflect substantial improvements in practice; but additional patients could benefit from this inexpensive, effective treatment that reduces death from heart disease, recurrent heart attacks, and stroke.
The demand for training in fields such as health economics, health care outcomes, and organizational/management health care research exceeds the supply. Employment among students trained is high. Virtually all of students supported through AHRQ training programs begun in 1986 (94-98% of postdoctoral students who have completed training) are gainfully employed in health services research or administration.
Three-quarters of all students graduating from AHRQ-sponsored training programs publish in refereed journals, and up to 80% are first authors on their publications. The remaining students are actively conducting applied research or its administration, working in the Government, private industry, or research foundations, and the health care delivery system.
Key recent publications produced by former students in journals such as the Journal of the American Medical Association (JAMA) and the New England Journal of Medicine (NEJM) have been nationally acclaimed. For example, one article drew attention to the need for greater use of computerized physician order entry systems and staffing of ward-based clinical pharmacists to curtail pediatric inpatient medical errors. Anther article found no difference in neonatal outcomes or HMO expenditures between early discharge programs and state-mandated program preventing early discharges.
Research or research methods produced by former students and in emerging centers of excellence in the Building Research Infrastructure and Capacity (BRIC) and the Minority Research Infrastructure (M-RISP) programs supported by AHRQ have resulted in recent impacts, such as:
- Contributing to the structure of CMS nursing home quality indicators on weight loss in nursing homes.
- Influencing modifications in how the Health Resources and Services Administration (HRSA) measures primary care availability for future designations of shortage areas.
- Leading to changes in New Hampshire's Board of Nursing re—licensure to enable tracking of the State's workforce to improve availability and diversity.
- Providing a foundation for improvement in areas of neurological injury at eight medical centers in New England.
- Adapting novel community and church—based recruitment efforts to:
- Enhance participation in prevention research focusing on mammography use among women in a rural southern State.
- Development of research partnerships among dental providers, State agencies and day care provides in the Mississippi Delta region that have resulted in enhanced delivery of dental services for poor children who prior to the establishment of these networks did not receive such services.
4. Discussion of Measures
As discussed in the Summary, we are aligning our investments with our strategic goal areas and portfolios of work. As a result, we developed a number of measures to support these portfolios. Beginning with this plan, current and proposed measures are portrayed under this structure. As we progress, we will refine our measures to better array strategic goal outcomes and the portfolio measures that support those outcomes. We will also have better funding linkage as we develop our software application. Please note that the measures negotiated with OMB for the PART reviews remain the same.
5. Program Assessment Rating Tool (PART)
Data Collection and Dissemination
This program collects data on the cost (MEPS), use (HCUP), and the quality of health care in the United States and develops and surveys beneficiaries regarding their health care plans (Consumer Assessment of Health Plans, CAHPS®). In the FY 2004 Final Conference, AHRQ received an increase of $5 million above the FY 2003 budget to support efforts to ensure continued collection and availability of national health care cost, use, and quality data. These funds will be directed to performance-based improvements for the three data collection and dissemination programs.
Translating Research into Practice
In FY 2005, AHRQ is requesting $10.4 million, an increase of $3.4 million from the FY 2004 Final Conference, for studies focused on Translating Research Into Practice (TRIP). The increase in funds is attributable to AHRQ's new grant and contract program: Research Empowering America's Changing Healthcare System (REACHES). These grants and contracts will expand work in the area of adopting research findings in real-world settings and assessing their impact and generalizability.
REACHES places greater emphasis on translation, dissemination, and implementation in a broader sense. AHRQ's planned revision of the strategic goals and its organizational realignment allows for this implementation strategy.
Table 2. Data Collection and Dissemination/Translating Research Into Practice (TRIP)
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Contact Patricia Bosco at (301) 427-1207 about this document.
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Current as of May 2004