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AHCPR reorganizes to streamline operations
The Agency for Health Care Policy and Research has been
reorganized to strengthen its role as the nation's focal point
for health services research, according to Clifton R. Gaus,
Sc.D., AHCPR's Administrator. The reorganization reduces the
Agency's operational units from 34 to 13 and redraws its
organizational chart to "flatten" the organization, with all
major operating units reporting directly to the Administrator.
This new structure creates direct lines of communication between
the Agency's leadership and its operations, permitting more
efficient and effective management of resources.
The reorganization streamlines the Agency's operations,
eliminates redundant and unnecessary management and operational
levels, and helps to ensure that appropriate priority is given to
all of the Agency's program goals and objectives, notes Dr. Gaus.
As part of the reorganization, Dr. Gaus named Lisa Simpson, M.B.,
B.Ch., M.P.H., as Acting Deputy Administrator.
The Agency's 13 operational units and their responsibilities
- Office of the Administrator, Clifton R. Gaus, Sc.D.—directs
the activities of the Agency to ensure achievement of strategic
- Office of Management, Willard B. Evans, Jr.,
director—coordinates Agency-wide administrative
- Office of Planning and Evaluation, Phyllis M. Zucker,
director—coordinates the agency's strategic
planning and program evaluation and coordinates research
activities focusing on special populations.
- Office of Policy Analysis, Larry Patton, director—provides
support and technical assistance in the analysis and synthesis of
health care research, serves as AHCPR's legislative liaison, and
facilitates the activities of AHCPR's National Advisory
- Office of Scientific Affairs, Linda K. Demlo, Ph.D., acting
director—manages the scientific review process for grants
and contracts and the assignment of projects to Agency
centers, manages Agency research training programs, and
evaluates the medical and scientific contributions of
proposed and ongoing research, demonstrations, and
- Office of the Forum for Quality and Effectiveness in Health
Care, Douglas B. Kamerow, M.D., director—sponsors
development of and research on methods and materials to
promote evidence-based clinical practice.
- Center for Health Information Dissemination, Christine G.
Williams, acting director—designs, develops, implements, and
manages programs for disseminating the results of Agency
- Center for Information Technology, J. Michael Fitzmaurice,
Ph.D., director—conducts and supports studies of health
information systems, computerized patient record systems,
and medical decision analysis.
- Center for Outcomes and Effectiveness Research, Carolyn M.
Clancy, M.D., acting director—conducts and supports studies
of the outcomes and effectiveness of diagnostic,
therapeutic, and preventive health care services and
- Center for Health Care Technology, Thomas V. Holohan, M.D.,
director—conducts and supports a comprehensive program of
health care technology assessment.
- Center for Quality Measurement and Improvement, Sandra
Robinson, acting director—conducts and supports research on
the measurement and improvement of the quality of health
- Center for Primary Care Research, Carolyn M. Clancy, M.D.,
director—conducts and supports studies on primary care and
clinical, preventive, and public health policies and
- Center for Cost and Financing Studies, Ross H. Arnett III,
director—conducts and supports studies of the cost and
financing of health care and develops data sets to support
policy and behavioral research and analyses.
- Center for Organization and Delivery Studies, Irene Fraser,
Ph.D., director—conducts, supports, and manages studies of
the structure, financing, organization, behavior, and
performance of the health system and providers within it.
One of the guiding principles behind the reorganization is to
enhance the Agency's ability to respond more quickly to the needs
and demands of the rapidly changing private sector. Dr. Gaus
wants AHCPR to be able to anticipate and respond quickly and
efficiently to the research and information needs of the
marketplace so the Agency can provide the science-based tools to
help the private sector control health care costs while improving
AHCPR receives $125.3 million in FY 1996 funding
Congress has passed a fiscal year 1996 spending bill that
includes $125.3 million for the Agency for Health Care Policy and
Research. The final resolution of the FY 1996 budget allows
Agency officials and the health services research community to
proceed with pending projects.
At this level of funding, AHCPR will be able to continue its
support of existing grantees and assure the continued health of
the field by funding some new awards. Decisions on awards will be
announced shortly. In addition, AHCPR will restore nearly half of
the reductions in awards made to grantees since September 1995,
when AHCPR's FY 1996 funding level was in doubt.
In addition, AHCPR recently released several requests for
applications (RFAs), soliciting applications for projects to
compare the effectiveness and outcomes of hysterectomy, study
patient referrals from primary care to specialty care, and
develop and test new health care quality measures. Awards made in
response to these RFAs will be announced in September 1996.
Administrator testifies in support of AHCPR's FY 97
The Agency for Health Care Policy and Research's Administrator,
Clifton R. Gaus, Sc.D., presented the President's FY 1997 budget
request for AHCPR to the House Labor/HHS/Education Appropriations
Subcommittee on April 30, 1996. The request totals $143.8
million. Highlights of AHCPR's FY 1997 program as presented by
Dr. Gaus include:
- AHCPR will serve as a "science partner" for provider
societies, managed care organizations, purchasing groups,
and other private sector entities by supplying the
scientific evidence they need to produce and implement their
own clinical practice guidelines. AHCPR will provide support
for Centers for Evidence-based Practice to respond to
requests from these groups but will no longer be directly
involved in clinical practice guideline development.
- AHCPR will work with key groups to cosponsor an online
database of clinical practice guidelines through a National
- AHCPR will continue its research and evaluation efforts and
broaden dissemination to promote incorporation of scientific
knowledge into day-to-day clinical practice.
- AHCPR will implement the full data collection phase of the
Medical Expenditure Panel Survey (MEPS), an interrelated
series of surveys that replaces the National Medical
Expenditure Survey (NMES).
- AHCPR will continue to support outcomes research in areas
such as hysterectomy and heart disease.
- AHCPR will continue efforts to construct tools for measuring
quality of care.
- AHCPR will continue to support research on computerized
decision support systems (CDSS) to assist providers'
decisionmaking and promote cost-effective health care.
- AHCPR will continue to focus on ways to help consumers select
high quality health plans and services.
- AHCPR will continue to seek a better understanding of trends
in the health care marketplace, including the implications
of these trends for quality of care and access to care.
Special attention will be given to the impact of changes in
health care organization on referrals from primary care to
- AHCPR will support an ongoing initiative on market forces to
examine how changes in the structure of defined markets have
affected the way health care providers produce and deliver
care and the price, distribution, and quality of services
Dr. Gaus concluded his testimony by stressing the important role
AHCPR plays in helping consumers, providers, purchasers, and
policymakers determine what works and what doesn't work in
AHCPR, Duke University, and DuPont Merck agree on joint
project to continue stroke prevention research
The Agency for Health Care Policy and Research has signed a
landmark agreement with Duke University and DuPont Merck
Pharmaceutical Company to extend the work of the AHCPR-funded
Patient Outcomes Research Team (PORT) to examine the most
effective way to prevent stroke in high-risk patients.
Under the agreement, Duke University will conduct a 3-year
randomized clinical trial to evaluate the effectiveness of a
comprehensive strategy for educating patients and physicians
about the appropriate use of stroke-preventing therapy using the
anticoagulant drug warfarin. The study will be conducted in
various managed care organizations and will involve 2,500
patients with atrial fibrillation, a condition characterized by
rapid and erratic beating of the heart which increases the risk
of stroke. The project will be headed by David Matchar, M.D.,
principal investigator of AHCPR's stroke prevention PORT, and
will receive up to $1.5 million from DuPont Merck, which
manufactures warfarin, to supplement AHCPR's funding.
The stroke prevention PORT was originally funded by AHCPR in
1991. The study has produced a number of key findings about
preventing stroke in persons who have experienced minor strokes,
as well as in individuals who have not had these transient
attacks but who may have clogged arteries.
Last fall the investigators announced that, based on a synthesis
of the best scientific evidence available, increasing use of
warfarin could prevent as many as 40,000 strokes a year in
persons with atrial fibrillation and save nearly $600 million a
year in health care costs. It is generally acknowledged that
warfarin is underutilized in atrial fibrillation patients.
According to AHCPR Administrator Clifton R. Gaus, Sc.D., Duke
University will provide the clinical and research expertise,
AHCPR will provide scientific oversight and financial support,
and DuPont Merck will provide technical assistance and financial
support for the project, which will be called the Managing
Anticoagulation Services Trial (MAST).
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