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Agency reauthorization brings new challenges and renews a strong commitment to health services research
On December 6, 1999, President Clinton signed legislation that transformed the Agency for Health Care Policy and Research into the Agency for Healthcare Research and Quality. This legislation was enacted less than 2 weeks before AHCPR was to celebrate its 10th anniversary on December 19. On that day in 1989, President Bush signed the legislation that created AHCPR and set forth the Agency's primary objective to enhance the quality, appropriateness, and effectiveness of health care services and access to care.
John M. Eisenberg, M.D., formerly AHCPR's Administrator, will continue to lead the Agency in his new role as AHRQ Director. Lisa Simpson, M.B., B.Ch., M.P.H., also continues in her role as Deputy Director.
For the past 10 years, AHCPR has sponsored and conducted health services and outcomes research, provided leadership to the field, fostered the development of new research tools and methodologies, and disseminated information on a wide variety of health care topics to enhance health care decisionmaking. Agency staff can look back on a decade of challenges met, obstacles overcome, and accomplishments that have helped to change the face of health care in the Nation. Now AHCPR has become
AHRQ, and Agency staff are looking to the future—a future that will include an expanded role in fostering improvements in health care quality through research.
The reauthorization legislation validates the Agency's core mission and its role as a "science partner," working collaboratively with public- and private-sector organizations to improve the quality and safety of patient care. Although the sponsors of the legislation emphasized quality and outcomes research, they also reaffirmed the Agency's commitment to supporting research on the costs and use of health care, as well as access to care. Indeed, the new legislation includes more references to this component of AHRQ's research portfolio than the previous statute.
The reauthorization legislation directs AHRQ to conduct and support research on the measurement and improvement of health care quality, including research on the most effective means of communicating findings to the public. As part of this effort, AHRQ will develop and disseminate annual reports to the Nation on health care quality and trends in health care disparities among various segments of the population.
In the area of medical errors/patient safety, AHRQ will support research and build partnerships with health care practitioners and health care systems to reduce medical errors. The authorizing legislation also establishes the Centers for Education and Research on Therapeutics (CERTs) as a permanent program. This initiative will help reduce drug-related medical errors by supporting timely research on the appropriate use of medications and increasing awareness of new uses of drugs and potential risks associated with drugs, biological products, and devices.
Finally, the reauthorization legislation requires AHRQ to advance the use of information technology for coordinating patient care and conducting quality and outcomes research. To address this requirement, the Agency will support the use of information systems to develop individual provider and plan-level comparative performance measures, create effective linkages between various sources of health information to enhance the delivery and coordination of evidence-based health care services, and promote the protection of patient information.
Congress has appropriated $205 million in fiscal year 2000 funding for AHRQ, only $1 million less than the President's request. This increase of $34 million is 20 percent over the fiscal year 1999 level and is the largest dollar and percentage increase in the Agency's 10-year history. This level of funding reflects strong bipartisan support for AHRQ and its mission to foster the use of evidence as the foundation for informed health care decisionmaking by patients, clinicians, health system leaders, purchasers, and policymakers.
AHRQ has adopted a theme for the new millennium—Closing the Gap, which represents a fitting goal for an Agency whose new acronym is pronounced "arc,"—to ensure that the knowledge gained through health care research is translated into measurable improvements. Four gaps in particular need to be addressed:
- The gap between current knowledge and current practice in health care.
- The gap between the evidence available now and the evidence still lacking in order to improve care in the future.
- The gap between the questions confronting health care decisionmakers and the information they now have available.
- The gap between minority populations and whites in access to health care services and the quality and outcomes of care.
To address these gaps, in fiscal year 2000, AHRQ will fund research in three priority areas:
- New research on priority health issues. This includes the identification of conditions with national significance and a commitment of sufficient funds to achieve significant advancements in each area in the next 3 to 5 years, as well as a coordinating strategy to link researchers with those who will use the findings to facilitate rapid adoption of findings.
- New tools and talent for a new century. This includes the development of tools that will enable AHRQ to close the information gaps that interfere with effective decisionmaking at all levels of the health care system. To this end, AHRQ will work in partnership with decisionmakers to craft a system of sentinel indicators and an "early warning system" that can be used to track and understand changes in quality at the national, State, and community levels.
- Translating research into practice. Building on a 10-year foundation of health care research, AHRQ will identify goals for improvement in all areas of health care, establish public-private partnerships, support practice networks, and fund demonstration grants to systematically test strategies for implementing findings.
Of AHRQ's $205 million fiscal year 2000 budget, $5 million is specifically designated for research in the area of bioterrorism. More specifically, Congress has instructed AHRQ to support and conduct research on rapid response systems and the most effective clinical interventions to treat patients who have been exposed to chemical and biological agents.
You will be hearing more over the next few months about the new initiatives outlined in AHRQ's reauthorization legislation and in the Agency's fiscal year 2000 budget. Many of you have been AHCPR grantees. You have helped to build an agency that is well prepared to take on the challenges and the opportunities facing the Agency for Healthcare Research and Quality. AHRQ will continue to work in partnership with you to facilitate improvements in health care quality through research.
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