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Performance Budget Submission for Congressional Justification

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Fiscal Year 2000 Budget Policy

Funding Mechanisms and Research Approach

AHCPR's fiscal year 2000 budget request of $206,255,000 reflects an increase of $35,200,000, or 20 percent, over the fiscal year 1999 President's Budget. The request provides a significant increase in our investment to close the gap between what we know and what we do in health care. To accomplish this goal, AHCPR will make increased use of mechanisms rarely employed previously. For instance, the request includes nine program project grants (P01) at an average cost of approximately $1,000,000. AHCPR's previous use of program project grants was confined mainly to our Patient Outcomes Research Team (PORT) projects focused on identifying gaps in health care for common, costly conditions. Now we will fund program project grants to close these gaps. This mechanism will allow us to direct research toward a range of problems having a central research focus, in contrast to the usually narrower focus of the traditional research project grant. The request also supports 19 demonstration projects (U18, U54, U88) at an average cost of approximately $500,000. These projects will allow us, by means of carefully designed interventions that can be evaluated, to speed the transfer and application of techniques derived from previous research to improve the quality and outcomes of health care.

The use of program project grants and demonstration projects represents a shift not only in the mechanisms AHCPR uses to fund grants, but in our approach to health care research. By acknowledging the need to promote the adoption and use of research findings into daily practice, AHCPR has shifted to a quantifiable, results-focused research orientation. This shift in research orientation comes at a price—program project grants and major demonstration are costly to implement and require a steady source of funding, but the benefits that will accrue in cost effectiveness and improved quality of care justify this investment.

The fiscal year 2000 request also includes $13,500,000 for new investigator-initiated grants. While these grants will also support research in each of the fiscal year 2000 request priority areas, the nature of investigator-initiated research will tend to yield studies that are more methodologic in focus, exploratory, and basic in nature. These types of studies begin to build the foundation for investments 3 to 5 years from now. As such, they represent the Agency's "down payment" for future advances upon which the applied research of the 21st century will be built. These grants will be submitted in response to Program Announcements (PAs) or Requests for Applications (RFAs) and therefore will be less directed than most of the research supported through the three priority areas. Exactly how much of the $13.5 million will be spent in each of the three priority areas cannot be predicted because it will depend on the ingenuity and rigor of the scientists applying and the results of peer review. However, we expect the studies submitted to be in response to the Agency's updated Health Services Research Program Announcement, published in March 1998. This announcement closely mirrored the Agency's Strategic Plan which also served as the driving force for the fiscal year 2000 request. That PA expresses AHCPR's priority interests in research, demonstration, dissemination, and evaluation projects to:

  • Support improvements in health outcomes.
  • Strengthen quality measurement and improvement.>
  • Identify strategies to improve access, foster appropriate use, and reduce unnecessary expenditures.

The fiscal year 2000 request continues AHCPR's policy of working in partnership with other Federal entities as well as private organizations to leverage resources and, often more importantly, to promote rapid implementation of our research results. We will initiate new partnerships as well as continue to work with Federal partners such as the Health Care Financing Administration, the Office of Personnel Management, the Veterans Administration, and the Department of Defense as well as individual States; with private organizations such as the National Committee for Quality Assurance (NCQA), the Foundation for Accountability (FACCT), and the Joint Commission on the Accreditation of Health Care Organizations (JCAHO); and with health plans, provider organizations, purchasers, professional societies and practice networks.

AHCPR will continue to build capacity for health care research through its research training programs. These awards will be used to continue to develop scientists, committed to health care research, in need of basic and advanced training as well as additional experience. The fiscal year 2000 request includes support for:

  • Small Grants.
  • Institutional Incentive Awards.
  • Career Development Awards.
  • Dissertation Grants.
  • Minority Access to Research Careers (MARC).
  • National Research Service Awards. (1)

(1) AHCPR administers the National Research Service Awards using 1 percent funds appropriated to the National Institutes of Health.

Summary of Fiscal Year 2000 Request

The fiscal year 2000 request totals $206,255,000, an increase of $35,200,000 over the fiscal year 1999 President's Budget:

Budget Authority ................................ $ 26,667,000
1-percent Evaluation Funds..................... 179,588,000
Total, Program Level...............................$206,255,000

The request fully funds commitments, provides $13,500,000 for new investigator initiative projects, and supports the following major priorities :

New Research on Priority Health Issues: $10.055 Million

Item Cost
Improving health outcomes and health care research on vulnerable populations (minorities, chronically ill and elderly, children, women) $3.500 million
Assessing the outcomes, effectiveness, and cost-effectiveness of clinical treatment programs for domestic violence victims 1.000 million
Cross-cutting research in clinical preventive services 1.000 million
Pharmaceuticals research 2.000 million
Evaluating the impact of managed care 2.205 million
Research management 0.350 million

New Tools and Talent for a New Century: $13.200 Million

Item Cost
Develop databases and research tools for decisionmaking
--Monitor quality of care by strengthening national tracking capacity of MEPS ($7.000)
--Redesign and enrich HCUP, enhancing its power to inform State and community policymakers ($1.500)
$8.500 million
Build the toolbox to improve the health care system 2.850 million
Nurture next generation of health services researchers 1.500 million
Research management 0.350 million

Translating Research Into Practice: $13.500 Million

Item Cost
Identifying aims for improvement No cost
Establish public-private partnerships and practice networks $2.500 million
Fund experiments that test the effectiveness of improvement approaches 9.500 million
Measure the success of these strategies and promote broader implementation 1.200 million
Research management 0.300 million

This request also provides $29,000,000 for continued funding for the Medical Expenditure Panel Survey (MEPS). In addition, the fiscal year 2000 request includes:

Contributions to Secretarial Initiatives
(integrated in funding above)

Item Cost
HHS Race and Health Disparities ($10.150 million)
Long-term Care ($ 1.500 million)
Chronic Disease and Prevention ($ 9.000 million)
Violence Against Women ($ 1.080 million)

Current as of February 1999


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