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Performance Budget Submission for Congressional Justification

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FY 2004: Research on Health Care Costs, Quality and Outcomes (HCQO) (continued)

2. Non-MEPS Research Contracts and IAAs (+$13,576,000)

The FY 2004 request provides an increase of $10,576,000 for patient safety research contracts and IAAs over the FY 2003 President's budget level of $15,164,000. In the FY 2004 request, expiring patient safety grant commitments of $9,140,000, expiring patient safety supplements of $1,436,000, and $1,424,000 in expiring patient safety contracts will finance $12,000,000 in new patient safety activities. These new patient safety contracts will be directed to improving patient care and safety through the use of technology.

The FY 2004 request for non-patient safety contracts and IAAs is increased by $3,000,000 from the FY 2003 President's budget of $35,740,000. The $3,000,000 will be directed to performance-based improvements for HCUP and CAHPS®. For other contracts, the FY 2004 request is maintained at the FY 2003 President's budget level.

Patient Safety Contracts and IAAs: Realizing the Possibilities of 21st Century Health Care—Improving patient care and safety through the use of technology (+$12,000,000)

This initiative will focus on the following two areas:

  • Accelerate the Adoption and Use of Information Standards and Technology to Support Health Care Quality and Patient Safety.
  • Demonstrating Health Information Technology to Improve Patient Safety Across Settings.

Accelerate the Adoption and Use of Information Standards and Technology to Support Health Care Quality and Patient Safety. A consensus has emerged that a major obstacle to the development and use of health information systems to support quality improvements and patient safety is the lack of clinical messaging and terminology standards that support interoperability. Progress is occurring as a result of several efforts, including the recommendations of the National Committee on Vital and Health Statistics, Federal inter-agency efforts such as the CHI Working Group, and the activities of voluntary industry standards development organizations, but significant advances on a broad scale are unlikely without dedicated federal resources, leadership and coordination.

Under the leadership auspices of the Office of the Secretary, this initiative will be coordinated with related, ongoing data policy efforts in HHS and will involve a variety of priority projects and activities designed to accelerate the adoption and use of information standards and technology to support health care quality and patient safety, including support for:

  1. The development, evaluation, adoption and maintenance of voluntary industry clinical messaging and terminology standards in the United States.
  2. The development, refinement, maintenance and evaluation of a national standard nomenclature for drugs and biological products.
  3. The acquisition or development and maintenance of a comprehensive clinical terminology and nomenclature standard.
  4. Related research, development and evaluation activities to advance and accelerate the adoption of interoperable information technology in health care.

Demonstrating and Applying Health Information Technology to Improve Patient Safety Across Settings. AHRQ will also utilize its new Patient Safety Improvement Corps, experts working with State health departments to expand State and local capacity to use existing knowledge to identify and eliminate threats to patient safety, to specifically apply IT for patient safety improvement.

Non-Patient Safety Contracts and IAAs

The FY 2004 request for non-patient safety contracts and IAAs is increased by $3,000,000 from the FY 2003 President's budget of $35,740,000. The $3,000,000 will be directed to performance-based improvements for HCUP and CAHPS®. Funds will be directed to improve weaknesses cited in the Office of Management and Budget's (OMB) Performance Assessment and Review and to help achieve the ambitious outcome goals developed for the PART reviews of data collection and dissemination efforts. A summary of the PART assessment is provided on page 77. For other contracts, the FY 2004 request is maintained at the FY 2003 President's budget level.

CAHPS®. AHRQ requests $1,000,000 to address two areas OMB has suggested need attention: a program impact evaluation and technical assistance.

Program Impact Evaluation. Since its inception in l997, the CAHPS® project has consistently used public comment and outside expert review to shape the program's development, develop, test, and revise products, and make recommendations regarding the program's direction. There is a need to assess the impact of the program from the perspective of a variety of audiences: consumers, health care providers, and purchasers. Award funds would be used to conduct such an evaluation via a contract with an outside organization experienced in the area of impact evaluation. The final analysis of the evaluation data will be useful in identifying areas of strength, as well as those project components that might need to be revised and/or terminated. Maintenance of this impact evaluation effort could be built into the scope of work for the Survey User Network (SUN) contract, a 5-year contract, currently held by Westat, which provides support and technical assistance to CAHPS®users, including the CAHPS®II grantees.

Technical Assistance. Funds would also be used to enhance the services currently provided by the Survey Users Network (SUN), including the work that will be necessary to formalize the program impact evaluation. Technical assistance needs are expected to increase substantially in FY 2004 due to a new Hospital CAHPS® initiative and will require the development and dissemination of new products for new sets of audiences, including hospitals and ambulatory care services. These functions will have substantial resource and staffing implications for the support contractor.

HCUP. By 2010, AHRQ has committed to achieving five outcomes goals for its HCUP and HCUP Quality Indicators (QI) programs. Specifically, at least five organizations will use HCUP databases, products, or tools to improve health care quality for their constituencies by 5 percent as defined by the AHRQ Quality Indicators (e.g., 5 percent reduction in preventable hospitalizations, complication rates, or mortality rates; 5 percent increase in use of superior technology). To help achieve this ambitious goal, $2 million is requested in FY 2004 investments to improve availability of the data itself, make it more usable, and facilitate effective use.

Expand and Improve Outpatient Data. Standardized, sophisticated emergency department and other outpatient data collections are precursors to assessing, benchmarking and ultimately improving the quality of health care in these settings. Fewer than half of the states collect statewide emergency department data, and collection of data from most other outpatient data sites is very rare. In FY 2004, the HCUP program will expand and improve this data through several strategies such as organizing workshops for state data organizations, providing technical assistance, and developing and disseminating best practice models for states to use in standardizing, expanding and improving these data.

Make HCUP Data and Quality Indicators (QI) More Usable. Hospitals, States, employers, community groups and others who seek to make quality improvement efforts generally do not have the research staff or analytic capacity to work with raw data and measures. Under this initiative, in 2004, AHRQ will make both the data and the quality measures more usable:

  • For the HCUP data, AHRQ will create user-friendly software programs, templates, and analytic tools that States, employers, community groups and others can use to translate HCUP data into meaningful, actionable information. For example, AHRQ will develop software and templates for briefs analyzing HCUP data by clinical diagnosis, by geographic area, by special population, by race, etc.
  • For the QIs, AHRQ will act on suggestions from the early wave of QI users, and incorporate technical enhancements to make the QI software more user-friendly. For example, AHRQ will provide benchmarks for different categories of hospital user groups and payer groups so that key user groups more readily can see how their own performance compares to that of their relevant peer group. AHRQ also will develop hospital report card templates to guide how the QIs are communicated to the public at large as well as to special populations such as the elderly. In addition, AHRQ will develop user friendly software as a companion to the set of QI indicators to facilitate increased use of QIs so that users will no longer be required to purchase SPSS or SAS software as currently is the case.

Facilitate Effective Use through Technical Assistance and Outreach. To achieve these quality improvement goals, stakeholders must not only use the HCUP data and Quality Indicators, but use them well and effectively. To this end, the QI program will increase technical assistance to a targeted group of critical QI users, particularly hospitals, state health departments and activist employers. AHRQ will convene series of national and regional workshops for QI users and potential QI users to identify and address implementation issues, instruct on QI use, and take first steps in setting the stage for the 2010 impacts.

3. Research Management (No Change)

The FY 2004 request for research management is maintained at the FY 2003 President's budget level.

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