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Performance Plans for FY 2004 and 2005 and Performance Report for FY 2003

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Agency for Healthcare Research and Quality


Mission Statement

The Agency's mission is to improve the outcomes and quality of health care services, reduce its costs, address patient safety, and broaden access to effective services, through:

  • The establishment of a broad base of scientific research.
  • The promotion of improvements in clinical and health system practices, including the prevention of diseases and other health conditions.

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.

Summary of Measures

Table 3 summarizes measures back to the FY 2000 report.

Narrative Description of Layout of Report

The report is laid out according to the guidance provided by the Department. In the Discussion and Performance Analysis section, the report divides portfolio measures with supporting text among the budget lines. Select Table 4 for the structure.

Contribution to:

President's Management Agenda—Symbol = PMA
We now devote a portfolio—Organizational Excellence—to our efforts to meet the requirements of the President's Management Agenda. As you will see in our performance measures, we are making every effort to meet the requirement to "get to green" in each initiative.

HHS Strategic Plan—Symbol = SG
AHRQ funded programs that support our portfolios of work and strategic goal areas clearly align with the HHS Strategic Plan. The Appendix Table displays that alignment. We also reflect the specific alignment of our measures in the performance analysis section of this document.

Healthy People 2010—Symbol = HP
Our portfolios and strategic goal areas also align with Healthy People 2010, as portrayed in the performance analysis section.

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Discussion and Performance Analysis: Budget Line 2.1. Research on Health Care Cost, Quality and Outcome (HCQO)

HCQO Program Description and Context

FY 2003 Enacted FY 2004 Final Conference FY 2005 Request
$252,663,000 $245,695,000 $245,695,000
Full Costa
$254,900,000 $247,900,000 $247,900,000

a. Full cost funding includes a distribution of the program support budget activity.

HCQO Performance Analysis

Quality/Safety of Patient Care Portfolio

Reauthorization language in December 1999 states that the Director of AHRQ shall conduct and support research and build private-public partnerships to identify the causes of preventable health care errors and patient injury in health care delivery; develop, demonstrate, and evaluate strategies for reducing errors and improving patient safety; and disseminate such effective strategies throughout the health care industry. In response, AHRQ established the Center for Quality Improvement and Patient Safety (CQuIPS), concentrating in one organizational unit the responsibility for planning, managing, and directing its patient safety initiative and addressing each of Congress' concerns.

AHRQ has successfully used existing research structures and networks to implement patient safety research, has supported the development of new networks, and funds the world's largest patient safety research initiative. AHRQ supports a small but growing network of researchers whose primary interest is patient safety, and its training grants are expanding that foundation. AHRQ is also helping to develop the evidence-base for safe practices that organizations can use to eliminate or reduce the risk of injury from health care. AHRQ is also supporting health care organizations as they assess threats to patient safety and identify and implement interventions to improve the safe delivery of health care. Additionally, AHRQ is providing short-term, practical training to assist States in their efforts to improve patient safety through the analysis of reported patient safety events and the development of suitable interventions. Furthermore, AHRQ has established a successful and active working relationship with a growing international network of patient safety researchers and program personnel.

Our longer term view is to continue to shift an increased proportion of research from new development to adoption of effective patient safety practices. We are also investing in the development and implementation of information technology solutions to improve patient safety. In addition, we will shift the focus of our patient safety database activities from development of the databases to the creation of baselines from which to measure annual and long-term success.

Select to access Table 5 for performance analysis of the Quality/Safety of Patient Care Portfolio.

Informatics Portfolio

Despite promises of reduced costs and improved quality, physicians, hospitals and other health care facilities have lagged behind other industries in their adoption of information technologies (IT). Among other factors, the implementation of health care information technologies has been hindered by payment systems that fail to reward information technology investments and associated quality improvements, the fragmentation of the health care industry, the absence of industry standards, resistance by clinicians to change practice patterns, the failure of many technology companies to perform at promised levels and appreciable upfront IT investment costs.

There are however a number of encouraging signs. Pressure on providers to comply with new federal regulations and to invest in, e.g., computerized prescription order entry (CPOE) systems in response to State legislative mandates and employer initiatives should result in broader adoption of technologies that improve patient safety and health care industry efficiency. Studies of providers' successes integrating clinical IT into their practices and analyses of emerging Internet disease management and other applications should also bring the health care industry closer to an understanding of IT's benefits.

To encourage the health care industry's progress, health services research is needed to understand both the factors that influence adoption of emerging health care information technologies among various types of providers and health care systems as well as the costs and organizational and system challenges associated with implementing new applications. Most generally, the Agency is therefore working to understand better IT application in the health care delivery setting as well as uptake and performance trends related to health care providers' use of emerging information technology.

Select to access Table 6 for performance analysis of the Informatics Portfolio.

Data Development Portfolio
Health Care Utilization Program (HCUP)

HCUP is a Federal-State-industry partnership to build a standardized, multi-State health data system. This long-standing collaborative endeavor has built and continues to develop and expand a family of databases and powerful, user-friendly software to enhance the use of administrative data.

The HCUP family of databases currently includes:

HCUP includes data on hospital discharges from participating States, as well as a nationwide sample of discharges from community hospitals. AHRQ has expanded HCUP beyond inpatient hospital settings to include hospital-based ambulatory surgical facilities, and a pilot effort is underway to capture information from emergency department databases.

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, charges incurred for hospital stays, and resulting outcomes.

AHRQ has made available the second Kids' Inpatient Database (KID), the Nation's first comprehensive database on hospital use, charges, and outcomes focused exclusively on children and adolescents. The KID contains 1.9 million pediatric discharges representing 6.7 million pediatric discharges nationwide and data on various hospital characteristics such as region, location (urban/rural), bed size, ownership, teaching status, and children's hospital status.

The Nationwide Inpatient Sample (NIS) is the largest all-payer inpatient database in the United States. It provides information on about 7 million inpatient discharges from about 1,000 hospitals, including data from 1988 to 2000. According to NIS data:

  • About 135,000 hospital stays a year for treatment of depression, and alcohol- and substance-related mental disorders are not covered by either private insurance or public insurance programs such as Medicare and Medicaid
  • Childbirth is the leading type of hospital care not covered by private or public insurance. About 5 percent of all hospitalizations for childbirth-roughly 191,000 hospital stays a year-are uninsured.
  • Two chronic diseases, which if appropriately treated in primary care practices do not ordinarily result in hospitalization, also are among the top 10 types of uninsured inpatient care-asthma and diabetes. Together they account for 65,000 hospital admissions a year.

The AHRQ Quality Indicators (QIs), developed using HCUP data, are a set of quality measurement software tools that can be used with HCUP data and other inpatient administrative data to highlight potential quality concerns, identify areas that need further investigation, and track changes over time. Users include providers, purchasers, policymakers, researchers and others at the Federal, State and local levels. The software is available free on the AHRQ Web site), and includes three modules:

  1. Prevention Quality Indicators (PQIs)—or ambulatory care sensitive conditions—identify hospital admissions that evidence suggests could have been avoided, at least in part, through high-quality outpatient care.
  2. Inpatient Quality Indicators (IQIs) reflect quality of care inside hospitals and include:
    • Inpatient mortality for medical conditions.
    • Inpatient mortality for procedures.
    • Utilization of procedures for which there are questions of overuse, underuse, or misuse.
    • Volume of procedures for which there is evidence that a higher volume of procedures is associated with lower mortality.
  3. Patient Safety Indicators (PSIs) also reflect quality of care inside hospitals, but focus on surgical complications and other iatrogenic events.

The AHRQ QIs are being used by a variety of providers, purchasers, and State agencies as an integral part of quality improvement programs. For example, the Healthcare Association of New York State (HANYS), which represents more than 500 nonprofit and public hospitals, long-term care facilities, and home health agencies, has adapted AHRQ's QIs to produce annual reports for its member hospitals to help them target areas for improving quality of care and efficiency. Other users include purchasers, such as the Niagara Health Coalition, an organization that is using the IQI software to generate comparative data and reports for all hospitals in the State of New York. State agencies, such as the Texas Healthcare Information Council (THCIC), also are using the QIs to create comparative data and reports for all hospitals in the State of Texas.

Consumer Assessment of Health Plans (CAHPS®)

CAHPS® is an easy-to-use kit of survey and reporting tools that provides reliable information to help consumers and purchasers assess and choose among health plans, providers, hospitals and other health facilities. Since its beginning in 1995, the CAHPS® team has produced survey and reporting products for:

  • Commercial populations (managed care and fee for service plans).
  • Medicare recipients (managed care, fee for service and disenrollees from plans.
  • Children with special health care needs.
  • State Medicaid programs.

CAHPS® will also allow health plans and purchasers to assess and track areas for quality improvement. Information from CAHPS® surveys was available to help more than 123 million Americans with their 2003 health care benefits decisions.

The CAHPS® team and AHRQ work closely with the health care industry and consumers to ensure that the CAHPS® tools are useful to both individual consumers and to employers and other institutional purchasers of health plans. Collaborations include the following:

  • In the past couple of years, the CAHPS® team had worked together with the California Health Care Foundation and the Pacific Business Group on Health to develop and test a version of CAHPS® through which consumers could rate the care they receive via physicians in group practice. We are currently developing a version of CAHPS® through which individuals can assess care received from individual providers. We are considering development of an instrument that combines questions about providers, group practices and health plans in order to reduce burden (cost and respondent fatigue).
  • AHRQ and CMS are collaborating in the development of a CAHPS® survey to obtain consumers' assessments of health care and services received in nursing homes. Survey development and sampling and data collection procedures were completed in FY 2002. The remaining part of this project is for the CAHPS® team to prepare an OMB clearance package which will happen within the next few months. CMS has not indicated that they want the CAHPS® team to field test this survey so we will stop work after the FY 2002. For this reason, we are unable to complete the projected FY 2004 goal, "Establish a baseline for number of consumers using Nursing Home CAHPS®."
  • In 2002, CMS requested that the CAHPS® team develop and test an instrument through which patients can assess the care they receive in hospitals. Since this standardized tool enables hospital-to-hospital comparisons using the same criteria, CMS plans to publish the results on their Web site to assist people in selecting a high-quality hospital. As of June 2003, the CAHPS® team has developed and cognitively tested a draft survey, sought input about the survey from various stakeholder groups (hospitals, data collection vendors and others) and incorporated changes in the instrument based on feedback from these groups. The instrument is now undergoing pilot testing in three States (New York, Arizona and Maryland). The CAHPS® team is also beginning to develop and test both text and data displays to be disseminated via CMS's "Medicare Compare" Web site.
  • In 2002, the CAHPS® team, in collaboration with the National Institute on Disability and Rehabilitation Research (NIDRR), the Centers for Disease Control and Prevention, and the National Rehabilitation Hospital Center for Health and Disability Research, began development for a version of CAHPS® to assess care given to people with mobility impairments (PWMI). We have clarified goals for this effort, specified the target audience and spelled out uses for the resulting data. Thus far, we have developed a draft screener through which to identify members of the target population and are searching for sources of data through which to test it. We are also beginning to identify content to guide development of items for the questionnaire itself.
  • At the request of CMS, the CAHPS® team is also working on a questionnaire through which patients with end stage renal disease (ESRD) can rate the facilities through which they receive dialysis.

Select to access Table 7 for performance analysis of the Data Development Portfolio.

Chronic Care Management Portfolio

In AHRQ's 1999 reauthorization legislation (PL 106-129), Congress directed that the Agency produce, on behalf of HHS, an annual report on the state of the Nation's health care quality, beginning in 2003. This first report provides a general picture of the state of health care quality for the entire country. It focuses on a select set of national priority conditions, attached to a limited set of core measures supported by a broad consensus among key stakeholders, and uses data collected at the national and State level from a variety of publicly accessible sources to track those conditions. In so doing, it synthesizes the overwhelming amount of health care quality information regularly reported by the media for policymakers, providers and consumers, consolidating diverse information in one place.

The congressional mandate to produce the National Healthcare Quality Report (NHQR) specified neither which conditions should be included in the report, nor how those conditions should be identified. The AHRQ contracted with the IOM (Institute of Medicine) to create a conceptual framework that would guide the identification and selection of priority conditions. The IOM framework consists of a matrix with the columns as dimensions of care (effectiveness, safety, timeliness, patient centeredness and equity) and the rows as patient needs (staying healthy, getting better, living with illness or disability, and coping with the end of life). AHRQ formed an Interagency Workgroup to populate the framework with priority conditions and with measures of quality for those conditions. The basis for priority conditions in the first NHQR is Healthy People 2010 and include: cancer, chronic kidney disease, diabetes, heart disease, HIV/AIDS, maternal and child health, mental illness-depression, respiratory disease, nursing home and home health.

Select to access Table 8 for performance analysis of the Chronic Care Management Portfolio.

Prevention Portfolio

Clinical prevention is the focus of the Agency's disease prevention research portfolio. Namely, those preventions interventions and services provided in a clinical setting between physician and patient, such as screening tests and/or counseling. AHRQ's clinical prevention program is based primarily on the activities of the U.S. Preventive Services Task Force and its implementation arm, the Put Prevention Into Practice (PPIP) program. The Task Force is an independent panel of private-sector experts in prevention and primary care. It conducts rigorous scientific assessments of the effectiveness of a broad range of clinical preventive services, including screening tests, chemoprevention, immunizations, and counseling. The PPIP program targets providers and patients using tools and resources that enable doctors and other health care professionals to determine what preventive services patients should receive as well as enable patients to more easily understand and keep track of their preventive care.

Select to access Table 9 for performance analysis of the Prevention Portfolio.

Bioterrorism Portfolio

Through its requests from other HHS agencies, AHRQ supports research in assessing and improving the U.S. health care system's capacity to respond to possible incidents of bioterrorism. These research projects examine an array of issues related to clinicians, hospitals, and health care systems, as well as linkages among these providers, local and State public health departments, emergency responders, and others preparing to respond to terrorist events and other public health emergencies. A third of the projects support regional planning and surge capacity issues. This work is an essential component to CDC and HRSA investments.

Select to access Table 10 for performance analysis of the Bioterrorism Portfolio.

Socio-economics of Health Care Portfolio

The program on financing, access, cost and coverage conducts, supports and manages studies of the cost and financing of health care, the access to health care services and related trends. These studies and data development activities are designed to provide health care leaders and policymakers with the information and tools they need to improve decisions on health care financing, access, coverage and cost. The program is responsible for understanding the dynamics of consumer, employer, and provider behavior as well as the factors underlying trends in the areas of health care costs, use and access.

To fulfill this mission, the program conducts and sponsors descriptive and behavioral analyses of the U.S. health care system including the population's access to, use of, and expenditures and sources of payment for health care; the availability and costs of private health insurance in the employment-related and non-group markets; the population enrolled in public health insurance coverage and those without health care coverage; and the role of health status in health care use, expenditures, and household decision making, and in health insurance and employment choices. Much of this research is informed by the development of analytical databases from MEPS. In addition, the program conducts and sponsors research and the development of models and data bases to support micro-simulation analyses of the impact on individuals and households of current and proposed changes in health care policy. Analyses focus on the impacts of health policies embodied in current law and on health care policies embodied in generic versions of proposed reforms. The end goal of the program is to provide health care leaders and policymakers with the information and tools they need to improve the health care system by improving their decisions on issues related to health care financing, access, coverage, and cost.

The program on delivery/organization/markets conducts, supports and manages studies designed to give health care leaders and policymakers the information and tools they need to improve health system performance. Performance in this context includes quality, safety, effectiveness, and efficiency. Through qualitative and quantitative research, delivery-based research networks and other partnerships, this program provides system and policy leaders with evidence on how changes in health care delivery affect performance across acute, community-based and long-term care settings. Delivery and organizational variables of special interest include structure, function, workforce, leadership, governance and culture. The mission of this program extends to capture how market forces such as payment methods, financial and non-financial incentives, funding of safety net providers, employer purchasing strategies, regulations, legislation and judicial actions and other aspects of the competitive environment influence health care delivery, organization, and ultimately provider performance. The end goal of this program is to improve healthcare by advancing the use of evidence by health care leaders and policymakers.

Select to access Table 11 for performance analysis of the Socio-economics of Health Care Portfolio.

Pharmaceutical Outcomes Portfolio

The Pharmaceutical Outcomes portfolio has three components:

  • The Centers for Education and Research on Therapeutics (CERTs).
  • The pharmaceutical outcomes research projects (all projects are complete).
  • Projects funded through investigator-initiated research and other AHRQ mechanisms.

There are other pharmaceutical studies funded by AHRQ that are included in the Patient Safety Portfolio rather than in this portfolio.

CERTs is a Federal initiative, originally authorized in the Food and Drug Modernization Act of 1997. The central objective of the CERTs initiative is to develop new and effective ways to improve the use of health care therapeutics throughout the Nation's health care system. Therapeutics includes drugs, biologics, and devices. The initiative combines support of basic health care research at research institutions (the centers) with concerted efforts to inform clinical practitioners and policymakers about the latest advances in therapeutics-related research.

The CERTs was authorized as a demonstration program, so the program does not provide comprehensive coverage of research to improve safety and effectiveness. Instead, CERTs has been designed as a prototype for a more comprehensive program to be funded when resources are available.


Medication errors account for a significant and prominent aspect of patient safety issues and medication errors are represented in both the Patient Safety and Pharmaceutical Outcomes Portfolios. The Patient Safety Portfolio stresses errors of commission, whereas the Pharmaceutical Outcomes Portfolio covers both errors of commission and omission. The CERTs is viewed in the same context as the Centers of Excellence in Patient Safety. Two of the CERTs research centers have large Patient Safety grants with overlap between the two portfolios.

Goal: Develop knowledge and understanding of errors in health care by developing a patient safety research agenda specific to medications. This would be done in partnership with the CQUIPs program and the Investigators from the projects within the Patient Safety Portfolio that have a focus on medication. The focus of this agenda would be identification of areas of overlap and ascertainment of gaps in medication error research.

The Patient Safety program, the Institute of Medicine, the CERTs and others focus considerable resources on inappropriate and product overuse. The Pharmaceutical Outcomes projects and the CERTs have done a number of studies and tested programs that have focused on under use of products. Such studies have included studies of beta-blocker use in patients who have been discharged after myocardial infarction (heart attack). Neither AHRQ nor the CERTs have been able to systematically quantify the clinical and economic impact of under use.

Goal: Convene a multi-disciplinary group of experts in clinical medicine, epidemiology, economics and policy to assist us in identifying methods to determine how to measure under use and its cost and clinical consequences.


The appropriate use of pharmaceutical agents is critical to effective, high quality, affordable health care. Understanding which agents work, for which patients, and at what cost, can inform programs to manage the selection, utilization, and cost of pharmaceutical therapies and services within a changing health care environment. This information is often not available for pharmaceuticals because the Food and Drug Administration (FDA) approval process requires pharmaceutical manufacturers to provide only evidence of safety and efficacy for one indication within rigidly controlled clinical trials.

CERTs and other pharmaceutical projects cover only a small portion of the potential universe of important questions of therapeutic effectiveness.

Goal: Develop a plan that identifies gaps in pharmaceutical effectiveness research and opportunities for implementation of evidence-based pharmaceutical usage. Using this information, develop a mechanism to increase the number of CERTs such that there are an adequate number of CERTs centers to comprehensively approach high priority questions of drug effectiveness.


The 1999 AHRQ reauthorization specifically adds cost-effectiveness research to the list of responsibilities for the CERTs. Each CERTs center will incorporate measures of cost effectiveness into Core (defined as those funded completely or in part through AHRQ funding) projects where feasible.

Goal: Expand the component programs of pharmaceutical outcomes research. Program staff will work with the CERTs Coordinating Center to identify the economic component of the CERTs. This information will be consolidated into a Program Note. We will coordinate with the AHRQ Research Initiative on Cost Effectiveness (RICE) program to develop a dissemination plan for this information.

Select to access Table 12 for performance analysis of the Pharmaceutical Outcomes Portfolio.

Training Portfolio

AHRQ activities encompass research capacity development both at the individual and institutional level. The intent of these activities is to develop, broaden and diversify the talent pool conducting health services research. Prime focus is placed on ensuring that the cadre of researchers and institutions conducting research are responsive to gauging changes in the delivery of the health care system and responding to them in order to enhance quality, efficiency and effectiveness of health care and reduce patient errors. Ultimately, the success of these endeavors is to be measured in terms of developing productive researchers who in turn develop new knowledge that is ultimately translated or contributes to improvements in health delivery, policy or clinical care at the local, State, or national level.

In FY 2003, AHRQ continued its investment in the development of researchers through its National Research Service Award (NRSA) program, which supports the training of over 150 investigators annually, as well as through over 15 dissertation and 10 new career development awards. In addition, AHRQ continued to embark on its mission to increase the geographic and demographic diversity in the pool of researchers through its BRIC and M-RISP programs, which respectively are designed to broaden the National capacity to conduct health services research across a wide range of States and in traditionally minority serving institutions. Currently, these projects support research largely focusing on health care disparities issues in the following States: Kentucky, Louisiana, Mississippi, New Jersey, Utah, Idaho, Montana, Nevada, Utah, Alabama, Hawaii, Texas, Georgia, Tennessee, North Carolina, and the District of Columbia.

Multi-staged goals are set for all of the above activities, with immediate, short-term success measured in terms of "graduation"—i.e., students completing training and centers of excellence being established. Intermediate objectives focus on research productivity and visibility of AHRQ-supported initiatives, with the goal to achieve long-term sustainability of initial investments through institutionalizing programs and the ability of new emerging centers of excellence to achieve independence. Long-term aims of these initiatives are to generate new knowledge, methods, and tools which are translated into improvements in clinical care, health care system delivery and health care policy at the local, State, regional or national levels.

Select to access Table 13 for performance analysis of the Training Portfolio.

Long-term Care Portfolio

Persons who need assistance with basic activities of daily living, homemaker activities and other normal role activities (e.g., work, school) comprise the long-term care (LTC) population. This population lives both in the community and in residential settings. Long-term care services are diverse; some of the most important include institutional/residential care, home care, personal assistance services, supportive housing, assistive technologies, services to promote education for children with special needs, services to foster employment for the disabled, rehabilitation and transportation services, and other associated health care services. These services are provided by agencies, family and friends, and institutions, and are paid and unpaid. There are many gaps in our knowledge about this population and the services received.

AHRQ has a long-standing role in supporting and conducting research to improve long-term care for the elderly, chronically ill and disabled. The goal of this research is to better understand how to foster independence, prevent unnecessary disability, provide services more efficiently, and improve the quality of care and the quality of life. In addition, this research identifies effective ways to integrate LTC and acute care services, assure patient safety, develop tools to improve quality of care, and reduce disparities in the delivery of long-term care.

The Agency's long-term care portfolio of grants and contracts are divided into four substantive areas: safety, quality, effectiveness, and efficiency. About half of the grants in the LTC portfolio are concerned with quality issues. The remaining grants are evenly divided into the other three categories.


Safety is a major concern for the elderly and especially persons in residential settings such as assisted living and nursing homes. It is also a concern for the staff in these facilities. The Agency funds conferences and provides funding to initiate centers to focus on safety issues in long-term care and supports research to improve technology. One study will test whether a computer-based clinical decision support system can lower the rate of adverse drug events (ADEs) and potential ADEs in the long-term care setting. A new center on patient safety in long-term care at Emory University in Atlanta, GA, will tell us how we can prevent falls and pressure ulcers in nursing homes and assisted living facilities. A center at New York University is focusing on safety in home care and a new center at the University of South Florida will tell us how to prevent falls for persons in the community. A study by AHRQ staff suggests that fractures in nursing homes can be prevented with increased aide staffing and adjustments to drug prescribing practices.

There are many quality concerns in the provision of long-term care services and caregiving. For example, a University of Colorado study will tell us the how well report cards and other varied information strategies help consumers make nursing home choices based on quality. Another study is developing quality indicators for comparing and tracking the quality of assisted living facilities. Other studies develop a nurse restorative care program for residential care; interventions to improve staff motivation, job design, work environment in nursing homes; improve assessment of pain and mobility in nursing homes; use electronic reminders to improve adherence to evidence based guidelines in home care; use a clinical algorithm to manage urinary tract infections and reduce antibiotic use in residential facilities; and evaluate the use of nurse practitioners to improve urinary incontinence care in nursing homes.

In addition, the Agency is encouraging building partnerships between healthcare organizations. Helping home care agencies collaborate on evidence-based quality improvement activities is one example. Two of these partnerships are implementing improvements in clinical information in a number of nursing homes to improve pressure ulcer care and increase the use of nursing home care guidelines for pain and pressure ulcers.


Another important part of the long-term care portfolio includes studies that assess the effectiveness of care. Generally, long-term care studies focus on outcomes such as the change in functioning, re-hospitalizations, and mortality. Some studies directly evaluate outcomes associated with interventions while others attempt to better understand the variation in outcomes associated with different heath conditions. For example, a training grant is funding outcome studies of persons in Program of All Inclusive Care for the Elderly (PACE) settings. Other studies include an evaluation of a geriatric nurse practitioner intervention is attempting to reduce behavioral problems for Alzheimer's patients and caregiver stress; tracking functional outcomes after trauma for adolescents; and assessing the impact of Medicare prospective payment on survival, discharge to community, and use of rehabilitation services.


Another important area in the AHRQ long-term care portfolio concerns the efficiency of provision of care across the continuum of care. Long-term care recipients often move between home care or residential care and hospitals. The high cost of hospital care makes it an important target for cost reduction. Hospital studies include the development of a model to assess factors that increase hospital admission rates for nursing home residents and an evaluation of the reasons for variation in hospitalization rates for pneumonia patients in Evercare-affiliated nursing homes. Evercare is a prospective payment model with incentives to reduce hospital care. Other studies include an assessment of the overall health care use of persons in assisted living facilities, and a study of access to care, preventive services and specialists for disabled adults. A study by AHRQ staff indicates that the decline in Medicare funding of home care after the Balanced Budget Amendment has been accompanied by increases in State and local expenditures.

Data Development

Two data development activities within MEPS are underway that will increase the ability to report on populations and services currently not being captured.

The first is a multi-year collaboration across HHS Agencies that has begun to develop data collection methodologies for the population in assisted living facilities, a group for which no national measures exist. Development of an instrument that would be used to identify characteristics and quality concerns of the assisted living population would then follow.

The second data effort is a project to measure the costs associated with informal care as measured with the time spent in caregiving. Development of an instrument is underway to design methods to measure the economic costs associated with providing care to the long-term care population. With these measures alternative policy options for the efficient delivery of services could be assessed.

Select to access Table 14 for performance analysis of the Long-term Care Portfolio.

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