Skip Navigation Archive: U.S. Department of Health and Human Services U.S. Department of Health and Human Services
Archive: Agency for Healthcare Research Quality www.ahrq.gov
Archival print banner

This information is for reference purposes only. It was current when produced and may now be outdated. Archive material is no longer maintained, and some links may not work. Persons with disabilities having difficulty accessing this information should contact us at: https://info.ahrq.gov. Let us know the nature of the problem, the Web address of what you want, and your contact information.

Please go to www.ahrq.gov for current information.

Significant Items

Performance Budget Submission for Congressional Justification, Fiscal

This statement summarizes budget information submitted to Congress for fiscal year 2009 by the Agency for Healthcare Research and Quality (AHRQ).

Significant Items

 

FY 2008 House Report No. 110-231

Health Information Technology [Health IT] Strategic Plan

1. House (Rept. 110-231) p. 184

Within the total available, the Committee does not provide funding requested by the Administration for the new "network of networks"under the personalized health care initiative. The Committee is concerned that HHS has yet to develop a detailed, integrated, and coherent implementation plan for achieving health information technology strategic goals, as recommended by the General Accounting Office. The Committee includes report language within the Office of the National Coordinator for Health Information Technology that requests a report that identifies specific program objectives; details the timelines and performance benchmarks to achieve these objectives; and links specific initiatives and resources to these program objectives. The report also should include information on health information technology activities funded through AHRQ.
Action Taken or to be Taken:
AHRQ's Health IT portfolio supports the Agency's overall mission to improve the quality, safety, efficiency and effectiveness of health care through the informed use of Health IT. Prior to 2007, funding commitments had targeted hospitals, health information exchange and rural settings. Subsequently healthcare stakeholders described an increasing need for evidence development and dissemination on Health IT use in the ambulatory setting. In FY2007, the Health IT portfolio at AHRQ began the Ambulatory Safety and Quality Program (ASQ). The overall goals for this program address the broad topics of medication management, evidence-based care, patient centered care, and quality measurement. This program began to address these goals by soliciting and awarding funding to innovative projects developing robust Health IT capabilities and evidence of the subsequent impact on quality and safety. A significant achievement during this time was the delivery of a Report to Congress on standards for electronic prescribing, mandated by the Medicare Modernization Act and produced by AHRQ in collaboration with CMS [Centers for Medicare & Medicaid Services]. This Report has led to a proposed regulation, requiring the use of selected standards for Medicare beneficiaries, which enjoys widespread support from the health care community because of its solid foundation of evidence.
In 2008, AHRQ has continued the ASQ program and is developing funding opportunities to produce further evidence of the benefits and demonstrate effective use of Health IT, measure the impact of these projects and overall progress towards our long-range goals, and disseminate those findings to relevant stakeholders. We work in partnership with key public stakeholders, including the Office of the National Coordinator, CMS, HRSA [Health Resources and Services Administration], and DoD [Department of Defense], and private stakeholders including providers, patients, payers, purchasers, relevant experts and their representative organizations. In 2009, AHRQ will continue to pursue the goals of the ASQ program through projects which build upon the lessons of our previous work and iteratively assesses our progress.

Safe Patient Handling and Movement

2. House (Rept. 110-231) p. 184/185

The Committee is concerned about the consequences of manual patient lifting, transferring and movement in hospitals, nursing homes and other patient care settings that can be a detriment to quality patient care, including increased risk of injury to patients from being lifted and moved without assistive equipment and patient injuries including skin tears, skin ulceration, falls and shoulder dislocations. The Committee is further concerned by findings that a nurse on a typical shift lifts 1.8 tons and that work-related injuries to nurses frequently result in loss of work time and can be debilitating, career ending events, and that injury and fear of injury are listed as top reasons why nurses leave the profession thereby exacerbating the already critical nursing shortage. The Committee urges AHRQ to undertake or commission a study to determine the impact of utilizing assistive devices and patient-lifting equipment on patient injuries and outcomes, the health and safety of nurses, and the financial implications of using available technology.
Action Taken or to be Taken:
AHRQ acknowledges the importance of the concern raised by the House and Senate Committees and will add this to the topics for investigation within the patient safety portfolio.

Spina Bifida

3. House (Rept. 110-231) p. 185

The Committee supports the expansion and development of the national spina bifida patient registry and encourages AHRQ to lead the effort to validate quality patient treatment data measures for the registry being developed with CDC. The Committee requests that AHRQ report to Congress on the status of this effort as part of the fiscal year 2009 budget justification. The Committee provides $55,300,000 for the Medical Expenditures Panel Surveys (MEPS), which is the same as the fiscal year 2007 funding level and the budget request. The MEPS provide data for timely national estimates of health care use and expenditures, private and public health insurance coverage, and the availability, costs, and scope of private health insurance benefits. This activity also provides data for analysis of changes in behavior as a result of market forces or policy changes on health care use, expenditures, and insurance coverage; develops cost/savings estimates of proposed changes in policy; and identifies the impact of changes in policy for subgroups of the population.
Action Taken or to be Taken:
With guidance from the spina bifida community, CDC continues to make considerable progress in creating a standardized clinic registry to systematically collect data on patient care and outcomes. CDC will share the current clinic information form and other information relevant to creation of quality measures with AHRQ. AHRQ will work closely with CDC and the spina bifida community on identification and validation of potential quality measures. Quality measures may be able to be derived from the current clinic information form and registry, or may need to be newly developed. AHRQ will share its expertise in quality measurement and validation (e.g., guidance included on the National Quality Measures Clearinghouse Web site; expertise of staff and advisors for the National Healthcare Quality Report and the National Healthcare Disparities Report; expertise of staff and other experts for the AHRQ Quality Indicators; expertise of our survey groups [CAHPS® and MEPS]) to ensure that spina bifida clinics can be assessed and compared for quality of care, and that individual clinics will have sufficient data to improve care quality, should there be an identified need. CDC expects the registry to be implemented in 6-8 pilot sites (clinics) in fiscal year 2008 and to have data to analyze by fiscal year 2009. AHRQ will work with CDC on the registry throughout this period.

Return to Contents

 

FY 2008 Senate Report No. 110-107

Deep Vein Thrombosis

4. Senate (Rept. 110-107) p. 176

Numerous studies conducted on deep vein thrombosis [DVT] have shown that there is a gap between knowledge and practice. A recent large scale national study found that only one-third of acute hospital patients who were at risk for DVT actually received the pharmacological or mechanical prophylaxis according to established guidelines. The Committee urges AHRQ to disseminate and make available evidence-based information to healthcare providers and patients as a step toward reducing the risks of serious and life-threatening complications from DVT.
Action Taken or to be Taken:
AHRQ agrees that DVT is a serious health issue and distributes over 20 evidence-based clinical practice guidelines on preventing and treating DVT through the National Guideline Clearinghouse (NGC) accessible at http://www.guideline.gov. AHRQ also distributes summaries of 14 quality measures relating to DVT through the National Quality Measures Clearinghouse accessible at http://www.qualitymeasures.ahrq.gov.

Investigator-initiated Research

5. Senate (Rept. 110-107) p. 176

The Committee values AHRQ for its critical role in supporting health services research to improve health care quality, reduce costs, advance patient safety, decrease medical errors, eliminate health care disparities, and broaden access to essential services. However, the Committee is troubled that AHRQ's investigator-initiated research portfolio has languished, even though many of the sentinel studies that have changed the face of health and health care in the United States are the result of researchers' ingenuity and creativity. To advance scientific discovery and the expansion of knowledge, AHRQ should invest at least as much on an investigator-initiated research agenda as it does on intramural health services research. The Committee urges the Department to expand funding for AHRQ's investigator-initiated research in its fiscal year 2009 budget request
Action Taken or to be Taken:
While targeted research investments comprise a large portion of our budget, we view investigator-initiated research as the foundation of our research portfolio. It is the basic research that provides the evidence-base for many of AHRQ's programs and activities, including patient safety and health care quality. In FY 2008, the Agency plans to continue its investment in investigator-initiated type of research that supports studies that are intended to improve the health care for all Americans. AHRQ will provide $3.7 million for new investigator-initiated research in FY 2008. The Agency will continue to work with the Department, OMB [Office of Management and Budget], and the Committee to develop ways to best leverage our resources to expand funding in investigator-initiated research.

Safe Patient Handling

6. Senate (Rept. 110-107) p. 176

The Committee is concerned about the consequences of manual patient lifting in hospitals, nursing homes and other patient care settings that increase the risk to patients of injuries such as skin tears, skin ulceration, falls and shoulder dislocations. Moreover, workplace injuries to nurses, such as back, shoulder and neck injuries, exacerbate the nursing shortage with loss of work time or debilitating, career-ending injuries. The Committee urges AHRQ to study the impact of utilizing assistive devices and patient lifting equipment on patient injuries and outcomes, as well as the health and safety of nurses.
Action Taken or to be Taken:
AHRQ acknowledges the importance of the concern raised by the House and Senate Committees and will add this to the topics for investigation within the patient safety portfolio.

Spina Bifida

7. Senate (Rept. 110-107) p. 176

The Committee encourages AHRQ to continue its efforts to validate quality patient treatment data measures for the National Spina Bifida Patient Registry being developed in partnership with the Centers for Disease Control and Prevention [CDC]. The Committee requests that the Agency report on the status of this effort in its fiscal year 2009 congressional budget justification.
Action Taken or to be Taken:
With guidance from the spina bifida community, CDC continues to make considerable progress in creating a standardized clinic registry to systematically collect data on patient care and outcomes. CDC will share the current clinic information form and other information relevant to creation of quality measures with AHRQ. AHRQ will work closely with CDC and the spina bifida community on identification and validation of potential quality measures. Quality measures may be able to be derived from the current clinic information form and registry, or may need to be newly developed. AHRQ will share its expertise in quality measurement and validation (e.g., guidance included on the National Quality Measures Clearinghouse Web site; expertise of staff and advisors for the National Healthcare Quality Report and the National Healthcare Disparities Report; expertise of staff and other experts for the AHRQ Quality Indicators; expertise of our survey groups [CAHPS® and MEPS]) to ensure that spina bifida clinics can be assessed and compared for quality of care, and that individual clinics will have sufficient data to improve care quality, should there be an identified need. CDC expects the registry to be implemented in 6-8 pilot sites (clinics) in fiscal year 2008 and to have data to analyze by fiscal year 2009. AHRQ will work with CDC on the registry throughout this period.

Unit-of-use Packaging

8. Senate (Rept. 110-107) p. 176

The Committee is aware that the Institute of Medicine has recognized the potential benefits provided to patients by unit-of-use packaging, which are drug products dispensed directly to patients in containers that provide enough medication for use during a specified time interval. The Committee urges AHRQ to conduct a comprehensive study to evaluate unit-of-use packaging and design approaches that would support various patient populations in their medication self-management, including children, chronically ill patients, patients taking prescription narcotics, and patients taking antibiotics.
Action Taken or to be Taken:
AHRQ is sponsoring several projects through the Centers for Education and Research on Therapeutics (CERTs) on safe transmittal of pharmaceuticals. One CERT is developing an initiative to look at the impact on patient adherence of packing medications in " bubble"packaging that apportions their medications according to when on each day they should take them.

Return to Contents

 

FY 2008 Conference Report No. 110-424

Preventing Medical Errors

10. Conference (Report No. 110-424) p. 148

The conferees encourage AHRQ to look favorably on proposals that would proactively detect medical errors and preemptively control injury via compact medical devices that acquire, analyze and filter data from multiple, disparate, wireless and wired sources.
Action Taken or to be Taken:
Traditionally the approach to the identification of risks and hazards to patient safety and medical error has relied on retrospective approaches to the problem, using chart review, event reporting from health professionals and the use of administrative data. In order to support a more proactive approach to the identification of risks and hazards and medical error, AHRQ has and continues to support proactive risk assessment efforts through both grant and contract projects. Beginning in fiscal year 2004, AHRQ funded seven grant projects ($1.4 million) to explore different approaches to proactive risk assessment. In FY 2007, the Agency funded 20 new proactive risk assessment projects ($4.0 million) in the area of ambulatory care. AHRQ has also supported over 25 grants and 4 contracts ($25.5 million) looking a proactive identification of risks and hazards and medical errors using what has become known as clinical triggers which come from the medical record and other clinical information systems. The integration of clinical information and device systems to detect risks and hazards proactively and to manage complex clinical operations in a dynamic and proactive manner is an area of great promise. AHRQ will continue to encourage researchers to explore these issues as well implement systems such as Triggers into vendor electronic health records (EHRs). In summary, AHRQ has and is funding over 52 grants and 3 contracts in the area of proactive risk assessment and detection of risk and hazards and medical error. These activities are an import part of AHRQ's patient safety portfolio of research and implementation efforts. We will continue to support such efforts in the future.

Healthcare Model

11. Conference (Report No. 110-424) p. 148

The conferees encourage AHRQ to investigate the feasibility of an open-source, no-cost license computer model capable of predicting the effects of health care policy alternatives for the purpose of improving health care quality and cost-effectiveness. The model should be developed with a consortium of university partners and be capable of predicting costs and health impacts.
Action Taken or to be Taken:
AHRQ will investigate the feasibility of the development of such of an open-source, no-cost license computer model.

Return to Contents

Page last reviewed February 2008
Internet Citation: Significant Items: Performance Budget Submission for Congressional Justification, Fiscal . February 2008. Agency for Healthcare Research and Quality, Rockville, MD. https://archive.ahrq.gov/cpi/about/mission/budget/2009/sig09.html

 

The information on this page is archived and provided for reference purposes only.

 

AHRQ Advancing Excellence in Health Care