Research on Health Costs, Quality, and Outcomes (HCQO) (continued)

Crosscutting Activities Related to Quality, Effectiveness, and Efficiency Research (continued)

B. Funding History

Funding for the Other Quality, Effectiveness, and Efficiency Research program during the last five years has been as follows:

Year	Dollars
2005	$143,077,000
2006	$153,908,000
2007	$151,153,000
2008	$156,800,000
2009	$159,514,000

C. Budget Request

The FY 2009 Estimate level provides $159,514,000 for Crosscutting Activities Related to Quality, Effectiveness, and Efficiency research, the same level of funding as the prior year. There are two changes within this portfolio that provide a net change of $0.

• HCQO: Crosscutting Activities Related to Quality, Effectiveness and Efficiency — Investigator-initiated Research Grants (-$2,478,000): The FY 2010 Estimate includes $37,124,000 (77 grants) in total research grants funds for HCQO: Crosscutting Activities Related to Quality, Effectiveness and Efficiency. This level provides a decrease of $2,478,000 from the FY 2009 level of $39,602,000 — equivalent to a decrease of approximately 52 small, investigator-initiated research grants with an average cost of $50,000. The FY 2010 President's Budget Request will fund $6,421,000 in new investigatorinitiated research grants, for a total of $23,551,000 in investigator-initiated research. This is a decrease of $2,478,000 from the FY 2009 funding level of $26,029,000 for investigator-initiated research grants.

  In addition, the FY 2010 Estimate level will provide for noncompeting research grant commitments for several grants programs, including the CAHPS and CERTs programs. Funding for CAHPS grants will total $2.9 million in FY 2010. In FY 2010, the CAHPS program will ensure that data will be more easily available to the user community and the number of consumers who have access to CAHPS information to make health choices will increase by 46 percent over baseline (go to performance table 1.3.23). If AHRQ meets this target for FY 2010, 146 million consumers will have access to CAHPS information.

  A total of $11.5 million is provided in FY 2010 in continuation grant support for the CERTs program. This program expects decreases in hospitalization for upper GI bleeding due to adverse events of medication or inappropriate treatment of peptic ulcer disease in those between 65 and 85 years of age and decreased number of admissions will continue to generate a per year drop in per capita charges for GI bleeding. The most recent results from FY 2008 did meet the corresponding target. In FY 2008, the target was a 5-percent drop and the actual result was a 5.1-percent drop ($87.10 per capita). The target selected for FY 2009 is a 6-percent drop ($90.75) relative to the original baseline, which is $99.54. The target selected for FY 2010 is a 7-percent drop. In FY 2009 the program will assess the ambitiousness of current targets.

• Research Contracts and IAAs ($0): The FY 2010 President's Budget Request maintains research contract and IAA support at $57,490,000. This level of support will allow AHRQ to continue core research contracts and IAAs that support Crosscutting Activities Related to Quality, Effectiveness and Efficiency research.

  Contracts that will continue in FY 2010 include HCUP at a total of $4.1 million. HCUP has set an effectiveness goal that by 2010, 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 AHRQ Quality Indicators. Of those, three new organizations use HCUP/QIs to assess potential areas of quality improvement, and at least two of them will develop and implement an intervention based on the QIs. Impact will be observed in one new organization after the development and implementation of an intervention based on the QIs. By increasing the number of organizations using HCUP and the Quality Indicator tools, we support the overall program goal. HCUP's long-term goal for efficiency is to achieve wider access to effective health care services and reduce health care costs by increasing the number of partners contributing data to the HCUP databases. Expanding to add new States and increasing the number of Partners that contribute ambulatory surgery and emergency department data improves national and regional representation. AHRQ added data from Maine for a total of 39 statewide data organizations participating in HCUP. The number of State Ambulatory Surgery Databases (AS) increased by three partners (California, Maine, and Oklahoma) and the number of State Emergency Department Databases (ED) increased by four partners (California, Maine, New York, and Rhode Island). They were selected based on the diversity-in terms of geographic representation and population ethnicity— they bring to the project, along with data quality performance and their ability to facilitate timely processing of data.

• Research Management (+$2,478,000): In FY 2010, research management costs for AHRQ total $67,600,000, an increase of $2,478,000 from the prior year. The FY 2010 President's Budget Request level provides $1,872,000 for pay raise costs for AHRQ as a whole. An additional $606,000 is provided in FY 2010 for required research management increases within AHRQ's budget, including rent increases, travel, printing, and data costs. In FY 2010, research management costs for AHRQ total $67,600,000.

D. Outputs and Outcomes Tables

Program: Crosscutting Activities Related to Quality, Effectiveness and Efficiency Research

Long-Term Objective 1: Reduce inappropriate antibiotic use in children between the ages of 1 and 14.

Measure	FY	Target	Result
4.4.1: The number of prescriptions of antibiotics per child aged 1 to 14 in the United States (Outcome)	2010	0.50 per child per year	Oct. 31, 20010
	2009	0.51 per child per year	Oct 31, 2009
	2008	0.52 per child per year	0.58 per child (Target Not Met)
	2007	0.53 per child per yea	0.52 per child (Target Met)
	2006	0.54 per child per year	0.60 per child (Target Not Met)
	2005	0.55 per child per year	0.59 per child (Target Not Met)

 

Measure	Data Source	Data Validation
4.4.1	MEPS	The MEPS family of surveys includes a Medical Provider Survey and a Pharmacy Verification Survey to allow data validation studies in addition to serving as the primary source of medical expenditure data for the survey. The MEPS survey meets OMB standards for adequate response rates, and timely release of public use data files.

Long-Term Objective 2: Reduce congestive heart failure hospital readmission rates in those between 65 and 85 years of age.

Measure	FY	Target	Result
4.4.2: The percentage of hospital readmissions within 6 months for congestive heart failure in patients between 65 and 85 years of age. (Outcome)	2010	34%	Oct. 31, 2010
	2009	34.5%	Oct 31, 2009
	2008	35.%	31.91% (Target Met)
	2007	35.5%	36.51% (Target Not Met)
	2006	36%	36.74% (Target Not Met)
	2005	37%	36.99% (Target Met)

 

Measure	Data Source	Data Validation
4.4.2	HCUP	HCUP and QI Project Officers use established methodology to check data.

Long-Term Objective 3: Reduce hospitalization for upper GI bleeding in those between 65 and 85 years of age.

Measure	FY	Target	Result
4.4.3: The decrease in the rate of hospitalization for upper GI bleeding due to the adverse effects of medication or inappropriate treatment of peptic ulcer disease in patients between 65 and 85 years of age. (Outcome)	2010	-4%	Oct. 31, 2010
	2009	-3%	Oct 31, 2009
	2008	-1.8%	49.75/10,000 (-3.5%) (Target Exceeded)
	2007	-2%	51.56/10,000 (-5.2%) (Target Exceeded)
	2006	-2%	54.38/10,000 (-1.1%) (Target Not Met)
	2005	-2%	55/10,000 (0%) (Target Not Met)
4.4.4: The cost per capita of hospital admissions for upper GI bleeding among patients aged 65 to 84. (Efficiency).	2010	$89.78 per capita	Oct. 31, 2010
	2009	$90.75 per capita	Oct 31, 2009
	2008	$91.71 per capita	$87.10 per capita (Target Met)
	2007	$92.68 per capita	$91.81 per capita (Target Met)
	2006	$93.64 per capita	$93.36 per capita (Target Met)
	2005	$94.61 per capita	$93.20 per capita (Target Met)

 

Measure	Data Source	Data Validation
4.4.3 4.4.4	HCUP	HCUP and QI Project Officers use established methodology to check data.

Long-Term Objective 4: Achieve wider access to effective health care services and reduce health care costs.

 

Measure	FY	Target	Result
1.3.15: Cumulative number of partners contributing data to HCUP databases will exceed by 5% the FY 2000 baseline of 39.3 (Output)	2010	Increase # of partners providing data	Oct. 31, 2010
	2009	Increase # of partners providing data by 3	Oct 31, 2009
	2008	Increase # of partners contributing to HCUP databases	27 AS 25 ED (Target Met)
	2007	Increase # of partners contributing to HCUP databases	24 AS 22 ED (Target Met)
	2006	N/A	21 Ambulatory Surgery (AS) 17 Emergency Department (ED) (Target Met)
	2005	N/A	5 new outpatient datasets (Target Met)
1.3.22: Number of additional organizations per year that use Healthcare Cost and Utilization Project (HCUP) databases, products, or tools in health care quality improvement efforts. (Outcome)	2010	3 organizations	Oct. 31, 2010
	2009	3 organizations	Oct 31, 2009
	2008	3 organizations	5 new organizations — Kentucky Hospital Association; SSM Health Care; IN CHCS; Robert Wood Johnson; University Hospital (Target Met)
	2007	3 organizations	3 new organizations — CO Health Institute; OH Department of Health; Harvard Vanguard Medical Association & Atrias Health (Target Met)
	2006	3 organizations	3 new organizations — Organization for Economic Cooperation & Development; CT Office of Health Care Access; Dallas-Fort Worth Hospital Council (Target Met)
	2005	2 organizations	2 organizations (Target Met)

³This measure is annual and represents additional partner data per year. The Healthcare Cost and Utilization Project (HCUP) is a family of health care databases and related software tools and products developed through a Federal-State-industry partnership and sponsored by AHRQ. HCUP databases bring together the data collection efforts of 39 State data organizations, hospital associations, private data organizations, and the Federal government in a voluntary data sharing partnership to create a national information resource of patient-level health care data. HCUP executes memorandums of agreements with its state-level data partners which specify the partnering arrangements and data permissions and restrictions. At present, only HCUP has held discussions with all the remaining U.S. States that collect and release hospital data to pursue partnership. Four States do not collect hospital inpatient data.

Measure	Data Source	Data Validation
1.3.15	HCUP database	HCUP Project Officer monitors the number of partners and reports by identifying the new data added to the existing baseline.
1.3.22	HCUP database	HCUP and QI Project Officers work with Project Contractors to monitor the field and collect specific information to validate the organizations' use and outcomes.

Long-Term Objective 5: Assure that providers and consumers/patients use beneficial and timely health care information to make informed decisions/choices.

Measure	FY	Target	Result
1.3.23: The number of consumers who have access to customer satisfaction data from the Consumer Assessment of Healthcare Providers and Systems (CAHPS) to make health care choices (Outcome)	2010	Increase 46% over baseline (146 million)	Oct. 31, 2010
	2009	Increase 44% over baseline (144 million)	Oct 31, 2009
	2008	Increase 42% over baseline (142 million)	41% (141 Million) (Target Not Met)
	2007	Increase 40% over baseline (140 million)	41% (141 Million) (Target Met)
	2006	Increase baseline	138 Million (Target Met)
	2005	Increase baseline	135 Million (Target Met)

 

Measure	Data Source	Data Validation
1.3.23	CAHPS Database National CAHPS Benchmarking Database	Prior to placing survey and related reporting products in the public domain a rigorous development, testing, and vetting process with stakeholders is followed. Survey results are analyzed to assess internal consistency, construct validity, and power to discriminate among measured providers.

Return to Contents
Proceed to Next Section