Online Performance Appendix: Performance Detail (by Activity)
Budget Estimates for Appropriations Committees, Fiscal Year 2010
Research on Health Costs, Quality and Outcomes (HCQO)
The Effective Health Care Program, launched in September 2005, supports the development of new scientific information through research on the outcomes of health care services and therapies, including drugs. By reviewing and synthesizing published and unpublished scientific studies, as well as identifying important issues where existing evidence is insufficient and undertaking new research, the program helps provide providers, clinicians, policymakers and consumers with better information for making informed health care treatment decisions. In this program, AHRQ seeks an emphasis on timely and usable findings, building on the thoroughness and unbiased reliability that have been hallmarks of efforts so far. Equally important is broad ongoing consultation with stakeholders, which helps ensure that the program responds to issues most pressing for health care decisionmakers. Collaboration is also a key principle of the program and AHRQ works closely with many HHS agencies to identify topics for research under the program and to communicate findings, including identified research gaps.
One measure the Effective Health Care Program uses to evaluate its success is the amount of evidence made available to the public. In FY 2006, the program released four systematic reviews and one summary guide. In FY 2007, the program released four systematic reviews and eight summary guides. Four new research reports, including a user's guide to registries evaluating patient outcomes and a Medical Care journal supplement on emerging methods in comparative effectiveness and safety, were also released. In FY 2008, the program released 7systematic reviews and 12 summary guides, including 2 guides that were translated into Spanish. In FY 2009, the program anticipates releasing 10 systematic reviews and 22 summary guides, including some translated into Spanish. The targets for FY 2009 are reported in key output #4.4.5 in section D, Outcome and Output Tables. In addition, several research topics for systematic reviews and new research reports are in development and will be awarded for research in FY 2010.
All reports produced by the program are available on the Effective Health Care Web site, http://www.effectivehealthcare.ahrq.gov. The Web site also includes features for the public to participate in the Effective Health Care Program. Users can sign up to receive notification when new reports are available. They can also be notified when draft key questions for research, draft reports, and other features are posted for comment, and can submit comments through the Web site. The public is also invited to use the Web site to nominate topics for research by the Effective Health Care Program. Also on the Web site is information about the expanded list of priority conditions that guide the work of the program. The priority conditions are targeted to Medicaid, Medicare, and State Children's Health Insurance Program (SCHIP) beneficiaries (see text box below).
There is growing interest in, and attention to, enhancing the role of the Effective Health Care Program's research in our health care system. For example:
- Consumer Reports Best Buy Drugs, a public education product of Consumers Union, uses findings from the program to help clinicians and patients determine which drugs and other medical treatments work best for certain health conditions. Over the course of the project, over 1 million reports have been downloaded. In addition to disseminating the consumer materials and reports via the Web site, Best Buy Drugs has an outreach program that links to existing groups with statewide reach and credibility throughout the medical community.
- The National Business Group on Health also uses findings from the Effective Health Care Program in their Evidence-based Benefit Design initiative to provide employers and their employees with the best available evidence for designing benefits and making treatment choices.
- Omnicare, Inc., a leading provider of pharmaceutical care for the elderly, uses Effective Health Care Program summary guides as a tool for its consultant pharmacists and facilities, which are primarily nursing homes. Omnicare serves approximately 1.4 million residents in more than 15,000 long-term care facilities in 47 States, Washington, DC, and Canada.
- Su Clinica Familiar, a multi-office health clinic in south Texas, uses AHRQ's Effective Health Care Program summary guides for clinicians and patients to better address concerns of patients and as teaching resources for patients.
- Medscape and the American Academy of Family Physicians offer CME credits based on comparative effectiveness reviews and numerous other organizations use the findings in their deliberations on patient care, formulary design, and areas for needed research.
These examples of organizations disseminating evidence from the Effective Health Care Program to their constituents are directly linked to key output (#1.3.25) listed in section D, Outcome and Output Tables.
Key output (#1.3.26) in section D, Outcome and Output Tables, increased amount of evidence from the Comparative Effectiveness (CE) Portfolio policymakers use as a foundation for population-based policies, helps guide our relationship with the AHRQ-sponsored Medicaid Medical Director's Learning Network. Twenty State Medicaid Medical Directors report that they use Effective Health Care Program resources in a variety of ways. For example, they are incorporated into clinical guidelines created and disseminated by the States, incorporated into health plan educations materials, and used to inform coverage decisions and to set criteria for prior authorization.
The FY 2010 President's Budget Request for Comparative Effectiveness is $50,000,000, maintaining the FY 2009 funding level. In FY 2010, a total of $50,000,000 will support:
- Planned dissemination outreach to stakeholders to engage them in the Effective Health Care Program. Topics for research in the Effective Health Care Program are selected and refined based on input from the public. The Effective Health Care Program considers public suggestions and examines the impact and relevance of the proposed topics to the Medicare, Medicaid, and SCHIP populations. The Effective Health Care Program also considers the importance of a potential topic, such as how many people are affected and the level of uncertainty for doctors and other decisionmakers, whether the topic has already been covered by research that has been completed or is in progress, and for research reviews, the amount and type of research available.
- Systematic research reviews to inform decisions and promote effective health care. Research reviews from the Effective Health Care Program are reported in several formats. Comparative Effectiveness Reviews (CERs) and Effectiveness Reviews aim to provide comprehensive appraisal and synthesis of evidence. Updates apply systematic methods to bring CERs and Evidence Reviews up to date by reviewing the current literature. Technical Briefs aim to provide an overview of key issues related to an emerging diagnostic or therapeutic intervention. FY 2010 funding will allow AHRQ to continue to develop and make available to the public systematic reviews. These outputs are a critical component to reach our long-term objective to improve a patient's quality of care and health outcomes through informed decisionmaking.
- Advancement of systematic review methodologies. AHRQ understands the importance of and is fully committed to improving the consistency and quality of systematic reviews, including comparative effectiveness reviews. AHRQ has been an international leader in this area. The science of systematic reviews is evolving and dynamic, and AHRQ is looked to as a promoter of gold standard methods development and dissemination on best ways to do systematic review. Advancement of systematic review methodologies means identifying key issues at each step involved in researching, writing, and translating a systematic review, conducting research on these issues, and then providing recommended approaches for addressing these difficult, frequently encountered methodological issues. The Effective Health Care Program will soon publish the Methods Guide for Comparative Effectiveness Reviews, both on the Effective Health Care Web site and in the scientific literature. Additional methods workgroups will be formed and the Methods Guide will be expanded.
- Effectiveness research in priority condition areas to develop new scientific evidence regarding the effectiveness and long-term treatment effects of diagnostic and therapeutic interventions and to address important knowledge gaps confronting health care decisionmakers.
- Multicenter research cooperatives for comparative and clinical effectiveness studies in diabetes, cancer, and cardiovascular disease. In FY 2010, the multicenter research cooperatives will continue to work closely with AHRQ to carry out coordinated and collaborative research agenda that address stakeholder questions about the comparative effectiveness, safety, and clinical effectiveness of therapies used in diabetes, cancer, and cardiovascular disease.
- Translation and dissemination work of the John M. Eisenberg Clinical Decisions and Communications Science Center. The Eisenberg Center will continue to facilitate access to and use of evidence-based clinical and health care delivery information, and foster informed health care decisions by patients, providers, and policymakers. As shown in the output table (#4.4.5), FY 2010 funding will allow for 22 Summary Guides to be produced.
- Building and enhancing the research and methodological capacity for conducting comparative and effectiveness research using the most rigorous methods possible and for the integration of evidence into practice and decisionmaking.
- Evaluating new clinical data sources and important clinical information (e.g., lab values, blood pressure readings) and performing more rigorous comparisons of treatments to draw inferences about complex clinical outcomes. This will increase the ability of clinicians to provide the right treatment to the right patient. Researchers will also work on the development and use of medical record and electronic administrative data systems.
- Continue efforts to train and develop the new generation of comparative effectiveness researchers. It is expected that three to four career development awards will be made in FY 2010, with a 3- to 5-year funding commitment for each award. Training and development activities will be closely tied to the programmatic strategic directions and the needs and challenges as identified by the Effective Health Care Program.
- Consultation and collaboration with HHS agencies and other stakeholders to identify topics for research, communicate findings, identify research gaps, and to ensure the Effective Health Care Program is responsive to the most pressing issues for health care decisionmakers.
Long-Term Objective 1: Improve patients' quality of care and health outcomes through informed decisionmaking by patients.
|1.3.24: Decrease mortality from and increase receipt of recommended care for subset of diseases measured and reported on in the National Health Care Quality Report)1|
|2010||TBD||Oct 31, 2010|
|2009||1st and 2nd Qtr—Obtain baseline measures|
3rd and 4th Qtr—Set targets for FY 2010-2019
|Oct 31, 2009|
|2008||Identify measures and limit to a subset based on priority conditions; work with AHRQ's planning, evaluation, and analysis contractors to limit to ~3 metrics to be tracked||Measures have been identified but a subset based on priority conditions has not yet been selected|
|2007||N/A||AHRQ created new Comparative Effectiveness Portfolio|
|2006||N/A||AHRQ launched new Effective Health Care Program, authorized under Section 1013 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003|
|2005||N/A||List of priority conditions for research under Medicare Modernization Act released|
|4.4.5: Increase # of systematic reviews (SR)) and summary guides (SG) produced per year|
|2010||TBD||Oct 31, 2010|
|Oct 31, 2009|
12 SG (includes 2 SG translated into Spanish)
|1.3.25: Increase # of organizations disseminating systematic reviews (SR) and summary guides (SG) to their constituents2|
|2010||TBD||Oct 31, 2010|
|2009||1st and 2nd Qtr—Obtain baseline data for this performance measure 3rd and 4th Quarter—Set targets for FY 2010-2019||Oct 31, 2009|
|2008||Work with AHRQ Effective Health Care's Eisenberg Center, Scientific Resource Center, and Stakeholder Group to identify methods for systematically identifying organizations that are disseminating SR and SG||Have not completed identifying methods for systematically identifying organizations that are disseminating SR and SG|
|1.3.26: Increase the amount of evidence from the Comparative Effectiveness (CE) Portfolio policymakers use as a foundation for population-based policies3|
|2010||TBD||Oct 31, 2010|
|2009||1st and 2nd Qtr—Obtain baseline data for this performance measure|
3rd and 4th Qtr—Set targets for FY 2010-2019
|Oct 31, 2009|
|2008||Work with the Medicaid Medical Directors (AHRQ Learning Network) and Health Plans to identify methods for systematically reviewing policy decisions for references to evidence from the Portfolio||Worked with Medicaid Medical Directors Learning Network to develop process for identifying how CE Portfolio products are used by these State clinical policymakers|
|Measure||Data Source||Data Validation|
|1.3.24||National Healthcare Quality Report (NHQR)|
Appendix A: Data Sources provide information about each database analyzed for the NHQR, including data type, sample design, and primary content.
|Data are validated annually by Federal public release data source NHQR. Data are analyzed, synthesized, and reported using established methodology|
|4.5.4||All AHRQ systematic reviews and summary guides are entered into a database, which is used to populate the AHRQ Effective Health Care Program Web site, http://effectivehealthcare.ahrq.gov/.||Effective Health Care Program staff will develop and document a methodology that will be used annually to check data|
|1.3.25||Requests for copies of AHRQ publications (ordered by title and publication number) are made to the AHRQ Publications Clearinghouse. Data will be provided bi-annually from the Publications Clearinghouse on the number of organizations requesting more than 50 copies of AHRQ comparative effectiveness research reports and summary guides.||Effective Health Care Program staff will develop and document a methodology that will be used annually to check data|
|1.3.26||Data from this output is available from AHRQ's Medicaid Medical Director's Learning Network (MMDLN). At an annual meeting, members of MMDLN report on how they use AHRQ's comparative effectiveness research reports and summary guides.||MMDLN members report their usage in a written document and AHRQ staff follow-up with members to verify information provided|
1 Baseline data will be established in FY 2009. Intermediate process measures will be used during the interim.
2 Baseline data will be established in FY 2010. Intermediate process measures will be used during the interim.
3 Baseline data will be established in FY 2010. Intermediate process measures will be used during the interim.