Performance Budget Overview 2008

A. Statement of AHRQ Mission

The U.S. health care system is considered by many to be the finest in the world. Americans are living longer, healthier lives, thanks to significant advances in biomedical and health services research. The translation of research findings into clinical practice has raised awareness of the importance of appropriate preventive services—such as timely screenings for cancer, heart disease, and other serious conditions—and the crucial role that maintaining a healthy lifestyle plays in maintaining health and enhancing quality of life.

However, our health care system faces many challenges including:

• Improving the quality and safety of health care.
• Ensuring access to care.
• Increasing value for health care.
• Reducing disparities.
• Increasing the use of health information technology.
• Finding new avenues for translating research into practice.

We have made progress in meeting these challenges, but we can and must do better. Failure to improve health care delivery substantially is likely to impede realizing the full benefits of current breakthroughs in molecular medicine that can lead to personalized treatments.

As 1 of 12 agencies within the Department of Health and Human Services (HHS), the Agency for Healthcare Research and Quality (AHRQ) supports health services research initiatives that seek to improve the quality of health care in America. AHRQ's mission is to improve the quality, safety, efficiency, effectiveness, and cost-effectiveness of health care for all Americans. The Agency works to fulfill this mission by conducting and supporting health services research, both within AHRQ as well as in leading academic institutions, hospitals, physicians' offices, health care systems, and many other settings across the country. The Agency has a broad research portfolio that touches on nearly every aspect of health care.

AHRQ-supported researchers are working to answer questions about:

• Clinical practice.
• Outcomes of care and effectiveness.
• Evidence-based medicine.
• Primary care and care for priority populations.
• Health care quality.
• Patient safety/medical errors.
• Organization and delivery of care and use of health care resources.
• Health care costs and financing.
• Health care system and public health preparedness.
• Health information technology.

The ultimate goal is research translation—that is, making sure that findings from AHRQ research are widely disseminated and ready to be used in everyday health care decisionmaking. AHRQ research findings are used by providers, patients, policymakers, payers, health care administrators, and others to improve health care quality, accessibility, and outcomes of care.

To Improve the Quality, Safety, Efficiency and Effectiveness of Healthcare for all Americans

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B. Discussion of Strategic Plan and Goals

The Agency's internal structure (select for Organization Chart) and activities are organized under a series of portfolios that contribute to AHRQ's overarching strategic goals and those of the Department (Figure). The strategic goals and research portfolios reflect the priorities of HHS, AHRQ, and those of the health care system.

HHS and AHRQ Strategic Goals

HHS Strategic Goals	AHRQ Strategic Goal Areas
	Safety/Qualitya	Efficiencyb	Effectivenessc	Organizational Excellenced
1. Reduce Major Threats to the Health and Well-being of Americans	X
2. Enhance the Ability of the Nation's Public Health System to Effectively Respond to Bioterrorism and Other Public Health Challenges	X		X
3. Increase the Percentage of the Nation's Children and Adults who have Access to Regular Health Care and Expand Consumer Choices		X
4. Enhance the Capacity and Productivity of the Nation's Health Science Research Enterprise		X	X
5. Improve the Quality of Health Care Services	X
6. Improve the Economic and Social Well-being of Individuals, Families, and Communities, especially Those Most in Need	X
7. Improve the Stability and Health Development of Our Nation's Children and Youth
8. Achieve Excellence in Management Practices				X

 

AHRQ Portfolios of Work	AHRQ Strategic Goal Areas
	Safety/Qualitya	Efficiencyb	Effectivenessc	Organizational Excellenced
System Capacity and Bioterrorism	X	X	X
Data Development	X	X	X
Care Management	X	X	X
Cost, Organization and Socio-Economics	X	X	X
Health Information Technology	X	X	X
Long-term Care	X	X	X
Pharmaceutical Outcomes	X	X	X
Prevention	X	X	X
Training	X	X	X
Quality/Safety of Patient Care	X	X	X
Organizational Support				X

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a. Reduce the risk of harm from health care services by using evidence based research to promote the delivery of the best possible care.
b. Transform research into practice to achieve wider access of effective health care services and reduce unnecessary health care costs.
c. Improve health care outcomes by encouraging providers, consumers, and patients to use evidence based information to make informed treatment choices/decisions.
d. Develop efficient and responsive business processes.

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In particular, AHRQ is striving to transform the healthcare system (Secretary's 500-Day Plan) through our investments in patient safety and health information technology (health IT). Investments in patient safety and health IT are allowing AHRQ to research, test and develop health IT that ultimately will increase the quality and safety of health care for all Americans (AHRQ's mission and HHS Strategic Goal #5 and HHS Strategic Goal #4.4). In addition, AHRQ's $15,000,000 investment in our Effective Healthcare Program will help to Modernize Medicare and Medicaid (Secretary's 500-Day Plan) by providing policy makers, clinicians and patients with better information for making coverage and treatment decisions (HHS Strategic Goal #3). Initial reports from this program will focus on effectiveness information relevant to Medicare beneficiaries. AHRQ continues our $55,300,000 investment in the Medical Expenditure Panel Survey (MEPS). MEPS is the only national source of data on how Americans use and pay for medical care. The data collected from MEPS supports all of AHRQ and many of HHS' strategic goal areas (HHS Strategic Goals #3,4,5, and 6) as the survey collects detailed information from families on access, use, expense, insurance coverage and quality of care.

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C. Overview of AHRQ Performance

The AHRQ strategic plan goals of Safety/Quality, Effectiveness, Efficiency, and Organizational Excellence guide the overall management of the Agency. Supporting these strategic goals are the Agency's portfolios of work. Each portfolio of work has developed a roadmap to success as identified through well-established long-term outcomes measures, performance goals, and annual targets. Through the extensive use of program logic modeling, Agency staff continues to successfully focus on achieving the higher-level outcomes for the portfolios and work, and ultimately identifying successful steps in improving the health care for Americans.

AHRQ continues its commitment to the President's Management Agenda. Work that is performed by the Organizational Excellence portfolio continues to focus on and support this agenda by establishing performance goals of "Getting to Green" on the Strategic Management of Human Capital Initiative; Improve Financial Management by maintaining a low risk improper payment risk status; Information Technology & E-Government through expanding E-Government and increasing IT Organizational Capability, improving IT Security/Privacy, and establishing Enterprise Architecture; and more closely integrating Budget and Performance through the use planning systems and software for facilitating the integration of these activities.

AHRQ has taken a proactive position when addressing program performance and management issues. Recognizing the value of the Performance Assessment Rating Tool (PART) instrument, each portfolio of work has benefited from full internal PART reviews and presentations to Executive Management members. AHRQ continues to benefit from the official PARTing of the Data Development and Collection Portfolio, the Quality/Safety of Patient Care Portfolio, and the Pharmaceutical Outcomes Portfolio. Finally, the Agency continues to develop strong measures of efficiency for each PARTed program.

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D. Overview of AHRQ Budget Request

AHRQ's FY 2008 Request of $329,564,000 is an increase of $10,872,000 or 3.4 percent from the FY 2007 Continuing Resolution (CR) level. At this level AHRQ will support ongoing efforts to improve the quality, safety, outcomes, access to and cost and utilization of health care services. This budget also provides $15,000,000 to accelerate the movement toward personalized health care and help bring "next generation" effectiveness of care for individual patients.

AHRQ's FY 2008 Request is arrayed below by AHRQ's budget activities:

• Research on Health Care Costs, Quality and Outcomes (HCQO).
• The Medical Expenditure Panel Survey (MEPS).
• Program Support (PS).

Select for details of the FY 2008 Request and discussion by strategic plan goals.

Budget Activity	FY 2007 Continuing Resolution (CR)	FY 2008 Request	Change from Prior Year
HCQO	$260,692,000	$271,564,000	+$10,872,000
Patient Safety (PS) Research	$84,000,000	$93,934,000	+$9,934,000
(PS Health Information Technology)	($49,886,000)	($44,820,000)	(-$5,066,000)
(General PS Funds)	($34,114,000)	($49,114,000)	(+$15,000,000)
Non-Patient Safety Research	$176,692,000	$177,630,000	+$938,000
(Effective Health Care Program)	($15,000,000)	($15,000,000)	($0)
MEPS	$55,300,000	$55,300,000	$0
Program Support	$2,700,000	$2,700,000	$0
Total AHRQ Budget	$318,692,000	$329,564,000	+$10,872,000

The FY 2008 Request for the HCQO budget activity totals $271,564,000, an increase of $10,872,000 from the FY 2007 Continuing Resolution level. It is within HCQO that AHRQ supports our patient safety and health information technology programs. MEPS continues to provide the only national source for annual data on how Americans use and pay for medical care. The FY 2008 Request will allow AHRQ to continue this successful and highly effective program. Finally, Program Support is maintained at the FY 2007 Continuing Resolution level to cover mandatory costs related to the overall direction of the Agency.

HCQO: Patient Safety Research

AHRQ's patient safety program is aimed at identifying risks and hazards that lead to medical errors and finding ways to prevent patient injury associated with delivery of health care.  AHRQ supports research that provides information on the scope and impact of medical errors, identifies the root causes of threats to patient safety, examines effective ways to make system-level changes to help prevent errors, and evaluates the effectiveness of health information technology as a critical component of efforts to reduce errors and increase efficiency. Dissemination and translation of these research findings and methods to reduce errors is also critical to improving the safety and quality of health care. To make changes at the system level, there also must be an environment, or culture, within health care settings that encourages health professionals to share information about medical errors and ways to prevent them.

The FY 2008 Request provides $93,934,000, an increase of $9,934,000 for the patient safety program. Of this total, $44,820,000 is dedicated to research related to Health Information Technology (health IT)—a decrease of $5,066,000 from the FY 2007 Continuing Resolution level. In FY 2008, the patient safety health IT program will continue grants and contracts related to the Ambulatory Patient Safety Program launched in FY 2007. The decrease in this program comes from non-competing grants that end in FY 2007. These funds were not re-invested into new patient safety health IT grants in FY 2008. General patient safety research is funded at $49,114,000, an increase of $15,000,000 from the FY 2007 Continuing Resolution level. The entire increase is dedicated to the Personalized Health Care Initiative. The remaining funds for general patient safety research focus on AHRQ's patient safety research portfolio, including funds dedicated to the Ambulatory Patient Safety Program and the Patient Safety and Quality Improvement Act of 2005.

HCQO: Patient Safety Research: Personalized Health Care Initiative

Within the patient safety program, a total of a $15,000,000 is devoted to the Personalized Health Care Initiative. The Personalized Health Care Initiative will accelerate the movement toward personalized health care and help bring "next generation" effectiveness of care for individual patients. This initiative is essential to our drive for health care transparency (by identifying and consistently measuring effective, high quality care).

Improving the quality and effectiveness of health care—providing the right care to the right patient at the right time, and getting it right the first time—remains a challenge in the United States. Today, the opportunities to expand high quality, cost-effective care are growing exponentially as a result of our ongoing investments in genomics, molecular biology, and basic biomedical research. The additional diagnostic and treatment options research yields will soon make it possible to provide highly effective individualized care in an unprecedented fashion. But we will also face growing challenges in making clinical use of this new knowledge. In a consumer- and value-oriented health care system, increased options need to be accompanied by the information necessary to evaluate those choices and make more informed decisions. The transition of patient care from a paper-based system to an electronic system has important implications. Adoption of health information technology means that information about new interventions can be deployed more rapidly and disseminated more broadly than ever before. Fortunately, health IT also provides us with the vehicle for transforming our health services research enterprise so that we can evaluate the effectiveness of these interventions in real-time by providing answers to questions such as:

• How the breakthrough compares with existing and other new interventions?
• Which classes of patients benefit most from each intervention?
• What is the most effective and efficient approach to delivery?

Today, only a few networks around the country have the data systems that will allow doctors, nurses, researchers and others to answer these important questions. However, the questions they can ask are often limited to the most common drugs and diagnoses. Many emerging breakthrough treatments will apply to a small number of patients, for example, a new treatment that cures 10 percent of patients with non-small-cell lung cancer would be effective for approximately 14,700 patients across the nation from the 147,000 affected. Even the largest systems with sophisticated health IT would be likely to include only a small percentage of these individuals, limiting capacity to detect adverse events and identifying individuals who meet the criteria for the new treatment but do not respond to the treatment effectively. A larger network, such as the one proposed here, offers the opportunity to capture a larger percentage of those who respond effectively, increasing the ability for doctors to provide the right treatment to the right patient. By leveraging the role of the federal government as a convener, in addition to its roles as the largest purchaser of health care and a major supporter of scientific advances, we will create a virtual network that will allow the data to remain within those systems while achieving the dramatic improvements in care seen from strongly centralized efforts to research and development. The results of our efforts will be health information that can be easily shared, searched, measured and analyzed to determine what treatments and drugs are most effective and at what cost regardless of the size of the network. In addition, this network will be designed to be relevant for multiple types of studies and surveillance efforts, thus offering sustainable or re-usable infrastructure. This initiative will:

• Provide incentive and infrastructure to support and promote collaboration of research networks and data sources to sustain both health practice improvement, increase value of services provided, and practical research while delivering health care.
• Improve the utility of administrative data sources for population-based research and quality assessment by linking clinical information from data repositories to administrative data.
• Take advantage of existing partnerships and administrative data sources by adding specific clinical information available through electronic health records, prescription data (multiple sources), and laboratory data (from laboratories) in a more efficient and practical approach to expanding research capacity than creating a new data infrastructure.
• Build new and link existing practical practice-based research networks and their de-identified patient data will make possible the generation of evidence—new knowledge—during the course of health care delivery at a lower cost and shorter timeline.

Select for more information about this initiative.

HCQO: Patient Safety Research: Patient Safety and Quality Improvement Act of 2005

The Patient Safety and Quality Improvement Act of 2005 amended the Public Health Service Act to encourage a culture of safety in health care organizations. It provides legal protection of information voluntarily reported to patient safety organizations (PSOs). To encourage health care providers to work with the PSOs, the Act provides Federal confidentiality and privilege protections. The Act prohibits the use of these analyses in civil, administrative, or disciplinary proceedings and limits their use in criminal proceedings. AHRQ is developing plans to help implement the Act as a science partner to the PSOs and health care providers. The Agency's goals are to help advance the methodologies that identify the most important causes of threats to patient safety, identify best practices for addressing those threats, and share the lessons learned as widely as possible. FY 2008 funding for this program will total $6,500,000.

HCQO: Patient Safety Research—Mechanism Discussion

Research grant support for the patient safety program totals $34,053,000 (78 grants) at the FY 2008 Request. This is a decrease of $6,786,000 (22 grants) from the FY 2007 Continuing Resolution level of $40,839,000. In terms of new research grants, the FY 2008 Request funds 15 new grants for a total of $5,941,000. All of the new patient safety grants at the FY 2008 Request will build on the proposals developed for the FY 2007 Ambulatory Patient Safety program. Areas of focus will include medication management tools such as e-prescribing, improved information tools at the point of care and for clinicians and consumers and improvements in chronic illness care and prevention. A total of $3,393,000 will be funded with patient safety Health Information Technology (health IT) funds, and $2,548,000 will be funded with general patient safety funds.

The FY 2008 Request continues the Ambulatory Patient Safety Program, comprised of $29,388,000 in patient safety health IT funds and $5,814,000 in general patient safety funds. This program continues AHRQ's overall patient safety vision to reduce the risk of harm from health care services by promoting the delivery of appropriate care that achieves the best quality outcome. The Ambulatory Patient Safety Initiative will both complement and contribute to the overall goals and objectives of the President's Health Information Technology (health IT) Initiative, of the American Health Information Community (AHIC), and those of the Office of the National Coordinator for Health Information Technology (ONC).

Support for patient safety research contracts totals $59,881,000 at the FY 2008 Request, an increase of $16,720,000 from the FY 2007 Continuing Resolution level. This increase funds the Personalized Health Care Initiative at $15,000,000. The Request also reflects an increase of $1,720,000 for several research contracts, including contracts and Interagency Agreements (IAAs) related to the Patient Safety and Quality Improvement Act of 2005 and the Ambulatory PS Program. No other new patient safety contracts are proposed at the FY 2008 Request.

HCQO: Non-Patient Safety Research

AHRQ's non-patient safety program has a broad research agenda that touches on nearly every aspect of health care. AHRQ-supported researchers are working to answer questions about: care management; cost, organization and socio-economics; data development; long-term care; pharmaceutical outcomes; prevention; training; quality of care; and system capacity and  bioterrorism. The FY 2008 Request provides support of $177,630,000, an increase of $938,000 from the FY 2007 Continuing Resolution level.

HCQO: Non-Patient Safety Research: Mechanism Discussion

At the 2008 Request level, AHRQ will support 131 non-patient safety grants for a total of $32,692,000. This is a decrease of $6,626,000 (65 grants) from the FY 2007 Continuing Resolution level of $39,318,000. The Request will provide $3,706,000 to support 42 new grants. The new grants will continue research in our three strategic plan goal areas and 10 research portfolios of work. The FY 2008 Request also provides approximately $9,000,000 in continuation support for new grants funded at the FY 2007 Continuing Resolution level.

10 Research Portfolios System Capacity and Bioterrorism. Data Development. Care Management. Cost, Organization and Socio-Economics. Health Information Technology. Long-term Care. Pharmaceutical Outcomes. Prevention. Training. Quality/Safety of Patient Care.

Support for non-patient safety contracts totals $84,838,000, an increase of $3,983,000 from the FY 2007 Continuing Resolution level. Of this increase, $3,730,000 will support contracts related to the Value-driven Healthcare Initiative, formerly known as the AQA Alliance pilot projects. The remaining $253,000 reflects an increase in non-patient safety continuation costs for several contracts. This Value-driven Healthcare initiative is joint effort with the Center for Medicare and Medicaid Services (CMS) and, ultimately, the private sector. The overarching goal of the Value-driven Healthcare Initiative (+$3,730,000) is to enhance person- and population-centered care by improving the quality of healthcare services and reducing healthcare costs. The initiative will seek to combine public and private information to measure and report on physician and hospital practice in a meaningful and transparent way for consumers and purchasers of health care.

In addition, the FY 2008 Request provides an increase of $3,581,000 for research management costs. These funds provide for mandatory increases within AHRQ's budget, including pay raises, seven additional Full-Time Equivalent (FTE) Employees, rent increases and funds for the Unified Financial Management System (UFMS) and the HHS Consolidated Acquisition System (HCAS). Select for more information on the UFMS and HCAS.

HCQO: Non-Patient Safety Research: Effective Health Care Program

AHRQ's Effective Health Care Program provides current, unbiased evidence about the comparative effectiveness of different health care interventions. The object is to help consumers, health care providers, and others make informed choices among treatment alternatives, including drugs. The program was created under Section 1013 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 to conduct research regarding "the outcomes, comparative clinical effectiveness, and appropriateness of health care items and services." The program was launched in 2005 with a $15,000,000 budget. It focuses initially on issues of special importance to Medicare but will be expanded to include Medicaid and the State Children's Health Insurance Program (SCHIP). The FY 2008 Request continues our $15,000,000 investment to support this important program.

Effectiveness of Noninvasive Diagnostic Tests for Breast Abnormalities Major Finding: Four common noninvasive tests for breast cancer are not accurate enough to routinely replace biopsies for women who received abnormal findings from a mammogram or physical exam. May miss about 4 to 9 percent of cases among women testing negative who have average risk for the disease. Common noninvasive tests: Magnetic resonance imaging. Ultrasonography. Position emission tomography scanning. Scintimammography. Comparative Effectiveness Review No. 2, Effectiveness of Noninvasive Diagnostic Tests for Breast Abnormalities, February, 2006.

Medical Expenditure Panel Survey (MEPS)

The FY 2008 Request for the Medical Expenditure Panel Survey (MEPS) totals $55,300,000, maintaining the same level of support as the FY 2007 Continuing Resolution level. In FY 2007 the MEPS received an additional $1,940,000 in technical support provided within the HCQO budget activity for the MEPS program. This support is not continued in FY 2008.

Program Support (PS)

The FY 2008 Request for Program Support totals $2,700,000, the same level of support as the FY 2007 Continuing Resolution level. Program support funds are used to support the overall direction of the Agency.

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