Fiscal Year 2000 Performance Plan: Executive Summary

Agency for Health Care Policy and Research


Following is a summary of the fiscal year 2000 performance plan of the Agency for Health Care Policy and Research (AHCPR). The fiscal year 2000 President's budget request for AHCPR incorporates the annual performance plan required under the Government Performance and Results Act (GPRA). The fiscal year 2000 performance goals and measures are detailed in AHCPR's performance plan and are linked to both the budget and to the Strategic Plan of the Department of Health and Human Services (HHS). Select for the full text of AHCPR's fiscal year 2000 performance plan.

Performance targets in the plan depend partly on resource levels requested in the President's budget and could change based on congressional appropriation action. GPRA requires that HHS plan, budget, and be accountable for program results. The intent of the Act is to improve program performance by considering performance information in decisionmaking and by involving our partners and stakeholders in accomplishing program results.


Contents

Overview of Agency
          1. Mission, Programs, and Programmatic Goals
          2. Program Intent
          3. Expected Results and Impact of Agency Programs
          4. Agency Program Administration
          5. AHCPR Cycle of Research
          6. Relationship to Other HHS Components
Approach to Performance Plan
          1. Organization
          2. Performance Measures/Indicators
          3. Data Collection
Summary of Annual Plan Goals and Objectives
          Fiscal Year 1999 Plan
          Fiscal Year 2000 Plan
Key Terms and Definitions

Overview of Agency

1. Mission, Programs, and Programmatic Goals

The Agency for Health Care Policy and Research (AHCPR) is a part of the Department of Health and Human Services (HHS) and was created in 1989 specifically to respond to the Nation's need for knowledge about the health care system. In fiscal year 1999, it has 275 full-time equivalent (FTE) positions and a total budget of $171,055,000.

The mission of AHCPR is to support, conduct, and disseminate research that improves the outcomes, quality, access to, and cost and utilization of health care services. This mission, which focuses on the effectiveness and value of health care in daily practice, is unique and complements the biomedical and behavioral research responsibilities of the National Institutes of Health (NIH). The products of the Agency include knowledge that supports decisionmaking to improve health care and tools that can improve quality and reduce costs.

We recognize that health care in 1998 is very different from 1989 when the Agency was created. The Agency has adjusted its agenda and priorities to meet the new challenges we face, while continuing our charge set forth by Congress. To this end, we have focused our priorities on three primary customers: clinical decisionmakers, health care systems leaders, and policymakers, each of whom need information to enhance their contribution to improve the quality of care in this country. We serve our customers with research on outcomes, quality, cost, use, and access.

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2. Program Intent

Outcomes Research

One of the most important priorities of AHCPR is to translate and disseminate the findings of research supported by the Agency into tools and information that can be used by its customers to improve the outcomes of the care they provide or to make good health care decisions. For example, AHCPR-supported research on cataracts at Johns Hopkins University led to the development of the VF-14, a visual function index that gauges the impact of cataracts on patients ability to perform 14 activities, including reading and driving. The index also allows for comparisons of patients' visual function before and after removal of a cataract. This index is widely used in research studies and clinical practice.

The research sponsored and conducted by AHCPR has concentrated on conditions that are common, costly, and for which there is substantial variation in practice. This research includes many of the conditions that represent a major expenditure for Medicare. AHCPR's research attempts to close the gap on variation and provide our customers with the information on what care is appropriate, how much is enough, and what resources are used to provide it. This includes developing valid measures of the outcomes that are important to patients (including their quality of life), implementing these measures to evaluate the effectiveness of health care, and sponsoring research on ways to improve outcomes.

Outcomes research conducted and sponsored by AHCPR also attempts to help decision makers understand the implications of structural and financing changes in the health care system on the outcomes of care delivered in the system. For example, AHCPR, in partnership with the American Association of Health Plans Foundation, is supporting a $7 million research initiative to determine the impact of different features of health plans on the outcomes of care provided to adults and children with chronic illnesses (select for press release).

Quality Measurement: For Choice and Improvement

In March, the President's Advisory Commission on Consumer Protection and Quality in the Health Care Industry released its final report. The Commission noted that "improving the quality of American health care and enhancing Americans' health requires a commitment to delivering health care based on sound scientific evidence and continuously innovating, effective health care practices and preventive approaches."

As an agency that has distinguished itself by conducting and sponsoring research on the structure, process, and outcomes of care, AHCPR has contributed to the Nation's quality of care agenda since the Agency's inception. AHCPR's research in quality falls into two categories: quality information for choice; and quality information for improvement.

The demand for information on quality has grown dramatically over the last decade as consumers and purchasers increasingly seek to make choices based on value. This desire for information that drives choice can be met by improved methods of quality measurement, including report cards and satisfaction instruments that allow consumers and purchasers to comparison shop health plans and providers. For example, AHCPR's Consumer Assessment of Health Plans (CAHPS®) currently being used by Federal Government agencies (Health Care Financing Administration and Office of Personnel Management), States, and private organizations can help consumers and group purchasers compare health plans and make more informed choices based on information about the quality of the services provided.

In addition to providing information on quality for consumers and purchasers, information is important to those who are trying to select the highest quality health care services. AHCPR sponsors research on measuring the quality offered by different providers and the quality available from different services. AHCPR's computerized compendium of clinical quality measures—CONQUEST and Q-Span projects—helps the Agency's customers select measures that best meet their needs. AHCPR recently funded eight grants designed to build the scientific foundation for developing new measures and new ways of assessing quality of care for conditions such as carotid endarterectomy.

Based on the recommendation of the President's Advisory Commission on Consumer Protection and Quality in the Health Care Industry, President Clinton directed Secretary Donna Shalala to establish the Quality Interagency Coordination Task Force (QuIC) in March 1998. The QuIC coordinates the Federal Government's efforts to improve the Nation's health care quality. The AHCPR Administrator serves as the operational chair of the task force. AHCPR's participation in the QuIC has resulted increased collaboration with the Department of Veterans Affairs, the Department of Labor, the Department of Defense, and the Office of Personnel Management.

Studies of Cost, Use, and Access

Policy is made at all levels of the health care system, from examining room to boardroom to legislative chamber. AHCPR seeks to provide information about the changes to the health care system and the development of the health care market that will allow these decisions to be made using evidence and a scientific foundation. Because the finest health care quality will not improve health if it does not get to people, research on cost, use and access is critical to all aspects of the Agency's agenda. For example, AHCPR's Medical Expenditure Panel Survey (MEPS) is used by public and private sector organizations to develop national and regional estimates of the impact of changes in financing, coverage, and payment policy, and to make estimates of who benefits from, and bears the cost of, these changes.

AHCPR also supports the HIV Cost and Services Utilization Study (HCSUS) and the Healthcare Cost and Utilization Project (HCUP-3). HCSUS is a large-scale study that provides policymakers with data on the costs and utilization of different services for persons infected with HIV. HCUP-3 provides policymakers with information tools to study inpatient hospital stays and their quality and costs.

Providing objective, science-based, timely information to health care decisionmakers—patient and clinicians, health system leaders, and policymakers—is the challenge that faces health services research and AHCPR in the next century. Meeting this challenge depends heavily on the continued collaboration and communication between the Agency and its partners. The Agency's goal is to conduct and support high quality, relevant research that is translated and disseminated to improve the quality of heath care services, and ultimately, the public's health.

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3. Expected Results and Impact of Agency Programs

AHCPR's fiscal year 2000 budget theme is "Closing the Gap." The research priorities will be focused on closing four gaps.

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4. Agency Program Administration

General program direction and strategic planning is accomplished through the collaboration of the Office of the Administrator (with its three administrative offices) and six research Centers, which have programmatic responsibility for portions of the Agency's research portfolio. The Agency has completed a 12-month process of linking the Agency's planning processes to budget planning and performance management through GPRA. This involved updating the Agency strategic plan using staff and customer input, directly linking budget development to the planning process, implementing strategic and annual operations plans for each Office and Center, and developing individual employee performance plans that link directly to the Agency and Office/Center plans.

Each Center and Office is responsible for creating its own plan within the context of the Agency plan, identifying critical success factors, and choosing performance measures that clearly illustrate how they will contribute to AHCPR's achieving its strategic and annual plan goals. The individual employee annual performance plans are based on his/her contribution to accomplishing the Center and Office plans. The AHCPR annual planning cycle provides a format for assessing all Agency operations against the framework of the strategic plan and progress toward achieving its goals. Thus, the philosophy of GPRA, measurement and accountability, permeates Agency management.

As a result of the increased emphasis on strategic planning, evaluation activities have taken on greater focus. Evaluations will be used to demonstrate the impact of Agency work on the health care system, to test and improve the usefulness and usability of Agency products, and to assess the effectiveness and efficiency of internal operations. The results of the evaluation studies will be used to make planning, budget, and operations decisions in subsequent years, as well as be used for GPRA reporting purposes.

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AHCPR Cycle of Research

Producing meaningful contributions to the Nation and to research on health care requires continuous activity focused on iterative improvement in priority setting, on developing research initiatives, and on research products and processes. The research cycle (image, 8 KB) describes the processes AHCPR uses to conduct its ongoing activities in order to make the most productive use of its resources.

Needs Assessment. Agency activities begin and end with the end-users of Agency research. Through a continuing dialogue with representatives of the end-users, staff identify major issues and decisions for which information on quality, outcomes, cost, access, and use is needed. The research agenda is based on an assessment of gaps in the knowledge base and on the needs of patients, clinicians, institutions, plans, purchasers, and State and Federal policymakers for evidence-based information. Input gained during the needs assessments feeds directly into the research initiatives undertaken by the Agency, as well as the products developed from research findings to facilitate use in health care.

Knowledge Creation. AHCPR will support and conduct research to produce the next generation of knowledge needed to improve the health care system. Building on the last 10 years of investment in outcomes and health care research, AHCPR will focus on national priority areas for which much remains unknown.

Translation and Dissemination. Simply producing knowledge is not sufficient; findings must be useful and made widely available to practitioners, patients, and other decisionmakers. The Agency will systematically identify priority areas for improving care through integrating findings into practice and will determine the most effective ways of doing this. Additionally, AHCPR will continue to synthesize and translate knowledge into products and tools that support its customers in problem-solving and decisionmaking. It will then actively disseminate the knowledge, products, and tools to appropriate audiences. Effective dissemination involves forming partnerships with other organizations and leveraging resources.

Evaluation. Knowledge development is a continuous process. It includes a feedback loop that depends on evaluation of the research's utility to the end user and impact on health care. In order to assess the ultimate outcomes of AHCPR research, the Agency will place increased emphasis on evaluation of the impact and usefulness of Agency-supported work in health care settings and policymaking. The evaluation activities will include a variety of projects, from smaller, short-term projects that assess process, outputs, and interim outcomes to larger, retrospective projects that assess the ultimate outcomes/impact of AHCPR activities on the health care system.

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6. Relationship to Other HHS Components

The main focus of AHCPR research is on the delivery of health care and identifying ways to improve it. Most of the Agency's research portfolio consists of extramurally funded work from leading universities and other research institutions throughout the Nation. The portfolio also contains an impressive body of intramural research. Both the extramural and intramural research study issues related to the quality, outcomes, effectiveness, cost and use of, as well as access to, health care. It measures the effectiveness of the services that deliver the preventive, diagnostic, and therapeutic care, compares them with existing practice, and evaluates the ability of the health care system to deliver them effectively. AHCPR also is increasing its investment in developing and evaluating methods for translating research into health care practice.

By contrast, NIH's principal focus is on studying the mechanisms of disease and treatment through biomedical research. Its goal is to acquire new knowledge to help prevent, detect, diagnose, and treat disease and disability, from the common cold to genetic disorders. AHCPR and NIH co-sponsor requests for applications, and co-fund individual projects, particularly clinical research, when they address issues of interest to both agencies. Additionally, there is close communication with the National Library of Medicine to coordinate efforts in promoting the use of information technology in health care delivery.

The Centers for Disease Control and Prevention (CDC) conducts health research that is primarily focused on public and community health. Its research focus is on the behaviors that put Americans at risk of death, quality of life issues for vulnerable populations, and understanding how to curb premature illness and death. The CDC and AHCPR collaborate in areas where AHCPR's research can support and inform CDC initiatives, and vice versa. For instance, the Agencies have collaborated to distribute information on the treatment of AIDS generated through an AHCPR-sponsored clinical practice guideline, and CDC contributed information to a compendium of public health data sources produced by AHCPR. Most recently, AHCPR and CDC co-funded the development of a Smoking Cessation guideline. Both agencies are distributing the Smoking Cessation Consumers' Tool Kit, developed by AHCPR based on guideline content. AHCPR is also concentrating on getting the guideline into use by the medical profession.

AHCPR's role in providing information and tools to health care decision makers is clearly illustrated through it's relationship with the Health Care Financing Administration (HCFA). Technology assessments conducted by AHCPR on behalf of HCFA have been the basis for coverage decisions for the Medicare program. Quality measures and methods for enhancing the quality of health care have been used by the Peer Review Organizations and by Medicare providers. Results from AHCPR's prevention research have been included in HCFA's health promotion initiatives. Information on the effect of organizational change has been used in HCFA's discussions with managed care organizations, and research on doctors' and hospitals' responses to financial incentives have informed HCFA's rate setting. Finally, HCFA will begin reporting results from the AHCPR-sponsored Consumer Assessments of Health Plans Study (CAHPS®) managed care survey in the Fall of 1998. The survey results will provide beneficiaries with detailed information about their choices among health care providers.

In addition to the agencies mentioned above, AHCPR also consults and collaborates with the Health Resources and Services Administration, Indian Health Service, and the Substance Abuse and Mental Health Services Administration where synergy can be created and use of resources maximized.

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Approach to Performance Plan

1. Organization

The goals and objectives of the AHCPR performance plan are aligned with the Agency's three budget lines.

Budget Line (1)—Research on Health Costs, Quality, and Outcomes (HCQO). This budget line represents the bulk of the Agency's research (extramural and intramural) portfolio. Dissemination and evaluation activities as well as the Agency's support of the Secretary's Initiative to Improve Health Care Quality are also included. The first five of the annual performance plan's seven goals are used to track Agency performance in these areas.

Budget Line (2)—Medical Expenditure Panel Surveys (MEPS). The sixth goal of the plan is made up of the key functions of the MEPS program: (a) fielding of the surveys, (b) releasing and disseminating the data and associated products that stem from MEPS, and (c) conducting intramural and extramural research and facilitating the use of the data and associated products by researchers, policymakers, purchasers, and plans.

Budget Line (3)—Program Support (PS). The seventh goal presents the major managerial efforts being made to enhance the Agency's ability to accomplish its mission.

While presented in basically the same framework, the goals and objectives in the fiscal year 2000 Annual Performance Plan have been refined, and in some cases changed, from the fiscal year 1999 plan. In addition, the overall number of performance measures has been decreased from 60 to 35. Select to access the full text of the performance plan for a detailed comparison between AHCPR performance plans for fiscal years 1999 and 2000.

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2. Performance Measures/Indicators

Accurately measuring the outcomes of research programs continues to be a challenge. By its very nature, research is unpredictable. Research activities may or may not yield conclusions that are immediately amenable to application. There can be a considerable time lag between research activities and the outcomes of those activities. Whether and how research findings get used in the health care system is dependent on countless variables over which AHCPR has no control. Another important limitation is the nature of extramural research. AHCPR cannot control what types of applications it will receive, nor what the results will be of the funded research. Thus, AHCPR, like other research agencies, continues to face the challenge of showing the impact of research activities within these constraints.

In order to mitigate these factors, the Agency sets research priorities based on its strategic plan and input from the end users of the research. Program announcements and requests for applications are used to communicate the research priorities to the field. The portfolio of research is managed to contain a mix of short and long term projects. Partnerships are integral to the conduct of AHCPR's work to promote timely application. More recently, added emphasis has been placed on efforts to translate research into practice to assure impact.

To understand and report on the impact of Agency programs on health care, additional emphasis is being placed on evaluation activities. As a result, the Agency will be able to report on process, output, and interim outcome goals through out the course of its major initiatives. Goal 4, Evaluate the effectiveness and impact of AHCPR research and associated activities, is designed to capture the results of the emphasis on evaluation of impact. In the fiscal year 2000 plan, the Agency has included a number of evaluations that will illustrate the impact of research products when used to inform consumers, measure quality, and make policy decisions.

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3. Data Collection

AHCPR recognizes that its commitment to accountability will not be achieved easily and that it entails an added investment in measurement as part of all of the Agency's programs. The Agency's approach consists of capitalizing on data collection opportunities as a byproduct of the work we do or sponsor, partnering with public and private organizations, and maximizing the use of information technology applications. AHCPR will use a variety of data collection methods.

Research Applications. Studies which address the translation of research into practice will be required to include in their design appropriate measures of impact.

Grants Management. AHCPR is investing in the development of an Intranet-based integrated information management system through which progress on funded grants and their results will be captured as part of routine reporting. A number of yes/no indicators are included in the plan, and they should present few data collection problems thanks to this system. (One example of this is found in fiscal year 1999 and fiscal year 2000 objective 2.3: AHCPR will document whether it did or did not fund a minimum number of grants in priority research areas.)

Information Technology. Expanded use of technologies (e.g., Intranet, Extranets, listservs) will permit efficient capturing of important qualitative information on the impact of Agency programs. (One example is in fiscal year 2000 objective 3.2, where AHCPR will report on the impact of the User Liaison Program by gathering user stories from attendees on their use of program information in decisionmaking.)

Performance Management System. AHCPR has aligned its employee performance management system with each organizational unit's plan and the Agency plan and incorporated many process and output measures into employee plans. These will be aggregated annually to yield some of the measures in the GPRA plan.

Customer Surveys. These are a critical source of information on the appropriateness, use, and quality of AHCPR products and services. This approach is being expanded in the fiscal year 2000 plan. In some instances, the mechanisms for collecting customer service data are already in place and the first set of data has been analyzed, such as with the AHCPR Publications Clearinghouse. In other instances, the customer surveys must be designed, fielded, and responses analyzed. Because of the substantial financial costs involved, often it will be necessary to survey large representative samples to obtain information on the usefulness, relevance, and quality of AHCPR's work and its associated impact. The Agency has started working on the issues, including cost analyses for the surveys required, and will continue throughout fiscal year 1999 so that the necessary infrastructure is in place for fiscal year 2000. We will work closely with HHS both to share our experience and to apply the knowledge and expertise of others. Identifying opportunities for collaborations and/or cost sharing will be a priority. Notations are made within the text of the plan for each measure that will use a survey mechanism.

Partnerships. Many public and private sector organizations collect data on processes of care which AHCPR programs and research are intended to improve. For example, Peer Review Organizations (PROs) have taken AHCPR research findings and recommendations, worked with practitioners and institutions to adopt them, and provided the Agency with feedback regarding improvements in practice. The Health Care Utilization Project (HCUP) database, developed in partnership with 19 States, provides additional insights regarding changes in clinical practice in those States. Another source of information will be the growing number of collaborative research projects that make use of the internal databases of large private sector health care delivery organizations. A rich source of information will be the external organizations that serve as partners for the reports being developed by the Agency's Evidence-based Practice Centers program. They have made a commitment to implement the reports in a variety of ways and will provide the Agency with data on the utilization and impact of their efforts. By working collaboratively we can meet some of our measurement needs more cost-effectively.

Evaluations. Specifically commissioned studies (both intramural and extramural) will be used to evaluate the impact of AHCPR programs more rigorously. These studies are presented in AHCPR's Goal 4. These studies will evaluate such things as: the effect a product, e.g., a quality measurement tool, had on improving the quality of health care; whether a product that is effective in one care setting can be generalized to other settings, e.g., a clinical decision support system; or whether a product is user friendly and useful. Because these studies will be complicated, resource intensive, and expensive, the Agency will propose a limited number each year.

Other Mechanisms. The Agency has developed a variety of other mechanisms that will enable it to collect information on the impact of its work. These include:

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Summary of Annual Plan Goals and Objectives

Feedback on the original fiscal year 1999 annual performance plan resulted in a major restructuring of the plan format and content for both fiscal year 1999 and fiscal year 2000. This summary provides an overview of the AHCPR fiscal year 1999 and fiscal year 2000 performance plans. For information on each goal, select to access the full text of the performance plan. It presents individual sections on the objectives, indicators, significance of the indicators, and data collection issues for each goal.

Fiscal Year 1999 Plan

Goal 1: Establish future research agenda based on user's needs.

Objective 1.1: Define direction of fiscal year 1999 project funding priorities, in large part, by needs assessment activities.

Goal 2: Make significant contributions to the effective functioning of the U.S. health care system through the creation of new knowledge. (HCQO)

Objective 2.1: Determine the salient findings from research for three priority populations and develop plan for next steps translation and dissemination.

Objective 2.2: Achieve significant findings from AHCPR sponsored and conducted research.

Objective 2.3: Initiate fiscal year 1999 research initiatives

Goal 3: Foster translation of new knowledge into practice developing and providing information, products, and tools on outcomes quality, and access, cost, and use of care. (HCQO)

Objective 3.1: Promote distribution of AHCPR publications, products, and tools through intermediary organizations.

Objective 3.2: Maximize dissemination of information, tools, and products developed from research results for use in practice settings.

Objective 3.3: Develop and facilitate use of new tools, talent, products, and implementation methodologies stemming from research portfolio.

Goal 4: Evaluate the effectiveness and impact of AHCPR research and associated activities. (HCQO)

Objective 4.1: Evaluate the impact of AHCPR sponsored products in advancing methods to measure and improve health care.

Objective 4.2: Evaluate major dissemination mechanisms.

Goal 5: Support of Department-wide Initiative to Improve Health Care Quality through Leadership and Research. (HCQO)

Objective 5.1: Provide leadership for the Executive Branch's Quality Interagency Coordination Task Force (QuIC)

Objective 5.2: Conduct research to expand the tool box of measures and risk adjustment methods available help to measure the current status of quality in the Nation.

Objective 5.3: Inform health care organizational leaders and others how to design quality into their systems.

Objective 5.4: Improve understanding of how to ensure that research affects clinical practice as appropriate.

Goal 6: Collect current data and create data tapes and associated products on health care use and expenditures for use by public and private-sector decisionmakers and researchers. (Medical Expenditure Panel Survey—MEPS)

Objective 6.1: Release and disseminate MEPS data and information products in timely manner for use by researchers, policymakers, purchasers, and plans. (MEPS)

Objective 6.2: Facilitate use of MEPS data and associated products as tools by extramural researchers, policy makers, purchasers, and plans.

Objective 6.3: Modify and enhance MEPS to enable reporting on the quality of health care in America.

Goal 7: Support the overall direction and management of AHCPR. (PS)

Objective 7.1: Provide prudent planning for all capital assets.

Objective 7.2: Maintain acquisition performance management system to ensure: (1) timely completion of transactions, (2) vendor and customer satisfaction, and (3) efficient and effective use of resources.

Objective 7.3: Continued enhancement and expansion of Agency Intranet site to ensure staff have immediate access to all current information. The site covers Agency administrative and operational processes, procedures, and policies. It also covers information on ongoing health care research as well as results and findings from all the research supported by the Agency.

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Fiscal Year 2000 Plan

Goal 1: Establish future research agenda based on users' needs. (HCQO)

Objective 1.1: Define direction of fiscal year 2000 project funding priorities, in large part, by needs assessment activities.

Goal 2: Make significant contributions to the effective functioning of the U.S. health care system through the creation of new knowledge. (HCQO)

Objective 2.1: Determine annually the salient findings from research in each of the three areas (outcomes; quality; and cost, access, and use) and develop a plan for next steps in translation and dissemination.

Objective 2.2: Achieve significant findings from AHCPR sponsored and conducted research.

Objective 2.3: Implement fiscal year 2000 priority (1) "New Research on Priority Health Issues."

Goal 3: Foster translation of new knowledge into practice by developing and providing information, products, and tools on outcomes; quality; and access, cost, and use of care. (HCQO)

Objective 3.1: Promote distribution of AHCPR publications, products, and tools through intermediary organizations.

Objective 3.2: Maximize dissemination of information, tools, and products developed from research results for use in practice settings.

Objective 3.3: Develop and facilitate the use of new tools, products, and implementation methodologies stemming from the research portfolio. fiscal year 2000 Priority (3), "Translating Research into Practice," focuses on the translation and dissemination of research findings, products, and tools to foster adoption and use in health care settings.

Goal 4: Evaluate the effectiveness and impact of AHCPR research and associated activities. (HCQO)

Objective 4.1: Evaluate the impact of evidence reports and/or technology assessments on decisions that support improvements in health care outcomes and quality.

Objective 4.2: Evaluate the impact of AHCPR sponsored products in advancing methods to measure and improve health care quality.

Objective 4.3: Evaluate the impact of MEPS data and associated products on policymaking and research projects.

Goal 5: Support Department-wide Initiative to Improve Health Care Quality through Leadership and Research. (HCQO)

Objective 5.1: Conduct research to help measure the current status of health care quality in the Nation.

Objective 5.2: Facilitate the use of quality information to improve health care in the Nation.

Objective 5.3: Improve quality measurement.

Goal 6: Collect current data and create data tapes and associated products on health care use and expenditures for use by public and private-sector decisionmakers and researchers. (MEPS)

Objective 6.1: Release and disseminate MEPS data and information products in a timely manner for use by researchers, policymakers, purchasers, and plans.

Objective 6.2: Facilitate use of MEPS data and associated products as tools by extramural researchers, policymakers, purchasers, and plans.

Objective 6.3: Modify and enhance MEPS to enable reporting on the quality of health care in America as part of fiscal year 2000 Priority (2), "New Tools for a New Century."

Goal 7: Support the overall direction and management of AHCPR. (PS)

Objective 7.1: Provide prudent planning for all capital assets.

Objective 7.2: Continue enhancement and expansion of the Agency Intranet site to ensure that staff have immediate access to all current information. The site covers Agency administrative and operational processes, procedures, and policies. It also covers information on ongoing health care research, as well as results and findings from all the completed research supported by the Agency.

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Key Terms and Definitions (alphabetical order)

CAHPS® (Consumer Assessment of Health Plans Study): A ground-breaking program to determine the factors that contribute most to consumer assessments of health plans; find ways to measure those factors; and determine if providing this information to consumers assists them in choosing high-quality care. The purpose of the CAHPS® program is to develop, test, and refine survey instruments, report formats, and a users' manual to produce an integrated set of standardized questionnaires that can be used to collect meaningful and reliable information from health plan enrollees about their experience. The surveys will address all types of insurance enrollees and the full range of health care delivery systems. Select to access CAHPS® Fact Sheet.

CONQUEST: An AHCPR software product (that contains a database of validated quality measures for a large variety of clinical conditions. Users can access the quality measures and use them directly, adapt them to local conditions, or use them for comparison purposes. Select to access CONQUEST Fact Sheet.

Cross-cutting themes: The Agency has identified two activity areas which require a synergistic strategy that cuts across the traditional functional lines in which AHCPR has been organized. The first of these addresses the needs of populations on which the Public Health Service and AHCPR have placed a priority emphasis: children, women, racial and ethnic minorities, the elderly, people with chronic illness/disabilities, and people living in rural areas. The second is assuring that a strong infrastructure for health services research is built through investments in training and the support of young investigators.

Dissemination: The process by which knowledge and information are conveyed to external audiences.

Evidence-based practice: An approach to clinical decisionmaking and health care policy that promotes the integration of the most valid and relevant evidence from scientific research with clinical observation and patient reports to decide which treatments, tests, and technologies are most effective and appropriate for program design, coverage, and patient care.

Evidence-based Practice Centers (EPCs): Centers of Excellence funded by AHCPR at 12 institutions. EPCs produce evidence reports and technology assessments for use by Federal and private-sector organizations to create clinical practice guidelines, quality measures, and other quality improvement tools. Select for details on EPCs.

Extramural research: Research sponsored by AHCPR through funding grant applications submitted by private-sector researchers professionals from domestic, nonprofit organizations.

Healthcare Cost and Utilization Project (HCUP): A Federal-State-industry partnership in health care data. The HCUP database is a powerful, all-payer, longitudinal database, which provides a comprehensive source of hospital inpatient financial, clinical, and patient demographic information. It is developed and maintained in partnership with 19 State governments and State hospital associations. HCUP includes all hospital discharges from participating States and can be tapped for State-level and community-level analysis. It is also linked with the American Hospital Association and Area Resource File data. The Agency has broadened the database to include all ambulatory surgery encounters in nine of the participating States as more health care moves from inpatient to outpatient settings. Select for HCUP information.

HIV Costs and Services Utilization Study (HCSUS): The first nationally representative sample of adults living with HIV infection who are in treatment. It was developed through a 5-year cooperative agreement with the RAND Corporation and examines issues having to do with delivery, cost, and utilization of health care services for HIV/AIDS treatment. Issues such as the utilization of home health care and nursing facility care services, Medicaid coverage, and patterns and correlates of health-related quality of life, including functional status, are examined. Select for HCSUS Fact Sheet.

Information products: A variety of vehicles used to disseminate information about health care quality, outcomes, cost, and access (e.g., reports, newspaper articles, the Internet, videos, professional journal articles, and consumer brochures).

Intramural research: Research conducted by research professionals who are part of the AHCPR staff.

Investigator-initiated research: Research proposed by private-sector researchers, usually in response to an Agency Program Announcement or a Request for Applications. Program Announcements are solicitations that broadly define subject areas that are relevant to the Agency's mission and goals for which the Agency would like to stimulate research interest. Requests for Applications solicit research projects that are more focused on defined areas of interest.

Outcomes research: Research that studies the end results of the structure and processes of health care on the health and well-being of patients and populations (Institute of Medicine, 1996). A unique characteristic of this research is the incorporation of the patient's perspective in the assessment of effectiveness.

Q-Span (Expansion of Quality of Care Measures): A project designed to strengthen the science base of quality measurement while expanding the scope and availability of validated, ready-to-use measures. Q-SPAN is building on past work in quality measurement by public and private organizations through eight cooperative agreements to develop and test additional clinical performance measures for specific conditions, patient populations, and health care settings. Select for Q-Span Fact Sheet.

Quality health care: Health care that is accessible, safe, fair, effective, and accountable.

Tools: Instruments and techniques that enhance the ability to complete an objective. Tools include performance measures, outcome measures, and educational and practice improvement techniques.

Translation: Putting research findings and other information into language that allows it to be understood and used by different audiences.

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Submitted February 1999 to the U.S. Congress with the Justification of Estimates for Appropriations Committees for the Department of Health and Human Services, Fiscal Year 2000.


Internet Citation:

Fiscal Year 2000 Performance Plan: Executive Summary. Agency for Health Care Policy and Research Agency for Health Care Policy and Research, Rockville, MD. http://www.ahrq.gov/about/gpra2000/exsumm00.htm


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