AHCPR Fiscal Year 2000 Performance Plan

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Structure of the AHCPR GPRA Annual Performance Plan

Goal Format

Information on each goal is presented in the following format:

Strategy: This section contains an explanation of the Agency's approach to accomplishing the goal.
Previous Successes: This section contains examples of previous achievements that are applicable to the goal and strategy.
Goal Statement.
Fiscal Year 1999 Objectives and Indicators.
Fiscal Year 2000 Objectives and Indicators.

Objectives and Indicators Template

The objectives and indicators are presented in the format illustrated in the following template.

Objective: Each objective for the Goal is listed.

Indicators: This information provides a list of the measures that will be used by AHCPR to determine if the objective has been achieved. Baseline information as appropriate.

Indicators Summary: This information, with numerators and denominators, provides the details how the measures will be calculated.

Type and Significance: The different types of measures are used as follows:

Process measures: To monitor the establishment of major new initiatives or implementation of improvements in core activities where significant resources are involved or the potential for significance of the ultimate impact is high.
Output measures: To record the results of research initiatives and dissemination activities essential to moving to the next step of implementation.
Outcome measures: To show the impact (or potential for impact) in affecting the outcomes, quality, access, cost, or use of health care.

AHCPR also includes an explanation of why the measure is appropriate and significant.

Data Collection Issues: This information provides an explanation of the data collection issues for each measure.

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

Strategy

In the field of health services research, the user of the information plays a critical role. If health services research is to improve the quality of health care, it must provide answers to the questions and issues that represent the barriers to improvement. AHCPR emphasizes open communication with users of its research to ensure that it is addressing important questions. This phase of the cycle of research will continue to be an area of emphasis as the Agency implements the initiatives in the fiscal year 2000 budget to assure that research begins and ends with the user.

Previous Successes

AHCPR has a history of consulting with the users of its research. The current program announcement that provides guidance to researchers on AHCPR's areas of interest was formed through consultations with many outside experts. A few examples include:

A meeting with experts from the private and public sectors in fiscal year 1997 led to Agency initiatives to study the roles of managed care and other market forces in the organization, delivery, and financing of health care and the ultimate effects of such forces on health care quality, access, and costs
A national conference on research about the interface of primary and specialty care for children which led to a publication, a request for applications, and the funding of eight projects
An expert meeting for Pharmaceutical Outcomes Therapy lead to the development of two initiatives that are proposed for the fiscal year 1999 and the fiscal year 2000 budget
A Federal Register notice and extensive mailings to solicit nominations for topic for the Evidence-based Practice Centers
The review of the draft AHCPR strategic plan by its National Advisory Council
The use of results from the evaluation of the AHCPR Web site by users to redesign the web site
Frequent meetings between the AHCPR Administrator and user groups including clinical, health systems, and policy decisionmakers.

Goal 1 Fiscal Year 1999 Objectives and Indicators

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

Indicators
Agency research agenda covering the three strategic research goals is developed in fiscal year 1999 and documented based on consultations with various groups. Baseline: The first summary report of consultation activities will be produced in fiscal year 1999.

Indicators Summary
Summary research agenda produced and made available to the public

Type and Significance
Output: AHCPR must be able to tie its research agenda to the needs of the users of health services research in order to accomplish its mission and ultimately impact the health care system. These consultations will take various forms, including focus groups, expert meetings, discussions at professional meetings, meetings with consumer groups, and consultations with peer review study section members and the National Advisory Council. The agenda will identify explicit criteria to drive new initiatives and ensure they are focused on specific priority areas.

Data Collection
Expert meetings and other consultations with users are routinely documented with meeting summaries that are reviewed by participants for verification of accuracy. The offices and centers that sponsor these activities will report annually on the contributions the outreach activities made to creating research agenda priorities.

Goal 1 Fiscal Year 2000 Objectives and Indicators

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

Indicators
Agency research agenda covering the three strategic plan research goals and the new fiscal year 2000 Closing the Gap initiatives are documented based on consultations with various groups. Baseline: First report will be produced in fiscal year 1999.

Indicators Summary
Summary research agenda produced and made available to the public

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

Strategy

There are many gaps in knowledge in all areas of health care. New questions emerge as new technologies are developed, the population's demographics change, areas of inquiry previously under-emphasized take on greater importance, and research previously undertaken identifies further areas that need attention. Therefore, AHCPR will continue to focus on creating new knowledge and assessing the findings that result from completed projects. This phase of the cycle of research identifies the opportunities for improvement from which changes in health care can be designed and implemented. AHCPR will continue to focus on developing a portfolio of peer-reviewed extramural and intramural research and will also place particular focus on the fiscal year 2000 initiative, "New Research on Priority Health Issues."

Previous Successes

Descriptive Research. AHCPR research has been descriptive in nature, documenting current patterns in care, identifying where quality or outcomes fall short, identifying barriers to access, measuring the costs and utilization of care, or focusing on the experience of care and the special needs of vulnerable populations. These studies have been extremely valuable in helping us to understand who is affected by illness, how these illnesses are managed, what they cost, how systems are organized and financed to deliver care, and what the consequences of care are.

Development of Tools and Analytic Methods. The second dominant aspect of the Agency's work in the last 10 years has been in the development of tools and analytic methods. These include development of tools to systematically review and synthesize literature, instruments to measure quality and outcomes, sophisticated techniques to measure risk and severity, and methods to characterize and study the changing nature of the health care system itself. Most of the instruments currently in use to measure health-related quality of life that are well designed and validated were developed with public sector support, often from AHCPR. Development of these has been clearly recognized by the private sector as a public good.

Comparative Studies. The third aspect of the Agency's work where additional emphasis has been placed in the last 3 years is in studies that directly compare interventions to improve care, including both clinical interventions and changes in the organization and financing of health services. Examples of clinical intervention studies include:

A large trial to implement the National Heart, Lung, and Blood Institute (NHLBI) guideline for asthma in three managed care settings.
Three trials to assess the effectiveness and cost-effectiveness of hysterectomies for non-cancerous conditions.
A study to compare the cost-effectiveness of home visits to office-based follow up for infants with lung disease due to prematurity.
Partnerships with the NIH to add cost-effectiveness components to new studies, e.g., the NHLBI/National Emphysema Treatment Trial (NETT) study of lung volume reduction surgery.
The current set of cooperative agreements to examine the impact of different features of managed care on the quality and outcomes of care for people with chronic conditions.

Goal 2 Fiscal Year 1999 Objectives and Indicators

Fiscal Year 1999 Objective 2.1: Determine the salient findings from research for three priority populations and develop plan for next steps in translation and dissemination.

Indicators
A report that synthesizes research on the major health concerns of at least three priority populations produced.

Baseline: Not applicable.

Indicators Summary
Not applicable.

Type and Significance
Process and output: The first product of research is information. This report will illustrate that AHCPR is investing in research with the potential to have significant impact when disseminated and implemented widely. A precursor of this type of report was produced by AHCPR in 1995, Better Quality Can Cost Less, which summarized research findings with potential to improve quality while decreasing costs.

Data Collection
AHCPR is implementing a strategy to routinely synthesize and report on major findings. This included the creation of a Research Translation Team to work closely with program staff to track the findings from AHCPR research and their relevance and potential impact. This Team, assigned to the Office of Health Care Information, will coordinate with dissemination staff to develop the plans for next steps. The AHCPR Automated Management Information System will provide data for these tracking activities. The Team approach will be evaluated at the end of fiscal year 1999 to assess its effectiveness.

Fiscal Year 1999 Objective 2:2: Achieve significant findings from AHCPR sponsored and conducted research.

Indicators
Findings from at least 10 AHCPR sponsored or funded research are published in major peer reviewed professional publications (New England Journal of Medicine,Journal of American Medical Association, etc.); receive national press coverage; are used in Federal or State policymaking; are used by professional associations or health plans as the basis of strategies to achieve quality; or are used to establish coverage decisions by health care purchasers, managed care organizations, or insurers, including Medicare or Medicaid.

Baseline: Data will be collected in fiscal year 1999.

Indicators Summary
Numerator—Number of extra- or intramural research grants that receive national attention or are used as detailed in the indicator.
Denominator—Total number of extra- and intramural research projects completed during the previous 2 years.

Type and Significance
Output: This indicator provides a first indication of whether the research funded or sponsored by AHCPR is significant. Coverage by popular and professional media is highly competitive. AHCPR's receiving coverage is an indication that the finding has the potential for significant impact. The actual use of the finding by purchasers, professional associations, managed care organizations, and/or insurers also signals that the new knowledge has the potential to make a difference. The ultimate outcome or impact will be evaluated after the finding has been implemented over a period of time.

Data Collection
The Research Translation Team and public affairs staff from the Office of Health Care Information track press coverage, journal placement, and other uses of research findings. The increased emphasis on working with program staff and researchers to gather this information will be evaluated at the end of fiscal year 1999.

Fiscal Year 1999 Objective 2.3: Initiate fiscal year 1999 research initiatives

Indicators
Funding of a minimum of 21 projects in:

Consumers use of information on quality.
Strengthen value-based purchasing.
Measure national health care quality.
Vulnerable populations.
Translating research into practice.

Baseline: Not applicable. This objective is not meant to be measured against previous or future performance (i.e., 9 grants vs. 10 isn't the issue). The objective represents the Agency's commitment to a certain level of effort that is necessary for the research initiative to succeed.

Indicators Summary
Numerator—Number of projects funded.
Denominator—Total number of extra- and intramural projects funded.

Type and Significance
Process: With increased funding, AHCPR is putting particular emphasis on the further development of the knowledge base in these areas.

Data Collection
The grants addressing these conditions will be identified through the grants management database.

Indicators
Funding of a minimum of 17 projects in:

Outcomes for the elderly and chronically ill.
Clinical preventive services.
Centers for Education and Research on Therapeutics (CERTs).
Improving the quality of children's health.

Indicators Summary
Numerator—Number of projects funded.
Denominator—Total number of extra- and intramural grants funded.

Type and Significance
Process: With increased funding, AHCPR is putting particular the further development of the knowledge base in these areas.

Data Collection
These grants will be identified through the grants management database.

Goal 2 Fiscal Year 2000 Objectives and Indicators

Fiscal Year 2000 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 plan for next steps translation and dissemination.

Indicators

Annual report on science advances in three research goal areas.
At least four major findings in each area that have potential to save significant amounts of money, improve quality, save lives or prevent physical suffering, or change the organization and delivery of health care.
For each finding, specific steps in translation and dissemination are identified and initiated.

Baseline: The first report will be published in fiscal year 2000.

Indicators Summary
Annual Report

Numerator—12 major findings from extra- and intramural research (4/goal).
Denominator—Total number of research findings from all completed extramural and intramural projects during fiscal year 2000.

Data Collection
AHCPR is implementing a strategy to routinely synthesize and report on major findings. This included the creation of a Translation Team to work closely with program staff to track the findings from AHCPR research and their relevance and potential impact. This Team, assigned to the Office of Health Care Information, will coordinate with dissemination staff to develop the plans for next steps. The AHCPR Automated Management Information System will provide data for these tracking activities. The Team approach will be evaluated at the end of fiscal year 1999 to assess its effectiveness.

Fiscal Year 2000 Objective 2:2: Achieve significant findings from AHCPR sponsored and conducted research.

Indicators
Findings from at least 10 AHCPR sponsored or funded research are published in major peer reviewed professional publications (New England Journal of Medicine, Journal of American Medical Association, etc.); receive national press coverage; are used in Federal or State policymaking; are used by professional associations or health plans as the basis of strategies to achieve quality; or are used to establish coverage decisions by health care purchasers, managed care organizations, or insurers, including Medicare or Medicaid.

Baseline: Data will be collected systematically for the first time in fiscal year 1999.

Data Collection
The Translation Team and public affairs staff from the Office of Health Care Information track press coverage, journal placement, and other uses of research findings. The increased emphasis on working with program staff and researchers to gather this information will be evaluated at the end of fiscal year 1999.

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

Indicators
Funding of a minimum of 10 projects that address gaps in knowledge about the priority problems faced by Medicare and Medicaid.

Baseline: Not applicable. This objective documents the Agency's level of commitment to this 2000 initiative.

Indicators Summary
Numerator—Number of projects funded on Medicare and Medicaid.
Denominator—Total number of extra- and intramural projects funded.

Type and Significance
Process: This is the first step of a new research initiative that addresses gaps in knowledge identified by previous research on conditions of critical importance to the Nation's health care. This will enable AHCPR to avoid duplication and to clearly define its areas of interest. In 1996, AHCPR's PORTs focused on 8 out of the 10 most costly diagnoses for Medicare hospitalizations, for example, acute myocardial infarction, stroke, hip fracture and repair, and pneumonia.

Data Collection
AHCPR researchers use Medicare and Medicaid to profile patterns of care in these programs. Annual updates will be used to guide research efforts.

The grants addressing these conditions will be identified through the grants management database.

Indicators
Funding of a minimum of 10 projects to address eliminating disparities in health care with particular emphasis on disparities that exist for racial and ethnic minorities.

Baseline: Not applicable. This objective documents the Agency's level of commitment to this 2000 initiative.

Indicators Summary
Numerator—Number of projects funded on disparities in health care for racial and ethnic minorities.
Denominator—Total number of extra- and intramural grants funded.

Type and Significance
Process: Research has documented that disparities exist. An increased emphasis is needed to identify the causes of those disparities so that the can be eliminated. AHCPR is committing to working on these issues.

Data Collection
These grants will be identified through the grants management database.

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