Justification of Budget Estimates for Appropriations Committees, Fiscal Year 2005


Mission and Vision

AHRQ promotes health care quality improvement by conducting and supporting health services research that develops and presents scientific evidence regarding all aspects of health care. Health services research addresses issues of "organization, delivery, financing, utilization, patient and provider behavior, quality, outcomes, effectiveness and cost. It evaluates both clinical services and the system in which these services are provided. It provides information about the cost of care, as well as its effectiveness, outcomes, efficiency, and quality. It includes studies of the structure, process, and effects of health services for individuals and populations. It addresses both basic and applied research questions, including fundamental aspects of both individual and system behavior and the application of interventions in practice settings."1

The vision of the Agency is to foster health care research that helps the American health care system provide access to high quality, cost-effective services; to be accountable and responsive to consumers and purchasers; and, to improve health status and quality of life. An essential part of this vision is assuring that research findings are ready to use by health care decisionmakers: policymakers; private sector leaders; providers; clinicians; and patients/consumers.

The Agency's mission is to:

AHRQ fulfills its mission through establishing a broad base of scientific research and promoting improvements in clinical and health system practices, including the prevention of diseases and other health conditions.

1. Eisenberg JM. Health Services Research in a Market-Oriented Health Care System. Health Affairs, Vol. 17, No. 1:98-108, 1998.

Strategic Plan

The strategic plan serves as the road map for AHRQ activities. AHRQ has identified four strategic goals, each of which will contribute to improving the quality of health care for all Americans.

AHRQ intends to change our budget activity structure to mirror our new strategic plan goals. It is expected that this change will better elucidate AHRQ's research goals and accomplishments. This change will be piloted in FY 2004. In continuing AHRQ's commitment to budget and performance integration, AHRQ recently reorganized the management structure. This new structure aligns those who are responsible for budget formulation, execution, and providing services and guidance in all aspects of financial management with those who are responsible for planning, performance measurement, and evaluation. These functions are now within one office: Office of Planning, Accountability, Resources, and Technology.

Accomplishments by Portfolio of Work

Over time, AHQR plans to provide detailed information about each strategic plan goal by a standard portfolio of work. Based on an analysis of current investments, Department priorities and our mission as articulated by the Congress in authorizing legislation, AHRQ has developed 11 standard portfolios of work. They include:

The FY 2005 request is AHRQ's first submission using the new strategic goal areas and the portfolios of work. At this point in time, AHRQ can only provide detailed reporting by one overarching portfolio of work. As the year progresses, AHRQ will move toward providing this information for each strategic plan goal and making transparent how each supports the overarching mission of improving health care quality. Table 1 highlights how AHRQ's portfolios of work are linked to our strategic plan.

Overview of the Performance Plan and Performance Report

The AHRQ Performance Plan is a companion piece to the AHRQ Strategic Plan and to the FY 2005 Budget Request. In this document, the initial FY 2005 and revised FY 2004 Performance Plans have been merged with the FY 2003 Performance Report to comply with the format developed by the Department of Health and Human Services (HHS).

The 2005 Performance Plan focuses on addressing the Agency's vision, mission and strategic goal areas of safety, effectiveness, efficiency and organizational excellence. Within those goal areas, the agency aligns its 11 portfolios of work—activities grouped by categories that reflect agency investments.

Program Assessment Rating Tool (PART) Assessments

Program performance assessments developed using the program assessment rating tool (PART) are an integral component of the President's budget. Table 2 is a progress update on AHRQ's efforts to complete recommendations coming for OMB's PART review of the Data Collection and TRIP programs. AHRQ had no recommendations coming from the FY 2004 PART reviews of the Data Collection and TRIP programs.

Table 2. Data Collection and Dissemination/Translating Research Into Practice (TRIP)

Recommendation Completion Date On Track? (Y/N) Comments on Status
No Recommendations N/A N/A N/A

FY 2004—Data Collection and Dissemination

AHRQ collects data on the cost (Medical Expenditure Panel Survey), use (Healthcare Cost and Utilization Project), and the quality of health care in the United States and develops and surveys beneficiaries regarding their health care plans (Consumer Assessment of Health Plans). In the FY 2005 request, AHRQ continues the $5,000,000 provided in the FY 2004 enacted level to support efforts to ensure continued collection and availability of national health care cost, use, and quality data. These funds will be directed to performance-based improvements for the three data collection and dissemination programs.

FY 2004—Translating Research into Practice

In FY 2005, AHRQ is requesting $10,400,000, an increase of $3,400,000 from the FY 2004 Enacted, for studies focused on translating research into practice (TRIP). The increase in funds is attributable to AHRQ's new grant and contract program: Research Empowering America's Changing Healthcare System (REACHES). These grants and contracts will expand work in the area of adopting research findings in real-world settings, assessing their impact and generalizability, and promoting rapid uptake of successful efforts.

This program refocuses TRIP activities to include activities other than just research grants. This places greater emphasis on translation, dissemination, and implementation in a broader sense. AHRQ's revision of the strategic plan/goals and its organizational realignment was specifically designed to assure successful implementation of evidence-based findings.

Research Coordination Council

AHRQ staff fully participated in the Research Coordination Council (RCC) work groups, which reviewed the FY 2005 research budget requests submitted by the agencies and assisted in the development of findings and recommendations for consideration by the Secretary's Budget Council. The purpose of these work groups is to identify ways to increase the efficient use of existing resources by identifying opportunities to collaborate with other Agencies. The following are some examples of how AHRQ contributed to the RCC:

AHRQ has a long history of developing partnerships and collaborations with a variety of HHS organizations, other components of the Federal Government, State and local governments and private-sector organizations, all of whom help us to achieve our goals.

AHRQ will continue to work with the RCC it begins to implement the FY 2005 budget. In addition, AHRQ will strengthen and build upon these partnerships as it moves to implement its FY 2006 budget request. Table 3 summarizes AHRQ's FY 2005 Research, Demonstration and Evaluation (RD&E) activities. These activities align with the Secretary's and President's priority areas and were included in our RCC discussions.

Summary of FY 2005 Request

The FY 2005 budget for AHRQ totals of $303,695,000, maintaining the FY 2004 enacted level. This request allows AHRQ to support ongoing efforts to improve the quality, safety, outcomes, access to and cost and utilization of health care services.

The FY 2005 budget enables AHRQ to renew several grant programs that help support the health care quality infrastructure. These include Building Research Infrastructure & Capacity Program (BRIC), Minority Research Infrastructure Support Program (M-RISP), Centers for Education and Research on Therapeutics (CERTs) program, and Practice-Based Research Networks (PBRNs).

The request also provides $6,639,000 for continued support of the following research grant programs:

In addition, AHRQ will fund $2,414,000 in new non-patient safety grants and $3,947,000 in new non-patient safety contracts for Research Empowering America's Changing Healthcare System (REACHES). These grants and contracts will expand work in the area of adopting research findings in real-world settings, assessing their impact and generalizability, and promoting rapid uptake of successful efforts.

In FY 2005, AHRQ will continue its work in area of patient safety. Unfortunately, fatalities due to medical errors continue to occur in our heath care system. In early 2003, organ transplant patient Jessica Santillan died at Duke University Hospital after receiving a second heart and lung transplant when her body rejected the first transplant because those organs were not matched to her blood type. This tragedy is not attributable to a knowledge deficit, but demonstrates how critical it is that we continue to focus on the role that the system plays in patient care. AHRQ has found through its research that by creating a safe and effective system of care we can significantly reduce the number of errors that occur. 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.

The FY 2005 request of $84,000,000, an increase of $4,500,000 from the FY 2004 enacted level, enables AHRQ to continue to support research activities that help health care providers, hospital and health care system leaders, and policymakers address the many challenges that they face and provides the foundation for which they can produce measurable quality improvements in health care.

Secretarial Priorities

At the requested level, AHRQ's programs will make important contributions to the Secretarial Priorities and Presidential Initiatives on improving the quality and safety of health care, costs, use and access to health care. AHRQ has worked closely with the Department's Research Coordination Council, Data Council and the Assistant Secretary for Planning and Evaluation (ASPE) so that investments in FY 2005 can be leveraged with the investments of other Operating Divisions (OPDIVs) to achieve maximum impact.

In addition, the Director of AHRQ co-chairs the Secretary's Council on Applications of Health Information Technology to promote synergy across HHS investments in health information technology, i.e., to identify and implement initiatives that address multiple department objectives, such as improving quality and safety, identifying adverse events and potential warnings of bioterrorist attacks, and conducting research.

FY 2005 Budget Policy

The FY 2005 request of $303,695,000 maintains the FY 2004 enacted level. This request allows AHRQ to support ongoing efforts to improve the quality, safety, outcomes, access to and cost and utilization of health care services. Specifically, this increase will:

Details of the FY 2005 request, by budget activity, are in Table 4.

Mechanism Discussion

The FY 2005 research portfolio for AHRQ follows.

Research and Training Grants

The FY 2005 request provides a decrease of $14,855,000 for research and training grants over the FY 2004 enacted level of $113,770,000.

An increase of $13,539,000 is requested to renew the following non-patient safety research programs: small grants, conference grants, dissertation grants, Centers for Education and Research on Therapeutics (CERTs), Building Research Infrastructure and Capacity Program (BRIC), the Minority Research Infrastructure Support Program, and Primary Care Practice-based Research Networks (PBRNs). An increase of $500,000 is requested for grant supplements, for a total increase of $14,039,000 for renewed grant programs. The FY 2005 request also provides $2,414,000 in new grant support for Research Empowering America's Changing Healthcare System (REACHES). These grants will expand work in the area of adopting research findings in real-world settings and assessing their impact and generalizability.

AHRQ is also requesting that the $7,000,000 in planning grants for the Health Care Information Technology program (patient safety) that ended in FY 2004 be reinvested in FY 2005. In FY 2005, these funds will be used for implementation awards for communities that have completed a successful planning process in FY 2004.

Non-MEPS Research Contracts and Interagency Agreements (IAAs)

The FY 2005 request provides an increase of $12,955,000 for research contracts and IAAs from the FY 2004 enacted level of $82,625,000.

The FY 2005 request for patient safety contracts and IAAs increases by $5,488,000 from the FY 2004 enacted level of $25,740,000. A total of $1,800,000 of this increase is for a new IAA to the Indian Health Service (IHS) for ambulatory information technology demonstrations.

The FY 2005 request for non-patient safety contracts and IAAs is increased by $7,507,000 from the FY 2004 enacted level of $51,564,000. A total of $3,560,000 will be directed to enduring research contracts. In addition, AHRQ requests $3,947,000 for new contracts focusing on Research Empowering America's Changing Healthcare System (REACHES). These contracts will be designed to further the adoption of research findings into real-world practice and assessment of their impact in our main portfolio areas.

Medical Expenditure Panel Survey (MEPS)

The FY 2005 request maintains the FY 2004 enacted level of $55,300,000. Select for details on MEPS.

Research Management

In FY 2005, AHRQ requests an increase of $1,900,000 for research management costs. These funds will provide for current services, including amortization of the FY 2004 pay raise and the FY 2005 pay raise.

The Unified Financial Management System (UFMS) is being implemented to replace five legacy accounting systems currently used across the Operating Divisions. The UFMS will integrate the Department's financial management structure and provide HHS leaders with a more timely and coordinated view of critical financial management information. The system will also facilitate shared services among the OPDIVs and thereby, help management reduce substantially the cost of providing accounting services throughout HHS. Similarly, UFMS, by generating timely, reliable, and consistent financial information, will enable the component agencies and program administrators to make more timely and informed decisions regarding their operations. AHRQ requests $907,000 to support this effort in FY 2005.

AHRQ's FY 2005 request includes funding to support the President's Management Agenda E-Gov priorities and Departmental enterprise information technology priorities identified through the HHS strategic planning process. Agency funds will be combined with resources in the Information Technology Security and Innovation Fund to promote collaboration in planning and project management and to achieve common goals such as secure and reliable communication and lower costs for the purchase and maintenance of hardware and software. The enterprise IT investments enable HHS programs to carry-out their missions more securely and at a lower cost. Examples of HHS enterprise projects currently being funded are Enterprise E-mail, Network Modernization, and Public Key Infrastructure.

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Budget Activities

All of AHRQ's funding is managed and appropriated in the following three budget activities:

  1. Health Care Costs, Quality, and Outcomes (HCQO).
  2. Medical Expenditure Panel Survey (MEPS).
  3. Program Support.

Health Care Costs, Quality, and Outcomes (HCQO)

The purpose of the Research on Health Care Costs, Quality and Outcomes activity is to support and conduct research that improves the outcomes, quality, cost, use and accessibility of health care. Accordingly, the Agency has identified three strategic plan goals that feed into this budget activity:

  1. Supporting improvements in health outcomes.
  2. Strengthening quality measurement and improvement.
  3. Identifying strategies to improve access, foster appropriate use, and reduce unnecessary expenditures.

The key themes throughout all three goals are to fund new research and to translate research into practice. In addition, AHRQ also has strengthened its commitment to support research that will improve health care for vulnerable populations. Lastly, AHRQ has enhanced specific activities that support all of our strategic goals.

For details from the justification, select Research on Health Costs, Quality, and Outcomes.

Medical Expenditure Panel Survey (MEPS)

The objectives of AHRQ's Medical Expenditure Panel Survey are to provide public and private sector decisionmakers with the ability to:

These objectives are accomplished through the fielding of the Medical Expenditure Panel Survey. MEPS is an interrelated series of surveys that replaces the National Medical Expenditure Survey (NMES). MEPS not only updates information that was last collected more than a decade ago in FY 1987, but also provides more timely data, at a lower cost per year of data, through the move to an ongoing data collection effort.

For details, select Medical Expenditure Panel Survey.

Program Support

Program Support provides support for the overall direction and management of the AHRQ. This includes the formulation of policies and program objectives; and administrative management and services activities.

For details from the justification, select Program Support.

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Current as of February 2004

Internet Citation:

Justification for Budget Estimates for Appropriations Committees, Fiscal Year 2005. February 2004. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/about/cj2005/cjweb05.htm

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