Agency for Healthcare Research and Quality

Performance Plans for FY 2003 and 2004 and Performance Report for FY 2002

Part 2. Goal-By-Goal Performance Measurement

Contents

2.1: Budget Line 1—Research on Health Care Cost, Quality and Outcomes (Tables)
2.2: Budget Line 2—Medical Expenditure Panel Surveys (MEPS) (Table)
2.3: Budget Line 3—Program Support (Table)
2.1: Budget Line 1—Research on Health Care Cost, Quality and Outcomes (Narrative)
2.2: Budget Line 2—Medical Expenditure Panel Surveys (MEPS) (Narrative)
2.3: Budget Line 3—Program Support (Narrative)

The FY 2004 Performance Plan continues AHRQ's transition from a plan focused on outputs to a plan more focused on outcomes.  The impact of research on health outcomes is rarely immediate or direct.  The results of AHRQ's investments, and its impact on the quality, safety, cost, use or access to health care should be measured as a whole, rather than as a single component.  As a result, the outcome measures we have chosen reflect the outcomes we expect to achieve over a span of several Fiscal Years. 

The indicators chosen to report are often the results of programs of research that have been underway for several years and reflect investments in building new knowledge.  The key is translation of that knowledge into information that is useful to our users.  For example, in FY 2003-04 AHRQ will track preventable hospitalizations for complications of pediatric asthma, the number of hospitalizations for elderly patients that could be prevented through the use of influenza immunizations and the number of premature infants who develop Respiratory Distress Syndrome (RDS) as a measure of success in improving health care outcomes.  Each of these indicators reflect the impact of investments which AHRQ has made in developing new knowledge and developing useful tools which providers can use to take the theoretical and make it practical.  In the Final FY 2004 Performance Plan AHRQ will use the National Healthcare Quality Report and the National Healthcare Disparities Report to identify other indicators to report the success of AHRQ's programs.

In addition, AHRQ identified program outputs for each goal for the Fiscal Year.  These program outputs will be used to show progress the programs are making to achieve the overall outcome goal.  For example, while reporting the number of hospitalizations for complications of pediatric asthma as a program output, AHRQ is committed to producing evidence reports on topics that will form the basis for future translation and implementation projects.  Reporting the Agency's program activities in this way will provide a clearer picture of where the agency is going and it's progress towards meeting its goals.

Finally, in future Performance Plan submissions, an analysis of the program will be incorporated into the goal-by-goal discussion.  For this report, FY 2002 results are addressed in Appendix II, Fiscal Year 2002 Performance Report Summary. 

The following tables present, by budget line, a selection of the long-term performance goals and Fiscal Year targets for AHRQ.  Some measures come from the results of OMB Program Assessment Rating Tool (PART) reviews of the following AHRQ programs:

Budget Line 2.1—Research on Health Care Cost, Quality and Outcomes

Goal 1:  To have measurable improvement in the outcomes, quality and safety of health care for Americans

Performance Goal

 FY Targets

 Actual Performance

 Reference

By 2010, at least 5 organizations will use HCUP databases, products or tools to improve health care quality for their constituencies by 10%, as defined by the AHRQ Quality Indicators.

Baseline: FY 2000—quality indicators developed.

FY 2004
Two new organizational users of HCUP will develop interventions using AHRQ QIs.
One organizational user will implement an intervention based on the QIs.

FY 2003
Two organizational users of HCUP will develop interventions using HCUP QIs.

Measure New in FY 2003

  

1 (1.1)

By 2008, CAHPS® data will be more easily available to the user community and the number of consumers who use information from CAHPS® to make choices about their healthcare will increase by 20% (Baseline FY 2002).

FY 2004
Produce a CAHPS® module for consumer assessments of hospital quality.
Establish baseline for number of consumers using Nursing Home CAHPS®.

FY 2003
Produce a CAHPS® module for consumer assessments of health and services received in nursing homes.

FY 2002 New Measure
Obtain baseline number of people with access to CAHPS® data.

Baseline developed:
Access—90 million Americans.

5 (5.3)

By 2010, evidence, translation tools and implementation strategies exist for improving the overall quality and safety of health of the American public so that: 

  • By 2010, reduce to 105,613 admissions, the rate of hospitalizations for pediatric asthma in persons under age 18.
  • By 2010, reduce to 520,441 the number of immunization-preventable pneumonia hospital admissions of persons aged 65 and older.
  • By 2010, reduce to 11,570 the number of immunization-preventable influenza hospital admissions of persons aged 65 and older.
  • By 2010, reduce to 500 per live births the number of premature babies who develop Respiratory Distress Syndrome (RDS).

FY 2004
Reduce by 5% below the baseline:

  • The rate of hospitalizations for pediatric asthma in persons under age 18.
  • The number of admissions for immunizations-preventable pneumonia for persons aged 65 or older.
  • The number of admissions for immunization-preventable influenza for persons aged 65 or older.
  • The number of premature babies who develop RDS.

FY 2003
Establish Validated Baselines. Following are FY 2000 baseline estimates:

Pediatric Asthma—150,876
Pneumonia—743,487
Influenza—16,529
RDS—5,707

  

1 (1.)

Report on national trends in health care quality.

FY 2004
Report on progress in core measure set. Identify private sector data to be used in future reports.

FY 2003
Produce first annual quality report.  Establish baseline data in core set of measures.

   

By 2004, 6 health facilities or regional initiatives to implement interventions and service models on patient safety improvements will be in place.

FY 2004
6 Teams will be in place.

FY 2003
Awards to be made to at least 6 facilities or initiatives.

 

5 (5.1)

By 2004, at least 10 States or major health care systems will have on-site Patient Safety Improvement Corp (PSIC) staff in place.

FY 2004
10 States or major health care systems will have on site experts in Patient Safety.

FY 2003
A Patient Safety Improvement Corp training program will be established.

FY 2002
Planning study completed.

Completed.

5 (5.1)

Identify the number and types of adverse events, no-harm events, and near miss events reported in demonstration projects.

FY 2004
Report on the number and types of adverse events.

FY 2003
Develop reporting mechanism and data structure for Demonstration projects.

  

5 (5.1)

By 2006, six national message format and clinical vocabulary standards would be identified/recommended by HHS as ready for voluntary adoption and deployment.

FY 2004
3 message format and clinical vocabulary standards will be recommended by HHS as ready for voluntary adoption and deployment.

FY 2003
Develop Consensus on standards.

 

5 (5.5)

By 2008, nursing homes will have evidence-based information needed to make informed purchasing strategies related to IT.

FY 2004
5 technologies currently shown to be effective in other clinical settings will be tested in nursing homes to evaluate the impact on safety, quality and cost of care.

  

5 (5.5)

Goal 2: To develop the evidence base for policymakers and health systems to use in making decisions about what services to pay for, how to structure those services, and how those services are accessed.

Performance Goal

 FY Targets

 Actual Performance

 Reference

Increase the number of partners contributing data to the HCUP databases by 5% above FY2000 baseline.

FY 2004
5% increase over FY00 baseline.

FY 2003
Increase the number of partners required.

  

4(4.1)

Goal 3: To build the capacity for improving the Quality of Health Care Delivery through Research and Training

Performance Goal

 FY Targets

 Actual Performance

 Reference

Increase the number of minority researchers trained as health services researchers by 5% annually.

FY 2004
5% increase over FY 2003 baseline.

FY 2003
New Measure Establish baseline.

  

4 (4.2)

Support training programs for junior-level researchers and mid-career scientists.

FY 2004
Maintain baseline

FY 2003
Establish Baseline # programs.

  

4 (4.2)

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Budget Line 2.2—Medical Expenditure Panel Survey (MEPS)

Goal 4:  To provide comprehensive, relevant and timely data on health care use and expenditures for use by public and private sector decisionmakers and researchers

Performance Goal

 FY Targets

 Actual Performance

 Reference

By 2008, point in time data from the MEPS survey will be available within 12 months.

FY 2004—12 months
FY 2003—12 months
FY 2002—12 months
FY 2001—12 months
FY 2000—12 months

12 months
12 months
12 months

  

Insurance Component tables will be available within 6 months of collection.

FY 2004—7 months
FY 2003—7 months
FY 2002—7 months
FY 2001—7 months
FY 2000—7 months

7 months
7 months
7 months

  

MEPS Use and Demographic Files will be available 12 months after final data collection.

FY 2004—15 months
FY 2003—17 months
FY 2002—19 months
FY 2001—23 months
FY 2000—28 months

19 months
23 months
28 months

  

Full Year Expenditure Data.

FY 2004—12 months
FY 2003—18 months
FY 2002—21 months
FY 2001—24 months
FY 2000—33 months

21 months
24 months
33 months

  

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Budget Line 2.3—Program Support

Goal 5: Maximize the value of AHRQ by developing efficient and responsive business processes, aligning human capital policies and practices with AHRQ's mission, building an integrated and reliable information technology infrastructure

Performance Goal

 FY Targets

 Actual Performance

 Reference

By FY 2007, Get to Green on the Presidents Management Agenda Initiatives
—Human Capital

FY 2004
Develop a plan to recruit new or train existing staff to acquire skills necessary to fill identified gaps.

FY 2003
Identify gaps in agency skills and abilities.
Integrate competency models into organizational processes.
Finalize the identification of technical competencies.
Engage a consultant to evaluate options and develop a plan for vertically & horizontally collapsing organizations.
Continue to reduce organizational levels.

FY 2002
Develop a model for leadership and core competencies in AHRQ.
Reduce the Number of Managers.
Reduce Organizational Levels.
Redeploy Staff to Mission-Critical Positions.

Completed.
— # of supervisory positions eliminated:  7
— # of organizational levels eliminated:  2
—  # of  administrative FTE's redeployed to support program functions:  12

Presidential Management Initiative

Expanded E-Government.
Increase IT Organizational Capability.

FY 2004
Complete implementation of the control review cycle.
Implement the evaluation cycle.
Integrate capital planning processes with enterprise architecture processes.

FY 2003
Implement the planning cycle.
Implement the select review cycle.
Initiate efforts for the control review cycle.

FY 2002
Establish IT project accountability.
Establish IT capital planning governance.
Stand up the IT Investment Review Board.
Develop integrated business transactions with contracts and budget.
Define operating procedures for capital planning's four cycles.

Completed.

  

Improve IT Security/Privacy.

FY 2004
Continue risk assessments on AHRQ's second tier systems.
Implement the business continuity and contingency program plans.

FY 2003
Continue risk assessments on AHRQ's mission critical systems.
Implement incident response plans and procedures.
Develop network security plans.
Develop anti-virus program plan.
Develop authentication program plan.

FY 2002
Establish security and privacy governance.
Complete the second cycle of NIST self assessments.
Complete risk assessments of seven of AHRQ's mission critical systems.

Completed.

Presidential Management Initiative

Establish IT Enterprise Architecture.

FY 2004
Develop the target architecture.
Create the migration plan.
Integrate enterprise architecture processes with capital planning processes

FY 2003
Continue to carry out business process assessments of key business lines.
Establish enterprise architecture governance.
Develop the baseline architecture.
Develop the technical reference model.
Establish technical standards.
Implement general desktop and network upgrades to reflect the technical architecture.

FY 2002
Stand up the enterprise architecture program office.
Implement the Enterprise Architecture Management System.

Completed.

Presidential Management Initiative

Budget and Performance Integration

FY 2004
Implement planning system.
Complete initial PART reviews on all major agency programs.

FY 2003
Develop and test planning system that links  budget and performance.
Conduct initial PART Reviews on selected agency programs.

FY 2002
Conduct initial PART reviews on selected agency programs.

Completed PART reviews on 5 agency programs.

Presidential Management Initiative

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