Carolyn M. Clancy, M.D., Acting Director, AHRQ
Before the House Subcommittee on Labor-Health and Human Services-Education Appropriations
Accompanied by, Dr. Lisa Simpson, Deputy Director, AHRQ; Rita Koch, Director, Division of Financial Management, Office of Management, AHRQ; Kerry Weems, Acting Deputy Assistant Secretary, Office of Budget, Department of Health and Human Services
Introduction
AHRQ's Research Improves Health Care
Fiscal Year 2003 Request
Secretarial Initiative to Improve Patient Safety
Reporting on Quality and Disparities
Translating Research Into Practice
Conclusion
Mr. Chairman and Members of the Committee, I am pleased to be here today to present the President's Fiscal Year 2003 budget request for the Agency for Healthcare Research and Quality (AHRQ). AHRQ's mission is to support, conduct, and disseminate research to improve the quality of health care, reduce its cost, improve patient safety, address medical errors, and broaden access to essential services.
Our mission, to which the Committee has provided guidance, is driven by the needs of users of our research—patients, clinicians, health system leaders, and policymakers. The primary focus of our mission is to ensure that the research we support is translated into practice so it can improve people's lives.
As one of the 13 agencies of the Department of Health and Human Services (HHS), AHRQ often collaborates with other HHS agencies, particularly the National Institutes of Health (NIH), the Centers for Disease Control and Prevention (CDC), and the Centers for Medicare and Medicaid Services (CMS). AHRQ's health services research complements the biomedical research of the NIH by helping clinicians, patients, and health care institutions make choices about what treatments work best, for whom, when, and at what cost.
The products of the Agency include the scientific evidence that supports decision making to improve health care, as well as tools that assist in efforts to improve quality and reduce costs. Our focus is on getting research results in the hands of those who can put it to practical use. I would like to provide the committee with some examples of how AHRQ's research has improved our Nation's health care.
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AHRQ's Research Improves Health Care
One of our greatest accomplishments is that the research we support and conduct has had a great impact on public programs, including Medicare and Medicaid.
For example, AHRQ provides CMS with technology assessments to inform coverage decisions. Based on a recent assessment by AHRQ, CMS now permits coverage for the treatment of actinic keratoses (AK), a common skin condition that is often the precursor of skin cancer. The assessment suggests that the presence of AKs is associated with the development of squamous cell carcinoma (SCC), which has the potential to metastasize and accounts for a large percentage of all non-melanoma skin cancer deaths in the Medicare population. Before the national coverage policy was issued, coverage decisions on whether to reimburse for AK removal were left up to local Medicare carriers but now the treatment will be covered nationally.
As a result of an AHRQ-funded study, the State of North Carolina is providing free vitamin D supplementation to breast-fed infants across the State. Researchers at the Center for Education and Research on Therapeutics (CERTs) at the University of North Carolina and Wake Forest University School of Medicine found that many exclusively breast-fed, dark-skinned infants would benefit from vitamin D supplementation. All of the rickets cases among pediatric patients were African-American children who were breast-fed and who had not had vitamin D supplementation. The study's findings caused an immediate change in North Carolina public health practice. The North Carolina Pediatric Society requested that the State of North Carolina distribute a multivitamin supplement free-of-charge to any exclusively breast-fed infant or child, 6 weeks of age or older. Funding for the supplementation was provided through a Maternal and Child Health Block Grant and distributed through the Supplemental Nutrition Program for Women, Infants, and Children. Over a 16-month period, more than 1,500 children received this supplementation at a cost of about $1.50 per month, per child.
AHRQ's research also helps consumers. For example, we supported the development of the Consumer Assessment of Health Plans (CAHPS), which is an easy-to-use kit of survey and reporting tools that provides reliable information to help consumers and purchasers make choices among health plans based on information on quality provided by plan enrollees. Information from CAHPS surveys was available to help more than 90 million Americans with their Year 2000 health care benefits decisions. There are CAHPS data available to nearly 40 million Medicare beneficiaries on 280 plans. These beneficiaries received the assessment of beneficiaries enrolled in managed care plans. Data were provided in the handbook sent to each beneficiary and were placed on the Medicare.gov website.
A randomized clinical trial, funded by AHRQ and the Health Resources and Services Administration's (HRSA) Maternal and Child Health Bureau, found that bag-valve-mask ventilation (BVM) used outside the hospital setting produced comparable survival rates for young children who have stopped breathing without the risk associated with invasive intubation. As a result of the study, both the Los Angeles and Orange County California Emergency Medical Systems ordered their paramedics to begin using that technique alone on children needing artificial respiration. The results of this study also prompted the American Academy of Pediatrics to modify its educational programs to encourage the appropriate use of BVM.
In another example, several States have incorporated the recommendations from AHRQ's schizophrenia research into their statewide treatment guidelines. The State of New York, in addition to establishing guidelines, has used the recommendations to develop quality indicators for their residency and rehabilitation programs as well as their clinics and hospitals. They also have developed automated pharmacy databases where the clinician's actual practices will be compared with the recommended regimes. Seven States have implemented the recommendations or portions of them. By developing the recommendations, AHRQ has given the field the first comprehensive, evidence-based review of all treatments for schizophrenia. Building on our research, the National Institute of Mental Health is funding the current effort to update the recommendations so that their usefulness will continue, especially in light of the ever-changing field of psychopharmacology.
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Fiscal Year 2003 Request
Now I would like to present AHRQ's FY 2003 request.
For FY 2003, we are requesting $252 million, a decrease of $49 million or a 16 percent decrease from FY 2002. The request will enable us to focus on four priority areas:
- Patient safety.
- Reporting on quality and disparities through enhancement of two AHRQ databases.
- Translating research into practice.
- Helping Americans make more informed decisions when choosing a health plan.
To focus on these four priority areas, some combination of reductions must be made to ongoing grant and contract commitments. Grant commitments will be reduced by over $27 million or 46 percent, and contract commitments will be reduced by over $6.5 million or 31 percent. In addition, no new nonpatient safety grants will be funded.
Our request also includes $10 million to cover the annual cost to support a sample expansion of the Department of Commerce's Current Population Survey to enhance analytic content, in order to improve the accuracy of State estimates of the uninsured and improve the measurement of expansions under the Health Insurance Flexibility and Accountability (HIFA) initiative.
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Secretarial Initiative to Improve Patient Safety
Early AHRQ-sponsored research on medical errors and patient safety laid the groundwork for current efforts to solve this critical health care problem. According to 1999 estimates of the Institute of Medicine, medical errors in hospitals alone claim between 44,000 and 98,000 lives each year.
Current AHRQ-sponsored patient safety research is helping the health care system identify and implement practices that will reduce errors and improve patient safety. For example, in FY 2001, AHRQ released an evidence report, compiled by AHRQ's Evidence-based Practice Center at the University of California San Francisco/Stanford University, outlining the evidence for 79 patient safety practices. The Agency also funded $50 million of patient safety research that will yield evidence-based practical tools and strategies for the health care system. An additional $55 million will be made available in FY 2002 for patient safety activities.
The FY 2003 Budget request for AHRQ includes an increase of $5 million for a total of $60 million devoted to improving patient safety. These funds support activities that build on prior AHRQ-funded research and promote the translation of patient safety research into programs and products for health care systems with the goal of having measurable improvement in the safety of health care for Americans. The proposed budget activities will allow the Department to act immediately on what we know works in improving patient safety while building more knowledge for the future.
This effort will allow us to work collaboratively with other agencies within HHS as we do through the Departmental Patient Safety Task Force with the CDC, CMS, HRSA, the Food and Drug Administration, Indian Health Service, and the Office of the Assistant Secretary for Planning and Evaluation. Through this collaboration, the Department will be able to coordinate other agency investments in improving patient safety to ensure that the Departmental effort will produce a "whole which is greater than the sum of the parts."
This will be done in two ways. First, we will implement local safety improvement priorities through challenge grants that will provide incentives to put systems-based interventions in place in health care organizations. These challenge grants will include an emphasis on the use of technology and informatics.
Second, we will develop a program to train on-site patient safety experts. The trainees will be used to improve local capacity in field assignments where they will provide technical assistance on information management, on-site assistance of experts in patient safety, support of regional health initiatives, and assistance in using administrative, regulatory, and payment mechanisms to support a culture of safety.
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Reporting on Quality and Disparities
The FY 2003 Request includes enhancements for two of AHRQ's databases. The Medical Expenditure Panel Survey (MEPS) is our main source to collect and examine comprehensive data on the level and distribution of health care use and expenditures, to monitor the dynamics of the health care delivery and insurance systems, and to assess health care policy implications. In FY 2003, MEPS totals $53.3 million, an increase of $4.8 million from the FY 2002 level. The increase consists of continuation costs from prior year enhancements to meet the congressional mandates to submit an annual report on national trends in health care quality and to prepare an annual report on health care disparities. In addition, $1 million will be allocated for enhancements to the MEPS Insurance Component both in terms of sample size and improvements in the collection of information from employers about health insurance offerings and costs for their employees. The enhancements will also permit more detailed analyses for population subgroups that include Asian and Pacific Islanders and individuals with incomes that are less than 200 percent of the poverty level.
The FY 2003 request also provides support for the Healthcare Cost and Utilization Project (HCUP), a Federal-State-industry partnership to build a standardized, multi-State health data system. This long-standing partnership has built and continues to develop and expand a family of administrative databases and powerful, user-friendly software to enhance the use of administrative data. HCUP data are used at all levels to inform decision making and it continues to be a very valuable resource. About 40 percent of personal health care expenditures in the United States go toward hospital care, making it the most expensive component of the health care sector. HCUP will be funded at $4.1 million in FY 2003.
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Translating Research Into Practice
Translating Research Into Practice (TRIP) is the final step of AHRQ's research pipeline. This step focuses on closing the gap between what we know and what we do. This effort will address the problem that the health care system does not always use the latest scientific evidence in purchasing, providing, and using health care services. We do this by working in partnership with key actors in the health care system to translate research and improve health care.
For example, a TRIP project at the University of Illinois is comparing the use of standard treatments with patient education via an interactive, multimedia computer program to improve diabetes-related knowledge and compliance with self-care recommendations. The study takes place at community health clinics serving predominantly African-American and Hispanic patients.
The Agency is committed to informing practitioners, patients, consumers, and other decision makers about needed health care changes as revealed by research. As we obtain the knowledge of what can be improved, we must be able to promote the adoption and use of research findings. By doing so, we will be better able to demonstrate that the benefits observed in research are achievable in daily practice and yield measurable and sustainable improvements in health care. TRIP grant commitments will be funded at $7 million in FY 2003.
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Help for Consumer Decisionmaking
In FY 2003, AHRQ will continue to fully support Consumer Assessment of Health Plans (CAHPS) grants. These projects focus on development and testing of new and more effective ways to report quality data to consumers, patients, care givers, and purchasers and will also translate questionnaires and reports into languages in addition to Spanish and English. The projects also include development of assessment instruments for people with mobility impairments and more refined questionnaire items for people who receive care through preferred provider organizations. CAHPS grants will be funded at $2.5 million in FY 2003.
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Conclusion
Mr. Chairman, I want to thank you and the Committee for giving me the opportunity to present the President's budget request of $252 million for AHRQ in FY 2003.
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Current as of May 2002
Internet Citation:
Testimony on the President's Fiscal Year 2003 Budget Request for AHRQ. Carolyn M. Clancy, M.D., Acting Director, AHRQ, before the House Subcommittee on Labor-Health and Human Services-Education Appropriations. May 1, 2002. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/about/cj2003/cjtest03.htm
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