Appendix to the Performance Plan

Linkage of AHRQ Strategic Goal Areas to HHS Strategic Plan & AHRQ Portfolios of Work

Goals/Portfolios of Work	AHRQ Strategic Goal Areas
	Safety/Quality Improve health care safety and quality for Americans through evidence based research and translation.	Efficiency Develop strategies to improve access, foster appropriate use, and reduce unnecessary expenditures.	Effectiveness Translate, disseminate, and implement research findings that improve health care outcomes.	Organizational Excellence Develop efficient and responsive business processes.
HHS Strategic Goals
1. Reduce Major Threats to the Health and Well-being of Americans	X
2. Enhance the Ability of the Nation's Public Health System to Effectively Respond to Bioterrorism and Other Public Health Challenges	X		X
3. Increase the Percentage of the Nation's Children and Adults who have Access to Regular Health Care and Expand Consumer Choices		X
4. Enhance the Capacity and Productivity of the Nation's Health Science Research Enterprise		X	X
5. Improve the Quality of Health Care Services	X
6. Improve the Economic and Social Well-being of Individuals, Families, and Communities, especially Those Most in Need	X
7. Improve the Stability and Health Development of Our Nation's Children and Youth
8. Achieve Excellence in Management Practices				X
AHRQ Portfolios of Work
Bioterrorism	X	X	X
Data Development		X	X
Chronic Care Management	X	X	X
Socio-Economics of Health Care		X	X
Informatics	X	X	X
Long-term Care		X	X
Pharmaceutical Outcomes	X	X	X
Prevention			X
Training	X	X	X
Quality/Safety of Patient Care	X	X	X
Organizational Support				X

Changes and Improvements Over Previous Years

Unique this year is the alignment of AHRQ's Portfolios of Work to each budget line and our strategic goals. These portfolios represent groupings of activities that are currently being funded by the agency along with planned activities in FY 2004 and 2005.

Partnerships and Coordination

AHRQ is not able to accomplish its mission alone. Partnerships formed with HHS Agencies, with other components of the Federal Government, with State and local governments, and with private sector organizations play a critical role in enabling the Agency to achieve its goals.

Most of the Agency's partnerships are related to:

The development of new research knowledge.

• AHRQ co-funds individual research projects and sponsors joint research solicitations with HHS Agencies such as NIH, CDC, the Substance Abuse and Mental Health Services Administration (SAMHSA), and HRSA.
• AHRQ co-funded research with the David and Lucille Packard Foundation and the Robert Wood Johnson Foundation.

The development of tools, measures, and decision support mechanisms.

• HRSA and AARP partnered with AHRQ to develop the Put Prevention into Practice Pocket Guide to Staying Healthy at 50+.
• An increasing number of agencies (such as NIH, CMS, and the Department of Veterans Affairs [VA]) are working closely with AHRQ's Evidence-based Practice Centers to develop assessments of existing scientific evidence to guide their work.
• Evidence reports are being used to develop clinical practice guidelines by organizations such as the American Psychiatric Association, American Academy of Pediatrics, American College of Obstetrics and Gynecology, American Academy of Physicians, the Consortium for Spinal Cord Medicine, American Academy of Cardiology, and the American Heart Association.
• HCUP is a long standing public-private partnership between AHRQ and 36 partner States to build a multi-state data system.

The Translation of Research into Practice (TRIP).

• 14 companies/organizations have joined AHRQ in disseminating its Quality Navigational Tool designed to assist individuals apply research findings on quality measures and make major decisions regarding health plans, doctors, treatments, hospitals, and long-term care—e.g., Midwest Business Group on Health, IBM, United Parcel Service, the National Consumers League.
• 14 organizations/companies have joined AHRQ in disseminating smoking cessation materials—e.g., American Cancer Society, American Academy of Pediatrics, Michigan Department of Community Health and the Utah Tobacco Prevention and Control System.

Data Verification and Validation

HCUP Data

Because administrative data on inpatient stays were not created for research purposes, there may be problems with the reliability and validity of certain data elements. Green and Wintfield (1993) summarized the literature on coding errors for hospital administrative data and described a decline in error rates during the 1970s and 1980s. Fisher, Whaley, Krushat et al. (1992) reported that the accuracy of principal diagnosis and procedure has improved since 1983, when such information became important for determining reimbursement by Medicare and other payers. Green and Wintfield (1993) reported the results of a reabstraction study using records from the California Office of Statewide Health Planning and Development. Information on age and sex was most reliable (error rates less than 1 percent), and principal diagnosis was inaccurate in 9 percent of records.

Subsequent studies have shown over 90% agreement between hospital administrative data and other sources of data for serious conditions and for in-hospital procedures (Baron et al., 1994; Pinfold et al., 2000; Du et al., 2000). A Veterans Affairs study compared administrative data to medical records and found adequate reliability for demographics, length of stay, and selected diagnoses (Kashner, 1998). A study that compared the accuracy of Medicare claims data to tumor registry data in identifying procedures performed for cancer found that claims data are accurate for studying surgical treatment but are less accurate in identifying diagnostic procedures (Cooper, et al., 2000). However, questions have been raised about the accuracy of administrative data for some conditions such as trauma, specifically splenic injury and thoracic aorta injury. Type of injury, injury severity, use of specific procedures, and complications were all under-reported in administrative data compared with trauma registry data (Hunt et al., 1999; Hunt et al., 2000).

Other problems inherent in hospital inpatient data include missing data, underreporting of socially stigmatized conditions such as alcoholism and drug abuse, and underreporting of minor procedures. One study found that analyses limited to principal diagnoses and procedures will produce an underestimate of diagnoses that tend to appear in secondary positions such as hypertension, osteoporosis, and Alzheimer's disease (May, Kelly, Mendlein et al., 1991). However, another study concluded that while administrative data may underestimate the presence of comorbidities, there is a high degree of agreement between administrative data and medical records for symptomatic comorbid conditions (Humphries et al., 2000).

Performance Measurement Linkages

The AHRQ GPRA annual performance report and plans are aligned with the Agency's three budget lines:

1. Research on Health Care Costs, Quality, and Outcomes.
2. Medical Panel Expenditure Surveys.
3. Program Support.

Agency programs are funded within the first two budget lines. Unique this year is the alignment of AHRQ's Portfolios of Work to each budget line. These portfolios represent groupings of activities that are currently being funded by the agency along with planned activities in FY 2004 and 2005. The table above portrays the alignment of the agency portfolios of work to our strategic goals of safety, quality, efficiency, effectiveness, and organizational excellence.

Summary of Full Cost of Performance Program Areas: Full Cost Table

Research on Healthcare Cost, Quality and Outcomes (HCQO), Millions of $

Full Cost and All Associated Annual Measures	FY2003	FY2004	FY2005
Research on Healthcare Cost, Quality and Outcomes (HCQO)	$254.9	$247.9	$247.9
Quality/Safety of Patient Care Portfolio Measures	$66.3	$32.3	$32.3
Informatics Portfolio Measures	$28.3	$64.4	$64.4
Data Development Portfolio Measures	$12.7	$12.4	$12.4
Chronic Care Management Portfolio Measures	$30.6	$29.8	$29.8
Prevention Portfolio Measures	$30.0	$29.2	$29.2
Socio-Economics of Health Care Portfolio Measures	$40.7	$39.6	$39.6
Pharmaceutical Outcomes Portfolio Measures	$15.3	$14.8	$14.8
Training Portfolio Measures	$8.2	$8.1	$8.1
Long-term Care Portfolio Measures	$17.8	$17.3	$17.3
Bioterrorism Portfolio Measures	$5.0	$0.0	$0.0

Medical Expenditure Panel Survey (MEPS), Millions of $

Full Cost and All Associated Annual Measures	FY2003	FY2004	FY2005
Medical Expenditure Panel Survey (MEPS)	$53.8	$55.8	$55.8
Data Development (MEPS) Portfolio Measures	$53.8	$55.8	$55.8

Program Support (PS), Millions of $

Full Cost and All Associated Annual Measures	FY2003	FY2004	FY2005
Program Support (PS) ($ spread in HCQO Portfolio Measures)	$0.0*	$0.0*	$0.0*
Organizational Support Portfolio Measures

* The full cost program support funding is distributed to the portfolios in the HCQO and MEPS budget activities.

Summary of Full Cost of Performance Program Areas, Millions of $

Program Performance Area	FY2003	FY2004	FY2005
Research on Healthcare Cost, Quality and Outcomes (HCQO)	$254.9	$247.9	$247.9
Medical Expenditure Panel Survey (MEPS)	$53.8	$55.8	$55.8
Program Support (PS) ($ in HCQO)	$0.0**	$0.0**	$0.0**
AHRQ Total Full Cost	$308.7	$303.7	$303.7

** The full cost program support funding is distributed to the HCQO and MEPS budget activity totals.

The full cost presentation is an initial attempt to get to budget and performance integration. The display and methodology will change over time as more is learned about performance budgeting.

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Current as of May 2004

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Internet Citation:

Performance Plans for FY 2004 and 2005 and Performance Report for FY 2003. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/about/gpra2005/gpra05a.htm

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