Appendix I. AHRQ Strategic Planning Framework

AHRQ Strategic Plan

The strategic plan will serve as the road map for AHRQ activities through 2002. The current plan was released in December 1998 after an extensive planning process and was made widely-available for comment. In 2001, AHRQ published its second "Request for Ideas" (RFI) soliciting ideas from the Agency's customers and the general public for priorities in the context of planning for the new strategic plan. In addition, the National Advisory Committee (NAC) to AHRQ is providing feedback to the agency and several NAC members have agreed to participate in an ad hoc advisory planning group.

AHRQ assesses the progress made toward achieving each of the goals as part of the annual planning and budget development process. These assessments are integral to AHRQ's compliance with the Government Performance and Results Act (GPRA) of 1993 and provide the backdrop against which the next year's activities are planned. The completion of the 2000 performance report provided valuable information to the Agency on progress toward strategic goals. Results have been used to gather new knowledge, improve research management and strengthen dissemination activities.

AHRQ has identified three strategic goals, each of which will contribute to improving the quality of health care for all Americans.

AHRQ Goal 1. Support Improvements in Health Outcomes

AHRQ seeks to support research to understand and improve decisionmaking at all levels of the health care system, the outcomes of health care and in particular what works for whom, when, and at what cost.

AHRQ Goal 2. Strengthen Quality Measurement and Improvement

AHRQ is interested in a broad array of research topics, including studies to develop valid and reliable measures of the process and outcomes of care, causation and prevention of errors in health care, strategies for incorporating measures of quality improvement into programs and dissemination and implementation of validated quality improvement mechanisms.

AHRQ Goal 3. Identify Strategies To Improve Access, Foster Appropriate Use, and Reduce Unnecessary Expenditures

AHRQ will focus on whether particular approaches to health care delivery and financing, or characteristics of the health care market, alter behaviors in ways that improve access and promote cost-effective use of health care resources.

Organization, Programs, Operations, and Strategies

The main focus of AHRQ research is on the delivery of health care and identifying ways to measure and improve it. Most of the Agency's research portfolio consists of extramurally funded work from leading universities and other research institutions throughout the Nation. The portfolio also contains a body of intramural research. Issues related to the quality, cost and use of as well as access to health care are studied through extramural and intramural research. Extramural research is the primary source of studies on outcomes and effectiveness. AHRQ sponsored and conducted research measures the effectiveness of the services that deliver preventive, diagnostic, and therapeutic care, compares them with existing practice and evaluates the ability of the health care system to deliver them effectively. The Agency has an increasing focus on patient safety and the reduction in medical errors as well as research that will accelerate and magnify the impact of research on clinical practice and patient outcomes. Through the Translating Research Into Practice (TRIP) agenda, the Agency sponsors applied research to develop sustainable and replicable models and tools to improve the quality, outcomes, effectiveness, efficiency and cost effectiveness of health care.

The AHRQ portfolio reflects a "pipeline" of activities that together build the infrastructure, tools, and knowledge for improvements in the American health care system. This pipeline begins with the funding of new research that answers important questions about what works in American health care (New Knowledge on Priority Health Issues).

The second section in the pipeline (New Tools and Talent for a New Century) is focused on more applied research and translates new knowledge into instruments for measurement, databases, informatics and other applications that can be used to assess and improve care.

The final section of the pipeline is where the first two investments come together by closing the gap between what we know and what we do (Translating Research Into Practice). AHRQ funds research and demonstrations to translate the knowledge and tools into measurable improvements in the care Americans receive.

AHRQ Audiences

Agency activities begin and end with the end-users of Agency research. AHRQ customers require evidence-based information to inform health policy decisions. Health policy choices in this context represent three general levels of decisionmaking:

Clinical Decisions—Information is used every day by clinicians, consumers, patients and health care institutions to make choices about what works, for whom, when, and at what cost.

Health Care Organizations Policy Decisions—Health plan and system administrators, policymakers and purchasers are confronted daily by choices on how to improve the health care system's ability to provide access to and deliver high-quality, high-value care.

Public Policy Decisions—AHRQ research is used by policymakers to expand their capability to monitor and evaluate the impact of system changes on outcomes, quality, access, cost and use and to devise policies designed to improve the performance of the system. These decisions include those made by Federal, State and local policymakers and those that affect the entire population or certain segments of the public.

Producing meaningful contributions to the Nation and to research on health care requires continuous activity focused on iterative improvement in priority setting, on developing research initiatives and on research products and processes. The research cycle (1 KB) describes the processes AHRQ uses to conduct its ongoing activities in order to make the most productive use of its resources.

Needs Assessment

AHRQ's research agenda is based on an assessment of gaps in the knowledge base and on the needs of patients, clinicians, institutions, plans, purchasers and State and Federal policymakers for evidence-based information. Input gained during the needs assessments feeds directly into the research initiatives undertaken by the Agency as well as the products developed from research findings to facilitate use in health care.

Knowledge Creation

AHRQ will support and conduct research to produce the next generation of knowledge needed to improve the health care system. Building on the last 13 years of investment in outcomes and health care research, AHRQ will focus on national priority areas for which much remains unknown.

Translation and Dissemination

Simply producing knowledge is not sufficient; findings must be useful and made widely available to practitioners, patients and other decisionmakers. The Agency will systematically identify priority areas for improving care through integrating findings into practice and will determine the most effective ways of doing this. Additionally, AHRQ will continue to synthesize and translate knowledge into products and tools that support its customers in problem solving and decisionmaking. It will then actively disseminate the knowledge, products, and tools to appropriate audiences. Effective dissemination involves forming partnerships with other organizations and leveraging resources.

Evaluation

Knowledge development is a continuous process. It includes a feedback loop that depends on evaluation of the research's utility to the end user and impact on health care. In order to assess the ultimate outcomes of AHRQ research, the Agency will place increased emphasis on evaluation of the impact and usefulness of Agency-supported work in health care settings and policymaking. The evaluation activities will include a variety of projects, from smaller, short-term projects that assess process, outputs and interim outcomes to larger, retrospective projects that assess the ultimate outcomes/impact of AHRQ activities on the health care system.

Priority Populations

Health services research has consistently documented the persistent, and at times great, disparities in health status and access to appropriate health care services for certain groups. The Agency's reauthorization legislation, the Healthcare Research and Quality Act of 1999 (Public Law 106-129) mandated the creation of an Office of Priority Populations to continue and build the research and associated activities that AHRQ undertakes on health care for priority populations to eliminate disparities. These populations include racial and ethnic minorities, women, children (including adolescents), the elderly, people with special needs (disabilities, chronic illness, end-of-life issues), low income populations and those from inner-city and rural (including frontier) areas with health care delivery issues.

In FY 2000, AHRQ developed the structure for the Agency's Office of Priority Populations Research (OPPR) to continue focusing on developing science-based information to address issues of access to care, outcomes, quality, and the cost and use of services for each of these priority populations. In 2001 the Office of Priority Populations Research was established. A nationwide search is currently underway to recruit a leader in the field to serve as the Director of that office. Until a Director is recruited, the Deputy Director of the Agency has responsibility for overseeing OPPR priorities.

Training

AHRQ assures a strong infrastructure for health services research through investments in training and the support of young investigators. Critical areas of emphasis include:

• Bringing diversity to the health services research workforce by increasing the number of trained minority researchers.
• Instituting training programs to build research capacity in States that have not traditionally been involved in health services research, but are interested in developing the needed infrastructure.
• Training programs for junior-level researchers and mid-career scientists to emerging and innovative research methods.
• Training programs that build curricula and foster innovative training approaches.

Partnerships and Coordination with Other Federal Agencies

AHRQ is not able to accomplish its mission alone. Partnerships formed with the agencies within the Department of Health and Human Services, 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 agencies within HHS such as the National Institutes of Health (NIH), the Centers for Disease Control and Prevention (CDC), and the Substance Abuse and Mental Health Services Administration (SAMHSA).
• 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 Personal Health Guide for Adults Over 50.
• An increasing number of agencies (such as the National Institutes of Health [NIH], the Centers for Medicare & Medicaid Services [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.
• The Healthcare Cost and Utilization Project (HCUP) is a long standing public-private partnership between AHRQ and 22 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.

Crosswalk: Selected HHS Draft Strategic Goals and Objectives (FY 2003-2008) With AHRQ's 2003 Performance Measures and Activities

HHS Draft Goals and Objectives FY 2003-FY 2008	AHRQ Performance Measures and Activities
Objective 1.1 Reduce risky behaviors and other factors that contribute to the development of chronic diseases, especially diabetes and asthma.	Key Outcomes: Reduce by 5% the hospitalization rates for pediatric asthma. Decrease by 5% the number of premature babies who develop Respiratory Distress Syndrome (RDS). Reduce by 5% the immunization-preventable pneumonia or influenza in patients 65 and older.
Objective 2.1 Build the capacity of the health care system to respond to public health threats in a more timely and effective manner.	See ongoing bioterrorism activities noted under "From Evidence-based Knowledge to Implementation: Selected Examples of How AHRQ Research Helps People."
Objective 2.2 Improve the safety of food, drugs, biological products, and medical device. and Objective 4.2 Accelerate private sector development of new drugs, biologic therapies, and medical technology.	Centers for Education and Research on Therapeutics (CERTS): CERTS is a national initiative designed to increase the awareness of the benefits and risks of new, existing, or combined uses of therapeutics since information about the risks and benefits of new and older agents and about drug interactions is limited. The research conducted by the CERT's increases awareness of both the appropriate use and risks of new drugs, drug combinations, biological products, devices and mechanisms.
Objective 3.1 Create new, affordable health insurance options. and Objective 3.3 Strengthen and improve Medicare.	Key Outcomes in the Medical Expenditure Panel Survey/MEPS: Provide timely national estimates of health care use and expenditures, private and public health insurance coverage, and the availability, costs and scope of private health insurance benefits among the U.S. population. Analyze changes in behavior as a result of market forces or policy changes (and the interaction of both) on health care use, expenditures, and insurance coverage. Provide information on access to medical care, quality and satisfaction for the US population and for those with specific conditions, and for important sub-populations. Develop cost and savings estimates of proposed changes in policy. Identify the impact of changes in policy for key subgroups of the population (i.e., who benefits and who pays more). Consumer Assessment of Health Plans Survey (CAHPS®): CAHPS® makes available consumers' ratings of the quality of care and services they get from their health plans. This information is used by other consumers to make informed choices among health plans, by health care purchasers—such as employers or Medicaid programs—to select plans to offer their employees or beneficiaries, and by plans for quality monitoring and improvement. CAHPS® already has been used by more than 20 States, 10 employer groups and a wide range of health plans and companies.. CAHPS® also merged with the HEDIS (Health Plan Employer Data and Information Set) Member Satisfaction Survey and will be used by the National Committee for Quality Assurance to evaluate and accredit managed care plans for 40 million Americans. Finally, the Centers for Medicare and Medicaid Services (CMS) has used a specially developed version of CAHPS® to survey over 130,000 Medicare enrollees in managed care plans.
Objective 4.3 Strengthen and diversify the base of qualified health and behavioral science researchers.	Key Outcomes: Increase the number of minority researchers trained as health services researchers. Build research capacity in States that have not traditionally been involved in health services research, by supporting the development of the needed infrastructure. Support training programs for junior-level researchers and mid-career scientists to emerging and innovative research methods. Support training programs that build curricula and foster innovative training approaches.
Objective 5.1 Reduce medical errors. and Objective 5.4 Improve consumer and patient protections.	Key Outcomes: Nationally, 12 health facilities or regional initiatives will be funded to implement interventions and service models on patient safety improvements by 2004. On-site patient safety experts in 10 States and technical assistance to improve patient safety by 2004. Program Outputs: Invest $3 million in new activities designed implement local safety improvements priorities by providing incentives to put systems-based interventions in place in healthcare organizations. Invest $2 million in new programs designed to provide technical assistance to States and provide on-site patient safety experts to improve local capacity. Produce at least one synthesis of research findings and practical applications of AHRQ's research which will be available to clinical decisionmakers, health systems and policymakers. Report the interim data on the extent the patient safety best practices identified in the July 2001 EPC report have been adopted by health care institution. Identify the number and types of adverse events, no-harm events, and near miss events reported in demonstration projects.
Objective 5.2 Increase the Appropriate Use of Effective Health Care Services.	The Integrated Delivery System Research Networks (IDSRN) is model of field-based research that links the Nation's top researchers with some of the largest health care systems to conduct research on cutting edge issues in health care on an accelerated timetable. The IDSRN was developed explicitly to capitalize on the research capacity of, and research opportunities occurring within, integrated delivery systems. The network creates, supports, and disseminates scientific evidence about what works, and what does not work in terms of data and measurement systems and organizational "best practices" related to care delivery and research diffusion. It also provides a cadre of delivery-affiliated researchers and sites to test ways to adapt and apply existing knowledge. As a group, the IDSRN provides health services in a wide variety of organizational care settings to over 34 million Americans, including the privately insured, Medicare and Medicaid patients, the uninsured, ethnic and racial minorities, and rural and inner-city residents.
Objective 5.3 Increase consumer and patient use of health care quality information.	Maintain the number of projects being funded that bring healthcare quality information to the public in an understandable, user-friendly manner that facilitates its use in decisionmaking. Produce the National Healthcare Quality Report and the National Healthcare Disparities Report. Identify a core set of quality measures to be used to report on progress in improving the overall quality of health care.
Objective 5.5 Accelerate the development and use of an electronic health information infrastructure.	Through various mechanisms AHRQ is funding research what provide the following knowledge: Factors that influence adoption of emerging health care information technologies; Costs and organizational challenges associated with the adoption of health care information technology; Specific implementation challenges related to emerging applications such as telemedicine, computerized prescription order entry, and electronic medical records both in general facilities as well as in specialized facilities such as nursing homes; The impact that information sharing within and among local organizations has on health care quality; The desired effects of information technology achieved in routine use; The specific implementation challenges related to emerging applications in a variety of facilities; and, From the standpoint of health care outcomes, determining if it is better (and how much better) to invest in online healthcare applications, such as online disease management, than to invest in other health and medical care inputs.
Objective 8.5 Enhance the use of electronic commerce in service delivery and record keeping. and Objective 8.6 Achieve integration of budget and performance information.	Key Outcomes: BPR of grants process, complete with recommendations, will be complete by end of FY 2003. Succession plans for key Agency leadership roles will be in place by beginning of FY 04. AHRQ recruitment and retention plan will be designed to fill gaps identified in the assessment of current Agency workforce competencies. Conduct a review of AHRQ's FAIR Act Inventory. Identify and evaluate existing and new technologies to support AHRQ's revised business processes.

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