Summary
Introduction
The Agency for Health Care Policy and Research was reauthorized as the Agency
for Healthcare Research and Quality in December 1999 under P.L. 106-129,
the Healthcare Research and Quality Act of 1999. AHRQ, a part of the U.S. Public
Health Service within HHS, is the lead agency charged with supporting research designed to improve the quality of
health care, reduce its cost, improve patient safety, address medical errors,
and broaden access to essential services.
AHRQ sponsors and conducts research that provides evidence-based information
on health care outcomes, quality, cost, use, and access. The information
helps health care decisionmakers—patients and clinicians, health system leaders,
and policymakers—make more informed decisions and improve the quality of health
care services.
The AHRQ FY 2002 performance plan has the following format:
- Part 1 describes the Agency's mission, strategic goals, and programs and
includes the basic frameworks that the Agency uses to accomplish its core
business.
- Part 2 presents the Agency's six performance goals.
The structure of the performance goals and measures was modified in FY 2001
to reflect the two budget lines that fund the Agency's program activities:
- Research on health care outcomes, quality, cost, use and access.
- The Medical Expenditure Panel Survey (MEPS).
The goals for the third budget line, Program Support, focuses on internal
management issues for contracts management and information system development.
Although the measures continue to be important and remain in place for internal
accountability in the Office of Management Operations Plan and performance plans
for the managers and staff, they have been removed from the plan.
Return to Contents
Part 1: Agency Context for Performance Measurement
1.1. Agency Vision, Mission, and Long-term Goals
Vision. AHRQ's vision is to foster health care research that helps the American health care system provide
access to high quality, cost-effective services; be accountable and responsive
to consumers and purchasers; and improve health status and quality of life.
Mission. The Agency's mission is to improve the outcomes and quality of health care
services, reduce its costs, address patient safety, and broaden access to
effective services, through establishing a broad base of scientific
research and promoting improvements in clinical and health system
practices, including preventing diseases and other health conditions.
The Agency 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.
- Evaluates both clinical services and the system in which these services are provided.
- Provides information about the cost of care, its effectiveness, outcomes, efficiency, and quality.
- Includes studies of the structure, process, and effects of health services for individuals and populations.
- 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)
Strategic Goals. AHRQ has identified three strategic goals that will contribute to
improving the quality of health care for all Americans:
- 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.
- 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.
- Identify Strategies To Improve Access, Foster Appropriate
Use, and Reduce Unnecessary Expenditures. AHRQ focuses 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.
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 will publish 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.
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 of
1993 and provide the backdrop against which the next year's activities are
planned. The completion of the 1999 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.
1. Eisenberg JM. Health Services Research in a Market-Oriented Health Care
System. Health Affairs, Vol. 17, No. 1:98-108, 1998.
Return to Contents
1.2 Organization, Programs, Operations, and Strategies
AHRQ Organization. General program direction and strategic planning is accomplished through the
collaboration of the Office of the Director (with its 3 administrative
offices) and 6 Research Centers that have programmatic responsibility for
portions of the Agency's research portfolio. The Agency planning processes are
linked to budget planning and performance management through GPRA.
Each Office and Center (O/C) has individual strategic and operations plans.
The annual operations plans identify critical success factors that illustrate
how each O/C contributes to AHRQ achieving its strategic and annual
performance plan goals, as well as internal O/C management goals. At the end of
each year, the O/C Directors and their staffs review their
accomplishments in relation to the annual operations plans and draft the next
year's plans. The results of the reviews contribute significantly to performance reports that are influential in revising the operations plans.
As a result of the increased emphasis on strategic planning, evaluation
activities have taken on greater focus. Evaluations are used to demonstrate the
impact of Agency work on the health care system, to test and improve the
usefulness and usability of Agency products, and to assess the effectiveness and
efficiency of internal operations. The results of the evaluation studies are
used to make planning, budget, and operations decisions in subsequent years, as
well as for GPRA reporting purposes. Goal 4 of the Performance Report presents evaluations of significant AHRQ programs.
AHRQ Programs, Operations, and Strategies. The main focus of AHRQ research is on delivering health care and
identifying ways to measure and improve it. The Agency's research portfolio
consists of intramurally and extramurally funded work. 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's reauthorization led to an increased focus on patient
safety, the reduction in medical errors, and 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 Research Pipeline. The AHRQ portfolio reflects a "pipeline" (26 KB) 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 part of 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 part of the pipeline brings the first two parts 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 Policy 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. Information is used by policymakers to expand
their capability to monitor and evaluate the impact of system changes on
outcomes, quality, access, cost, and use of health care 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.
Goal
Areas |
Levels of Decisionmaking |
|---|
Clinical Services |
Health Systems |
Public Policy |
| Outcomes |
|
|
|
| Quality |
|
|
|
| Access, Cost, & Use |
|
|
|
AHRQ Cycle of Research. 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 following research cycle (8 KB)
describes the processes AHRQ uses to conduct its ongoing activities in order to
make the most productive use of its resources.
Needs Assessment. Agency activities begin and end with the end-users
of Agency research. The 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 10 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 decision making. 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 that includes
a feedback loop that depends on evaluating 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 evaluating 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 and 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
1999 reauthorization legislation mandated creating an Office of Priority Populations to
continue to build the research and associated activities that AHRQ undertakes to eliminate disparities in
health care for priority populations . 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. The OPPR leadership
will be implemented in FY 2001.
Training. AHRQ assures a strong infrastructure for health services
research through investments in training and supporting 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 in emerging and innovative research methods, aimed at junior-level researchers and mid-career scientists.
- Training programs that build curricula and foster innovative training
approaches.
Return to Contents
1.3. Partnerships and Coordination
AHRQ is not able to accomplish its mission alone. Partnerships formed with
the agencies within HHS, 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:
- Developing new research knowledge:
- AHRQ co-funds individual research projects and sponsors joint research
solicitations with agencies within HHS, such as the National Insitutes of Health (NIH), Centers for Disease Control (CDC), and the Substance Abuse and Mental Health Services Administration (SAMHSA).
- AHRQ co-funds research with academic institutions and foundations such
as the David and Lucille Packard Foundation.
- Developing tools, measures, and decision support mechanisms:
- Health Resources and Services Administration (HRSA) and the AARP partnered with AHRQ to develop the Put Prevention into
Practice Personal Health Guide for Adults Over 50, launched at the
Healthy People 2010 conference on January 25, 2000.
- An increasing number of agencies (such as NIH, HCFA, and the Veterans Administration (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, American Academy of Cardiology, American
Heart Association, and the Consortium for Spinal Cord Medicine.
- The Healthcare Cost and Utilization Project (HCUP) is a long standing
public-private partnership between AHRQ and 26 partner states to build a
multi-state data system.
- Translating research into practice:
- 14 companies and organizations (e.g. Midwest Business Group on Health, IBM,
United Parcel Service, National Consumers League) have joined AHRQ in
disseminating its Quality Navigational Tool designed to assist individuals
to apply research findings on quality measures and make major decisions
regarding health plans, doctors, treatments, hospitals, and long-term care.
- 14 organizations and companies have joined AHRQ in disseminating smoking
cessation materials (e.g. American Cancer Society, American Academy of
Pediatrics, Michigan Department of Community Health, Utah Tobacco Prevention
and Control System).
Return to
Contents
1.4. Summary FY 2000 Performance Report: Accountability through Performance
Measurement
AHRQ uses its strategic plan to integrate the Agency's planning processes
with budget development and implementation, and performance management and
evaluation. The current focus is to improve the linkage between the performance
indicators and the O/C annual operations plans, clarify and
strengthen Agency performance reporting systems, and document more
thoroughly how the results of the performance plans are used in managing the Agency.
One of the strengths of the performance plan is its alignment with the cycle
of research (needs assessment, creation of new knowledge, translation and
dissemination, and evaluation), and the strategic Agency plans for projects like
the quality initiative, and the core MEPS
activities. This alignment allows the Agency to more readily conduct gap
analyses, determining where we are and where we want to be. The results of these analyses
help AHRQ identify where to place further emphasis, where to continue on its
current course, and where to discontinue an initiative. AHRQ investment in
these core activities are rewarded by high rates of customer satisfaction and
user input. For example, 90 percent of the users of MEPS data indicate they are highly
satisfied, and the number of AHRQ grants funded in FY 2000 using MEPS data are
twice the target goal. Additionally, the response to user requests are at and
above target goals: requests received from policymakers, purchasers and plans
for MEPS data tapes, analyses, and reports were responded to within promised
time frames 95 percent of the time, with staff responding to 96 percent of all user requests
for technical assistance within 4 working days. This is a reduction of a full
day over last year's performance. In other goals, figures often exceed the
targets.
As another example of its ongoing efforts to involve customers in
the developmental stage, AHRQ has solicited and received extensive user
contributions toward the development of the National Quality Report. Customer
input has identified thousands of potential indicators of quality care. This
extensive list of initial measures is currently under review for selection of a
core set of broadly applicable quality measures.
Increasingly, within its annual operations plans, AHRQ is placing emphasis
on:
- Translating and disseminating research findings, referred to by the Agency as "Translation of Research Into Practice" or TRIP.
- Evaluating research and products developed by the Agency
that are in use in the health care system.
These two core activities are critical to the AHRQ mission to use
its investments in research to change health care and impact the well being of
the American public. The benefits of AHRQ funding of TRIP grants is evidenced by
the scope of funded projects that span conditions, populations, and health care
settings. Examples include:
- Assessing a model for accelerating the use of evidence-based treatment guidelines for acute ischemic stroke.
- Comparing usual care with interactive, multi-media computer based patient education to improve diabetes-related knowledge, attitudes, self-efficacy and compliance with self-care recommendations.
- Comparing two methods of integrating services in a group practice plan serving a low-income minority Medicaid population.
- Focusing on improving asthma outcomes for poor, inner-city, minority children.
The studies funded under the TRIP initiative also address 5 of the 6
priority conditions identified in the Department's Racial and Ethnic Disparities
in Health strategy.
AHRQ has maintained the same structure, goals, and objectives for the FY 2002
performance plan. As the Agency's programs move through the cycle of research, some
of the specific measures used under any one goal change from year to year to
reflect the programs' stages: process stage, output stage, or
outcome stage. For instance, in the FY 1999 Plan, the Evidence-based Practice
Centers (EPC) are represented with measures under Goal 3 representing
translation and dissemination. In FY 2000 and FY 2001, the EPCs are represented under
Goal 4 (evaluation) because the Agency will have moved on to assessing the
actual use and impact of the EPC products in the health care system.
The performance measures give the Agency an opportunity to reflect
on its efforts during the fiscal year, and assess the approaches that have been the
most productive in supporting its mission (supporting, conducting, and disseminating
research that improve access to care and the outcomes, quality, cost, and
use of health care services). The Performance Report for FY 2000
demonstrates that the Agency has a high degree of success with its efforts to realize
its goals and objectives. AHRQ has reported on 100 percent of the 53 measures
contained in the Performance Report for FY 2000. Of these 53 objective
performance measures, 98 percent (52 measures) of the target goals have been met
or exceeded. The remaining measure is being reviewed to determine if the
baseline target was overly optimistic. While the Agency's efforts to meet
target goals have been very good, AHRQ continually reviews target goals to
assess the need for reformulation.
A summary of AHRQ's annual performance plans' measures for FY 1999-FY 2002
follows.
Return to Contents
Proceed to Next Section
540 Gaither Road Rockville, MD 20850