Chapter 7. Strategic Goals and Performance Planning at AHRQ

A Road Map for AHRQ's Activities

The Agency for Healthcare Research and Quality (AHRQ) promotes health care quality improvement by conducting and supporting health services research to develop and disseminate scientific evidence regarding all aspects of health care. Health services research addresses issues of organization, delivery, financing, use, patient and provider behavior, quality, outcomes, effectiveness, safety, and cost. It evaluates both clinical services and the systems in which these services are provided.

Health services research includes studies of the structure, processes, and effects of health services for individuals and populations. It addresses both basic and applied research questions, including fundamental aspects of both individual and system behavior and the application of interventions in practice settings.

In FY 2003, AHRQ made significant progress in establishing our "Portfolios of Work," which represent the groups of activities currently being funded by the Agency. The Portfolios of Work are linked to our strategic goal areas as noted in the table below.

We are in the process of refining AHRQ's performance goals to better address planned activity in each portfolio, and we are creating outcome goals for our portfolios to meet the health care challenges confronting us in this first decade of the 21st Century. Our current and future efforts include the development of a software application that will map each AHRQ-funded activity to the portfolio structure.

AHRQ 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.
Bioterrorism	X	X	X
Data Development		X	X
Chronic Care Management	X	X	X
Socioeconomics 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
System Capacity and Bioterrorism	X	X	X
Organizational Support				X

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Program Performance Overview: Performance at a Glance

Performance Measure	FY 2003 Target	FY 2003 Results
Quality/Safety of Patient Care Portfolio
Patient safety events report	Develop reporting mechanism data structure	X
Implementation of patient safety practices	Awards to six facilities or initiatives	X
Deploy hospital practices	Established Patient Safety Improvement Corps training	X
Informatics Portfolio
Identify/recommend national message format and clinical vocabulary standards	Develop consensus on standards	X
Chronic Care Management Portfolio
Improve the quality and safety of health care for the American public	Establish baselines for: Pediatric asthma Pneumonia Influenza	X X X
Report on national health care trends	Publish the first National Quality Report	X
Pharmaceutical Outcomes Portfolio
Develop a structure to fulfill authorizing legislation	Finalize charters for the steering committee and public-private partnerships	X
Data Development Portfolio
Timeliness in availability of: Insurance Component tables MEPS use and demographic files Full year expenditure data	Within 7 months of data collection Within 17 months of final data collection Within 18 months of end of data collection	X X X
Use of HCUP databases, products, or tools	Two organizations will use HCUP/QIs	X
Partners contributing data to HCUP databases Increase availability of CAHPS data and increase the number of users	Increase the number of partners required Produce a CAHPS module for consumer assessments of care received in nursing home settings	X X
Organizational Support Portfolio
Strategic management of human capital	Identify gaps in agency skills/abilities Integrate competency models into organizational processes Finalize identification of technical competencies Plan for vertically/horizontally collapsing organizations Reduce organizational levels	X X X X X
Information technology and E-government	Increase IT organizational capability Improve IT security/privacy Establish IT enterprise architecture	X X X
Budget/performance integration	Develop/test planning system linking budget and performance Conduct PART reviews on selected agency programs	X X

X = Goal achieved.

Bioterrorism

AHRQ conducted two 1.5 day regional bioterrorism and health system preparedness workshops focusing on AHRQ-supported bioterrorism research findings and promising practices implemented by States, localities, and health systems.

Chronic Care Management

A team-oriented approach to testing for chlamydia increased the screening rate of sexually active 14- to 18-year-old female patients from 5 percent to 65 percent in a large California HMO, according to new study findings from researchers at the University of California, San Francisco, Department of Pediatrics, and Kaiser Permanente of Northern California. This screening should greatly reduce the incidence of infertility, since chlamydia is a major cause of infertility.

Data Development

Four new State partners joined HCUP in FY 2003: Minnesota, Nebraska, Rhode Island, and Vermont. They were selected on the basis of their diversity, in terms of geographic representation and the population ethnicity they bring to the project, along with the quality of their data and their ability to facilitate timely processing of data.

Socioeconomics of Health Care

An AHRQ Integrated Delivery System Research Network (IDSRN) project conducted by Marshfield Health Clinic assessed the impact of its Coumadin Clinic on health care use, including urgent care, emergency department, and inpatient care. While the estimates are still preliminary, testimony given by Marshfield Clinic representatives before the Way and Means Committee's Subcommittee on Health strongly suggest that State disease management projects like this one offer the potential for significant cost reductions by averting hospital inpatient stays and emergency department visits. Medicare, for example, would save an estimated $235,943 per 100 person years. Moreover, failure to manage patients on Coumadin appropriately is a leading cause of avoidable medical errors in older patients.

Informatics

AHRQ is funding two projects that are studying the use of handheld computerized physician order entry (CPEO) systems with decision support capability (i.e., software that taps into database resources to assist users in making decisions on issues such as care options) in primary care clinics. The studies are evaluating the impact of these systems on reducing medical errors and improving clinical care. They are also assessing the barriers to use of these systems and the cost-effectiveness of using this technology.

Long-term Care

AHRQ is funding centers to focus on safety issues for the elderly and especially those in residential care settings such as assisted living and nursing homes. Safety is a major concern for the elderly as well as for the staff in these facilities. The center at New York University is focusing on safety in home care, while the center at Emory University is determining how to prevent falls and pressure ulcers in nursing homes and assisted living facilities.

Pharmaceutical Outcomes

AHRQ's Duke University Center for Education and Research on Therapeutics (CERT) program found that patients with certain types of heart disease are not taking medicines that may save their lives. Aspirin is inexpensive and available over-the-counter, and it greatly reduces the risk of health attack, stroke, and related death in people with coronary artery disease (CAD). Similarly, beta-blockers have been shown to help people with congestive heart failure (CHF).

Data collected by the Duke University CERT showed that 97 percent of cardiac patients were using aspirin. This reflects, in part, the adoption of the recommendations from the AHRQ-sponsored U.S. Preventive Services Task Force. However, data collected by Duke also confirmed that 13 percent of people with CAD were not receiving adequate therapy. People with CAD who were not taking aspirin were almost twice as likely to die within 2 years as those who were taking aspirin. The news was only slightly better for people with CHF who were not taking a beta-blocker; they had 1.5 times the risk of dying compared with people who were taking the medicine. The Duke CERT is now investigating ways to get life saving medicine to people who need it. Programs to overcome barriers and save lives can be designed once more is understood about why people are not taking these medicines.

Prevention

In FY 2003, AHRQ's U.S. Preventive Services Task Force reviewed the evidence of effectiveness and developed recommendations for clinical preventive services covering screening for cervical cancer, prostate cancer, dementia, diabetes, gestational diabetes, and osteoporosis, as well as counseling for tobacco use, prevention of cancer and cardiovascular disease, and breastfeeding.

Training

Virtually all of the students supported through AHRQ training programs begun in 1986 (94 to 98 percent of postdoctoral students who have completed training) are gainfully employed in health services research or administration. Three-quarters of all students graduating from AHRQ-sponsored training programs publish in peer-reviewed journals, and up to 80 percent are first authors on their publications. The remaining trainees are actively engaged in the conduct of applied research or its administration and are working in government, private industry, research foundations, and the health care delivery system.

Key recent publications produced by former students in journals such as JAMA (Journal of the American Medical Association) and the New England Journal of Medicine have been nationally acclaimed. For example, one published research project found no difference in neonatal outcomes or HMO expenditures between early discharge programs and State-mandated programs preventing early discharge of newborns.

Quality/Safety of Patient Care

Medicare patients treated in the outpatient setting may suffer as many as 1.9 million drug-related injuries a year because of medical errors or adverse drug reactions not caused by errors, according to medical researchers sponsored by AHRQ and the National Institute on Aging. About 180,000 of these injuries are life-threatening or fatal, and more than half are preventable, say the researchers, who based the estimates on a study of over 30,000 Medicare enrollees followed during 1999-2000.

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