Message from the Director

I am pleased to present the Agency for Healthcare Research and Quality's (AHRQ) Fiscal Year (FY) 2008 Performance Budget. We all benefit from safe, effective, and efficient health care. Our performance-based budget demonstrates our continued commitment to assuring sound investments in programs within these three areas that will make a measurable difference in the health care.

The Agency's mission is to improve the quality, safety, efficiency, and effectiveness of health care for all Americans. In support of this mission, the Agency is committed to improving patient safety by developing successful partnerships and generating the knowledge and tools required for long term improvement. Building on past successes, AHRQ continues to use health information technology (Health IT) as a strategy to improve patient safety. We continue to see technologies developed by AHRQ put into practice, providing us with new opportunities to evaluate effective implementation efforts. For example, an insurance company is funding efforts to have software, developed through AHRQ research, installed in hospital intensive care units (ICUs). We look forward to expanding our Health IT efforts to the primary care setting through our Ambulatory Patient Safety program.

Providing another tool to support patient safety improvement, AHRQ successfully partnered with other organizations to provide hospitals and health systems with a method to perform ongoing evaluations of the safety culture in their facilities. This tool allows health care facilities to continually monitor improvements and make changes to reduce adverse events and prevent patient harm in their organization by assuring that employees are empowered to identify potential harms to patients, and participate in developing effective solutions. This tool has been adopted by organizations like the Veterans Administration, the Department of Defense, the Premier Hospital System and Catholic Health Initiatives. The Palo Alto Medical Foundation in San Francisco administered the Hospital Survey on Patient Safety Culture to 1,180 staff members and received responses from 73 percent of the employees. Palo Alto is using the survey to establish a baseline measurement of employee perceptions to see how their combined efforts for improvement are working. Results of the survey helped establish priorities. For example, 76 percent of employees had never completed an incident report, an area that Palo Alto will make an immediate priority.

AHRQ continues to improve patient care through the Effective Health Care Program. As authorized by the Medicare Modernization Act of 2003 (MMA), the Effective Health Care Program has begun a series of state-of-the-science reviews of existing scientific information on effectiveness and comparative effectiveness of health care interventions, including prescription drugs. In October 2006, AHRQ released its fifth comparative effectiveness review, Comparative Effectiveness of Management Strategies for Renal Artery Stenosis (RAS). While many RAS patients are treated with drugs, this report found that an increasing numbers of patients with narrowed kidney arteries are undergoing vessel-widening angioplasty and placement of a tubular stent. Medicare data show that angioplasty more than doubled from 7,660 in 1996 to 18,520 in 2000. The average charge of RAS angioplasty done in the hospital was $27,800 in 2004, according to data from AHRQ's Healthcare Cost and Utilization Project. However, this review concluded that a shortage of direct comparisons between drug therapy and angioplasty has left important questions unanswered, including which therapy is more likely to improve kidney function.

We are seeing results of efforts to improve quality of care. AHRQ released the fourth annual reports focusing on quality of and disparities in health care in America. Overall, the review of 40 core quality measures found a 3.1 percent increase in the quality of care—the same rate of improvement as the previous 2 years. However, the use of proven prevention strategies lags significantly behind other gains in health care. Except for vaccinations for children, adolescents, and the elderly, which improved by almost 6 percent, the improvement rate for other preventive measures—screenings, advice, and prenatal care—was less than 2 percent. As in previous years, the federal disparities report found access to care varied widely between racial, ethnic and economic groups.

With our continued investment in successful programs that develop useful knowledge and tools, I am confident that we will have more accomplishments to celebrate. The end result of our research will be measurable improvements in health care in America, gauged in terms of improved quality of life and patient outcomes, lives saved, and value gained for what we spend.

—Carolyn M. Clancy, M.D.
Director, Agency for Healthcare Research and Quality

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