Structure of the AHCPR GPRA Annual Performance Plan
Goal Format
Information on each goal is presented in the following format:
- Strategy: This section contains an explanation of the Agency's approach to accomplishing the goal.
- Previous Successes: This section contains examples of previous achievements that are applicable to the goal and strategy.
- Goal Statement.
- Fiscal Year 1999 Objectives and Indicators.
- Fiscal Year 2000 Objectives and Indicators.
Objectives and Indicators Template
The objectives and indicators are presented in the format illustrated in the following template.
Objective: Each objective for the Goal is listed.
Indicators: This information provides a list of the measures that will be used by AHCPR to determine if the objective has been achieved. Baseline information as appropriate.
Indicators Summary: This information, with numerators and denominators, provides the details how the measures will be calculated.
Type and Significance: The different types of measures are used as follows:
- Process measures: To monitor the establishment of major new initiatives or implementation of improvements in core activities where significant resources are involved or the potential for significance of the ultimate impact is high.
- Output measures: To record the results of research initiatives and dissemination activities essential to moving to the next step of implementation.
- Outcome measures: To show the impact (or potential for impact) in affecting the outcomes, quality, access, cost, or use of health care.
AHCPR also includes an explanation of why the measure is appropriate and significant.
Data Collection Issues: This information provides an explanation of the data collection issues for each measure.
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Goal 1: Establish future research agenda based on users' needs. (HCQO)
Strategy
In the field of health services research, the user of the information plays a critical role. If health services research is to improve the quality of health care, it must provide answers to the questions and issues that represent the barriers to improvement. AHCPR emphasizes open communication with users of its research to ensure that it is addressing important questions. This phase of the cycle of research will continue to be an area of emphasis as the Agency implements the initiatives in the fiscal year 2000 budget to assure that research begins and ends with the user.
Previous Successes
AHCPR has a history of consulting with the users of its research. The current program announcement that provides guidance to researchers on AHCPR's areas of interest was formed through consultations with many outside experts. A few examples include:
- A meeting with experts from the private and public sectors in fiscal year 1997 led to Agency initiatives to study the roles of managed care and other market forces in the organization, delivery, and financing of health care and the ultimate effects of such forces on health care quality, access, and costs
- A national conference on research about the interface of primary and specialty care for children which led to a publication, a request for applications, and the funding of eight projects
- An expert meeting for Pharmaceutical Outcomes Therapy lead to the development of two initiatives that are proposed for the fiscal year 1999 and the fiscal year 2000 budget
- A Federal Register notice and extensive mailings to solicit nominations for topic for the Evidence-based Practice Centers
- The review of the draft AHCPR strategic plan by its National Advisory Council
- The use of results from the evaluation of the AHCPR Web site by users to redesign the web site
- Frequent meetings between the AHCPR Administrator and user groups including clinical, health systems, and policy decisionmakers.
Goal 1 Fiscal Year 1999 Objectives and Indicators
Objective 1.1: Define direction of fiscal year 1999 project funding priorities, in large part, by needs assessment activities.
Indicators
Agency research agenda covering the three strategic research goals is developed in fiscal year 1999 and documented based on consultations with various groups.
Baseline: The first summary report of consultation activities will be produced in fiscal year 1999.
Indicators Summary
Summary research agenda produced and made available to the public
Type and Significance
Output: AHCPR must be able to tie its research agenda to the needs of the users of health services research in order to accomplish its mission and ultimately impact the health care system. These consultations will take various forms, including focus groups, expert meetings, discussions at professional meetings, meetings with consumer groups, and consultations with peer review study section members and the National Advisory Council. The agenda will identify explicit criteria to drive new initiatives and ensure they are focused on specific priority areas.
Data Collection
Expert meetings and other consultations with users are routinely documented with meeting summaries that are reviewed by participants for verification of accuracy. The offices and centers that sponsor these activities will report annually on the contributions the outreach activities made to creating research agenda priorities.
Goal 1 Fiscal Year 2000 Objectives and Indicators
Objective 1.1: Define direction of fiscal year 2000 project funding priorities, in large part, by needs assessment activities.
Indicators
Agency research agenda covering the three strategic plan research goals and the new fiscal year 2000 Closing the Gap initiatives are documented based on consultations with various groups.
Baseline: First report will be produced in fiscal year 1999.
Indicators Summary
Summary research agenda produced and made available to the public
Type and Significance
Output: AHCPR must be able to tie its research agenda to the needs of the users of health services research in order to accomplish its mission and ultimately impact the health care system. These consultations will take various forms, including focus groups, expert meetings, discussions at professional meetings, meetings with consumer groups, and consultations with peer review study section members and the National Advisory Council. The agenda will identify explicit criteria to drive new initiatives and ensure they are focused on specific priority areas.
Data Collection
Expert meetings and other consultations with users are routinely documented with meeting summaries that are reviewed by participants for verification of accuracy. The offices and centers that sponsor these activities will report annually on the contributions the outreach activities made to creating research agenda priorities.
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Goal 2: Make significant contributions to the effective functioning of the U.S. health care system through the creation of new knowledge.
(HCQO)
Strategy
There are many gaps in knowledge in all areas of health care. New questions emerge as new technologies are developed, the population's
demographics change, areas of inquiry previously under-emphasized take on greater importance, and research previously undertaken identifies
further areas that need attention. Therefore, AHCPR will continue to focus on creating new knowledge and assessing the findings that result from
completed projects. This phase of the cycle of research identifies the opportunities for improvement from which changes in health care can be
designed and implemented. AHCPR will continue to focus on developing a portfolio of peer-reviewed extramural and intramural research and will
also place particular focus on the fiscal year 2000 initiative, "New Research on Priority Health Issues."
Previous Successes
Descriptive Research. AHCPR research has been descriptive in nature, documenting current patterns in care, identifying where quality or
outcomes fall short, identifying barriers to access, measuring the costs and utilization of care, or focusing on the experience of care and the special
needs of vulnerable populations. These studies have been extremely valuable in helping us to understand who is affected by illness, how these
illnesses are managed, what they cost, how systems are organized and financed to deliver care, and what the consequences of care are.
Development of Tools and Analytic Methods. The second dominant aspect of the Agency's work in the last 10 years has been in the
development of tools and analytic methods. These include development of tools to systematically review and synthesize literature, instruments to
measure quality and outcomes, sophisticated techniques to measure risk and severity, and methods to characterize and study the changing nature of
the health care system itself. Most of the instruments currently in use to measure health-related quality of life that are well designed and validated
were developed with public sector support, often from AHCPR. Development of these has been clearly recognized by the private sector as a public
good.
Comparative Studies. The third aspect of the Agency's work where additional emphasis has been placed in the last 3 years is in studies that
directly compare interventions to improve care, including both clinical interventions and changes in the organization and financing of health
services. Examples of clinical intervention studies include:
- A large trial to implement the National Heart, Lung, and Blood Institute (NHLBI) guideline for asthma in three managed care settings.
- Three trials to assess the effectiveness and cost-effectiveness of hysterectomies for non-cancerous conditions.
- A study to compare the cost-effectiveness of home visits to office-based follow up for infants with lung disease due to prematurity.
- Partnerships with the NIH to add cost-effectiveness components to new studies, e.g., the NHLBI/National Emphysema Treatment Trial (NETT) study of lung volume reduction
surgery.
- The current set of cooperative agreements to examine the impact of different features of managed care on the quality and outcomes of care for
people with chronic conditions.
Goal 2 Fiscal Year 1999 Objectives and Indicators
Fiscal Year 1999 Objective 2.1: Determine the salient findings from research for three priority populations and develop plan for next steps in translation
and dissemination.
Indicators
A report that synthesizes research
on the major health concerns of at
least three priority populations
produced.
Baseline: Not applicable.
Indicators Summary
Not applicable.
Type and Significance
Process and output:
The first product of research is
information. This report will
illustrate that AHCPR is
investing in research with the
potential to have significant
impact when disseminated and
implemented widely. A precursor of this type of report
was produced by AHCPR in 1995,
Better Quality Can Cost Less,
which summarized research
findings with potential to improve
quality while decreasing costs.
Data Collection
AHCPR is implementing a
strategy to routinely synthesize
and report on major findings.
This included the creation of a
Research Translation Team to
work closely with program staff
to track the findings from
AHCPR research and their
relevance and potential impact. This Team, assigned to the
Office of Health Care
Information, will coordinate
with dissemination staff to
develop the plans for next
steps. The AHCPR Automated
Management Information
System will provide data for
these tracking activities. The
Team approach will be
evaluated at the end of fiscal year 1999
to assess its effectiveness.
Fiscal Year 1999 Objective 2:2: Achieve significant findings from AHCPR sponsored and conducted research.
Indicators
Findings from at least 10 AHCPR
sponsored or funded research are
published in major peer reviewed
professional publications (New
England Journal of Medicine,Journal of American Medical
Association, etc.); receive national
press coverage; are used in
Federal or State policymaking; are
used by professional associations
or health plans as the basis of
strategies to achieve quality; or are
used to establish coverage
decisions by health care
purchasers, managed care
organizations, or insurers,
including Medicare or Medicaid.
Baseline: Data will be collected in
fiscal year 1999.
Indicators Summary
Numerator—Number of extra- or intramural
research grants that receive
national attention or are used as
detailed in the indicator.
Denominator—Total number of extra- and
intramural research projects
completed during the previous 2
years.
Type and Significance
Output: This indicator provides a first
indication of whether the
research funded or sponsored
by AHCPR is significant.
Coverage by popular and
professional media is highly
competitive. AHCPR's
receiving coverage is an
indication that the finding has
the potential for significant
impact. The actual use of the
finding by purchasers,
professional associations,
managed care organizations,
and/or insurers also signals
that the new knowledge has
the potential to make a
difference. The ultimate
outcome or impact will be
evaluated after the finding has
been implemented over a period
of time.
Data Collection
The Research Translation Team
and public affairs staff from the
Office of Health Care Information
track press coverage, journal
placement, and other uses of
research findings. The increased
emphasis on working with
program staff and researchers to
gather this information will be
evaluated at the end of fiscal year 1999.
Fiscal Year 1999 Objective 2.3: Initiate fiscal year 1999 research initiatives
Indicators Funding of a minimum of 21
projects in:
- Consumers use of information on quality.
- Strengthen value-based purchasing.
- Measure national health care quality.
- Vulnerable populations.
- Translating research into practice.
Baseline: Not applicable. This objective is
not meant to be measured against
previous or future performance (i.e., 9 grants vs. 10 isn't the issue).
The objective represents the
Agency's commitment to a certain
level of effort that is necessary for
the research initiative to succeed.
Indicators Summary
Numerator—Number of projects funded.
Denominator—Total number of extra- and
intramural projects funded.
Type and Significance
Process: With increased funding,
AHCPR is putting particular
emphasis on the further
development of the knowledge
base in these areas.
Data Collection
The grants addressing these
conditions will be identified
through the grants management
database.
Indicators
Funding of a minimum of 17
projects in:
- Outcomes for the elderly and chronically ill.
- Clinical preventive services.
- Centers for Education and Research on Therapeutics (CERTs).
- Improving the quality of children's health.
Baseline: Not applicable. This objective is
not meant to be measured against
previous or future performance (i.e., 9 grants vs. 10 isn't the issue).
The objective represents the
Agency's commitment to a certain
level of effort that is necessary for
the research initiative to succeed.
Indicators Summary
Numerator—Number of projects funded.
Denominator—Total number of extra- and
intramural grants funded.
Type and Significance
Process: With increased funding,
AHCPR is putting particular the
further development of the
knowledge base in these areas.
Data Collection
These grants will be identified
through the grants management
database.
Goal 2 Fiscal Year 2000 Objectives and Indicators
Fiscal Year 2000 Objective 2.1: Determine annually the salient findings from research in each of the three areas (outcomes; quality; and cost, access, and
use) and develop plan for next steps translation and dissemination.
Indicators
- Annual report on science advances in three research goal areas.
- At least four major findings in each area that have potential to save significant amounts of money, improve quality, save lives or prevent physical suffering, or change the organization and delivery of health care.
- For each finding, specific steps in translation and dissemination are identified and initiated.
Baseline: The first report will be
published in fiscal year 2000.
Indicators Summary Annual Report
Numerator—12 major findings from extra- and intramural research (4/goal).
Denominator—Total number of research findings
from all completed extramural and
intramural projects during fiscal year 2000.
Type and Significance
Process and output: The first product of research is
information. This report will
illustrate that AHCPR is
investing in research with the
potential to have significant
impact when disseminated and
implemented widely. A precursor of this type of report
was produced by AHCPR in 1995,
Better Quality Can Cost Less,
which summarized research
findings with potential to improve
quality while decreasing costs.
Data Collection
AHCPR is implementing a
strategy to routinely synthesize
and report on major findings.
This included the creation of a
Translation Team to work
closely with program staff to
track the findings from AHCPR
research and their relevance
and potential impact.
This Team, assigned to the
Office of Health Care
Information, will coordinate
with dissemination staff to
develop the plans for next
steps. The AHCPR Automated
Management Information
System will provide data for
these tracking activities. The
Team approach will be
evaluated at the end of fiscal year 1999
to assess its effectiveness.
Fiscal Year 2000 Objective 2:2: Achieve significant findings from AHCPR sponsored and conducted research.
Indicators
Findings from at least 10 AHCPR
sponsored or funded research are
published in major peer reviewed
professional publications (New
England Journal of Medicine,
Journal of American Medical
Association, etc.); receive national
press coverage; are used in
Federal or State policymaking; are
used by professional associations
or health plans as the basis of
strategies to achieve quality; or are
used to establish coverage
decisions by health care
purchasers, managed care
organizations, or insurers,
including Medicare or Medicaid.
Baseline: Data will be collected
systematically for the first time in
fiscal year 1999.
Indicators Summary
Numerator—Number of extra- or intramural
research grants that receive
national attention or are used as
detailed in the indicator.
Denominator—Total number of extra- and
intramural research projects
completed during the previous 2
years.
Type and Significance
Output: This indicator provides a first
indication of whether the
research funded or sponsored
by AHCPR is significant.
Coverage by popular and
professional media is highly
competitive. AHCPR's
receiving coverage is an
indication that the finding has
the potential for significant
impact. The actual use of the
finding by purchasers,
professional associations,
managed care organizations,
and/or insurers also signals
that the new knowledge has
the potential to make a
difference. The ultimate
outcome or impact will be
evaluated after the finding has
been implemented over a period
of time.
Data Collection
The Translation Team and public
affairs staff from the Office of
Health Care Information track
press coverage, journal placement,
and other uses of research
findings. The increased emphasis
on working with program staff and
researchers to gather this
information will be evaluated at
the end of fiscal year 1999.
Fiscal Year 2000 Objective 2.3: Implement fiscal year 2000 priority (1) "New Research on Priority Health Issues."
Indicators
Funding of a minimum of 10
projects that address gaps in
knowledge about the priority
problems faced by Medicare and
Medicaid.
Baseline: Not applicable. This objective
documents the Agency's level of
commitment to this 2000
initiative.
Indicators Summary
Numerator—Number of projects funded on
Medicare and Medicaid.
Denominator—Total number of extra- and
intramural projects funded.
Type and Significance
Process: This is the first step of
a new research initiative that
addresses gaps in knowledge
identified by previous research
on conditions of critical
importance to the Nation's
health care. This will enable
AHCPR to avoid duplication
and to clearly define its areas
of interest. In 1996, AHCPR's
PORTs focused on 8 out of the
10 most costly diagnoses for
Medicare hospitalizations, for
example, acute myocardial
infarction, stroke, hip fracture
and repair, and pneumonia.
Data Collection
AHCPR researchers use Medicare
and Medicaid to profile patterns of
care in these programs. Annual
updates will be used to guide
research efforts.
The grants addressing these
conditions will be identified
through the grants management
database.
Indicators
Funding of a minimum of 10
projects to address eliminating
disparities in health care with
particular emphasis on
disparities that exist for racial
and ethnic minorities.
Baseline: Not applicable. This objective
documents the Agency's level of
commitment to this 2000
initiative.
Indicators Summary
Numerator—Number of projects funded on
disparities in health care for racial
and ethnic minorities.
Denominator—Total number of extra- and
intramural grants funded.
Type and Significance
Process: Research has
documented that disparities exist.
An increased emphasis is needed
to identify the causes of those
disparities so that the can be
eliminated. AHCPR is committing
to working on these issues.
Data Collection
These grants will be identified
through the grants management
database.
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