Performance Plans for FY 2003 and 2004 and Performance Report for FY 2002
Summary
Agency Mission and Vision
The Agency for Healthcare Research and Quality
(AHRQ) 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. It evaluates both clinical services
and the system in which these services are provided. It provides information
about the cost of care, as well as its effectiveness, outcomes, efficiency,
and quality. It includes studies of the structure, process, 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."1
The vision of the Agency is to foster health
care research that helps the American health care system provide access to
high quality, cost-effective services; to be accountable and responsive to
consumers and purchasers; and, to improve health status and quality of life.
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 the establishment of a broad
base of scientific research and through the promotion of improvements in clinical
and health system practices, including the prevention of diseases and other
health conditions.
Return to Contents
Overview of the Plan and Performance Report
The
AHRQ Performance Plan is a companion piece to the AHRQ Strategic Plan and
to the FY 2004 Budget Request. In this document, the initial FY 2004 and
revised FY 2003 Performance Plans have been merged with the FY 2002 Performance
Report to comply with the format developed by the Department of Health and
Human Services (HHS).
The
2004 Performance Plan being submitted is the final stage in the extensive
review, reorganization and revision of AHRQ's Performance Plan. This new
organization will allow AHRQ to more tightly integrate budget and performance
management over the coming years. In addition, moving the Agency's Plan from
a process-oriented system focused on outputs to a more outcomes oriented performance
measurement system will increase its clarity and usefulness as a strategic
management tool. This document reflects the agencies transition from goals
which were closely aligned with the "Cycle of Research" to goals which are
more closely reflect the Agency's vision, mission and strategic goals. As
a result, the FY 2002 Performance Report continues to be organized around
the seven goals identified in the FY 2002 Congressional Justification. Beginning
with the 2003 Performance Plan, however, performance goals will be more closely
aligned with the agencies strategic goals and performance measures will include
both output and outcome measures. Specifically, these changes include:
-
Individual sections devoted to
a single strategic goal. Each section will contain the Strategic Goal and
Strategic Objectives, followed by the Performance Goal, Performance Measure,
and Strategies.
- Use of the results by AHRQ and
issues related to data availability and integrity as well as the identification
of key factors that influence success have been rewritten and incorporated
with the performance goals they support.
- Strategies receive a greater
focus, as they give direction and guidance to AHRQ staff and outline how we
will achieve our goals.
- Program performance is integrated
throughout the document to make clear how the Agency is building on previous
successes as it plans for out-year performance.
These revisions will enable AHRQ to determine
how well the basic knowledge which forms the core
of AHRQ's work provides information which can be turned into actions by policymakers,
those who make clinical decisions, purchasers and providers who make decisions
about what services to use, pay for and how to organize those services.
Return to Contents
FY 2002 Performance Highlights
The Agency's mission is to conduct and sponsor
research that will help improve the outcomes and quality of health care, reduce
costs, address patient safety and medical errors, and broaden access to effective
services. AHRQ's ability to sustain a high level of performance during Fiscal
Year 2002 is evidenced by how its research has ultimately been used to provide
better health care delivery services.
From Evidence-based Knowledge to Implementation:
Selected Examples of How AHRQ Research Helps People
Among other recommendations, the AHRQ-sponsored U.S.
Preventive Services Task Force recommended this past year that:
- Mammography screening, with or
without clinical breast examination, occur every one to two years for women
ages 40 and over. The USPSTF published two earlier breast cancer screening
recommendations, in 1989 and 1996, that both endorsed mammography for women
over age 50. The USPSTF is now extending that recommendation to all women
over age 40 but found that the strongest evidence of benefit and reduced mortality
from breast cancer is among women ages 50-69. The recommendation acknowledges
that there are some risks associated with mammography, e.g., false-positive
results that lead to unnecessary biopsies or surgery but that these risks
lessen as women get older.
- Clinicians discuss the potential
benefits of taking tamoxifen to reduce the risk of breast cancer with female
patients who are at high risk for the disease.
- Clinicians also discuss the benefits
and harms of aspirin therapy with healthy adult patients who are at increased
risk of coronary heart disease (CHD), primarily heart attacks. Recent studies
found that regular use of aspirin reduced the risk of CHD by 28 percent in
persons who had never had a heart attack or stroke but who were at increased
risk. Those considered at increased risk for CHD are men over the age of 40,
post-menopausal women, and younger persons with risk factors for CHD, e.g.,
those that smoke and/or have diabetes and hypertension. Every year, more
than 1 million Americans die from heart attacks and other forms of CHD.
- All adults age 50 and over get
screened for colorectal cancer, the Nation's second leading cause (after lung),
of cancer deaths. Currently less than half of all Americans over 50 are
being screened.
- Primary care clinicians screen
their adult patients for depression. Formal screening can make it easier
to identify depression, a common (five to nine percent of adult patients in
primary care settings suffer from depression, 50 percent of cases go undetected)
and treatable condition that often is not recognized by patients or their
doctors. It's estimated that depression increases health care utilization
and costs $17 billion in lost workdays each year.
- Free software released this past
summer (2002) by AHRQ provides the Nation's hospitals with a quick and relatively
easy-to-use quality check on their in patient care. AHRQ's Inpatient Quality
Indicators (IQI) software can be downloaded via this Agency Web address: http://www.qualityindicators.ahrq.gov/data/hcup/inpatqi.htm.
- AHRQ along with the Centers for
Medicare & Medicaid Services (CMS), and the U.S. Office of Personnel Management
(OPM) officially launched a new Government Web site designed to help benefit
managers, consumer advocates, and State officials communicate with their audiences
about health care quality. The site, http://www.TalkingQuality.gov, provides
step-by-step instructions on how to implement a quality measurement and reporting
project such as a health plan report card.
- AHRQ funded research showed that
women with mild to moderate pelvic inflammatory disease (PID)—a leading
cause of infertility—who are treated as outpatients have recovery and reproductive
outcomes similar to those for women treated in hospitals. Treating the approximately
85,000 women with mild/moderate who are currently hospitalized as outpatients
may save approximately $500 million each year.
- Florida's "passive re-enrollment"
policy, which does not require parents to take steps to prove that their children
are still eligible for the State Children's Health Insurance Program (SCHIP),
results in a significantly lower percentage of children losing coverage than
in States that require parents to verify periodically their children's eligibility.
This research finding is part of a set of studies being conducted under the
Child Health Insurance Research Initiative (CHIRI™), sponsored by AHRQ, the
David and Lucile Packard Foundation and the Health Resources and Services
Administration (HRSA). The study found that only five percent of children
in Florida SCHIP fell off the rolls at re-enrollment, as compared to one-third
to one-half of children in Kansas, Oregon, and New York. Currently,
only a handful of States have passive re-enrollment policies in place.
- A new questionnaire added to
AHRQ's Medical Expenditure Panel Survey (MEPS) found that while a majority
of parents report that their experiences with health care for their children
are good, there are significant variations by age, race/ethnicity and type
of insurance coverage. This data provides the first nationally-representative
information about parent's experiences with health care for their children.
- Using a managed care "carve-out"
arrangement to provide equal coverage for mental health services did not raise
costs for one large employer. AHRQ-funded researchers examined the impact
of a State's mental health parity mandate on a large employer group that simultaneously
implemented a managed care "carve-out" for its mental health and substance
abuse benefits. Carve-outs are services provided within a standard health
benefit package but delivered and managed by a separate organization. The
researchers compared plan costs, use patterns and access in the one year prior
to the changes with the three years following the changes.
- A nationwide study sponsored
by AHRQ showed that Black and Hispanic HIV patients are only about half as
likely as non-Hispanic whites to participate in clinical trials of new medications
designed to slow the progression of the disease.
- Patients
who take beta blockers (drugs to slow the heart rate and reduce contractions
of the heart muscle) prior to bypass surgery appear to have improved survival
and fewer complications during and after the procedure, according to an AHRQ
study. Researchers indicate that up to 1,000 lives potentially could be saved
each year by giving patients beta blockers. The study was the first ever
to examine the outcomes of beta blocker use before bypass surgery.
- AHRQ-funded research led by Mount
Sinai School of Medicine found that hospitalized patients with abnormal vital
signs, mental confusion and problems with eating or drinking in the 24 hours
prior to discharge are more likely not to be able to resume normal activities
and face greater chance of hospital readmission or death. Therefore, hospital
and insurance plan guidelines that shorten length of hospital stays should
build in a safety check to measure clinical stability prior to discharge.
- Elderly patients who had any
of 14 high-risk cardiovascular or cancer operations in hospitals performing
a high volume of their particular procedure were more likely to survive than
those who went to hospitals with a low volume of their type of surgery, according
to a nationwide study sponsored by AHRQ. Going to the high-volume hospitals
made the biggest difference for patients undergoing surgery for cancer of
the pancreas. Only four percent of such patients at highest-volume hospitals
died, compared to 16 percent at lowest-volume hospitals. The study also found
that hospital volume was important for patients undergoing heart valve replacement,
abdominal aneurysm repair, and surgery for lung, stomach or bladder cancer.
For each these procedures, death rates at the highest-volume hospitals were
between two percent to five percent lower than at the lowest-volume hospitals.
- AHRQ-funded research conducted
by the Stanford University Patient Education Research Center found that the Chronic Disease Self-management Program
(CDSMP) can help prevent or delay disability, even in patients with heart
disease, hypertension or arthritis. The CDSMP is a 17-hour course taught
by trained lay people that teaches patients with chronic disease how to better
manage their symptoms, adhere to medication regimens and maintain their functional
ability.
- AHRQ funded the design of a new
tool that helps identify nursing home residents at relatively low risk for
death from lower respiratory infection (LRI)—which means patients may be
treated safely without transferring them to a hospital. LRIs, primarily pneumonia,
are the leading causes of hospitalization and death among nursing home residents.
The new tool helps clinicians determine the severity of the illness and the
risk of death, which can help them choose the location for treatment more
quickly. Residents at low risk of dying may be managed best in the nursing
home, which may prevent complications or discomfort that can occur from a
hospital admission.
- AHRQ released A Step-by-Step
Guide to Delivering Clinical Preventive Services: A Systems Approach.
This new publication, the newest from AHRQ's Put Prevention
Into Practice Program, helps guide clinicians in the development of a
system for delivering clinical preventive services in the primary care setting.
Research shows that the most effective and accepted preventive services are
not delivered regularly in the primary care setting. For example, in 1997
pneumococcal disease caused 10,000-14,000 deaths, but only 43 percent of persons
aged 65 and older received a pneumococcal vaccine.
- AHRQ published Prevention Quality
Indicators—a free tool for detecting potentially avoidable hospital admissions
for diabetes and other illnesses which can be effectively treated with high-quality,
community-based primary care. The AHRQ Prevention Quality Indicators will
allow users to measure and track hospital admissions for uncontrolled diabetes
and 15 other conditions using their own hospital discharge data and will provide
the information needed to improve the quality of primary care for these illnesses
in a community or State.
- AHRQ released a new synthesis
of AHRQ-funded research on diabetes management which shows that providers
can help patients achieve good glycemic control and postpone major complications
of the disease through a combination of intensive drug therapy and a team
approach to care. The synthesis, Improving Care for Diabetes Patients
Through Intensive Therapy and a Team Approach, is based on AHRQ-supported
research that has examined what can be achieved when treating patients in
an office practice. The synthesis indicates that the components of effective
management of diabetes include:
- More frequent use of two oral medications, or one oral medication plus insulin.
- Three or more daily injections for insulin recipients.
- Four or more visits per year for many patients, and visits with both physicians and nurse practitioners.
Improving Care for
Diabetes Patients reflects the substantial investment AHRQ has made in
research addressing conditions like diabetes, as well as how to translate
those research findings into improved clinical practice. AHRQ also announced
the release of a new fact sheet showing that racial and ethnic minorities
are at greater risk for diabetes, and that certain minorities also have much
higher rates of diabetes-related complications and death. This fact sheet,
Diabetes and Disparities Among Racial and Ethnic Minorities, is based
on a review of research articles that appeared in peer-reviewed journals.
- Analysis funded by AHRQ and others
found that data on nurse staffing levels (in eleven States among 799 hospitals
covering 6 million patients) confirms that there is a direct link between
the number of registered nurses and the hours they spend with patients and
whether patients develop a number of serious complications or die while in
the hospital.
- AHRQ's significant investment
in bioterrorism research has lead to the following:
- Researchers at the University of
Alabama at Birmingham and
Research Triangle Institute have developed Web-based training modules to teach
health professionals how to address varied biological agents. Separate modules
exist for ER practitioners, radiologists, pathologists, and infection control
specialists. These clinicians can obtain continuing medical education (CME)
credit at this site: http://www.bioterrorism.uab.edu.
- Through collaborations with the
University of Maryland, Emory University, District of Columbia Hospital Association,
and Booz-Allen Hamilton, a questionnaire has been developed that can help
assess the current level of preparedness of hospitals or health systems and
their capacity to respond to bioterrorist attacks. The Department of Defense
is already using this assessment in pilot work.
- In collaboration with the New
York City Department of Health and the Mayor's Office of Emergency Management,
AHRQ's Integrated Delivery System Research Network (IDSRN) based at the Weill
Medical College of Cornell University has developed a computer simulation
model for city-wide response planning for bioterrorist attacks. This model
for mass prevention of disease in the event of a bioterrorist attack was validated
by a live exercise funded by the Department of Justice.
- Researchers at the Children's
Hospital of Boston are exploring
the feasibility of building decision support models for information systems
using linked health care data. These information systems would help to link
the public health infrastructure with the clinical care delivery system to
speed reporting and enhance rapid dissemination of relevant information. A
preliminary product is a literature review that clarifies the potential of
Web-based systems for clinicians to obtain timely information and report potential
bioterrorist events to public health authorities.
- Researchers at the University of
Pittsburgh and
Carnegie-Mellon are continuing the development of a "Real-time Outbreak and
Disease Surveillance (RODS) System" for bioterrorist events. The purpose
of RODS is to provide early warning of infectious disease outbreaks, possibly
caused by an act of bioterrorism, so that treatment and control measures can
be initiated to protect and save large numbers of people.
- The Science Applications International
Corporation (SAIC) in collaboration with Johns Hopkins University, George Washington University, and the Joint Commission on Accreditation of Healthcare
Organizations (JCAHO) has completed extensive work on assessing and recommending
improvement in the linkages between the medical care, public health, and emergency
preparedness systems to detect and respond to bioterrorist events.
- Among others, AHRQ's User Liaison
Program's May 2002 teleconference disseminated bioterrorism research findings
to over 500 State and local health policymakers, information that helped them
assess and strengthen the capacity of the health care system within their
jurisdictions.
- The Primary Care Practice-Based
Research Network at the University of Indiana is using a city-wide electronic
medical records system as a model for surveillance and detection of potential
bioterrorism events across a wide range of health care facilities, including
primary care practices, public health clinics, emergency rooms, and hospitals.
Return to Contents
Program Performance Report Summary
| Year |
Measures in Plan |
Results Reported |
Results Met |
Unreported |
| 1999 |
40 |
40 |
40 |
0 |
| 2000 |
53 |
40 |
53 |
0 |
| 2001 |
54 |
54 |
54 |
0 |
| 2002 |
60 |
60 |
60 |
0 |
| 2003 |
36 |
NA |
NA |
NA |
| 2004 |
23* |
NA |
NA |
NA |
*9 Measures associated with 6 Long-term Performance
Goals.
14 Measures associated with 14 FY 2004 Performance Goals. |
Return to Contents
Current as of April 2003
Internet Citation:
Performance Plans for FY 2003 and 2004 and Performance Report for FY 2002. Executive Summary. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/about/gpra2004/exsumm04.htm
Proceed to Next Section
|
540 Gaither Road Rockville, MD 20850