Following is a summary of the Fiscal Year 2003 performance plan of the Agency for Healthcare Research and Quality (AHRQ). The Fiscal Year 2003 President's budget request for AHRQ incorporates the annual performance plan required under the Government Performance and Results Act (GPRA). The Fiscal Year 2003 performance goals and measures are detailed in AHRQ's performance plan and are linked to both the budget and to the Strategic Plan of the Department of Health and Human Services (HHS).
Select for the Full Text of AHRQ's Fiscal Year 2002 and 2003 performance plans (including the Summary of Fiscal Year 2001 Performance Report Results).
Performance targets in the plan depend partly on resource levels requested in the President's budget and could change based on congressional appropriation action. GPRA requires that HHS plans and budgets be accountable for program results. The intent of the Act is to improve program performance by considering performance information in decisionmaking and by involving our partners and stakeholders in accomplishing program results.
Introduction
Part 1. Agency Context for Performance Measurement
1.1. Overview of the Context of GPRA in AHRQ
1.2. Agency Vision, Mission, and Strategic Goals
1.3. Organization, Programs, Operations, and Strategies
1.4. Partnerships and Coordination with Other Federal Agencies
1.5. Summary of Fiscal Year 2001 Performance Report: Accountability Through Performance
Measurement
Part 2. Summary of AHRQ Performance Objectives
Knowing is not enough; we must apply —Goethe |
The Agency for Healthcare Research and Quality (AHRQ) Performance Plan is a companion piece to the AHRQ Strategic Plan and to the FY 2003 Budget Request. In this document, the initial FY 2003 and revised FY 2002 Performance Plans have been merged with the FY 2001 Performance Report to comply with the format developed by the Department of Health and Human Services (HHS).
The 2003 Performance Plan being submitted has undergone an extensive review, reorganization and revision that we believe will increase its clarity and usefulness as a strategic management tool. This document reflects the agency's 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 2001 Performance Report and the FY 2002 Performance Plan will continue 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:
We believe that these revisions will enable us to determine how well the basic knowledge which forms the core of AHRQ's work provides information which can be turned into actions by those who make clinical decisions, purchasers and providers who make decisions about what services to use, pay for and how to structure those services, as well as by policy makers.
General program direction and strategic planning is accomplished through the collaboration of the Office of the Director (with its four administrative offices) and six Research Centers, which have programmatic responsibility for portions of the Agency's research portfolio. The Agency planning processes, facilitated by the electronic Planning System completed in FY 2000, are linked to budget planning and performance management through GPRA.
The agency's strategic plan guides the overall management of the agency. Each Office and Center (O/C) have 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. In turn these critical success factors serve as the basis for each employee's annual performance plan. This nesting of plans allows the individual employee to see how her or his job and accomplishments further the respective unit's goals and the Agency's mission. At the end of each year, the Office and Center 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 the performance reports, which are influential in revising the operations plans and in turn, the agency strategic plan.
Select to access illustration of Strategic Management at AHRQ (9 KB).
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.
The vision of the Agency for Healthcare Research and Quality (AHRQ) 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.
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.
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. 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
1 Eisenberg JM. Health Services Research in a Market-Oriented Health Care System. Health Affairs, Vol. 17, No. 1:98-108, 1998.
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 published 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. In addition, the National Advisory Committee (NAC) to AHRQ is providing feedback to the agency, and several NAC members have agreed to participate in an ad hoc advisory planning group.
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 2000 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.
AHRQ has identified three strategic goals, each of which will contribute to improving the quality of health care for all Americans.
AHRQ Goal 1. Support Improvements in Health Outcomes. AHRQ seeks to support research to understand and improve decision-making 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.
AHRQ Goal 2. 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.
AHRQ Goal 3. Identify Strategies To Improve Access, Foster Appropriate Use, and Reduce Unnecessary Expenditures. AHRQ will focus 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.
The main focus of AHRQ research is on the delivery of health care and identifying ways to measure and improve it. Most of the Agency's research portfolio consists of extramurally funded work from leading universities and other research institutions throughout the Nation. The portfolio also contains an impressive body of intramural research. Issues related to the quality, cost and use of, as well as access to, health care are studied through extramural and intramural research. 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 has an increasing focus on patient safety and the reduction in medical errors, as well as 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 AHRQ portfolio reflects a "pipeline" (4 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 section in 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 section of the pipeline is where the first two investments come 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.
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 decision-making:
Clinical 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. Policymakers to expand their capability to monitor and evaluate the impact of system changes on outcomes, quality, access, cost, and use of health care use Information 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.
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 research cycle (14 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 12 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 decision makers. 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. It includes a feedback loop that depends on evaluation of 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 evaluation of 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/impact of AHRQ activities on the health care system.
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 reauthorization legislation, P.L. 106-129, the Healthcare Research and Quality Act of 1999, mandated the creation of an Office of Priority Populations to continue and build the research and associated activities that AHRQ undertakes on health care for priority populations to eliminate disparities. 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. In 2001 the Office of Priority Populations Research was established. A nationwide search is currently underway to recruit a leader in the field to serve as the Director of that office. Until a Director is recruited, the Deputy Director of the Agency has responsibility for overseeing OPPR priorities.
AHRQ assures a strong infrastructure for health services research through investments in training and the support of young investigators. Critical areas of emphasis include:
AHRQ is not able to accomplish its mission alone. Partnerships formed with the agencies within the Department of Health and Human Services, 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:
A summary table (Text Version) of program performance for FY 2001 follows:
Status of AHRQ FY 1999-2003 Performance Measures
| Goal | Number of Measures | Data Not Available | Number of Measures Where Targets Were Achieved or Exceeded* | Number of Measures Where Targets Were Not Achieved |
|---|---|---|---|---|
| Goal 1: Establish future research needs based on user's needs. (HCQO) | FY 01: 1 FY 00: 1 FY 99: 1 |
FY 01: 0 FY 00: 0 FY 99: 0 |
FY 01: 1 FY 00: 1 FY 99: 1 |
FY 01: 0 FY 00: 0 FY 99: 0 |
| Goal 2: Make significant contributions to the effective Functioning of the U.S. health care system through the creation of new knowledge. (HCQO) | FY 01: 8 FY 00: 7 FY 99: 5 |
FY 01: 0 FY 00: 0 FY 99: 0 |
FY 01: 8 FY 00: 7 FY 99: 5 |
FY 01: 0 FY 00: 0 FY 99: 0 |
| Goal 3: Foster translation and dissemination of new knowledge into practice by developing and providing information, products, and tools on outcomes; quality; and access, use, and cost of care. (HCQO) | FY 01: 12 FY 00: 17 FY 99: 15 |
FY 01: 0 FY 00: 0 FY 99: 0 |
FY 01: 12 FY 00: 17 FY 99: 15 |
FY 01: 0 FY 00: 0 FY 99: 0 |
| Goal 4: Evaluate the effectiveness and impact of AHRQ research and associated activities. (HCQO) (Note: All Agency evaluation activities, including MEPS-related studies, are included under Goal 4. This is because the MEPS budget line covers only costs associated with data design, data collection and analysis, and data products.) | FY 01: 17 FY 00: 11 FY 99: 7 |
FY 01: 0 FY 00: 0 FY 99: 0 |
FY 01: 17 FY 00: 11 FY 99: 7 |
FY 01: 0 FY 00: 0 FY 99: 0 |
| Goal 5: Support of initiative to improve health care quality through leadership and research. (HCQO) | FY 01: 6 FY 00: 6 FY 99: 6 |
FY 01: 0 FY 00: 0 FY 99: 0 |
FY 01: 6 FY 00: 6 FY 99: 6 |
FY 01: 0 FY 00: 0 FY 99: 0 |
| Goal 6: Produce and release information from MEPS on health care access, cost, use, and quality. | FY 01: 4 FY 00: 6 FY 99: 11 |
FY 01: 0 FY 00: 0 FY 99: 0 |
FY 01: 4 FY 00: 6 FY 99: 11 |
FY 01: 0 FY 00: 0 FY 99: 0 |
| Goal 7: Support the overall direction and management of AHRQ. | FY 01: 6 FY 00: 5 FY 99: 5 |
FY 01: 0 FY 00: 0 FY 99: 0 |
FY 01: 6 FY 00: 5 FY 99: 5 |
FY 01: 0 FY 00: 1 FY 99: 0 |
*Note: Includes performance which is within 5 percent of estimated target.
As the table demonstrates, AHRQ performance for the output and process measures in the earlier performance plans has been excellent, and serves as a strong foundation for building future program performance goals. The future challenge will be to demonstrate excellent program performance as the plan evolves from one focused on outputs and process to goals with more outcome focus. More detail on AHRQ's 2001 performance can be found in the appendix of this document.