Agency for Healthcare Research and Quality

Performance Plans for FY 2003 and 2004 and Performance Report for FY 2002

Executive Summary

Following is a summary of the Fiscal Year 2004 performance plan of the Agency for Healthcare Research and Quality (AHRQ). The Fiscal Year 2004 President's Budget Request for AHRQ incorporates the annual performance plan required under the Government Performance and Results Act (GPRA). The Fiscal Year 2004 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 2003 and 2004 performance plans.

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.

Contents

Summary
   Agency Mission and Vision
   Overview of the Plan and Performance Report
   FY 2002 Performance Highlights
   Program Performance Report Summary
Part 1. Overview of Performance Measurement
Part 2. Goal-by-Goal Performance Measurement
   2.1: Budget Line 1—Research on Health Care Cost, Quality and Outcomes
   2.2: Budget Line 2—Medical Expenditure Panel Surveys (MEPS)
   2.3: Budget Line 3—Program Support
Appendix I. AHRQ Strategic Planning Framework
Appendix II. Fiscal Year 2002 Performance (Report) Summary
      GPRA Goal 1
      GPRA Goal 2
      GPRA Goal 3
      GPRA Goal 4
      GPRA Goal 5
      GPRA Goal 6
      GPRA Goal 7

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. 

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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.

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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.

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Program Performance Report Summary

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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

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