Fiscal Year 2010 Budget in Brief
Agency for Healthcare Research and Quality
(dollars in millions)
| 2008 | 2009 | 2009 | 2010 | 2010 |
Health Costs, Quality and Outcomes Research | |||||
Patient Safety Research: | |||||
Health Information Technology | 45 | -- | 45 | 45 | -- |
General Patient Safety Research | 34 | -- | 49 | 49 | -- |
Subtotal, Patient Safety | 79 | -- | 94 | 94 | -- |
| 30 | 700 | 50 | 50 | -- |
Crosscutting Activities Related to Quality, Effectiveness, and Efficiency Research | 157 |
| 160 | 160 | -- |
Value | 4 |
| 4 | 4 | -- |
Prevention/Care Management | 7 | -- | 7 | 7 | -- |
Total, Health Costs, Quality and Outcomes | 277 | 700 | 314 | 314 | -- |
| 55 | -- | 55 | 55 | -- |
Program Support | 3 | -- | 3 | 3 | -- |
| 335 | 700 | 372 | 372 | -- |
| |||||
PHS Evaluation Funds | -335 | -- | -372 | -372 | -- |
Total, Budget Authority | -- | 700* | -- | -- | -- |
| 297 | -- | 300 | 338 | +38 |
*American Recovery and Reinvestment Act of 2009 (Recovery Act)
The Agency for Healthcare Research and Quality is charged with improving the quality, safety, efficiency, and effectiveness of health care for all Americans.
The FY 2010 Budget request for the Agency for Healthcare Research and Quality (AHRQ) is $372 million, the same amount as FY 2009, excluding Recovery Act funds. The FY 2010 Budget request maintains AHRQ’s base funding for comparative effectiveness research; supports efforts to improve patient safety through investments in health IT and through a network of patient safety databases mandated by the Patient Safety and Quality Improvement Act of 2005; and provides funding for research on the organization, financing, and delivery of health care. The Budget request also supports data collection through Medical Expenditure Panel Surveys (MEPS) and other survey instruments.
AHRQ conducts and sponsors health services research to inform decision-making and improve clinical care and the organization and financing of health care. AHRQ evaluates both clinical services and the system in which these services are provided. This work contributes not only to improved clinical care, but also to more efficient and safer care. The agency’s research agenda is broad and spans from medical informatics to health care system redesign, and from comparative effectiveness research to prevention and care management of patients with chronic conditions.
The Recovery Act appropriated $1.1 billion to AHRQ for comparative effectiveness research as part of the President’s health reform agenda. AHRQ is required to transfer $400 million of the $1.1 billion to the National Institutes of Health. Of the remaining $700 million, $400 million is available for allocation at the discretion of the Secretary. AHRQ will invest the remaining $300 million in expanding its comparative effectiveness research activities.
Recovery Act
On March 19, 2009, HHS announced the members of the Federal Coordinating Council for Comparative Effectiveness Research (FCC). The purpose of the FCC is to foster optimum coordination of comparative effectiveness and related health services research conducted or supported by the relevant Federal departments and agencies. The FCC’s goal is to reduce duplicative efforts and encourage coordinated and complementary use of resources.
Members of the FCC include representatives from:
- Agency for Healthcare Research and Quality
- Centers for Medicare and Medicaid Services
- Centers for Disease Control and Prevention
- Substance Abuse and Mental Health Services Administration
- Health Resources and Services Administration
- National Institutes of Health
- Office of the National Coordinator for Health Information Technology
- Food and Drug Administration
- HHS Office of the Secretary
- Veterans Administration
- Department of Defense
- Office of Management and Budget
HEALTH COSTS, QUALITY, AND OUTCOMES
The FY 2010 President's Budget provides a total of $314 million to support improvements through research on the cost, efficiency, and quality of health care. This includes investments in research on the comparative effectiveness of pharmaceuticals, medical devices, and health care services and their impact on health outcomes; health information technology; patient safety research; organization, financing, and delivery systems for safe and efficient health care; and reducing disparities in health care access and services.
Comparative Effectiveness Research: The FY 2010 Budget provides $50 million, the same as FY 2009, for comparative effectiveness research through AHRQ’s Effective Health Care Program. Comparative effectiveness research improves health care quality by providing patients and physicians with state of the science information on which medical treatments work best for a given clinical condition.
This program supports research on the outcomes of health care services and therapies by comparing different therapies for a given clinical condition. The program has developed a process to generate new evidence, synthesize existing evidence, and translate research into user-friendly formats to inform health care decision-making. The Developing Evidence to Inform Decisions about Effectiveness (DEcIDE) Network conducts new research by analyzing information from electronic health information databases containing health data on over 50 million Americans. This information is used to compare the effectiveness and outcomes of treatments, improve effectiveness research, identify inappropriate drug prescribing patterns, evaluate the effects of benefits and formulary structure on health outcomes, and examine the clinical benefits of genetic testing.
AHRQ also supports the Centers for Education and Research on Therapeutics (CERTs) Program which conducts new research where limited information exists on the risks, benefits, and interactions of drugs, biologics, and medical devices. Evidence based practice centers synthesize existing scientific literature, identify research gaps that the literature does not address, and recommend studies and approaches to fill the gaps. Finally, the Eisenberg Center translates research into user friendly formats by developing plain language summary guides for each type of stakeholder: consumers, clinicians, and policymakers. The Center also creates web based tools to improve patients’ abilities to make health care treatment decisions. In FY 2010, AHRQ will also continue implementing Recovery Act comparative effectiveness research activities.
Comparative Effectiveness
Comparative effectiveness research is part of the President’s health reform agenda. Comparing the effectiveness of medical treatments to give patients and physicians better information on what works best for patients with specific conditions is expected to improve patients’ quality of health care.
Investing in Health IT: The FY 2010 Budget includes $45 million for health IT investments to develop and disseminate evidence and evidence based tools about how health IT can be used to improve the quality, safety, efficiency, and effectiveness of care.
AHRQ will use $29 million to continue its Ambulatory Safety and Quality program, including over $14 million for new grants to discover and evaluate how health IT can be used to improve care. AHRQ will invest over $15 million in its National Resource Center for Health IT and other efforts to translate and disseminate research into tools, technical assistance, and products that inform health IT implementation, use, and policymaking. The portfolio will develop and share best practices in the use of health IT to support patient-centered care, clinical decision support and improved decision-making, and the effective use of electronic prescribing and medication management. AHRQ will also synthesize findings from its recently completed grant program on the use of health IT by hospitals and other providers in rural, underserved, and safety net settings.
Supporting Other Patient Safety Activities: AHRQ’s patient safety budget includes $49 million to support a variety of activities. Since FY 2006, AHRQ has provided funds to initiate activities authorized under the Patient Safety and Quality Improvement Act of 2005. This Act establishes patient safety organizations nationwide to collect information from providers about adverse events affecting patient safety. In FY 2010, these funds will allow AHRQ to continue its work creating a network of patient safety databases.
In FY 2010 AHRQ will also continue disseminating its best practices for healthcare-associated infections (HAI) prevention to States. AHRQ has provided funding for ten states to implement proven techniques for reducing central line associated blood stream infections in hospital intensive care units. This activity will help hospitals in their ongoing efforts to provide patients with the safest, highest quality care possible and reduce a known, serious problem with a high morbidity and mortality. In FY 2010, AHRQ will expand this effort to additional states and additional health care settings.
Performance Highlight
AHRQ plans to focus on best practices for healthcare-associated infection (HAI) prevention through disseminating proven techniques for reducing central-line associated blood stream infections in hospital intensive care units in 10 States. AHRQ will also initiate testing of similar techniques for other infection sites, such as catheter-associated urinary tract infections.
Each year, an estimated 250,000 cases of central line-associated bloodstream infections occur in hospitals in the United States, leading to at least 30,000 deaths, according to the Centers for Disease Control and Prevention. The average additional hospital cost for each infection is over $36,000, which totals over $9 billion in excess costs annually.
Results from this project can potentially improve care, save lives, and lead to substantial cost savings for participating hospitals and the health care system.
Supporting Research and Dissemination Activities Outside Patient Safety: In FY 2010, AHRQ will invest $170 million in research and dissemination activities in prevention care management, the delivery of healthcare services, and other research areas to support the quality and effectiveness of health care and ensure findings are accessible to the public. AHRQ will also continue to sponsor the United States Preventive Services Task Force in FY 2010.
MEDICAL EXPENDITURE PANEL SURVEYS (MEPS)
The FY 2010 Budget request for MEPS is $55 million, the same as FY 2009. MEPS collects detailed, national data on the health care services Americans use, how much they cost, and who pays for them. It is the only national source of individual, family, and visit-level information on medical expenditures. MEPS enables policy makers and researchers to model health disparities and the impact of health reform initiatives. MEPS data has been used by the Congressional Budget Office and by executive branch departments responding to Congressional inquiries regarding health care expenditures, insurance coverage, health initiatives, and source of payments. MEPS provides a better understanding of the quality of care the typical patient receives, and of disparities in the care delivered. MEPS data are critical for tracking the impact of Federal and State programs, including the Children's Health Insurance Program, Medicare and Medicaid.