Testimony

Statement by
Carolyn Clancy, MD Director Agency for HealthCare Research and Quality
on
Fiscal Year 2004 Budget Request
before the
The House Subcommittee on Labor-HHS-Education Appropriations

April 3, 2003

Introduction

Mr. Chairman and Members of the Committee, I am pleased to be here today to present the President's FY 2004 budget request for the Agency for Healthcare Research and Quality (AHRQ). AHRQ's mission is to support, conduct, and disseminate research to improve the quality of health care, reduce its cost, improve patient safety, address medical errors, and broaden access to essential services.

Our mission, about which the Committee has provided guidance, is driven by the needs of the people who use our research -- patients, clinicians, health system leaders, and policymakers. We fulfill this mission by supporting research and through partnerships with physicians, nurses, and a variety of health care organizations, to assure that the findings of our research are translated into practice. Our mission is not fulfilled unless the research evolves into improved safety, quality and efficient health care.

AHRQ's Research Improves Health Care

I would like to give you a few examples of how AHRQ's research is being used to help people and improve the day to day functioning of the U.S. health care system. The U.S. Army is using the findings from AHRQ–sponsored research on depression as part of a joint project between the Department of Veterans' Affairs and the Department of Defense to develop and implement guidelines to diagnose and treat depression. The DoD/VA program will be tested in 5 Army military training facility sites: Walter Reed Army Medical Center, Washington, D.C.; Tripler Army Medical Center, Hawaii; DeWitt Army Community Hospital, Fort Belvoir, Virginia; Ireland Army Community Hospital, Fort Knox, Kentucky; and Madigan Army Medical Center, Fort Lewis, Washington. A successful bilingual chronic disease self-management program in San Antonio, Texas, is the result of a research study co-sponsored by AHRQ and the State of California. The program is titled "Living with Chronic Illness: How to Overcome Your Symptoms through Self-Management." The San Antonio program is offered free through the Texas Diabetes Institute in both English and Spanish and is based on the Chronic Disease Self-Management Program, developed through a five-year research study funded by AHRQ.

Findings from a study funded by AHRQ on the effects of a computerized physician order entry system on the costs of health care led to Wishard Memorial Hospital adopting the system for use throughout its inpatient departments. Wishard Memorial is a county tax-supported public hospital primarily serving indigent patients in Indiana. Results from this and other AHRQ-funded studies examining effective use of information technology to improve health care set the stage for this year's request.

FY 2004 Request

I'll turn now to the FY 2004 Request. AHRQ's request totals $279 million. As you know, the AHRQ budget was developed before action was completed on the FY 2003 appropriation. While the Request is less than the FY 2003 level, it originally reflected a 12 percent increase over the FY 2003 President's Budget and funds important initiatives that are not included in the FY 2003 appropriation. The request will enable us to focus on three priority areas: translating research into practice, promoting the use of information technology in hospitals to improve quality and patient safety, and enhancing two databases to improve reporting on quality and disparities.

Our request also includes $10 million to cover the annual cost for a sample expansion of the Department of Commerce's Current Population Survey to enhance analytic content, improve the accuracy of State estimates of the uninsured, and enhance the measurement of expansions under the Health Insurance Flexibility and Accountability initiative.

Translating Research into Practice

Our first FY '04 priority is translating research into practice. We know that the health care system does not always use the latest scientific evidence in purchasing, providing, and using health care services. Our goal in translating research into practice is to close the gap between what we know about providing high quality health care and what we do by ensuring that the use state-of-the-science evidence drives the health care system.

We achieve this goal by working in partnership with, and encouraging partnerships among, the people who can translate the findings of AHRQ-supported research and tools into measurable improvements in health care. For example, HealthPartners, a large managed care organization, and the Minnesota Diabetes Program at the Minnesota Department of Health (MDH) have formed a partnership to improve outcomes of patients with diabetes at primary care clinics. This partnership, which also includes the Centers for Disease Control and Prevention (CDC) and the Institute for Clinical Systems Improvement, illustrates how public and private organizations can collaborate to prevent disabilities and complications from diabetes.

Based on AHRQ-supported research, investigators have documented substantial improvement in glycemic and lipid control among adults with diabetes receiving care at large multi-specialty medical groups in Minnesota. In addition, the program has been instrumental in focusing attention on the need for diabetes care improvement at HealthPartners, which provides care for over 18,000 individuals with diabetes. The MDH's annual update on diabetes reported that almost 267,000 Minnesotans have diabetes though 96,000 of them are unaware they have the disease.

As part of our translation efforts, we recently funded a coordinated set of 22 projects called Partnerships for Quality. The projects will develop partnerships among researchers, health plans, medical and nursing facilities and services, employers, consumer groups and professional societies to test prototype activities aimed at accelerating the health system's adoption of research that has been shown to improve quality of care. The organizations funded under this project include the American Medical Association, the Leapfrog Group, the Visiting Nurse Service of New York, the Institute for Healthy Communities, and Association of California Nurse Leaders. The projects span much of the nation and involve more than 88,000 medical providers, 5,800 hospitals, nursing homes and other health care facilities; and 180 health plans.

Secretarial Initiative on Patient Safety Hospital Information Technology

AHRQ is requesting a total of $84 million dedicated to patient safety activities in FY 2004. Of that, we will spend $50 million to help hospitals invest in information technology – or IT – designed to improve patient safety, with a special emphasis on the needs of small community and rural hospitals. They often don't have the resources or the information needed to implement cutting-edge technology.

Our goal is to encourage hospitals to use technologies that can reduce medical errors and improve patient safety, including computerized physician order entry, computer monitoring to prevent potential adverse drug events, automated medication dispensing, computerized reminder systems to improve compliance with guidelines, handheld devices for prescription information, computerized patient records, and computerized support groups for patients. These systems represent a powerful approach for assuring that patients receive the most current evidence-based care – that is predictably safe.

Through this initiative, hospitals will serve as a model and will help make the "business case" for these technologies. Working with public- and private-sector partners, AHRQ will help use the data from this hospital initiative to promote proven technologies through the health care system and in settings other than hospitals where medical errors can occur.

AHRQ will use $10 million of the proposed patient safety funding to promote and accelerate the adoption of IT standards in health care. The lack of uniform terminology and language standards is a major obstacle to the development and use of health information systems to support quality improvements and patient safety.

For example, a recent study co-funded by AHRQ and NIH's National Institute on Aging found that Medicare patients treated in the outpatient setting may suffer as many as 1.9 million drug-related injuries a year because of medical errors or adverse drug reactions not caused by errors. About 180,000 of these injuries are life-threatening or fatal, and more than half are preventable, say the researchers, who based the estimates on a study of over 30,000 Medicare patients followed during 1999-2000. Successful adoption of standards will promote safe and effective medication use among the elderly.

AHRQ will also use $2 million to expand the scope of our Patient Safety Improvement Corps – a group of experts who, beginning in FY '03, will provide technical assistance to State and local health departments in using existing knowledge and tools to identify and eliminate threats to patient safety.

Reporting on Quality and Disparities

The FY 2004 Request includes enhancements for two of AHRQ's databases: the Medical Expenditure Panel Survey (MEPS) and the Healthcare Cost and Utilization Project.

MEPS is a powerful source of data on health care costs, use and access from a nationally representative sample of 24,000 individuals and 10,000 households. MEPS data allows us to monitor and analyze the dynamics of the health care delivery and insurance systems, and to assess implications of health care policy decisions. Data from MEPS are integral data to the National Healthcare Quality Report and the National Healthcare Disparities Report. The National Healthcare Quality Report, which will provide, for the first time, a systematic picture of the quality of health care in America to highlight areas where improvement is needed. The National Healthcare Disparities Report will show where racial and ethnic inequities exist in health care delivery and what we can do to improve.

In FY 2004, the request for MEPS totals $55.3 million, an increase of $2 million over the FY 2003 level. This requested increase will be used to improve the usefulness and timeliness of MEPS data by sustaining enhancements made in FY '03 to the sample size and content of the individual surveys that make up the MEPS data collection effort.

MEPS data also are a vital resource for tracking the impact of Federal and State programs, including the State Children's Health Insurance Program (SCHIP), Medicare and Medicaid.

The FY 2004 request also provides an increase of $2 million for the Healthcare Cost and Utilization Project (HCUP) to improve availability of data on outpatient care. The funding also will help make these data more useful and enhance the HCUP Quality Indicators – tools which use HCUP data that can be used to highlight potential quality concerns, identify areas that need further study and investigation, and track changes over time.

Consumer Assessments of Health Plans

The FY '04 budget request also includes a $1 million increase in the Consumer Assessment of Health Plans (CAHPS) to improve AHRQ's ability to provide technical assistance to users of the surveys. The CAHPS surveys currently in use give health plans enrollees information on the quality of the health plans available to them based on the perceptions of other beneficiaries. The funding also will allow us to assess of the impact of CAHPS from the perspectives of a variety of audiences: consumers, health care providers, and purchasers, including the Centers for Medicare and Medicaid Services and the Office of Personnel Management.

Conclusion

Mr. Chairman, I want to thank you and the Committee for giving me the opportunity to present the President's budget request of $279 million for AHRQ in FY 2004.