Mr. Chairman, thank you for giving me the opportunity to address the Subcommittee on
the programs and activities of the Agency for Health Care Policy And Research (AHCPR).
AHCPR's mission is to provide good and objective science-based information that will
improve decision making at all levels, from
patients, to clinicians, to health care system leaders, to public and private
policymakers. AHCPR's goal is to ensure in an increasingly market-based health care system
that state-of-the-science information drives informed decision making.
AHCPR was established by Congress in 1989 "for the purpose of enhancing the
quality, appropriateness, and effectiveness of health care services and access to care."While we have met this objective during the past
nine years, we recognize that health care in 1998 is very different from 1989, and the
Agency has adjusted its agenda and priorities to meet the new challenges we face, while
continuing our charge set forth by Congress. Here are our priorities:
- To ensure that clinicians, patients, health
care system leaders, and policymakers have the information that will enhance quality of
- To identify gaps in access to and use of
health care services, achieving value for the Nation's health care dollar, and helping the
market and policymakers find ways to address those gaps.
Research That Helps Patients
Mr. Chairman, before turning to our programs and the way we conduct our work, I want to
emphasize that this research has already had a profound effect on the quality of care
patients receive. After all, that is the bottom line for our Agency: improving patient
health. A welcome side benefit, for programs over which you have jurisdiction such as
Medicare and Medicaid, is that these quality improvements, in a surprising number of
cases, have also led to lower costs and more appropriate use of health care resources. For
- Pneumonia. Approximately 450,000 Medicare patients are hospitalized for pneumonia
each year. With AHCPR support, one group of researchers developed a way for clinicians to
determine which patients with pneumonia can be safely treated at home. This option avoided
hospitalization entirely. Studies of health systems that have implemented this decision
tool found that it not only reduces hospitalization rates (and, consequently, Medicare
costs by 26% in one major hospital) but also that home treatment is preferred by many
- Diabetes. A significant advance in diabetes treatment during recent years has been
the demonstration that tight control of blood sugar, using intensive management
strategies, reduces the risk of long-term complications from the disease. The intensive
monitoring and self-care needed to achieve this, however, is costly and time-consuming for
patients and clinicians alike. AHCPR's sponsored
research has helped provide the information that diabetics and their health professionals
need as they choose the best long-term management strategy for each individual. For type 1
diabetics, for example, AHCPR-funded research has shown that using continuous insulin
infusion, a newer mode of insulin delivery, to achieve tighter control can decrease the
incidence of ketoacidosis and low blood sugar crisis.
- Heart Attacks. About 1.5 million Americans are admitted to hospitals yearly for
serious chest pain. However, of those admitted to inpatient cardiac units, only 30 percent
end up with a diagnosis of threatened or confirmed myocardial infarction (MI). This means
that 70 percent undergo an expensive workup before they know that they have not had a MI,
which translates to more than $3 billion of unnecessary expenditures per year. One group
of AHCPR-funded investigators has tested the effectiveness of a chest pain observation
unit, located within a hospital emergency department, for patients experiencing a possible
MI. This intervention has revealed some very positive effects: fewer heart attacks go
undiagnosed compared to hospitals with only inpatient observation units; fewer patients
are mistakenly sent home without being observed; there is a 55 percent reduction in
hospital admission rates; and there is a 25 percent drop in the average length of stay
when an exercise electrocardiogram (ECG) is added to the evaluation procedure. Savings in
total hospital costs are calculated at $567 per patient. In addition, patients who receive
treatment in the chest pain units are more satisfied with their care, compared to those
actually admitted to inpatient cardiac units for observation.
This research has also had a significant but unexpected impact on the way that medical
research is conducted and clinical decision making takes place. For example, urologists,
working with researchers we funded, found new ways of determining which men with enlarged
prostates should have surgery. Health services research shifted the views of clinicians by
emphasizing the importance of taking into account the patient's assessment of how the prostatism affected his
ability to function, and his assessment of the risk of surgery. Our work has broadened the
focus for evaluating the success or outcomes of medical care from only physiologic
measures (such as urinary track pressure measures) to include important clinical outcomes,
such as patients' perceptions of, and preferences for, their ability to function after
treatment. This research has provided the foundation for truly informed patient choice
among alternative clinical treatments and higher patient satisfaction, as patients become
involved to the extent they want to be in making these choices. Plus, we have funded the
translation of this research into practice, and we are already seeing reduced costs along
with better outcomes through partnership with urologists and their patients. We are now
funding similar research in other fields, such as breast cancer and the care of children.
Health care quality is very much in the news and a major issue for the Congress. I want
you to know that our Agency has played a pivotal role in the effort to improve the quality
of patient care. We have worked closely with all of the major organizations committed to
improving the quality of patient care, such as the American Medical Association (AMA), the
Foundation for Accountability (FACCT), the National Committee for Quality Assurance
(NCQA), the Joint Committee on Accreditation of Healthcare Organizations (JCAHO), and many
others. And we are using every aspect of health services research to address the
challenges we face.
But let me start with a basic question: what do we mean when we say
"quality?" At the most basic level, quality means doing the right thing, at the
right time, in the right way, for the right person. As someone who recently left clinical
medicine, I am personally sensitive to the challenge clinicians face every day in knowing
what the right thing is, when the right time is, and what the right way is. We are using
our clinical research, often referred to as outcomes and effectiveness research, to
address those three questions. And we are undertaking efforts, equally as important, to
provide clinicians with the information they need most: syntheses of what we already know
so that they can provide care to their patients that takes into account the latest
We are working to develop better information on the quality implications of the way we
organize, deliver, and reimburse health care services. We are developing the measures and
tools that will help us to assess, compare, and improve the quality of care in different
plans and settings. And we are working to provide you with a better sense of how quality
is faring over time, much like the "leading
economic indicators" that provide you with a
touchstone for how the economy is faring.
We recognize that our focus on the quality and outcomes of care needs to be paired with
a focus on issues related to access to that care. And we have a special responsibility to
address the needs of vulnerable populations, who are most likely to face barriers to
access. Our research has demonstrated that a growing percentage of the population are not
offered health insurance; that of those offered health insurance, a growing number of
Americans decline insurance coverage; and that even with health insurance, access to
quality health care is not assured. And the reasons for this lack of access can be
surprising and disturbing. For example, the Washington Post highlighted on its front page
several weeks ago an AHCPR-funded study that found that primary care physicians were
prepared to recommend very different courses of treatment for patients of different races
and gender who outlined identical symptoms. These physicians recommended referrals for
cardiac catherization only 60% as often for black patients than white patients, and there
was a clear impact of gender as well. Black women were referred only 40% as often. These
results are disturbing and suggest that we have a broad array of issues to address in
ensuring access to quality care.
The Conduct and Planning of our Research.
Mr. Chairman, let me know turn to how we conduct and plan our research and our specific
research activities. As you well know, AHCPR is not a regulatory or enforcement agency,
but a scientific research agency that sponsors, conducts and translates research. We
follow the same rigorous evaluation and peer review standards for awarding research grants
as does the National Institutes of Health. Three-quarters of AHCPR's research funds are
used to support researchers throughout the country.
Since I have been at the Agency, we have been going through an extensive planning
process. We are consulting our National Advisory Council, seeking input from our
stakeholders, and welcome advice from the Subcommittee. We hope that the reauthorization
process will provide an opportunity to gain additional insight from you and the other
witnesses at this hearing as well as strengthen the relationship between AHCPR and this
The planning process has focused our priorities on four primary customers: clinicians,
patients, health care systems leaders, and policymakers, each of whom need information to
enhance their contribution to improve the quality of care in this country. In the rest of
my testimony, I will describe how we are serving our customers with research on outcomes,
quality, cost, use, and access.
Providing Information that Helps Clinicians Provide Better Care and Patients Receive
I see AHCPR's clinical research as a continuum. First, we build the science base by
conducting health services research that serves as the foundation for improved care.
Second, we translate and disseminate the research in a format that can be used in clinical
practice. Third, we evaluate the translation and dissemination of that research to make
sure that it has reached the relevant audiences and is used appropriately.
Measuring Health Outcomes
First, let me concentrate on how we serve decisionmakers with information on outcomes
of clinical care. AHCPR's sponsored research attempts to answer these questions for a wide
variety of medical conditions and treatments. The findings of this research have
been translated into useful tools for every day clinical practice. For example, AHCPR
sponsored research at John Hopkins University developed a visual function indexCthe VF-14Cthat
measures the effects of cataracts on patients' ability to perform 14 everyday activities,
including reading and driving. The index also allows for comparisons of patients' visual
function before and after removal of a cataract.
The VF-14 index is a sensitive and reliable measure of the impact of cataracts on
visual function. As a result, it can be used to help determine the value of cataract
surgery for specific patients. In a study of more than 500 patients 4 months after
cataract removal, changes in patients' ratings of satisfaction with their vision
correlated more strongly with changes in VF-14 scores than with traditional ways of
measuring changes in visual acuity. Compared with other outcome measurements, a changed
VF-14 score was also the strongest predictor of changes in patients' satisfaction with
Another tool developed by AHCPR-supported research should have a great impact on the
quality of care provided to patients who suffer heart problems. An outcomes project funded
by AHCPR recently found that many patients with heart attacks do not receive thrombolytic
therapy (drugs to dissolve clots inside coronary arteries). Another research project at
the New England Medical Center led to the development of a new tool to care for patients
having a heart attack. The tool estimates whether a patient is likely to benefit from
potentially lifesaving treatment with thrombolytic therapy in the emergency room. The
information is provided to the doctor in "real time." The tool also calculates
the patient's likelihood of developing serious complications, such as hemorrhagic stroke
or major bleeding, if given thrombolytic therapy.
A trial to assess whether this instrument, which plugs into an existing
electrocardiograph machine, will increase the proportion of eligible patients receiving
recommended treatment is in progress. The researchers are also working with the major
manufacturer of EKG machines to make this tool widely available.
Understanding Variation in Health Care
AHCPR's research emphasis has been on conditions that are common, costly, and for which
there is substantial variation in practice. This research includes many of the conditions
that represent a major expenditure for Medicare.
The issue of variation is not new to you. Dr. John Wennberg's work has shown that
medical practice varies widely in this country. AHCPR has sponsored a substantial portion
of Dr. Wennberg's work in the area of prostate disease. His research team found that the
rate of radical prostatectomy for Medicare patients in Clearwater, FL is nearly twice the
rate in Medina, OH (the national average is 2.0 surgeries per 1000 Medicare beneficiaries
while the rates in Clearwater and Medina are 2.8 and 1.5 respectively). These variations
can vary region to region, State to State, or within States. For example, the rate for
radical prostatectomy for Medicare patients in Baltimore, MD, is approximately three times
the rate in Salisbury, MD.
Variation provides us an opportunity to study what care is appropriate, how much is
enough, and what is fair. This involves understanding when variation is due to issues of
uncertainty, issues of access, and issues of overuse or under use. I would like to note
that variation isn't inherently bad. The research that AHCPR supports and conducts helps
us understand whether variation in medical practice should be celebrated or eliminated. In
some cases, variation is caused by geographical, epidemiological, or cultural preferences.
For example, we expect to have a higher rate of skin cancer in the South, and therefore
more treatment for skin cancer.
Outcomes researchCwhich provides the basic
knowledge of what works and what doesn't workCis
the foundation for all efforts to improve the quality of health care services. We can use
this knowledge to determine what the right thing is, when the right time is, and what the
right way is, and whether we are getting value for what we spend.
Supporting Evidence-based Practice
A key issue in variation is professional uncertainty. If clinicians don't know what
works and what doesn't work, they may be inadvertently providing inappropriate or
ineffective care. AHCPR supports 12 Evidence-based Practice Centers (EPCs), which provide
the scientific evidence that others will use to reduce unnecessary variation by reducing
uncertainty. The 12 Centers develop scientific analyses, known as "evidence reports,"
of the evidence of the effectiveness of a particular treatment, technology, or procedure.
These analyses are then used by health care organizations, medical societies, physician
practices, and others to develop their own quality improvement tools, including
guidelines, quality improvement programs, and performance measures.
For example, the Agency developed an evidence report on the findings on colorectal
cancer screening. The information contained in AHCPR's evidence report led to a clinical
practice guideline that was developed by the American Gastroenterology Association on
colorectal cancer, which in turn, contributed to Congress' decision to expand Medicare
coverage for colorectal cancer screening.
An important component of AHCPR's Evidence-based Practice Initiative is collaboration.
The EPC topics are nominated by public and private sector organizations which will use and
help us disseminate the information. The nominators are our partners. For example, the
American Academy of Pediatrics and the American Psychiatric Association nominated
attention deficit/hyperactivity disorder as a topic, and they have incorporated AHCPR's
evidence report into a guideline they developed. Similarly, a consortium of patient and
provider groups nominated management of urinary problems in paralyzed persons as a topic,
and they will also create a guideline from it. And the Health Care Financing
Administration asked us to evaluate swallowing problems in the elderly to help them
determine their coverage policy for this area.
Translating Research into Practice
In addition to providing information on outcomes to clinicians and patients, we want to
help them use the information to enhance the quality of care provided and received.
Obviously, developing the information isn't enough. We need to make sure that it is
available in a useful format to anyone who needs it. To achieve that goal, AHCPR, the
American Association of Health Plans, and the American Medical Association worked together
to provide one-stop-shopping for best practices in clinical care. We developed the
National Guideline Clearinghouse that makes clinical practice guidelines available to
every clinician, health system leader, patient, and policymaker who can use a computer.
AHCPR also is looking at the effectiveness of clinical preventive services, and the
potential they have for saving lives and reducing health care costs. The medical
literature increasingly recognizes that some clinical preventive services provide enormous
benefit. We need to know which services are most appropriate and effective for which
patients and when. The Balanced Budget Act expanded Medicare coverage for prevention
services. The information AHCPR develops will be invaluable to you as you deliberate about
further expansions in coverage for preventive services.
As a central component of these efforts, AHCPR will support renewed activities of the
U.S. Preventive Services Task Force. Their 1996 report provides clinicians with the
information on the effectiveness and appropriateness of the full range of preventive careCscreening tests for the early detection of disease,
advice to help people change their risky health-related behaviors, and immunizations to
prevent infections. AHCPR will support major new assessments of preventive services and
updates of priority topics by the Task Force. As requested in the Balanced Budget Act, the
Task Force will also work with the Institute of Medicine to evaluate the implications of
including new preventive services under Medicare.
Supporting the U.S. Preventive Services Task Force will continue a long and productive
partnership between the government and the leading primary care medical and nursing
organizations. Our activities complement the major investment being made by the Centers
for Disease Control and Prevention (CDC) in the study of preventive services in
community-based settings. We look forward to working with the CDC on integrating our
research in this area.
Finally, I want to thank the Subcommittee for providing the Agency with its authority
to support Centers for Education and Research Therapeutics or CERTS, under the Food and
Drug Administration Modernization Act. We expect to announce to announce funding for
several centers before the end of this fiscal year. The CERTS will improve the effective
use of medical products, such as pharmaceuticals. This new authority builds on our
existing research in this area. For example, clinicians can receive the information they
need to help reduce the costs of medical care through AHCPR's research on pharmaceuticals.
With funding from AHCPR, Michael Fine of the University of Pittsburgh and colleagues found
that using the antibiotic erythromycin for treating community-acquired pneumonia in most
outpatients aged 60 and under significantly reduces treatment costs compared with the use
of other antibiotics ($5.43 versus $18.51) and has no adverse effect on medical outcomes.
About 600,000 of the 4 million Americans who develop community-acquired pneumonia are
hospitalized each year. This research could lead to significant savings.
Improving Decisionmaking in Health Care Systems
The health care system has gone through some significant changes over the past several
years. These changes have created new structures, processes, and settings in which care is
delivered. These changes have also raised a number of issues such as what is the impact on
quality, what happens to patients' access to services, the cost of those services, how
they are used, and the outcomes of patients who use the services. For example, some of the
questions we can ask are: What happens when patients are discharged quickly from the
hospital? How are managed care and traditional insurance changing and how are the new
arrangements affecting access to care and the quality of that care?
Unfortunately, these changes are happening quickly and we have little scientific
evidence regarding their impact on the health care system, generally, and on quality
specifically. AHCPR is conducting and supporting research to fill this void.
Providing Research on Market Changes
I believe that outcomes research is more than measuring the outcomes of clinical
treatments. Our customers need to understand the outcomes of the organizational and
financial structures in the way medical care is delivered. It isn't enough to know that
clinical services are safe, effective and appropriate if the structure for delivering that
care is shaky or untested.
The journal Health Affairs featured AHCPR's research that presents the first
comprehensive look at what is currently happening in the health care marketplace. The
articles form an invaluable evidence-based core of information for current discussions of
policy options by all health care system participantsCboth
public and private.
These studies, which had a 2-year turnaround from funding to report, provide
fundamental knowledge about the link between the financing and delivery of health care and
the quality of services. These studies empirically and rigorously examine issues of how
current, incentive-driven market decisions of multiple participantsChospitals, physicians, health plans, employers,
employees, and public, private and individual purchasersCdetermine
who gets health care, what kind of care, how much care, who pays and how much it costs.
Supporting Research To Improve Primary Care Systems
Issues of systems of care are not strictly limited to hospitals or other institutions.
We need to understand how patients gain access to the system. AHCPR is the only agency
that has an expressed responsibility to study the structure and delivery of primary care
services. This research is increasingly important as more care is delivered beyond the
More than half of all Americans are now covered by managed care plans, which often
require the use of a primary care physician or gatekeeper to manage the referral of
patients from primary to specialists. Access to specialists is a major concern among the
public, and has been the subject of much debate. To strengthen the scientific base
underpinning the referral policies of health plans, AHCPR funded ten grants on physician
referrals, and will be hosting a conference in Washington this September where the results
will be presented.
Preventing System Errors
AHCPR-supported research has demonstrated that the processes and systems used to
provide care are often faulty and can lead to avoidable accidents. One conclusion of the
research is that many of these accidents are not the fault of individuals, and therefore
can be prevented by evaluating and improving the system.
In an AHCPR-funded study, Dr. Lucian Leape, a pioneer in research on how to reduce
errors in medicine, estimated that the number of injuries caused by medical errors in
hospitals alone could be as high as three million annually, resulting in costs as much as
$200 billion each year. In his work on drug-related errors, Dr. Leape concluded that 70
percent of these errors are avoidable, and can be prevented by re-engineering the hospital
systems which allowed the errors to occur. Other organizations, such as the Department of
Veterans Affairs and the American Medical Association, are using this research to develop
programs to reduce preventable errors.
AHCPR is also examining how changes within systems of care affect the delivery of
services and their quality. The Health Resources and Services Administration (HRSA), the
National Institute of Nursing Research (NINR), and AHCPR in 1996 convened a joint meeting
of experts to set a research agenda on the impact of nurse staffing levels on the quality
of care in hospitals. We will be supporting additional research in this area during the
current fiscal year.
Developing the Science and Tools to Measure and Improve Quality
AHCPR is working to refine existing measures and develop new measures that accurately
reflect the changing health care system. An important component in our effort to develop
and test valid measures is to anticipate future measurement needs. The goal of our efforts
is to begin to identify and develop the "next generation" of quality measures
for certain conditions and population subgroupsCparticularly
vulnerable populations such as the chronically illCand
in the full spectrum of treatment settings such as rehabilitation and home care.
The Agency is involved in collaborative projects with private sector organizations to
develop their own quality measures. For example, AHCPR research found that elderly
patients who receive beta blockers following a heart attack are 43 percent less likely to
die in the first 2 years following the attack than patients who do not receive this drug.
That same study found that patients who receive beta blockers are rehospitalized for heart
ailments 22 percent less often than those who do not get beta blockers. However, only 21
percent of eligible patients receive beta blocker therapy.
The National Committee for Quality Assurance (NCQA) used the findings of this study as
the basis for changing the performance measurement for beta blocker use after acute
myocardial infarction to include patients over 75 years of age in the most recent version
of the Health Plan Employer Data and Information Set (HEDIS 3.0). An important component
of improving the quality of health care services is giving patients the information they
need to make informed choices about their health care coverage, physicians, and treatment
AHCPR's Consumer Assessments of Health Plans (CAHPS) survey consists of a series of
questionnaires designed to be used by public- and private-sector health plans, employers,
and other organizations to survey their members and employees. The information from CAHPS
questionnaires, presented in the CAHPS tested report formats, can help consumers and group
purchasers compare health plans and make more informed choices based on quality.
The CAHPS materials are designed for use with all types of health insurance enrollees
(Medicaid and Medicare beneficiaries as well as the privately insured) and across the full
range of health care delivery systems, from fee-for-service to managed care plans. In
addition to a core set of items designed for use with all respondents, some additional
questions are targeted for use with certain subgroups such as persons with chronic
conditions or disabilities, Medicaid and Medicare beneficiaries, and families with
We are not suggesting that all providers and plans in every clinical setting and every
region in this country be evaluated using the exact same measures. Measures and
instruments should not be one-size-fits-all, but should reflect the diversity of needs and
uses. We are advocating a "department store" of accepted quality measures, all
based on science and validated for reliability and usefulness, where users of measures can
pick the set that fits their need, whether that need is to compare health plans or
providers, or to conduct a hospital quality improvement project.
Supporting Policymakers with Data and Information
Policymakers need to understand how dramatic growth of managed care, changes in private
health insurance, and other dynamics of today's market-driven health care delivery system
have affected, and are likely to affect, the outcomes, quality of, cost of, and access to
the health care that Americans use.
Developing and Improving Information Technology
Informatics is another important tool for improving the quality of health care
services. There has been an explosion in the use of information technology in medicine,
such as telemedicine and computerized medical records. These technologies have greater
potential to improve the quality of, outcomes of, access to, cost of, and use of care. To
achieve this potential, we need research to determine what works and what doesn't work in
"high tech" health care.
Informatics is an area of research that is critical to every aspect of AHCPR's work .
Let me explain. First, the revolution in information technology is critical to the ability
of health care delivery systems to measure and improve the quality of care that they
provide their patients. They need seamless information systemsClinking administrative, financial, and clinical dataCthat can follow patients no matter where or from whom
they receive care. I am delighted to note that much of the pioneering work in developing
the prototypes and evaluating their usefulness in daily practice was supported by our
predecessor, the National Center for Health Services Research. AHCPR has an important and
continuing role to play in evaluating the impact of informatics on the cost, access, and
quality of clinical care and health care systems. Last year we funded eight projects to do
Second, the type of research that AHCPR conducts and supportsCto assess what works best in clinical practice and
how we organize and manage the systems in which care is deliveredCrelies upon information technology at every step. The
type of rapid analysis and dissemination of data on patient outcomes envisioned by some of
the quality of care proposals under consideration by the Congress will not be possible if
we do not advance the state of the technology and develop the common language that will
let systems from various providers, plans, purchasers, and payers communicate with one
For both of these reasons, we have recently taken steps to integrate our informatics
work into our other substantive research centers. This step will strengthen our commitment
to informatics in the long run.
Because the Secretary believes that health informatics is critical issue to the health
care system, she asked me shortly after I joined the Agency to co-chair the
Department-wide Data Council, which has become an increasingly important forum for
decisionmaking in the area of information technology and carrying out the Department's
statutory responsibilities. AHCPR's experts in informatics will help the Data Council as
it addresses issues of advancing a common language for information technology systems and
addressing questions of their appropriate use.
AHCPR's Medical Expenditure Panel Survey (MEPS) provides policymakers and others with
up-to-date, highly detailed information on how Americans as a whole, as well as different
segments of the population, use and pay for health care. This ongoing survey also looks at
insurance coverage and other factors related to access to health care. MEPS is the only
survey that collects expenditure data from the non-Medicare population.
MEPS data is used by Congress and Federal agencies, including HCFA and other components
of the Department of Health and Human Services, Office of Management and Budget, and
Department of the Treasury. If MEPS data were available during my tenure on the Physician
Payment Review Commission, it would have been an invaluable source of information in
helping to make recommendations to Congress on payment for physicians.
These data also are used widely in the private sector by researchers at The Heritage
Foundation, Lewin-VHI, Urban Institute, RAND Corporation, and Project Hope, as well as by
health insurance companies, pharmaceutical firms, and other health-related businesses.
Using MEPS data on the first 6 months of 1996, AHCPR researchers Philip F. Cooper and
Barbara Steinberg Schone have found that as many as 6 million Americans choose not to
accept health insurance when offered it by their employers. The study found that the
number of workers declining employment-based health insurance increased by 140 percent
between 1987 and 1996 while the number of employers offering health insurance increased
during those years. Those most likely to turn down insurance are young (under age 25),
single, Hispanic or black, and work for low wages. Possible factors driving this trend
include the decline in real wages, higher employee contribution rates, and State
legislation aimed at enhancing insurance coverage which may have increased costs.
AHCPR's assistance is not limited to Federal policymakers. An important AHCPR program
is the User Liaison Program (ULP), which plays a critical role in providing technical
assistance to States and local policymakers on a wide range of issues. For example, the
ULP program conducted a workshop geared toward State policymakers to examine the latest
research findings on the uninsured and what State governments have been doing to solve the
problem. In 1998, the ULP will provide technical assistance to help State legislators and
branch officials plan for and implement the State Children's Health Insurance
Program (CHIP) recently enacted by Congress.
One of AHCPR's statutory responsibilities is to conduct assessments of new technologies
for the Medicare program (HCFA) and the Department of Defense. This information is
invaluable to Federal policymakers and in some case drives coverage policy in the private
sector. A case in point is AHCPR's technology assessment on lung volume reduction surgery
(LVRS). This technology assessment concluded that there was insufficient evidence upon
which to make a scientific judgment regarding the effectiveness of LVRS. AHCPR recommended
that coverage be granted within the scope of a clinical trial, which is now being
conducted by the National Institutes of Health. AHCPR is supporting the cost-effectiveness
component of that trial. It is our hope that the collaborative efforts between the
agencies will yield the information needed to make an informed coverage decision on LVRS.
AHCPR's new Evidence-based Practice Centers will continue to produce timely technology
assessments that will assist Federal, State, and private sector decisionmakers make
difficult coverage decisions. Private-sector policymakers also use our research to make
informed health care decisions. Recently, the Pharmaceutical Research and Manufacturers of
America included AHCPR's research finding on atrial fibrillation to promote the use of
blood thinning drugs in an advertisement touting "three ways pharmaceuticals are
ganging up against health care costs."
AHCPR's research and data give policymakers the "big picture" on the cost,
use, and access to health care in this country for them to use in making decisions about
clinical policy, coverage, quality improvement, and spending.
In order for health services research to fulfill its potential to improve the quality
of the health care system, the foundation on which it rests must be strong. This
foundation includes the tools that can be used to improve health care, the training to
nurture and promote the best researchers, and the teams that foster partnerships and
collaborations among the public and private sectors.
All of these elements will enable AHCPR to meet the challenges we face. Mr. Chairman
and members of the Subcommittee, I respectfully request that you reauthorize AHCPR so that
we can help our Nation's health care system by:
- Conducting and supporting research on the outcomes and effectiveness of treatments.
- Ensuring that clinicians, patients, health care system leaders, and policymakers have
the information that will enhance quality of care.
- Identifying gaps in access to and use of health care services, achieving value for the
Nation's health care dollar, and
- Helping the market find ways to fill those gaps.
These issues are critical to a sound, high quality health care system. I look forward
to working with the Subcommittee in the months ahead to find ways to improve health care