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HHS FY2015 Budget in Brief

Agency for Healthcare Research and QualityAgency for Healthcare Research and Quality (AHRQ)

The mission of the Agency for Healthcare Research and Quality is to produce evidence to make health care safer, higher quality, more accessible, equitable, and affordable, and to work with HHS and other partners to make sure that the evidence is understood and used.

AHRQ Budget Overview

(Dollars in millions)

Health Costs, Quality and Outcomes Research (HCQOR)

2013

2014

2015

2015
+/
2014

Health Information Technology Research

26 

30 

23 

-6

Patient Safety Research

67 

72 

73 

+1 

PatientCentered Health Research

68 

93

106 

+13 

PCORTF Transfer (non-add) /1

58 

93 

106 

+13 

PHS Evaluation Funds (non-add)

10 

Health Services Research, Data and Dissemination 

111 

111 

93 

-18 

Prevention/Care Management

26 

23 

11 

-12 

PHS Evaluation Funds (non-add)

19 

16 

11 

-5 

Prevention and Public Health Fund (non-add)

6

7

-7

Value

4

3

-3

Subtotal, Program Level, HCQO

300 

331 

306 

-25 

Subtotal, PHS Evaluation Funds, HCQO (non-add)

236 

231 

201 

-31 

Medical Expenditure Panel Survey

61 

64 

64 

Program Support

68 

69 

70 

+1 

Total, Program Level

430

464 

440 

-24 

 

Less Funds From Other Sources

2013

2014

2015

2015
+/
2014

PHS Evaluation Funds

-365 

-364 

-334 

+30 

PatientCentered Outcomes Research Trust Fund

-58 

-93 

-106 

-13 

Prevention and Public Health Fund 

-6 

-7 

+7 

Total, Discretionary Budget Authority

3,210

3,435

3,298

 

Full Time Equivalents /2

2013: 311

2014: 326

2015: 326

2015 +/- 2014: 0

1/In FY 2011, AHRQ began receiving mandatory funds transferred from the Patient-Centered Outcomes Research Trust Fund to implement section 937 of the Public Health Services Act.

2/FTE levels reflect all discretionary and mandatory funding sources and additional estimated FTE funded by reimbursable agreements.

AHRQ Programs and Services

The FY 2015 Budget includes a total program level of $440 million for the Agency for Healthcare Research and Quality (AHRQ), $24 million less than the FY 2014 level. Within this total, the Budget includes $334 million in Public Health Service (PHS) Evaluation Funds, a reduction of $30 million below FY 2014, and $106 million from the Patient Centered Outcomes Research Trust Fund, an increase of $13 million above FY 2014.

AHRQ’s mission is to produce evidence to make American health care safer, higher quality, more accessible, equitable, and affordable, and to work with HHS divisions and other partners to make sure that the evidence is understood and used. AHRQ works toward these goals by undertaking health services research, data collection, and dissemination of evidence and evidence based tools. AHRQ translates evidence from research into practical solutions that health care organizations can implement to prevent, mitigate, and decrease patient safety risks and hazards, and improve the quality of care. The FY 2015 Budget will provide the resources needed to continue progress on health services research to improve outcomes, affordability, and quality. The Budget also supports the collection of vital information on health care spending and use.

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Health Costs, Quality, and Outcomes

PROGRAM HIGHLIGHT -- Preventing Healthcare-Associated Infections
The Budget provides $9 million to support the ongoing nationwide implementation of AHRQ’s Comprehensive Unit based Safety Program. This program reduces healthcare-associated infections by improving patient safety culture and implementing evidence-based practices in various health care settings. The targeted infections include catheter associated urinary tract infections, surgical site infections, and ventilator-associated pneumonia. This program reduced central line-associated bloodstream infections by 41 percent when implemented in over 1,000 intensive care units, thereby preventing over 2,100 infections, saving more than 500 lives, and averting over $36 million in excess costs.

The FY 2015 Budget includes a program level of $306 million, $25 million below FY 2014, for research on issues affecting the cost, quality, and effectiveness of health care services. AHRQ’s research on health costs, quality, and outcomes is organized into six main research portfolios: patient safety; health information technology; patient centered health research; prevention and care management; health services research, data and dissemination; and value.

Enhancing Patient Safety: The Budget provides $73 million, an increase of $1 million above FY 2014, for the AHRQ patient safety research portfolio. This portfolio supports lifesaving research and dissemination projects that prevent, mitigate, and decrease the number of medical errors, patient safety risks and hazards, and quality gaps. In order to make demonstrable improvements in patient safety, AHRQ funds measurement, reporting, dissemination, and implementation, while also funding research to strengthen the science base and develop more effective patient safety interventions. Research funded in FY 2015 will build on past successes and focus on the expansion of projects that have demonstrated impact in improving healthcare safety, including ongoing support for the dissemination and implementation of successful initiatives that integrate the use of evidence based resources such as the Surveys of Patient Safety Culture and Team Strategies and Tools to Enhance Performance and Patient Safety (Team STEPPS). AHRQ’s research in this area provides the evidence base that CMS and other HHS agencies use to improve patient safety on a national scale.

The Budget includes $15 million for a new initiative that will expand the implementation of recent advances in patient safety: Expanding Patient Safety Improvements to All Health Care Settings. This effort will build on AHRQ’s prior success in improving safety in hospitals, and expand it to other settings such as primary care practices and nursing homes, so that patients can expect safe care wherever they are. This multi-year initiative will identify, test, refine, and disseminate strategies and tools to prevent medical errors and include a rigorous evaluation component to determine what works best in providing safe care.

In FY 2015, AHRQ will provide $34 million, the same level as FY 2014, to prevent healthcare associated infections (HAIs) by supporting the creation of new knowledge and accelerating the widespread adoption of proven methods for preventing HAIs. A prime example of such an evidence-based method is the Comprehensive Unit-based Safety Program (see Program Highlight on prior page), which has been shown to be highly effective in reducing HAIs. AHRQ’s prevention efforts contribute significantly to the implementation of the HHS National Action Plan to Prevent HAIs and the CMS Innovation Center’s Partnership for Patients.

Health Information Technology Research: The Budget provides a total of $23 million, $6 million less than FY 2014, for the AHRQ health information technology (health IT) research portfolio. This program area develops and disseminates evidence and evidence-based tools to inform policy and practice on how health IT can improve the quality of American health care. In FY 2015, AHRQ will provide $20 million to support 40 grants for foundational health IT research to inform and support the meaningful use of health IT.

The portfolio operates in close coordination with other federal health IT programs in order to leverage resources and maximize their impact. For example, one focus of AHRQ’s health IT research is whether and how health IT improves health care quality. This research creates the evidence base and resources that are utilized by the HHS Office of the National Coordinator for Health Information Technology (ONC) and other stakeholders. In FY 2015, AHRQ will end support for the development of implementation tools and increase its focus on conducting research to enhance the evidence base for the effective use of health IT.

PR PROGRAM HIGHLIGHT -- National Guideline Clearinghouse/ National Quality Measures Clearinghouse
The National Guideline Clearinghouse™ (NGC) and the National Quality Measures Clearinghouse™ (NQMC) are databases containing structured summaries of public and private sector evidence-based clinical practice guidelines and health care quality measures, respectively, and made freely available on the Web at www.guideline.gov and www.qualitymeasures.ahrq.gov. The content of both resources are used by clinicians, guideline or quality measure developers, health plans, hospitals and health systems, state and federal agencies, policymakers, researchers, and others to help inform decisions about and improve the quality of patient care. Approximately 500,000 users visit NGC and NQMC each month searching over 4,000 guidelines and measures to find those of interest.

An independent evaluation of NGC in 2011 found NGC to be the ‘go to place’ to find clinical practice guidelines making it a flagship tool supporting health care decision making. All of the evidence-based clinical practice guidelines in NGC meet criteria for evidence resulting from the 2011 Institute of Medicine’s “Clinical Practice Guidelines We Can Trust” report.

A robust resource for finding health care quality measures, the NQMC includes measures and measure sets that meet criteria and a framework which have evolved over time as the field of health care quality measurement has evolved. NGC and NQMC show connections between guidelines and measures, when possible.

In FY 2014, with continued support in FY 2015, AHRQ will create new and updated summaries of guidelines and measures, ensuring that the content on the NGC and NQMC is up-to-date. Additionally, AHRQ will explore how to modify the NQMC inclusion criteria regarding evidence to align to the revisions made in the NGC.

Patient Centered Health Research: The Budget includes $106 million for Patient Centered Health Research (also known as Patient Centered Outcomes Research or Comparative Effectiveness Research), provided through the Patient Centered Outcomes Research Trust Fund. The fund, established by the Affordable Care Act, transfers funding to AHRQ to build research capacity, translate and disseminate comparative clinical effectiveness research, and establish grants to train researchers. In FY 2015, investments will build on current AHRQ efforts, such as grants to improve patient outcomes by expanding the capacity of primary care practices to implement evidence-based quality improvement techniques.

Prevention and Care Management: The Budget includes $11 million, $12 million less than FY 2014, for the AHRQ Prevention and Care Management research portfolio which supports improved evidence based clinical decision-making for preventive services through the U.S. Preventive Services Task Force (Task Force). The Task Force is an independent non-governmental panel focused on evaluating risks and benefits of clinical preventive services, making recommendations about which services should be incorporated into primary medical care, and identifying research priorities. AHRQ provides scientific and administrative support to the Task Force, including topic selection, methods development, systematic evidence review, and dissemination. In FY 2015, AHRQ will continue to focus on enhancing the quality of scientific support provided, as well as continue efforts to improve public engagement, transparency, and dissemination. AHRQ will end other research and dissemination activities previously included in this portfolio. AHRQ can still support investigator initiated research on improving primary care in its Health Services, Research, Data and Dissemination portfolio.

Advancing Health Services Research, Data and Dissemination: The Budget includes a total of $93 million, a decrease of $18 million below FY 2014, for research focused on examining how people get access to health care, how much care costs, and what happens to patients as a result of the care they receive. This portfolio conducts crosscutting research that focuses on quality, effectiveness and efficiency of health services. For example, AHRQ funds several rapid cycle research networks that are designed to accelerate the diffusion of new research findings into practice, which contributes to increased quality, a stronger evidence based culture of practice, and ultimately to better health for patients. One of these rapid cycle initiatives, the Evidence Based Practice Centers, reviews all relevant scientific literature on clinical, behavioral, and organizational and financing topics to produce evidence reports and technology assessments. These reports are used to develop quality measures, educational materials and tools, guidelines, and research agendas. The Budget level reduces funding for research contract support and less effective activities in this portfolio. Additionally, in FY 2015, AHRQ is eliminating the Value portfolio, a decrease of $3 million, and shifting some of these activities to the Health Services Research portfolio.

In FY 2015 AHRQ will provide $40 million for investigator-initiated research grants, of which approximately $20 million will be used to fund new grants. New investigator initiated research grants ensure that an adequate number of new and innovative ideas are pursued each year. Within the $20 million for new investigator initiated grants, $15 million will support a new initiative focusing on health economics research. AHRQ is anticipating grant proposals focused on increasing the efficiency, effectiveness, and value of the health care system. These grants could improve our understanding of the causes and consequences of lack of insurance, and of the effects of health insurance expansion on access to care, utilization of care, health care spending, health outcomes, and the labor market.

In addition, AHRQ will continue to support measurement and data collection activities, including the Healthcare Cost and Utilization Project (HCUP), the largest collection of all payer, longitudinal hospital discharge data in the United States. HCUP data supports many efforts, including the Partnership for Patients initiative to track and reduce injuries a mother may suffer during childbirth. HCUP data provide national estimates for two quality indicators that measure this kind of trauma. HCUP also contributes to the national benchmark for readmissions to community hospitals, so that clinicians and policymakers can accurately measure improvements in the rate of readmissions for patients as interventions are implemented under the Partnership for Patients.

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Medical Expenditure Panel Survey (MEPS)

The FY 2015 Budget includes $64 million, the same as FY 2014, for MEPS to maintain the precision and analytical capacity to continue providing valuable data on health status, medical expenditures, demographic disparities, and health care access, coverage and quality. This survey provides the only national source of annual data on how Americans, including the uninsured, use and pay for health care. MEPS includes three interrelated survey components: household, medical provider, and insurance.

MEPS data have become the linchpin for public and private economic models of health care utilization and expenditures. These data continue to be key for the evaluation of health reform policies and analyzing the effect of tax code changes on health expenditures and tax revenue.

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Program Support

The FY 2015 Budget includes $70 million, an increase of $1 million from the FY 2014 level, to support agency wide operational and administrative costs. Most of the requested increase is for one-time costs associated with AHRQ’s upcoming move to a different building. Program support costs largely consist of salaries, benefits, and rent.

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