HHS FY2016 Budget in Brief
Agency 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 within HHS and with 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)||2014||2015||2016||2016
|Health Information Technology Research||30||28||23||-5|
|Health Services Research, Data and Dissemination||111||112||112||—|
|PHS Evaluation Funds (non-add)||111||0||88||+88|
|Budget Authority (non-add)||0||112||24||-88|
|PHS Evaluation Funds (non-add)||16||—||—||—|
|Budget Authority (non-add)||0||12||12||—|
|Prevention and Public Health Fund (non-add)||7||0||—||—|
|Subtotal, Program Level, HCQO||238||229||223||-6|
|Subtotal, PHS Evaluation Fund Appropriation, HCQO (non-add)||231||—||88||+88|
|Subtotal, Budget Authority, HCQO (non-add)||—||229||135||-94|
|Subtotal, prevention Fund (non-add)||7||—||—||—|
|Medical Expenditure Panel Survey||2014||2015||2016||2016
|PHS Evaluation Appropriation||64||—||—||—|
|PHS Evaluation Fund Appropriation||69||—||—||—|
|Patient-Centered Outcomes Research Trust Fund Transfer/1||65||101||116||+4|
|Total, Program Level||436||465||479||+14|
|Less Funds from Other Sources||2014||2015||2016||2016
|PHS Evaluation Fund Appropriation||-364||—||-88||-88|
|Patient-Centered Outcomes Research Trust Fund||-65||-101||-116||-14|
|Prevention and Public Health Fund||-7||—||—||—|
|Total, Discretionary budget Authority||—||364||276||-100|
1/ AHRQ receives mandatory funds transferred from the Patient-Centered Outcomes Research Trust Fund to implement section 937 of the Public Health Services Act.
Full Time Equivalents /2
2016 +/- 2015: 0
AHRQ Programs and Services
The FY 2016 Budget includes a total program level of $479 million for the Agency for Healthcare Research and Quality (AHRQ), $14 million above the FY 2015 level. Within this total, the Budget funds $88 million of AHRQ’s activities with Public Health Service (PHS) Evaluation Funds and $276 million with discretionary budget authority. AHRQ will also receive $116 million from the Patient Centered Outcomes Research Trust Fund, an increase of $14 million above FY 2015, which accounts for the entirety of the increase of AHRQ’s total program level.
Improving Patient Safety Through Evidence-Based Practices: TeamSTEPPS
Patient safety experts agree that teamwork, communication, and culture are widely recognized as foundational bases on which patient safety can be improved. AHRQ actively works to address these factors by supporting the Team Strategies and Tools to Enhance Performance and Patient Safety program, also known as TeamSTEPPS®.
TeamSTEPPS is an evidence-based program aimed at optimizing performance among teams of healthcare professionals – enabling them to respond quickly and effectively to whatever situations arise in their facilities. This curriculum was developed by a panel of experts, incorporating over 26 years of scientific research. The Budget provides $1 million for this program in FY 2016 to perform needs assessments, tool dissemination, and training in health care organizations across the country to prevent and mitigate medical errors and patient harm.
AHRQ conducts and supports a broad range of health services research within hospitals, research institutions, and health care systems that informs and enhances decision-making, and improves healthcare services, organization, and financing. AHRQ’s research provides evidence that becomes the foundation for large scale implementation by other HHS Operating Divisions, such as the Centers for Disease Control and Prevention (CDC) and the Centers for Medicare & Medicaid Services (CMS), and nationwide improvement of the healthcare system. For example, AHRQ has developed evidence-based practices for preventing healthcare associated infections in hospital intensive care units. These practices have been adopted and implemented across the country by the Partnership for Patients, funded by the Center for Medicare and Medicaid Innovation. AHRQ translates evidence from research into practical solutions that health care organizations can implement to prevent and mitigate patient safety risks and hazards, and improve the quality of care. The FY 2016 Budget continues support for core health services research on delivery system quality, safety, cost, and outcomes. The Budget also supports key data collections on changes in health costs, the use of health services, and insurance coverage.
Health Costs, Quality, and Outcomes
The FY 2016 Budget includes a program level of $223 million, $7 million below FY 2015, for research on how to improve the value, effectiveness, quality, and results of health care services. AHRQ organizes these activities into four main research portfolios: patient safety; health information technology; prevention and care management; and health services research, data, and dissemination.
Enhancing Patient Safety: The Budget includes $76 million, a decrease of $1 million below FY 2015, for the AHRQ patient safety research portfolio. The lifesaving research and dissemination projects supported by this portfolio actively reduce the number of medical errors and patient safety risks. AHRQ’s patient safety projects seek to implement initiatives to advance patient safety and quality, establish cultures in healthcare organizations that support patient safety and maintain vigilance through adverse event reporting to prevent patient harm, while also conducting research to strengthen the science base and develop more effective patient safety interventions. The FY 2016 Budget includes ongoing support for the dissemination and implementation of successful initiatives that integrate the use of evidence-based resources such as toolkits for improving safety and quality of care, and Team Strategies and Tools to Enhance Performance and Patient Safety, which provides training and tools for health care providers to create a culture of safety. 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.
In FY 2016, AHRQ will provide $34 million, the same level as FY 2015, to prevent healthcare‑associated infections by advancing new knowledge and accelerating the widespread adoption of proven methods for preventing these dangerous infections. Within this amount, the Budget includes $10 million, a $4 million increase, for healthcare‑associated infections activities that will support expanding AHRQ’s efforts to address the growing threat of antibiotic resistant bacteria. This goal will be achieved by developing and pilot testing effective approaches for conducting stewardship programs, which seek to reduce inappropriate antibiotic use. These efforts will contribute to the Administration’s National Strategy for Combating Antibiotic Resistant Bacteria.
The FY 2016 Budget also provides $4 million for the Comprehensive Unit-based Safety Program, which has been shown to be highly effective at reducing healthcare-associated infections by improving patient safety culture and implementing practices informed by research. In FY 2016, this program will focus on addressing catheter associated urinary tract infections and central line associated blood stream infections in intensive care units, a subset of which have persistently elevated infection rates in need of targeted improvement, as well as conducting further phases of current projects that are implementing the safety program. AHRQ is actively collaborating with CMS and CDC on the Agency Priority Goal that seeks to reduce catheter-associated urinary tract infections by 10 percent by the end of 2015. AHRQ’s prevention efforts have contributed significantly to a nationwide 17 percent reduction in hospital-acquired conditions from 2010 to 2013, which translates to an estimated 1.3 million fewer incidents, 50,000 fewer patient deaths, and $12 billion saved in health costs.
Health Information Technology Research: The Budget provides $23 million, $5 million less than FY 2015, for the AHRQ health information technology (health IT) research portfolio. This program area develops and disseminates research findings and evidence-based tools to inform policy and practice on how health IT can improve the quality of American health care. In FY 2016, this portfolio will devote $20 million to support 55 grants to continue building foundational evidence necessary to successfully leverage the significant national investment in health IT to improve the effectiveness, safety, and efficiency of the U.S. health care system. In recent years, grants in this area have examined the information needs of clinicians and patients, and evaluated the barriers to health IT adoption in rural America.
This portfolio operates in close coordination with other federal health IT programs in order to leverage resources and maximize their impact. For example, this research creates the evidence base and data that are utilized by the HHS Office of the National Coordinator for Health Information Technology to inform Meaningful Use Stage 3.
Prevention and Care Management: The Budget includes $12 million, the same level as FY 2015, for the AHRQ Prevention and Care Management research portfolio, which is focused on supporting 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 that evaluates the risks and benefits of clinical preventive services, makes recommendations about which services should be incorporated to improve primary medical care, and identifies research priorities. In FY 2016, AHRQ will continue to support systemic evidence reviews, research methods development, public engagement, transparency, and public dissemination of research findings.
Advancing Health Services Research, Data and Dissemination: The Budget provides a total of $112 million, the same level as FY 2015, for research focused on improving health care quality, effectiveness, and efficiency. This portfolio conducts crosscutting research to identify the most effective ways to organize, manage, finance, and deliver high quality care.
The Budget includes $5 million for a new effort to reduce prescription drug and opioid overdoses. This funding is a component of a department-wide action plan being developed to ensure that this public health epidemic is addressed with resources commensurate with the national need.
Increasing access to substance abuse treatment, including medication assisted treatment, is essential to effectively addressing prescription drug use. Primary care settings offer a tremendous opportunity for expanding access to medication assisted treatment, especially in rural areas that may lack access to community-based, specialty treatment centers. To date, relatively few primary care professionals and practices are providing evidence-based substance abuse treatment including medication assisted treatment. To respond to this need, AHRQ will invest $1 million to conduct a systematic evidence review on the implementation of medication assisted treatment in primary care settings. The evidence review will summarize what works for current providers and identify where more research is needed. In addition, AHRQ will support $4 million of grants to develop and test new methods, processes, and tools for better implementing these treatment strategies.
Optimizing Care for Patients with Multiple Chronic Conditions
The FY 2016 Budget includes $12 million for a new initiative to improve the care of patients with multiple chronic conditions. This initiative addresses the challenges of a high-cost, high-need growing patient population by developing tools with promise to improve care coordination, and quality of life, while reducing unnecessary expenses.
Health care for patients with multiple conditions is often fragmented, inefficient, costly, and ineffective. To address this problem, AHRQ is launching a project that will develop and evaluate evidence-based tools for clinicians to use to better coordinate health care for these complex patients. These tools will be based on integrated care plans, which are a new model that takes into account clinical and non-clinical factors to improve the comprehensiveness of, and adherence to, health care regimens. The project will also address information gaps by collecting national data to better understand care management and coordination for this population. Funding for this project is divided into two parts: $9 million in the Health Services Research, Data, and Dissemination portfolio, and $3 million in the Medical Expenditure Panel Survey.
This effort also supports the quality improvement goals of the HHS Strategic Framework on Multiple Chronic Conditions published in December 2010, and builds upon earlier research by the AHRQ-funded Multiple Chronic Conditions Research Network that investigated the safety and effectiveness of medical interventions for this population.
Additionally, in FY 2016 the Budget proposes $12 million for a new project to develop clinician tools to improve care for individuals with multiple chronic conditions. The Budget also proposes over $1 million for new research to the identify types of health care that are most likely to respond to financial incentives.
In FY 2016 AHRQ will provide $44 million for investigator-initiated research grants, of which approximately $14 million will be used to fund new grants. New investigator initiated research grants ensure resources are available to support new and innovative ideas each year. The Budget reduces funding for less effective activities in this portfolio and dissemination and translation projects, which will be re-scaled and focused on leveraging external partnerships. This portfolio’s grant activities also include continuing support for 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.
Medical Expenditure Panel Survey
The FY 2016 Budget includes $69 million, an increase of $4 million above FY 2015, for Medical Expenditure Panel Survey to continue providing vital national-level 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. The Survey’s data help the public and researchers know how employer-sponsored health insurance plans are changing over time, how much families can expect to pay for care, which types of doctor visits are increasing, and how health costs and service patterns are evolving. The Medical Expenditure Panel Survey includes three interrelated survey components: household, medical provider, and insurance.
Three million of the requested funding increase for the Medical Expenditure Panel Survey in FY 2016 is for the new Optimizing Care Patients with Multiple Chronic Conditions initiative, and will support data collection for the project. The funds will support additional targeted sampling to fulfill the need for nationally representative data on care management, coordination, and satisfaction of patients with multiple chronic conditions.
The FY 2015 Budget includes $72 million, which is $2 million above the FY 2015 level, to support costs essential to AHRQ’s ability to conduct and manage research. The largest single expense category supported by these funds is staff salaries, and other large expenses include employee benefits and rent. The majority of the requested increase in FY 2016 is for temporary costs associated with AHRQ’s move to a different building.
Patient Centered Health Research
In FY 2016 AHRQ will receive $116 million from the Patient Centered Outcomes Research Trust Fund, for Patient Centered Health Research (also known as Patient Centered Outcomes Research or Comparative Effectiveness Research). In FY 2016, projects will continue to drive systemic improvement and adoption of best practices in health care settings by supporting the training of researchers and the public dissemination and translation of comparative clinical effectiveness research findings.