HHS FY 2017 Budget in Brief - AHRQ
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 (HCQO)||2015||2016||2017||
|Health Information Technology Research||28||22||23||+1|
|Health Services Research, Data and Dissemination||112||89||113||+24|
|PHS Evaluation Funds (non-add)||--||--||83||+83|
|Budget Authority (non-add)||112||89||30||-59|
|U.S. Preventive Services Task Force||12||12||12||--|
|Subtotal, Program Level, HCQO||229||197||224||+27|
|Subtotal, PHS Evaluation Fund Appropriation, HCQO (non-add)||--||--||83||+83|
|Subtotal, Budget Authority, HCQO (non-add)||229||197||141||-56|
|Medical Expenditure Panel Survey||65||66||69||+3|
|Patient Centered Outcomes Research Trust Fund Transfer /1||79||94||106||+12|
|Total, Program Level||443||428||470||+41|
|Less Funds from Other Sources||2015||2016||2017||
|PHS Evaluation Fund Appropriation||--||--||-83||-83|
|Patient-Centered Outcomes Research Trust Fund||-79||-94||-106||-10|
|Total, Discretionary Budget Authority||364||334||280||-54|
1/ AHRQ receives mandatory funds transferred from the Patient-Centered Outcomes Research Trust Fund to implement section 937 of the Public Health Services Act.
The FY 2017 Budget provides a total program level of $470 million for the Agency for Healthcare Research and Quality (AHRQ), an increase of $41 million above the FY 2016 level. The Budget funds AHRQ with three types of budgetary resources: $83 million of Public Health Service (PHS) Evaluation Funds, $280 million of budget authority, and $106 million from the Patient Centered Outcomes Research Trust Fund.
AHRQ produces and disseminates evidence to make health care higher quality, safer, and more affordable. Patients, caregivers, health care practitioners, federal agencies, researchers, and policymakers rely on AHRQ to conduct, support, and distribute the results of a broad range of health services research that informs and enhances decision-making, and improves healthcare services, organization, and financing. AHRQ has been charged with discovering how to ensure that America’s annual $3.0 trillion investment in health care can be more effective, higher value, and better aligned with the needs of all Americans. In accomplishing its mission, AHRQ engages in three types of activities:
- Investing in research to make health care safer and improve quality and access;
- Creating materials to teach and train health care providers to catalyze improvements in care; and,
- Generating measures and data to track and improve performance and evaluate progress.
The goal of these activities is to build knowledge about what works and spread this information throughout the health care system. By doing so, AHRQ enables interventions to be taken to scale and achieve maximum impact. AHRQ is a key supplier of the research findings and evidence-based practices that are implemented on a large scale by other HHS Operating Divisions, such as the Centers for Disease Control and Prevention and the Centers for Medicare & Medicaid Services, to achieve nationwide improvement. The FY 2017 Budget reverses the significant reductions to research activities in FY 2016 and makes investments in AHRQ’s core mission areas of improving patient safety, developing quality improvement tools, and sustaining key data resources on access, care delivery, and affordability.
Health Costs, Quality, and Outcomes
The FY 2017 Budget includes a program level of $224 million, $27 million above FY 2016, for research to inform clinicians, providers, and policymakers on how to improve the value, effectiveness, quality, and results of health care services. AHRQ undertakes these activities through four research portfolios: patient safety; health information technology; the U.S. Preventive Services Task Force; and health services research, data, and dissemination.
Enhancing Patient Safety
Improving patient safety and reducing medical errors is a major priority of the Department. The Budget includes $76 million, an increase of $2 million above FY 2016, for the AHRQ patient safety research portfolio. This funding supports lifesaving research and projects that prevent, mitigate, and decrease the number of medical errors, patient safety risks and hazards, and quality gaps. AHRQ’s patient safety projects develop the evidence base about effective practices to maximize safety, as well as disseminate and implement these practices in real world settings across the health care system. To further leverage the impact of these proven practices, AHRQ partners with private and public sector organizations such as primary care practices, the Department of Defense patient safety program, and CMS’s Hospital Engagement Networks. AHRQ’s approach to patient safety has yielded positive results: from 2010 to 2014, hospital-acquired infections and conditions have decreased nationally by 17 percent, which translates to an estimated 87,000 lives saved; $19.8 billion in unnecessary health care costs averted; and 2.1 million instances of harm avoided. AHRQ developed many of the resources that are used by hospitals to make care safer as well as the data strategy for measuring the impact of this effort. The FY 2017 Budget includes ongoing support for knowledge-building research grants that expand our understanding of why patient safety problems and harms occur and how to prevent them, integration of new findings into common practice, prevention and reduction of healthcare-associated infections, and adverse event reporting and data collection.
In FY 2017, AHRQ will provide $34 million, a decrease of $3.3 million from the prior year, to prevent healthcare associated infections by developing new methods of preventing these dangerous infections and promoting the adoption of these methods into settings with the highest needs, such as intensive care units. Within this amount, $12 million, an increase of $2 million, is dedicated to expanding AHRQ’s efforts to address the growing public health threat of antibiotic resistant bacteria. These activities contribute to the Department’s efforts in supporting the National Action Plan for Combating Antibiotic-Resistant Bacteria. As part of these activities, the Budget invests $4 million to continue a project of the Comprehensive Unit-based Safety Program to promote the establishment of antibiotic stewardship programs to reduce inappropriate antibiotic use in multiple health care settings.
The FY 2017 Budget also provides $7 million to continue two additional projects that will use the Comprehensive Unit-Based Safety Program in areas ripe for improvement. One project will apply new enhanced recovery protocols to improve outcomes for post-surgical patients. The other project will focus on reducing catheter associated urinary tract infections and central line associated blood stream infections in intensive care units, a setting with persistently elevated infection rates in need of targeted improvement. AHRQ is actively collaborating with CMS and CDC on decreasing the incidence of these harmful infections. In this effort, AHRQ provides evidence from this program about how to reduce infection rates, trains hospital staff in applying effective methods of preventing infections, and uses standardized data for tracking nationwide infection rates.
A Targeted Approach to Combating Antibiotic Resistance
Antibiotic resistant infections are becoming increasingly common and harder to treat. In response, the Administration has created a cross-agency National Action Plan for Combating Antibiotic-Resistant Bacteria. In FY 2017, the Budget provides $4 million to slow the development of antibiotic resistance by using AHRQ’s Comprehensive Unit-based Safety Program. This program, which fosters improved clinical practices, has reduced healthcare-associated infections by implementing a toolkit of evidence-based practices together with training to achieve improvements in safety culture, teamwork, and communication. In recent years, this program has achieved dramatic reductions in infections when applied to prevent central line-associated blood stream infections.
AHRQ is now targeting the Comprehensive Unit-based Safety Program at antibiotic resistance. This project will promote and guide the implementation of antibiotic stewardship programs in hospitals, ambulatory care facilities, and long-term care centers. By establishing antibiotic stewardship programs where they are currently lacking, this investment can reduce inappropriate antibiotic use, thereby reducing the emergence of antibiotic resistance and decreasing both the number and the virulence of these infections.
Health Information Technology Research
The Budget provides $23 million, an increase of $1 million above FY 2016, for the AHRQ health information technology (IT) research portfolio. Within the federal health IT ecosystem, AHRQ has a unique role: to develop the evidence-base on what works to improve the use of health IT across the healthcare system. The evidence developed by AHRQ informs the implementation, oversight, and governance decisions of other HHS agencies such as the Office of the National Coordinator for Health Information Technology, CMS, and IHS. To fulfill this role, AHRQ supports research grants to build knowledge, to develop tools to help stakeholders implement best practices, and to synthesize and disseminate evidence on the safe and meaningful use of health IT. For example, current projects include an examination of how exchanging health information can drive population-level clinical decision support and an update of a tool that evaluates the safety performance of inpatient electronic health records after deployment. The $1 million increase will support additional investigator-initiated research grants related to health IT to help ensure clinicians have the best evidence at their disposal as they incorporate health IT into daily practice.
U.S. Preventive Services Task Force
The Budget includes $12 million, the same as FY 2016 for the United States Preventive Services Task Force. The Task Force is an independent panel of national experts that reviews the medical literature and makes recommendations about the harms and benefits of clinical preventive services and health promotion to improve primary care. By statute, AHRQ provides the Task Force with scientific, administrative, and dissemination support, but the recommendations are up to the members of the panel. The Task Force provides doctors and patients the evidence they need to help determine how to maintain health and prevent disease. The Task Force’s recommendations serve as a roadmap for health practitioners looking for authoritative syntheses of the latest evidence on effective prevention practices. With the requested resources, the Task Force will conduct evidence reviews of relevant topics, seek public comments on draft recommendations and disseminate the latest findings.
Advancing Health Services Research, Data and Dissemination
The Budget provides a total of $113 million, an increase of $24 million above FY 2015, for research to identify the most effective ways to organize, manage, finance, and deliver high‑quality care. This research goes beyond simply the “what” of patient care to the “how”– how inputs, policies, procedures, and training can be changed to produce a better functioning health system and better outcomes for patients.
The increase of $24 million will reverse reductions enacted in FY 2016 that limited AHRQ’s ability to drive quality improvement. AHRQ will invest $1 million in the Evidence-Base Practice Centers, which did not receive any discretionary funding from AHRQ in FY 2016 due to the reduced level for this portfolio, to close evidence gaps by reviewing the latest research and publishing syntheses of effective practices. Health care providers rely on this evidence to ensure that the standard of practice is based on the latest, most accurate medical evidence. An increase of $2 million in support of AHRQ’s National Healthcare Quality and Disparities Reports will allow AHRQ to analyze and produce these public data resources after operating on a reduced publication schedule in FY 2016. Additional dissemination funding will be provided to produce and disseminate the State-based information and topic-specific chapters from these reports.
The Budget includes new investments in high need areas of research and dissemination. AHRQ will invest $9 million in a new project to develop clinician tools to improve care for individuals with multiple chronic conditions. This initiative addresses the challenges of a high-cost, high-need, growing patient population by creating resources to help improve care coordination and quality of life, while reducing unnecessary expenses. This effort builds upon earlier descriptive research by the AHRQ-funded Multiple Chronic Conditions Research Network and supports the quality improvement goals of the HHS Strategic Framework on Multiple Chronic Conditions. In support of the Administration’s Delivery System Reform initiative, the Budget also proposes over $1 million of new research on paying for value. This effort will explore new ways to link payments to quality and value, and not simply to the volume of health care services provided.
The Budget includes $3 million to continue projects to reduce prescription drug and opioid overdoses first awarded in FY 2016. These projects develop and test new methods and tools for implementing medication assisted treatment in primary care practices. This funding is a component of a Department-wide efforts being developed to ensure that this public health epidemic is addressed rapidly and comprehensively.
In FY 2017 AHRQ will provide $47 million for investigator-initiated research grants, of which approximately $11 million will be used to fund new grants. Making these new resources available allows AHRQ to support emerging and innovative proposals that may not have been available in the prior year. AHRQ will also continue several rapid cycle research networks that are designed to increase the availability of new research findings into practice. These types of activities contribute to increased quality, a stronger evidence-based culture of practice, and ultimately to better health for patients.
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.
Reducing Hospital Readmissions
In October AHRQ introduced the Nationwide Readmissions Database, the first all payer nationwide data resource that supports tracking and analysis of hospital readmission rates. Hospital readmissions are a critical policy issue for health care quality and safety improvement. The new database addresses a major gap in health care data by providing the first all payer comprehensive data source on readmissions. Clinicians, researchers, public health professionals, administrators, and policymakers will be able to use the data in their analyses and decision making to target, understand and improve conditions with high rates of readmissions.
This data resource is part of the AHRQ Healthcare Cost and Utilization Project, the largest collection of all-payer, longitudinal hospital discharge and billing data in the United States. The FY 2017 Budget includes $8 million to continue this flagship project. This project supports many efforts, including the Partnership for Patients initiative to track and reduce injuries a mother may suffer during childbirth. Data from this project will provide national estimates for two quality indicators that measure this type of trauma, as well as use the readmissions database to track improvements in readmission rates as part of the Partnership for Patients.
Medical Expenditure Panel Survey (MEPS)
The FY 2017 Budget includes $69 million, an increase of $3 million above FY 2016, for MEPS in order to maintain the integrity of the sample size and the quality of the core data products on a state and national level. MEPS includes three interrelated surveys components: household, medical provider, and insurance. These three surveys provide the only nationally representative source of annual data on how Americans, including the uninsured, use and pay for health care. MEPS data have become the linchpin for public and private analyses of health care utilization and expenditures. In addition, MEPS provides estimates of measures related to health status, demographic disparities, employment, and health care access, coverage, and quality. In FY 2017, the requested funding increase will provide the additional resources for data collection needed to maintain the quality of state-level estimates and the timeliness of key production milestones.
The FY 2017 Budget includes $71 million, the same as the FY 2016 level, to support agency-wide operational and administrative costs that help ensure efficient management of research activities and stewardship of federal resources. The largest single expense category in Program Support is staff salaries, and other large expenses include employee benefits and rent. AHRQ has identified efficiencies by consolidating into less expensive office space.
Patient Centered Health Research
In FY 2017 AHRQ will receive $106 million from the Patient Centered Outcomes Research Trust Fund, to advance Patient Centered Health Research (also known as Comparative Effectiveness Research). These funds are authorized for translating and disseminating comparative clinical effectiveness research and awarding grants to train researchers. Funded projects distribute up to date information about the benefit and harms of treatment options so that patients and their caregivers can make informed health care decisions. New AHRQ projects include resources for the public to more easily search for and find reliable research results, and efforts to facilitate the rapid adoption of research findings into practice.