Accompanied by, Lisa Simpson, M.B., B. Ch., Deputy Director, AHRQ; Ms. Rita Koch, Chief, Office of Management, Division of Financial Management; Dennis P. Williams, Deputy Assistant Secretary, Office of Budget, Department of Health and Human Services
Introduction
Fiscal Year 2001 Request
Patient Safety and Reducing Errors in Medicine
Worker Health and Health Care
Continuing Priorities
Conclusion
Mr. Chairman and Members of the Committee, I am pleased to be here today to present the President's Fiscal Year 2001 budget request for the Agency for Healthcare Research and Quality (AHRQ, formerly the Agency for Health Care Policy and Research).
I understand, Mr. Chairman, that you will be retiring from Congress at the end of this legislative session. While I had the pleasure of working with you for only 3 of your 20 years of service, I know that your commitment to quality in health care has played a major role in shaping the way this Agency does its business. Your emphasis on excellence in research and the translation of research into quality health care has been a guiding force for us, and it has resulted in better health care for people.
Mr. Chairman, I am here today as the Director of the newly reauthorized and renamed Agency for Healthcare Research and Quality (AHRQ). The reauthorization changes how we focus our research agenda, but it maintains our core mission to ensure that the knowledge gained through health care research is translated into measurable improvements in the health care system.
This mission, to which the Committee has provided guidance, is driven by the needs of the users of our research—patients, clinicians, health system leaders, and policymakers. It is also grounded in the Agency's "pipeline of research," which begins with investing in new research that examines what works in health care, moves to developing the tools needed to apply the knowledge gained with this investment, and finally, translates the knowledge and tools into measurable improvements in health care.
For example, the users of our research nominated pharmacological treatments for depression as a topic for the AHRQ-supported Evidence-based Practice Centers (EPCs). The nominators of the topic, and other partners, pledged to use the findings to develop tools for depression treatment. Our EPC at the University of Texas Health Science Center in San Antonio found that newer antidepressant drugs are equally as effective as older antidepressants in treating depression. The American Psychiatric Association and the American Pharmaceutical Association are now developing practice guidelines on the use of antidepressant drugs based on the evidence report.
We are currently funding six grants as part of a special initiative to translate research into practice. A project at the University of Chicago is designed to improve the quality of care and outcomes of vulnerable patients with diabetes who receive their care at urban and rural community health centers (CHCs). Forty CHCs in the Midwest Clinicians' Network will receive basic training in total quality management and chronic disease management. Conducting this research in CHCs will help expedite quality improvements because the knowledge and tools will already be in the hands of those who can make the difference.
Our agenda to translate research into practice will continue to be a touchstone at AHRQ, as demonstrated by our Fiscal Year 2001 request. We are requesting $250 million, an increase of $46 million from Fiscal Year 2000. The increase will enable us to focus on three new priority areas:
In addition, the request will support our continuing priorities:
In Fiscal Year 2001, we are requesting an additional $20 million to address the issue of patient safety and medical errors, as highlighted by the Institute of Medicine's (IOM) recent report, To Err is Human. According to the IOM report, as many as 98,000 people die each year in hospitals because of medical errors, making medical errors the fifth leading cause of death in this country, outpacing deaths from motor vehicle accidents, breast cancer, or AIDS. If errors were a disease, we would call it an epidemic, and would respond by targeting resources for research and getting that research into practice.
While the IOM report is distressing, it also offers some hopeful news—errors can be prevented. Although high profile cases—such as surgery that removes the wrong limb—capture the public attention, errors can occur in the most routine tasks, such as giving too much salt to a patient on a salt-free diet, or triggering a prescription error due to illegible handwriting. Landmark research supported by this Agency demonstrated that errors result from system failures, and therefore can't be solved by blaming individuals. Like the patients they care for, health care professionals are human, and humans are not perfect. This is something we cannot change.
However, we can change the system in which providers care for patients. Research, some funded by AHRQ, has shown that system improvements can prevent medical errors. For example, the Agency supported research that discovered that failures at the system level accounted for over three-fourths of adverse drug events. These included failures in disseminating pharmaceutical information and checking drug doses and patient identities. The researchers concluded that any effort to reduce medical errors in an organization would require making changes to system design.
In Fiscal Year 2001, the Agency is proposing to build on our existing research on errors to carry forward many recommendations in the IOM report. We have already made a down payment in Fiscal Year 2000 that attacks the problem in two ways:
The CERTs will study and increase awareness of both the uses and risks of new drugs and drug combinations.
It will take resources and teamwork to make a significant reduction in errors. Although achieving this goal will require an investment, it will reap substantial benefits. The IOM estimates that we could save between $17 and $29 billion spent each year as a result of medical errors.
Mr. Chairman, we propose a broad research initiative for Fiscal Year 2001, spanning the Agency's full pipeline of research:
President Clinton and HHS Secretary Shalala both have made a personal commitment to reduce medical errors and improve patient safety. This will require teamwork within the Administration, and with our private-sector partners, including the leaders in this field, such as the American Medical Association and the National Patient Safety Foundation, and others, such as the Joint Commission on Accreditation of Healthcare Organizations.
We are requesting an additional $5 million to harness the power of information technology to improve patient care. In its very early days, the Agency funded research to develop many of the computer applications used in health care today. However, health care lags behind other industries in the use of technology.
Ironically, technology—such as clinical decision-support systems—could be a major force in reducing medical errors. For example, an Agency-supported project at LDS Hospital in Salt Lake City had great success with a computer-assisted management program to reduce drug-related errors. The program proved so effective that LDS officials have reported that eight other hospitals in their system have requested the program for their facilities.
We will invest in the development and testing of Web-based applications for providing evidence-based information to providers and patients. We will build on the success of AHRQ's National Guideline Clearinghouse™ to develop a "one-stop shopping" Internet site for evidence-based information on clinical conditions. In Fiscal Year 2001, we will make it possible for all sectors of the health care industry to navigate one site to find the tools for their specific needs. For example, guidelines for treating asthma will be linked with tools for assessing whether best practices are implemented.
The final component of our investment in this area will develop and test strategies to collect data in clinical settings, such as measuring the functional outcomes for elderly patients in primary care. We also propose to support research to study and identify best practices for protecting patient data while making it available for research and quality improvement. AHRQ will work closely with the National Library of Medicine and other NIH agencies, the Health Care Financing Administration, the Department of Defense, and the Department of Veterans Affairs, as well as States and the private sector in this effort.
For Fiscal Year 2001, the President has requested $10 million for AHRQ to support research in the area of worker health. This initiative will help employers ensure that injured workers receive quality health care. Our research will focus on potentially disabling, acute conditions, and the management of disability and chronic disease. The goal is the development of validated performance measures and strategies for assessing the effectiveness of alternative approaches of care appropriate to workers compensation programs.
We also will focus on the quality of the health care workplace, which has the highest nonfatal occupational injury and illness rates in the service industry. Our research will examine how system changes will affect worker health, and how these changes affect their ability to do their jobs. We also will support research for improving the quality and outcomes of clinical interventions for conditions that significantly affect the workplace.
In Fiscal Year 2001, we are requesting $11 million to continue and enhance existing priorities. In 1998, the President's Quality Commission concluded that the "lack of comprehensive information on the quality of American health care is unacceptable." As a result, the President has requested $7 million for AHRQ to develop a National report on the state of quality in the United States. Congress, which also recognized the need for this information, mandated such a report in AHRQ's authorizing statute.
AHRQ is requesting $2 million in Fiscal Year 2001 for another continuing priority: improving clinical preventive services. This effort will target populations who are receiving too few, too many, or poor-quality clinical preventive services. Special emphasis will be on clinical prevention for vulnerable populations: women, children, and minorities.
Finally, we are requesting $2 million in Fiscal Year 2001 to continue the Agency's support of training opportunities for young researchers to help build the capacity for health services research. The Agency will work to diversify the pool of health services researchers both ethnically and geographically.
In addition, AHRQ plans to continue its support for the Medical Expenditure Panel Survey (MEPS) at a level of $41 million in Fiscal Year 2001. MEPS is a nationally representative survey of health care use, expenditures, sources of payment, and insurance coverage for the U.S. civilian noninstitutionalized population, as well as a national survey of nursing homes and their residents.
In conclusion, Mr. Chairman, AHRQ is proposing a comprehensive plan that addresses key issues of importance in health care quality. I want to thank the committee for giving me the opportunity to present the President's budget request of $250 million for AHRQ in Fiscal Year 2000. Thank you.
Current as of February 2000
Internet Citation:
Testimony on the President's Fiscal Year 2001 Budget Request for AHRQ. John Eisenberg, MD, Administrator, AHRQ, before the House Subcommittee House Subcommittee on Labor-Health and Human Services-Education Appropriations. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/about/cj2001/cjtest01.htm
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