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| Performance Budget Submission for Congressional Justification
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Significant Items
FY 2008 House Report No. 109-515
Detection of Medical Errors
House (Rept. 109-515) p. 140
The Committee also encourages the Agency for Healthcare Research and Quality (AHRQ) to look favorably on proposals that would
proactively detect medical errors and preemptively control injury via compact medical
devices that acquire, analyze and filter data from multiple, disparate, wireless and wired
sources.
Action Taken or to be Taken
In response to the Committee's encouragement, AHRQ has funded several proposals to proactively detect medical errors. AHRQ's health information technology portfolio now
funds over 100 projects, many of which use electronic medical records and
computerized physician order entry systems to monitor the safety of care as well as
proactively guide patients and providers to better and safer care. In one project funded
by AHRQ at Duke University, the hospital based medication error monitoring system has
been so successful the institution is extending the project into its outpatient clinics.
Integrated Medication Delivery Systems
-
House (Rept. 109-515) p. 140
Within the total for research on health costs, quality, and outcomes, the Committee
provides $84,000,000 for the patient safety program, which is the same as the fiscal year
2006 funding level and the budget request. This amount includes $50,000,000 for
grants to support the health information technology (health IT) initiative. The Committee
urges AHRQ to play a key role in the initiative being developed in the Office of the
National Coordinator for Health Information Technology. The Committee is aware of
several pilot projects being funded that demonstrate the reduction in patient harm from
the use of integrated medication delivery systems and urges AHRQ to continue making
such systems a component of its health IT grants.
Action Taken or to be Taken
In response to the Committee's urging, AHRQ has actively sought to provide funding for
integrated medication delivery systems which reduce patient harm and improve the
quality of healthcare. In addition to our current projects, AHRQ just published a funding
opportunity announcement for demonstrations of technologies to improve the safety and
quality of medication management and to deliver evidence based medicine at the point
of care.
AHRQ has also been an active partner and collaborator with the Office of the National
Coordinator for Health Information Technology (ONC). In addition to co-funding
nationwide projects on privacy and security of healthcare information with ONC, AHRQ
directly participates in all activities of the American Health Information Community
(AHIC) and supports the recommendations of AHIC through its projects and
demonstrations. AHRQ has additionally engaged with ONC to provide support and
guidance as that office has further developed its mission and goals.
Treatment of Mental Illness in the Geriatric Population
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House (Rept. 109-515) p. 141
The Committee is concerned about the prevalence of undiagnosed and untreated mental
illness among older Americans. Affective disorders, including depression, anxiety,
dementia, and substance abuse and dependence, are often misdiagnosed or not
recognized at all by primary and specialty care physicians in their elderly patients.
Research has shown that the treatment of mental illness can improve health outcomes
for those with other chronic diseases. While effective treatments for these conditions
are available, there is an urgent need to translate advancements from biomedical and
behavioral research to clinical practice. The Committee urges AHRQ to support
evidence-based research projects focused on the diagnosis and treatment of mental
illnesses in the geriatric population, and to disseminate evidence-based reports to
physicians and other health care professionals.
Action Taken or to be Taken
AHRQ recognizes that mental health conditions have a substantial burden on the
elderly, and we are actively engaged in developing and disseminating evidence-based
information to assist with the identification and management of such conditions.
Regarding screening, the U.S. Preventive Services Task Force, an independent panel of
experts in primary care and prevention that is supported by AHRQ, has released
recommendations on screening for dementia, screening for alcohol misuse, and
screening for depression. AHRQ's Put Prevention Into Practice Program works to
facilitate incorporation of these recommendations into clinical practice. AHRQ's
Evidence-based Practice Centers Program (EPC) has released reports on
pharmacotherapy for alcohol dependence, post-myocardial infarction depression, and
pharmacologic treatment of dementia.
In addition, through our new Effective Health Care (EHC) Program, we are currently
conducting reports on Evidence for Off-Label Use of Atypical Anti-psychotic Medications
and on Comparative Effectiveness of Pharmacotherapeutics for Depression. Both
reports are due to be released shortly. As part of the EHC Program, the John M.
Eisenberg Clinical Decisions and Communications Science Center was created to
translate knowledge about effective health care into understandable, actionable
language for all decisionmakers. An important function of the Center is to present the
often complex scientific information in a format that stakeholders and the public can
easily understand. In 2006, AHRQ awarded a cooperative agreement to establish a
Center for Education and Research on Therapeutics (CERT) that specializes on mental
health located at Rutgers University.
AHRQ has worked closely with Department of Health & Human Services (HHS) sister Agencies, in response to the 2003 Report of
the President's New Freedom Commission on Mental Health, on mental health
transformation and spearheaded the collaborative development of an Evidence-based
Practice Report slated for 2007 funding. Participating Federal agencies are Substance Abuse and Mental Health Services Administration (SAMHSA),
Health Resources and Services Administration (HRSA), Indian Health Service (IHS), and others. The focus of the EPC Report will be integrating mental health
and primary care and will include a focus on treatment of the elderly. Other plans for
2007 funding include supporting a collaboration with the Centers for Medicare & Medicaid Services (CMS), National Institute of Mental Health (NIMH), and the Department of Veterans Affairs (VA) focused
on the development of a nursing home evidence-based electronic resident assessment
protocol (e-RAP) for depression. This interactive decision support tool presents a true
opportunity to test IT solutions in nursing homes as electronic RAPs could ultimately be
mandated by CMS in 16,000 nursing homes. AHRQ also supports a breadth of research
to develop new knowledge about effective care for mental health in the elderly.*
*Recent/Ongoing Grants on Mental Health Related Projects.
A program of collaborative care for Alzheimer Disease (2001-2006); Different
Approaches to Information Dissemination (2002-2006); Expert system diagnosis of
depression and dementia (1998-1999); Pilot—Provide AHRQ guidelines to African
Americans with diabetes and depression (2000-2005); Accelerating Translating Research Into Practice (TRIP) in a Practice-Based Research Network (2002-2006); "Depression Care Using Computerized Decision
Support" (1996-2002); "Patient Centered Depression Care for African Americans" (2003-2008)
Use of Simulation-based Medical Education For Patient Care
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House (Rept. 109-515) p. 141/142
The Committee is aware that simulation-based medical education can ensure clinical
competence and reinforce best practices by allowing medical students and experienced
clinicians to practice procedures in a realistic setting. The enhanced clinical skill
development provided by simulation-based medical training benefits patients and
healthcare consumers in the form of improved health outcomes, patient safety, and
quality; reduced medical errors and deaths; and increased healthcare cost savings. The
Committee encourages AHRQ to support research, convene workshops, and perform
outreach to medical, nursing, and allied health schools to improve the utilization and
development of simulation technologies in medical education and demonstrate the value
of simulation-based medical training. AHRQ is encouraged to collaborate with the
Department of Defense (DoD), the Telemedicine and Advanced Technology Research Center
(TATRC), the Department of Veterans Affairs, and the National Institutes of Health (NIH) in the
further deployment of medical simulation research, tools, and training to improve patient
care.
Action Taken or to be Taken
AHRQ recently awarded more than $5 million for 19 new grants under its "Improving
Patient Safety through Simulation Research" request for applications. Medical
simulation involves scenarios in which real-life medical situations are re-created so that
health care providers can practice new procedures and techniques before performing
them on patients and potentially placing them at risk. Medical simulation is deemed a
valuable approach to reducing medical error and improving patient safety. The
simulation projects focus on a range of interventions that can contribute to a safer health
care environment. Several projects focus on teamwork in high-risk settings such as
emergency departments, labor and delivery units, and intensive care units. Other
projects focus on effective communication among members of the health care team,
disclosure of medical errors to patients and their families, the effects of implementing
health information technology, patient handoffs, transitions of care within hospitals, and
improving clinician diagnostic skills for patients with life-threatening diagnoses. These
19 projects will have an immediate and long-term impact by accelerating the
implementation of new simulation tools to improve patient safety and reduce or eliminate
patient harm. The projects funded by AHRQ will inform providers, health educators,
payers, policy makers, patients, and the public about the effective use of simulation in
preventing medical errors and improving patient safety. In reviewing these projects in
preparation for funding selections, AHRQ's review panel included staff from TATRC and
VA reviewers were excluded because of conflicts of interest (i.e., applications from
principal investigators with VA affiliation). As the work gets underway with the portfolios,
we anticipate collaboration/coordination with the DoD, VA, NIH, and TATRC.
Additionally, when the projects are completed, there will be widespread dissemination of
findings to government and non-government health care organizations.
Research on Outcomes of Dialysis Methods
-
House (Rept. 109-515) p. 142
The Committee is concerned about end stage renal disease (ESRD) and the difference
in prevalence of treatment modalities, especially the significant difference between
peritoneal dialysis and hemodialysis. The Committee urges AHRQ to conduct a
comprehensive meta-analysis of the best available research studies comparing short
and long term outcomes of dialysis methods, especially those affecting the quality of life
of ESRD patients, and the costs associated with the treatment of these patients.
Action Taken or to be Taken
AHRQ agrees that ESRD is an important clinical condition with significant impact on
quality of live. AHRQ will explore the feasibility of doing a meta-analysis comparing
short and long term dialysis methods and the availability of research evidence on
which to base a meta-analysis.
FY 2008 Senate Report No. 109-287
Duchenne and Becker Muscular Dystrophy (DBMD)
-
Senate (Rept. 109-287) p. 183
The Committee is pleased that AHRQ is working with the Centers for Disease Control
and Prevention (CDC) to establish evidence-driven standards of care for DBMD patients,
and encourages both agencies to complete this work by February 1, 2007.
Action Taken or to be Taken
Duchenne muscular dystrophy is part of a group of genetic, degenerative diseases
primarily affecting voluntary muscles. As DMD eventually affects all voluntary muscles,
including the heart and breathing muscles, the care of individuals with the disease often
requires the close collaboration of a clinical team with various specialties and patient
families. The national advocacy organizations have provided an invaluable service to
both the patient and the provider communities in raising the awareness of the diseases
and patient needs, and in the calls to support more research. In response to these
efforts, AHRQ provided input to CDC to help them plan a conference on this issue. This
conference involves a wide range of stakeholders and will discuss the evidence
regarding best practices for the diagnosis, treatment, and ongoing management of DMD.
We look forward to continuing to consult with CDC to help their efforts to clarify what we
know and what we still need to know to improve the care of DMD.
Mental Illness
-
Senate (Rept. 109-287) p. 183
The Committee is seriously concerned about the prevalence of undiagnosed and
untreated mental illness among older Americans. Affective disorders, including
depression, anxiety, dementia, and substance abuse and dependence, are often
misdiagnosed or not recognized at all by primary and specialty care physicians in their
elderly patients. While effective treatments for these conditions are available, there is an
urgent need to translate advancements from biomedical and behavioral research to
clinical practice. The Committee urges AHRQ to support evidence-based research
projects focused on the diagnosis and treatment of mental illnesses in the geriatric
population, and to disseminate evidence-based reports to physicians and other health
care professionals.
Action Taken or to be Taken
AHRQ recognizes that mental health conditions have a substantial burden on the
elderly, and we are actively engaged in developing and disseminating evidence-based
information to assist with the identification and management of such conditions.
Regarding screening, the U.S. Preventive Services Task Force, an independent panel of
experts in primary care and prevention that is supported by AHRQ, has released
recommendations on screening for dementia, screening for alcohol misuse, and
screening for depression. AHRQ's Put Prevention Into Practice Program works to
facilitate incorporation of these recommendations into clinical practice. AHRQ's
Evidence-based Practice Centers Program (EPC) has released reports on
pharmacotherapy for alcohol dependence, post-myocardial infarction depression, and
pharmacologic treatment of dementia.
In addition, through our new Effective Health Care (EHC) Program, we are currently
conducting reports on Evidence for Off-Label Use of Atypical Anti-psychotic Medications
and on Comparative Effectiveness of Pharmacotherapeutics for Depression. Both reports are due to be released shortly. As part of the EHC
Program, the John M. Eisenberg Clinical Decisions and Communications Science
Center was created to translate knowledge about effective health care into
understandable, actionable language for all decisionmakers. An important function of the
Center is to present the often complex scientific information in a format that stakeholders
and the public can easily understand. In 2006, AHRQ awarded a cooperative agreement
to establish a Center for Education and Research on Therapeutics (CERT) that
specializes on mental health located at Rutgers University. AHRQ also supports a
breadth of research to develop new knowledge about effective care for mental health in
the elderly.*
* Recent/Ongoing Grants on Mental Health Related Projects
A program of collaborative care for Alzheimer Disease (2001-2006); Different
Approaches to Information Dissemination (2002-2006); Expert system diagnosis of depression and dementia (1998-1999); Pilot—Provide AHRQ guidelines to African Americans with diabetes and depression (2000-2005); Accelerating TRIP in a Practice-Based Research Network (2002-2006); "Depression Care Using Computerized Decision Support" (1996-2002); "Patient Centered Depression Care for African Americans" (2003-2008)
Nurse Managed Health Centers
- Senate (Rept. 109-287) p. 183
The Committee encourages AHRQ to include nurse managed health centers and
advanced practice nurses in research and demonstration projects conducted by the
agency.
Action Taken or to be Taken
AHRQ has provided infrastructure support for two primary care research networks
composed entirely of advanced practice nurses (APNs). The Midwest Nursing Center
Consortium Research Network (MNCCRN) is comprised of 23 community nursing
centers located in 9 midwestern states that provide primary care to underserved
populations, in both rural and urban settings. The Advanced Practice Registered Nurse
Network (APRN), based at Yale University, has 56 current members who conduct and
facilitate practice-based research relevant to advanced practice nursing practice, with an
emphasis on developing culturally competent, evidence-based practice models.
MNCCRN has published papers based on AHRQ-supported research detailing how to
measure quality in nurse-managed centers using Health Plan Employer Data and Information Set (HEDIS) measures. Infrastructure
support from AHRQ has allowed APRN to expand its capacity to use electronic
communications and data collection as well as to translate research findings into its
members' practices. The network has published papers on practice patterns of
advanced practice nurses in New England and on privacy/confidentiality issues in
primary care advanced practice nursing practices.
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