Letter from the Director

I am pleased to present the Agency for Healthcare Research and Quality's (AHRQ's) Fiscal Year (FY) 2009 Performance Budget. We all benefit from safe, effective, and efficient health care. Our performance-based budget demonstrates our continued commitment to assuring sound investments in programs within these three areas that will make a measurable difference in health care for all Americans. The Agency's mission is to improve the quality, safety, efficiency, and effectiveness of health care for all Americans. In support of this mission, AHRQ is committed to improving patient safety by developing successful partnerships and generating the knowledge and tools required for long term improvement.

AHRQ continues to improve patient care through the Effective Health Care Program. As authorized by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA), this program has begun a series of state-of-the-science reviews of existing scientific information on effectiveness and comparative effectiveness of health care interventions, including prescription drugs. In October 2007, AHRQ released Comparative Effectiveness of Percutaneous Coronary Interventions and Coronary Artery Bypass Grafting for Coronary Artery Disease. The report found that patients with mid-range coronary artery disease are more likely to get relief from painful angina and less likely to have repeat procedures if they get bypass surgery rather than balloon angioplasty with or without a stent. The report also found that for mid-range coronary artery disease, bypass surgery and angioplasty patients had about the same survival rates and similar numbers of heart attacks, but that bypass surgery presents a slightly higher risk of stroke within 30 days of the procedure. Coronary artery disease, a common type of heart disease, affects about 15 million Americans and is the leading cause of death for men and women.

AHRQ released its fourth annual reports on quality and disparities in 2007. These reports serve as tools for monitoring health care delivery by summarizing information, making clear where improvement is most needed, and facilitating the use of common measures. We are seeing results of efforts to improve quality of care. The 2007 Quality Report demonstrates that we are making steady progress in improving quality of care. For selected aspects of patient safety in hospitals, improvements over 10 percent were found, with much larger improvements associated with public reporting efforts by the nation's hospitals and nursing homes. At the same time, there are still areas in need of major improvements. In contrast, the 2007 Disparities Report founds that despite some examples of improvement, pervasive disparities related to race, ethnicity, and socioeconomic status persist.

AHRQ is excited about a new initiative in FY 2009—the Health Insurance Decision Tool. This initiative will facilitate the development of State-specific affordable health plans for low income individuals and to provide State decisionmakers with the tools and information they need to design effective programs and policies for reducing the numbers of uninsured Americans. This initiative will advance the President's goal to provide access to basic health insurance at an affordable price. In addition, this initiative will provide Federal decisionmakers with the information they need for evaluating States' proposals, and could assist in understanding the impacts of other Federal initiatives, for example, consumer driven health plans, on the overall U.S. healthcare system.

With our continued investment in successful programs that develop useful knowledge and tools, I am confident that we will have more accomplishments to celebrate. The end result of our research will be measurable improvements in health care in America, gauged in terms of improved quality of life and patient outcomes, lives saved, and value gained for what we spend.

—Carolyn M. Clancy, M.D.
Director, Agency for Healthcare Research and Quality

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