Prevention/Care Management

Program	FY 2007 Enacted	FY 2008 Omnibus Level	FY 2009 Estimate
Prevention/Care Management	$7,100,000	$7,100,000	$7,100,000
Total	$7,100,000	$7,100,000	$7,100,000

FY 2009 Authorization: Title III and IX and Section 937(c) of the Public Health Service Act.

Allocation Method: Competitive Grants/Co-operative agreement, Contracts, and Other.

A. Program Description and Accomplishments

The purpose of the AHRQ's Prevention/Care Management portfolio is to increase the adoption and delivery of evidence-based clinical services—both preventive and chronic disease-related—to improve the health of all Americans. This is accomplished through work in the areas of knowledge generation, knowledge synthesis and dissemination, and implementation and use of knowledge. The portfolio fulfills AHRQ's congressionally mandated role to convene the United States Preventive Services Task Force (USPSTF) to conduct scientific evidence reviews of a broad array of clinical preventive services (screening, counseling and preventive medication) and to develop recommendations for the health care community. The portfolio provides ongoing administrative, research, technical, and dissemination support to the USPSTF, which is an independent panel of nationally renowned, non-federal experts in prevention and evidence-based medicine comprising primary care clinicians (e.g., internists, pediatricians, family physicians, gynecologists/obstetricians, nurses, and health behavior specialists) with strong science backgrounds.

The USPSTF develops and releases evidence-based recommendations for the health care provider community to improve the delivery of appropriate preventive services in the clinical setting. The multi-year process of generating a recommendation begins with a solicitation of topic nominations through a Federal Register notice and consultation with stakeholders. The USPSTF prioritizes nominated topics for review and for updating. From the pool of USPSTF prioritized topics, portfolio staff select specific clinical preventive service(s) based on Agency and Departmental strategic goals to focus the portfolio's work. In 2007, the USPSTF released new recommendations for 5 clinical preventive services, and work was either initiated or continued on approximately 30 topics. As reflected in key outcome measures for fiscal years 2008 and 2009 and to continue through 2014, portfolio staff have prioritized screening for colorectal cancer because current rates of uptake of screening for colorectal cancer are low, colorectal cancer is the third most common cancer in the United States, and there are health disparities in receipt of the service.

USPSTF recommendations provide one essential foundation for dissemination, implementation, and integration activities within the portfolio. The Prevention/Care Management portfolio advances the delivery of appropriate, evidence-supported clinical services through myriad means: publication of articles in scientific peer-reviewed journals, utilization of information technology interfaces (Web access and the "electronic Preventive Services Selector," a downloadable interactive PDA program), convening of meetings to facilitate knowledge transfer between stakeholders, generation of products targeting priority populations, forming and sustaining strategic partnerships, and developing effective tools for system integration.

Because of the portfolio's strategic focus on colorectal cancer screening, specific activities are underway to improve rates of the delivery of this service. Portfolio staff are full and active members of the National Colorectal Cancer Roundtable, and a joint project is underway with Federal and non-Federal partners to translate implementation guidance into more accessible electronic formats to improve the delivery of screening. These activities are reflected in key outcome measures provided in the next section.

B. Funding History

Funding for the Prevention/Care Management program during the last five years has been as follows:

Year	Dollars
2004	$7,100,000
2005	$7,100,000
2006	$7,100,000
2007	$7,100,000
2008	$7,100,000

C. Budget Request

AHRQ requests $7,100,000 for Prevention and Care Management Research at the FY 2009 Estimate level—a level equal with FY 2008 Enacted level. These funds are being financed using PHS Evaluation Funds. These funds will allow AHRQ to continue funding important research on prevention and care management, including the following activities:

• Provide ongoing support to the grants initiative, Optimizing Prevention and Healthcare Management for the Complex Patient.
• Support Evidence-based Practice Centers to conduct systematic evidence reviews for use by the USPSTF in making recommendations on clinical preventive services.
• Generate and synthesize knowledge of how new recommendations and evidence-based services are incorporated into clinical practice and/or health care systems.
• Promote the implementation and use of appropriate evidence-based clinical services.
• Convene the USPSTF 3 times during the fiscal year.
• Support the training of preventive medicine residents in evidence-based medicine.

In addition, as shown in our performance tables below, in FY 2009 AHRQ will release an updated USPSTF recommendation on screening for colorectal cancer. Clinical preventive services recommended by the United States Preventive Services Task Force have been demonstrated to improve health outcomes when delivered appropriately. Along with the release of the updated recommendation, AHRQ will finalize a modification of American Cancer Society (ACS) colorectal screening implementation toolkit (via an Inter-agency Agreement [IAA] with with the Centers for Disease Control and Prevention [CDC]) to an electronic format. This electronic toolkit will help ARHQ meet the following outcome: By 2014, increase by 3% the percentage of men and women age 50 or older who report having been screened for colorectal cancer using data tracked by AHRQ's National Health Care Quality Report (NHQR) and National Health Care Disparities Report (NHDR).

AHRQ faces many challenges in being able to measure the impact of the Prevention Portfolio on screening rates, including the availability of trend data. Specifically, the prevention/care management portfolio does not direct or control how preventive services usage data are gathered via the National Health Interview Survey (NHIS) or how and when the data are presented in the NHQR and NHDR. For example, the 2004 NHQR provided separate estimates for 1) the number of men and women over age 50 who reported having received fecal occult blood testing (FOBT) in the past 2 years, and 2) the number of men and women over age 50 who reported ever having a flexible sigmoidoscopy/colonoscopy.

In the 2006 NHQR, the rates of colorectal cancer screening that were reported were for one combined variable that included adults age 50 and older who reported ever having received a sigmoidoscopy, colonoscopy, or proctoscopy or who report fecal occult blood test within the past 2 years, 2000 and 2003. It is therefore not possible to determine what the rates of screening specific to FOBT or flexible sigmoidoscopy/colonoscopy were. Changes in the way screening rate data are gathered and reported make it impossible to track improvements in screening rates from year to year based on the original baseline rates. AHRQ is working to address this challenge.

D. Performance Analysis

Long-Term Objective 1: To translate evidence-based knowledge into current recommendations for the provision of clinical preventive services that are implemented as part of routine clinical practice, thereby contributing to improvements in the quality of preventive care and improved health outcomes in the general population and in priority populations.

#	Key Outcomes	FY 2004 Actual	FY 2005 Actual	FY 2006		FY 2007		FY 2008 Target	FY 2009 Target	Out-Year Target
				Target/Est.	Actual	Target/Est.	Actual
2.3.4	Increase percentage of men and women age 50 or older who report having been screened for colorectal cancer (based on NHQR/NHDR) Developmental1	NA	NA	NA	NA	NA	NA	Finalize evidence report and decision analysis screening for colorectal cancer Finalize dissemination & implementation situational analysis for screening for colorectal cancer. AHRQ Prevention staff participate as full members of National Colorectal Cancer Round Table	Release updated USPSTF recommendation on screening for colorectal cancer. Finalize modification of ACS colorectal screening implementation toolkit (via IAA with CDC) to electronic format.	2014 increase to 3%
2.3.5	Increase rates of additional Portfolio-prioritized clinical preventive service(s) Developmental2	NA	NA	NA	NA	NA	NA	Publish Federal Register notice soliciting new topic nominations for USPSTF review. USPSTF will prioritize nominated topics for review. Portfolio will prioritize clinical preventive service(s) in alignment with strategic goal areas.	Finalize work plan for an Evidence-based Practice Center (EPC) evidence report and dissemination & implementation situational analysis for additional Portfolio-prioritized clinical preventive service(s).	2014 increase rates for additional Portfolio-prioritized clinical preventive service(s)

^1. Baseline data will be established in FY 2010. Intermediate process measures will be used during the interim.
^2. Baseline data will be established in FY 2012. Intermediate process measures will be used during the interim.

Long-Term Objective 1: To translate evidence-based knowledge into current recommendations for the provision of clinical preventive services that are implemented as part of routine clinical practice, thereby contributing to improvements in the quality of preventive care and improved health outcomes in the general population and in priority populations.

#	Key Outcomes	FY 2004 Actual	FY 2005 Actual	FY 2006 Target/Est. Actual		FY 2007 Target/Est. Actual		FY 2008 Target/Est.	FY 2009 Target/Est.	Out-Year Target/Est.
				Target/Est.	Actual	Target/Est.	Actual
2.3.6	Improve integration of Prevention and Care Management activities	NA	NA	NA	NA	NA	NA	Launch new Prevention/Care Mgmt Portfolio and create key outcome measures for Care Mgmt	TBD	TBD
	Appropriated Amount ($ Million)	$7.1M	$7.1M	$7.1M	7.1M	$7.1M	$7.1M	$7.1M	$7.1M

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