Letter from the Director

I am pleased to present the Agency for Healthcare Research and Quality's (AHRQ) FY 2010 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 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 which conducts comparative effectiveness research. 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 the comparative effectiveness of health care interventions, including prescription drugs. In addition to our FY 2010 President's Budget, the American Recovery and Reinvestment Act appropriated $1.1 billion for comparative effectiveness research. This investment is part of the President's health reform agenda. Of the $1.1 billion, AHRQ will transfer $400 million to the National Institutes of Health and $400 million is available for allocation at the discretion of the Secretary. AHRQ will invest $300 million to expand the comparative effectiveness research activities of its Effective Health Care Program.

In March 2009 a study funded through AHRQ's DEcIDE (Developing Evidence to Inform Decisions about Effectiveness) research network, which is part of the agency's Effective Health Care Program, found that heart disease patients 65 and older who receive stents coated with medicine to prevent blockages are more likely to survive and less likely to suffer a heart attack than people fitted with stents not coated with medication. The findings provide important new evidence for decisionmaking by heart disease patients and their physicians. These results should help resolve lingering questions regarding the safety of drug-eluting stents in recent years.

AHRQ's work to improve patient care continues through our investments in research to eliminate hospital-acquired infections. Each year, an estimated 250,000 cases of central line-associated bloodstream infections occur in hospitals in the United States, leading to at least 30,000 deaths, according to the Centers for Disease Control and Prevention. The average additional hospital cost for each infection is over $36,000, which totals over $9 billion in excess costs annually. In October 2008, AHRQ provided $3 million to 10 States to implement a comprehensive unit-based patient safety program to help prevent infections related to the use of central line catheters. Central venous catheters or central line catheters are tubes placed into a large vein in a patient's neck, chest or groin to administer medication or fluids or to collect blood samples. The comprehensive safety program is designed to help ICU staff ensure patient safety.

The program, which has been used successfully in more than 100 ICUs in Michigan, includes tools to help health care professionals identify opportunities to reduce potential health care-associated infections and implement policies to make care safer. Within 3 months of implementation in Michigan, the program helped reduce infection rates to zero in more than 50 percent of participating hospitals. The States are California, Colorado, Florida, Massachusetts, Nebraska, North Carolina, Ohio, Pennsylvania, Texas, and Washington. In addition, the California Hospital Patient Safety Organization, the North Carolina Center for Hospital Quality and Patient Safety, and the Ohio Patient Safety Institute will participate in the project. Thus, results from this project can potentially improve care, save lives, and lead to substantial cost savings for participating hospitals and the health care 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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