GPRA Goal 4: Evaluate the effectiveness and impact of AHRQ research and associated activities. (HCQO)

Note: All Agency evaluation activities, including MEPS-related studies, are included under Goal 4. This is because the MEPS budget line covers only costs associated with data design, data collection and analysis, and data products.

Strategy: Cycle of Research Phase 4: Evaluation

As explained in other portions of this document, interim outcomes of research can be evaluated on a relatively short-term basis. However, the ultimate outcome of how the research affects people receiving health care or people interacting with the system requires large, expensive retrospective studies. AHRQ is implementing a growing portfolio of evaluations that will show, iteratively, the outcomes of the investments of Agency funds.

Types of Indicators: Interim outcomes of research

Use of Results by AHRQ

AHRQ conducts evaluations of its major programs or products to achieve one or more of the following:

• Evaluate the current state of the program or product including impact in health care.
• Improve customer satisfaction with the program or product.
• Target or prioritize future activities to increase their usability or usefulness.

Data Issues

Many of the evaluations are conducted with the assistance of consultants who are highly skilled in evaluation research and/or the subject matter. Some are done through surveys for customer satisfaction that were cleared through OMB. The third category is evaluations conducted through consultations with experts and users to obtain direct feedback on a particular product. In order to ensure the integrity of the evaluations, the AHRQ staff assigned to the projects were not program staff responsible for the day-to-day administration of the program. Additionally, advice on the evaluation questions as well as on the interpretation and use of the results is often sought from experts on the AHRQ National Advisory Council.

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GPRA Goal 4 - Fiscal Year 2000 Results

Objectives 4.1 and 4.2: Evaluate the impact of AHRQ sponsored products in advancing methods to measure and improve health care. (Objectives 4.1 and 4.2 were inadvertently the same. They have been consolidated to simplify the reporting.)

The following evaluations of core Agency program/projects were completed in Fiscal Year 2000.

Indicator 1

AHRQ's HCUP Quality Indicators (QI's) will be redesigned based on consultations with state policy makers, researchers, hospital associations, and others about their past use of the QI's. By the end of March 2001, a new set of quality indicators will be defined and feedback obtained from a new set of HCUP QI users. In addition, AHRQ will provide access to recent national-level QI information via both the Internet and through published reports, with special focus on disseminating information to hospital users and organizations with responsibility for hospital quality reporting.

Results

A new set of HCUP Quality Indicators (QIs) has been defined, and some feedback has been obtained. The new set of QIs include several measures that were contained in the original version. Additional QIs will encompass new areas such as chronic medical conditions, pediatric conditions, and volume of procedures. The first round of feedback helped the Stanford team to focus on particularly effective measures and to fine tune their descriptions of the results of the literature review and the empirical evaluation. The QI portion of the project was complete in March, 2001. Patient Safety indicators are expected to be complete by May, 2001.

National-level QI information was made available via the Internet during September 2000. Due to technical difficulties, the information has been removed. When it is re-posted to the Internet, it will contain the most current information available for 1996 and 1997. The QI Web site was developed by NAHDO, under sponsorship from AHRQ. NAHDO provides for the development and enhancement of statewide and national health information systems, bringing together a network of state, federal, and private sector technical and policy leaders and consultants to expand health systems development and shape responsible health information policies. The website developed by NAHDO provides statistics on the QIs by patient and hospital characteristics, while protecting the privacy of patients and hospitals. The information can be employed by users of the QIs as benchmarks in order to compare performance of their own organizations.

Indicator 2

Use of evidence reports (ERs) and technology assessments (TAs) to create quality improvement tools in at least 10 organizations.

Results

The Agency has been very successful in its partnerships with a wide variety of health care organizations. While the majority of evidence reports are being used by professional associations to create clinical practice guidelines, they are also being used by patient groups and health systems. Examples of the uses of the Agency's evidence reports (ERs) and technology assessments (TAs) are listed below:

1. Depression Treatment with New Drugs. The American Psychiatric Association used the ER in developing their Practice Guidelines for the Treatment of Psychiatric Disorders. The guideline was published as a Supplement to the American Journal of Psychiatry, Volume 157, No. 4, April 2000, and is also a book published by the APA in 2000.
2. Management of Unstable Angina. Guidelines based on this evidence report were developed by the American College of Cardiology and the American Heart Association and published in the Journal of the American College of Cardiology (September 2000).
3. Diagnosis of Attention-Deficit/Hyperactivity Disorder. The American Academy of Pediatrics (AAP) developed practice guidelines based on this ER. They were published in the AAP Journal in May 2000 (Committee on Quality Improvement, Subcommittee on Attention-Deficit/Hyperactivity Disorder, AAP. Diagnosis and Evaluation of the Child With Attention-Deficit/Hyperactivity Disorder (AC002). AAP Journal. Volume 105, No. 5. May 2000. pp. 1158-1170).
4. Treatment of Attention-Deficit/Hyperactivity Disorder. The American Academy of Pediatrics (AAP) is currently finalizing a guideline on treatment of ADHD, based on the ER, expected to be completed in November or December 2000. In addition the U.K. National Institute for Clinical Excellence (NICE) may consider this ER as they appraise the use of methylphenidate (Ritalin) for hyperactive children.
5. Testosterone Suppression Treatment for Prostate Cancer. The Department of Veterans Affairs Employee Education System is using the meta-analysis on monotherapies for androgen suppression in men with advanced prostate cancer as part of their continuing medical education program and are disseminating results of the meta-analysis to VA medical personnel.
6. Evaluation of Cervical Cytology. The U.K. National Institute for Clinical Excellence (NICE) issued a Technology Assessment (TA) on Liquid-Based Cytology in Cervical Screening in January 2000. In their analysis, the report's authors included AHRQ's ER, along with other published systematic reviews. The report includes a comparison table, and it favorably cites AHRQ's ER (Payne N, Chilcott J, and McGoogan E. Liquid-Based Cytology in Cervical Screening: A Report by the School of Health and Related Research (ScHARR), the University of Sheffield, for the NCCHTA on behalf of NICE. Trent Institute for Health Services Research. January 2000, Revised May 2000). The full text of the report can be obtained from the NICE website at www.nice.org. The American College of Obstetricians and Gynecologists (ACOG) is also developing a clinical practice guideline based on this ER.
7. Prevention of Venous Thromboembolism After Surgery. Our partner, the Eastern Association for Surgery of Trauma, is developing a guideline based on this evidence report that will be submitted for publication to the Journal of Trauma by the end of September. In addition, a multi-centered trial, sponsored by a pharmaceutical company manufacturing low-molecular heparin, will be getting underway shortly to answer the research gap identified by the evidence report regarding the best method of prophylaxis for venous thromboembolism.
8. Clinical Preventive Services. Based on the work of the USPSTF, the RTI-UNC EPC is developing promotional awareness messages for Medicare beneficiaries and providers on selected topics including: prostate specific antigen testing; screening mammography; and Papanicolaou testing. The first set of messages is due to be completed by the end of this calendar year.
9. Anesthesia Management During Cataract Surgery. Our partner, the American Academy of Opthalmology considered this ER in updating their Preferred Practice Parameter for Cataract in the Adult Eye. The updated guideline will be issued in September 2001 and will be posted on the AAO's website and disseminated to new opthalmic residents.
10. Treatment of Co-Existing Cataract and Glaucoma. Our partner, the American Academy of Opthalmology will consider this ER when it becomes available later this year to update their Preferred Practice Parameter for Cataract in the Adult Eye. The updated guideline will be issued in September 2001 and will be posted on the AAO's website and disseminated to new opthalmic residents.
11. Use of Epoetin in Oncology. Our partners, the American Society of Hematology/American Society of Clinical Oncology (ASH/ASCO) are currently developing a guideline based on this ER which is to be completed by the end of this year or early next year.
12. Pharmacotherapy for Alcohol Dependence. The American Society of Adolescent Medicine (ASAM) is developing guidelines based on this ER.
13. Evaluation and treatment of new onset atrial fibrillation in the elderly. The ACP-ASIM, with representation from AAFP, is developing guideline based on this evidence report. The American College of Cardiology (ACC), in conjunction with European Society of Cardiology is also planning to develop a guideline based on this report.
14. Management of Neurogenic/Neuropathic Pain Following Spinal Cord Injury. Our partner for the ER, the Paralyzed Veterans of America: Consortium for Spinal Chord Medicine is organizing to develop a guideline based on this ER. They will initiate work once the final evidence report is approved for publication and expect the process to take 10 to 12 months.
15. Otitis Media with Effusion. The American Academy of Family Physicians (AAFP) and the American Academy of Pediatrics (AAP) are developing guidelines based on the ER.
16. Acute Otitis Media. The American Academy of Family Physicians (AAFP) and the American Academy of Pediatrics (AAP) are developing guidelines based on the ER.

Indicator 3

For at least four evidence reports (ERs) or technology assessments TAs) per year, work with partners to measure how the reports or assessments were used and what impact they had on clinical decision making and patient care.

Results

Following are highlights of some of the Agency's efforts in Fiscal Year 2000 to work with partners to assess the use and impact of ERs and TAs on clinical decision making and patient care:

• AHRQ hosted a users meeting in October 2000 with partners that have participated in evidence reports to date. A key theme of the meeting was the critical role of the partners in using the evidence reports to develop guidelines and other quality improvement tools. Not only is it important to develop guidelines, it is equally important to promote their implementation and to assess their impact on clinical decisionmaking and patient care. This emphasis will be incorporated into the next round of EPC topic selection. Options for encouraging greater partner involvement in translation, implementation, and assessment are being explored. While some partners have initiated efforts to promote and evaluate the use of their guidelines and quality improvement tools, it is often difficult for professional associations to find the financial resources for these kinds of activities.
• AHRQ awarded a grant to collect baseline data for evaluating the impact of guidelines developed by the American Society of Clinical Oncology/American Society of Hematology (ASCO/ASH) based on the Uses of Epoetin in Oncology Evidence Report. The investigators have surveyed practicing clinician members of ASCO and ASH to assess patterns of EPO use prior to the dissemination of the ASCO/ASH guideline. They intend to submit a subsequent grant application to assess the impact of the introduction of the guidelines.
• AHRQ funded a project on the use of the evidence report on Management of Uterine Fibroids. As a first step in assessing the impact of the evidence report, this project will determine the degree to which clinicians informed about best evidence make global judgments consistent with the evidence-based decision model developed in the evidence report. Validation of the decision model will facilitate the adoption of evidence-based practices for the management of uterine fibroids.
• As part of an initial evaluation of the AHRQ Evidence-Based Practice Center (EPC) Reports, a survey was conducted of potential users of the EPC evidence reports. The survey population included quality improvement organizations, health care providers, third-party payers/managed care plans, health-related schools, health-related professional associations, government organizations, and government research agencies. The contractor conducted interviews with representatives of organizations that have collaborated in the development of EPC evidence reports, including topic nominators/partners, technical experts, and peer reviewers. The survey was conducted three months after the release of the first evidence reports to provide an early look at the potential market for these products. Selected key findings include:
  1. Of those surveyed, 34 percent indicated that they had or would use the EPC report that was mailed to them as part of the survey. In addition, 53 percent of the respondents said they had used or planned to use another EPC report. Details of this use are now being collected.
  2. The most common reason given for not using a report was that it was not relevant to their activities.
  3. The most common reason for using the EPC reports were for education of health professionals and the development of guidelines. Other reasons given for using the reports included making coverage decisions, creating patient education materials, assessing health care quality, and improving one's own clinical practice.

Indicator 4

At least 3 examples of how research informed changes in policies or practices in other Federal agencies. (Baseline under development.)

Results

Examples based upon AHRQ-sponsored programs include:

HCUP Data. Agency staff are working with NIH to provide HCUP data for a decision that will be made this fall about disseminating rotavirus vaccine to developing countries. From October 1998 to July 1999 rotavirus vaccine was used in the United States to prevent infant diarrhea. The vaccine was withdrawn from the market after it was linked with intussusception, a potentially life-threatening complication. Unfortunately, preliminary reports about the link with intussusception were dramatized and misunderstood to a degree that some believe there actually was a large vaccine-attributable increase in intussusception rates during the vaccination period. These circumstances have created a difficult climate for re-considering the rotavirus vaccine for use outside the U.S. This is unfortunate as this vaccine has the potential of reducing childhood mortality due to diarrheal diseases dramatically if used widely in developing countries. It is estimated that half a million lives could be saved with use of the rotavirus vaccine. The Agency is providing HCUP data for 1997-1999 to help estimate the impact of the vaccine on intussusception rates in 5 states in which rotavirus vaccine was widely used.

In addition, AHRQ supports two studies conducted by Richard Zimmerman Univ.v Pittsburgh) to understand the causes of low childhood immunization rates. A focus of the work has been an evaluation of why children are referred from private practices to public clinics for vaccinations (with attendant risks of lower immunization rates due to fragmented care and longer windows of inadequate vaccination). While the insurance status of the child turned out to be the major determinant, the effect of being uninsured was greatly reduced if the physician's office received free vaccine supplies through the Vaccines for Children Program (VFC). The VFC is administered by the CDC, and Zimmerman's study has bolstered support for this program.

MEPS Data. The Agency's design for the MEPS Nursing Home Component Questionnaire informed the design of the MCBS sponsored by HCFA.

AHRQ's research related to the design and implementation of the MEPS Insurance Component resulted in the best estimates of employer contributions to health insurance coverage costs that were adopted by the Bureau of Economic Analysis to inform the national estimates of the Gross Domestic Product (GDP).

Evidence Based Practice Centers (EPCs). In August, 2000, AHRQ signed an inter-agency agreement with the NIH Office of Medical Applications of Research (OMAR) to increase the scientific rigor of the Consensus Development Conference process, and to more effectively communicate evaluative summaries of the quality of research evidence to the medical research community, by routinely relying on scholarly input from the Evidence-Based Practice Centers (EPCs) on topics to be addressed at NIH Consensus Development Conferences and State-of-the-Science Conferences. The first EPC evidence report will be developed on Clinically Inaparent Adrenal Mass, for an NIH State-of-the-Science Conference to be held in early 2002. Other reports will be prepared on the role of Endoscopic Retrograde Cholangiopancreatography (ERCP) in Clinical Practice for a State-of-the-Science Conference to be held in December, 2001, Antisocial and Related Problem Behaviors for a Consensus Development Conference in April, 2002, and Management of Cancer-Associated Pain, Depression, Nausea, and Other Related Symptoms for a Consensus Development Conference in April, 2002.

Quality Interagency Coordination (QuIC) Task Force. AHRQ has taken a lead role in the QuIC Task Force efforts to address medical errors and patient safety in the U.S. Medical error and patient safety aren't well understood by most Americans. When the need for vital or risky health services occurs, patients want to believe that someone else has made sure the care they receive is safe. Sadly, every hour, 10 Americans die in a hospital due to avoidable errors; another 50 are disabled. As part of its efforts to improve patient safety and reduce medical errors, the QuIC Task Force has published Five Steps to Safer Health Care. The five steps were distilled from an earlier AHRQ publication, "20 Tips to Reduce Medical Errors." Those evidence based recommendations provide patients with guidance on how to improve their safety and have been widely adopted across the government through the QuIC. The OPM has included them in this year's health benefits brochure and you can see them on the Web site at http://www.opm.gov/insure/health/five_steps.htm

Indicator 5

AHRQ will report on the extent to which CONQUEST assists those who are charged with carrying out quality measurement and improvement activities and the extent to which it helps further state-of-the-art in clinical performance measurement. (Baseline will be established by the evaluation study.)

Results

AHRQ has funded an evaluation of CONQUEST. The evaluation, completed in Fiscal Year 1999, indicated CONQUEST needs to be available on the Internet to be maximally useful. In Fiscal Year 2000, AHRQ initiated a feasibility study to determine how to effect this transition, and in Fiscal Year 2001 the Agency will release a RFC to accomplish this.

Indicator 6

CAHPS® has assisted the Health Care Financing Administration (HCFA) in informing Medicare beneficiaries about their health care choices. The use and impact of this information is determined by surveying a sample of these beneficiaries.

Results

In a controlled study HCFA evaluated the impact of the information CAHPS provides in bulletins and the handbook, Medicare & You, about the performance of health plans on beneficiaries' confidence in their choice of plan and their use of such information. Findings showed, that beneficiaries who received this information were more confident in their choices, indicating that choosing a plan was made easier for them, and that they used the information to confirm their choice of plan. A journal article will be published in the Journal of Health Services Research in July 2001.

Indicator 7

At least one quality measure from Q-span (or instances where AHRQ research contributes to the development of measures) are used in the Health Plan Employer Data Information Set (HEDIS) by the National Committee for Quality Assurance (NCQA), measurement activities of the Joint Commission for the Accreditation of Healthcare Organizations (JCAHO) or other organizations monitoring health care quality. (Baseline in Fiscal Year 1998 - One quality measure adopted and one instance of AHRQ-sponsored research contribute to adoption of measures.)

Results

The Achievable Benchmarks of Case (ABC) system of performance profiling, is now adopted by many of HCFA's PROS (from the Kiefe Qspan project) as part of their response to the 6th SOW. The ABC system will be used for quality improvement efforts over the next two to three years with results becoming available at that time.

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Objective 4.3: Evaluate the impact of MEPS data and associated products on policymaking and research products.

Indicator 1

Use of MEPS data in 1% of research applications received by AHRQ.

Results

AHRQ periodically issues program announcements to solicit applications for extramural grants. A program announcement was released on June 22,2000 to solicit applications pertaining to priority interests of AHRQ (health outcomes, quality measurement, access/use/cost). The solicitation encourages the use of MEPS data. Of 684 research applications received by AHRQ in Fiscal Year 2000, 32 (4.7%) included the use of MEPS data. 10 (31%) of the 32 applications containing MEPS data were actually funded.

Indicator 2

Distribution of MEPS data sets to at least 2500 requestors. Baseline in Fiscal Year 1998 - 916 data sets downloaded from Web site. 1000 CD's distributed at conferences and other venues.

Results

Over 5,700 MEPS data files were downloaded from the MEPS Web site in Fiscal Year 2000 (a 500% increase over the baseline of 916 downloads established in Fiscal Year 1998). An additional 379 CD ROM's containing MEPS data were distributed via the AHRQ clearinghouse.

Indicator 3

At least 5 examples of how research using MEPS has been used to inform decisions by Federal, state, and private sector policymakers.

Results

In Fiscal Year 2000, the expertise of AHRQ staff was utilized in providing technical assistance to numerous public and private groups as they used MEPS data to initiate and implement healthcare-related projects. The following are examples of how the MEPS data were used to inform the activities of a diversity of groups:

• MEPS data were used to establish a baseline measure for healthy people 2010 objective on oral health and preventive dental visits.
• MEPS data were used as supporting evidence for a GAO analysis on oral health.
• MEPS data were used to inform the HHS Report to the president on Prescription Drug Use, Coverage, Spending, Utilization, and Prices. The MEPS data were particularly useful for comparing estimates of prices paid for drugs by elderly and non elderly persons with and without health insurance for prescribed medications.
• MEPS data were used to validate and benchmark the Hay Group Actuarial Model used to produce estimates of the costs of mental health parity for a recently released NIMH report to Congress and in testimony by Steven Hyman, MD, Director NIMH at a Senate hearing in May 2000.
• Data from the MEPS-IC were used by the Bureau of Economic Analysis to derive revised Gross Domestic Product Estimates for 1997 through the first quarter of 2000.
• MEPS data were used as part of a comprehensive study on chronic illness by investigators at the Johns Hopkins School of Public Health, the national program office for the Robert Wood Johnson Foundation's National Public Engagement Campaign on Chronic Illness, to create a profile of the population living with chronic illness.
• MEPS data were used in several tables in a study conducted for the Health Insurance Association of America (HIAA) on employment-based health insurance coverage produced by researchers at the Center for Risk Management and Insurance Research at Georgia State University.
• MEPS data were used by AARP to estimate national health expenditure rates for the elderly.
• MEPS data were used to provide information on days lost from work due to children's illnesses in estimating the indirect costs associated with pediatric acute conditions.
• MEPS data were used in a Penn State University project to assess policy options for Medicare buy-in or other incremental reforms for the population near 65.
• MEPS data were used by the Western Psychiatric Institute and Clinic to examine service utilization and costs associated with depression.
• MEPS data used to inform special tables on Insurance Component data for the state agency, Massachusetts Division of Health Care Finance & Policy.
• MEPS data were used to provide Blue Cross Blue Shield of Alabama with regional level estimates of out-of-pocket expenses for health care for the elderly.
• MEPS data were used by NBC Nightly News with Tom Brokaw to estimate how much is spent on out-of-pocket expenditures by individuals not covered by the government or their own insurance policy.
• MEPS data were related to facilitating analyses of health systems for American Indian/Alaska Native (AA/AN) populations in a presentation at a conference co-sponsored by HCFA and IHS held in Denver, Colorado on September 6-8,2000.

Indicator 4

Feedback from recipients of MEPS data indicating that the data were timely, useful, and of high significance. (Baseline under development).

Results

The Consumers Union contracted with Lewin and Associates to analyze the distribution of health care expenditures across the United States. This analysis was based on the 1996 MEPS. The Director for Policy at Consumers Union sent a letter to the director of AHRQ with a note indicating how useful and timely the MEPS data have been to Consumers Union.

GPRA Goal 4—Fiscal Year 2001 and 2002 Indicators

Objective	Fiscal Year 2001 Indicator	Fiscal Year 2002 Indicator
Objective 4.1: Evaluate the impact of AHRQ sponsored products in advancing methods to measure and improve health care.	Evidence-based Practice Centers Use of evidence reports and technology assessments to create quality improvement tools in at least 10 organizations. Budget: Commitment Base For at least four evidence reports or technology assessments per year, work with partners to measure how the reports or assessments were used and what impact they had on clinical decisionmaking and patient care. Budget: Commitment Base Findings from at least 3 evidence reports or technology assessments will effect State or Federal health policy decisions. Budget: Commitment Base Use of evidence reports or technology assessments and access to NGC site informed organizational decision making in at least 4 cases and resulted in changes in health care procedures or health outcomes. Budget: Commitment Base Research At least 3 examples of how research informed changes in policies or practices in other Federal agencies. Budget: Commitment Base Quality Measures Achievable Benchmarks of Care are used for quality improvement activities by Peer Review Organizations. Budget: Commitment Base Use of dental measures by dental service and insurance organizations. Budget: Commitment Base HCUP quality indicators incorporated into efforts by hospital associations and hospitals to improve the quality of care. National Guideline Clearinghouse™ At least 10 users of the National Guideline Clearinghouse™ will use site to inform clinical care decisions. Budget: Commitment Base Guideline development or quality improvement efforts by users will be facilitated through use of NGC in at least 5 cases. Budget: Commitment Base NGC information will be used to inform health policy decisions in at least 2 cases. Budget: Commitment Base Improvements in clinical care will result from utilization of NGC information in at least 3 cases. Budget: Commitment Base Training Programs 2/3 of former pre- and postdoctoral institutional award trainees are active in conduct or administration of health services research. Evaluation results to date show: 76% (of respondents) embark on a research or research administration career upon completion of training. 57% are actively involved in a research grant or contract. 75% have had at least one publication. Budget: Commitment Base	Evaluate the impact of the CERTS program in disseminating information regarding therapeutics to at least 3 health care providers or others in order to improve practice. Budget: Commitment Base Evaluation to determine whether AHRQ funded studies in methodological development have been effective in developing at least 3 new research techniques, whether the techniques are being implemented, and how these studies could be improved. Budget: Commitment Base Evaluation of the outcomes of the pharmaceutical studies the Agency has funded to assess impact. Budget: Commitment Base Interim assessment of the impact of the management system for tracking project profiles. Budget: Commitment Base Qualitative review by experts of results of one major research initiative to assess quality and productivity and potential impact. Budget: Commitment Base Identify at least 5 private sector uses of AHRQ findings, and describe any assessment of the impact on clinical practice and/or patient care. Budget: Commitment Base Evidence-based Practice Centers Use of evidence reports and technology assessments to create quality improvement tools in at least 10 organizations. For at least four evidence reports or technology assessments per year, work with partners to measure how the reports or assessments were used and what impact they had on clinical decision making and patient care. Findings from at least 3 evidence reports or technology assessments will effect State or Federal health policy decisions. Use of evidence reports or technology assessments and access to NGC site informed organizational decision making in at least 4 cases and resulted in changes in health care processes, quality, or health outcomes.
Objective 4.2: Evaluate the impact of MEPS data and associated products on policymaking and research products.	Use of MEPS data in AHRQ research applications will increase by 10 percent over number received in baseline period of 2000 Budget: Commitment Base Feedback from MEPS workshop participants indicating that they were useful and timely. Budget: Commitment Base At least 5 examples of how research using MEPS has been used to inform decisions by Federal, state and private sector policymakers. Budget: Commitment Base	Have a fully functional MEPS-based MEDSIM model to allow simulation of the potential impact of programmatic changes in health care financing and delivery Dec 2002. Budget: Commitment Base Produce baseline Fiscal Year statistics on number of MEPS-based articles published in peer review journals. Budget: Commitment Base Conduct customer satisfaction survey for MEPS workshop participants to assess how MEPS data is being used to inform research and public policy. Budget: Commitment Base Develop marketing plan to promote the MEPS-IC data to state officials Dec 2002. Budget: Commitment Base At least 5 examples of how research using MEPS has been used to inform decisions by Federal, state and private sector policymakers.

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