Significant Items

Performance Budget Submission for Congressional Justification

This statement summarizes budget information submitted to Congress by the Agency for Healthcare Research and Quality (AHRQ).

Significant Items

FY 2008 House Report No. 109-515

Detection of Medical Errors
  1. 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
  1. 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
  1. 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

  1. 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
  1. 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)
  1. 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
  1. 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
  1. 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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Current as of February 2007
Internet Citation: Significant Items: Performance Budget Submission for Congressional Justification. February 2007. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/about/mission/budget/2008/exhib08b.html