HCQO (Research on Health Care Costs, Quality and Outcomes)

Performance Budget Submission for Congressional Justification, Fiscal

This appendix provides more detailed performance information for all HHS measures related to the Agency for Healthcare Research and Quality's budget.

Performance Detail

HCQO (Research on Health Care Costs, Quality and Outcomes)

Comparative Effectiveness

Long-Term Objective 1: Improve patient's quality of care and health outcomes through informed decisionmaking by patients.

#Key OutcomesFY 2004 ActualFY 2005 ActualFY 2006 Target Est.FY 2006 ActualFY 2007 Target Est.FY 2007 ActualFY 2008 TargetFY 2009 TargetOut-Year Target
1.3.24Quality and Effectiveness of Care Measures (subset of those endorsed by the National Quality Forum and analyzed in the National Health Care Quality Report)1NAList of priority conditions for research under Medicare Modernization Act releasedNAAHRQ launched new Effective Health Care Program, authorized under Section 1013 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003N/AAHRQ created new Comparative Effectiveness Portfolio

1

Identify measures and limit to a subset based on priority conditions; work with AHRQ's planning, evaluation, and analysis contractors to limit to ~3 metrics to be tracked

1st and 2nd Qtr—Obtain baseline measures

3rd and 4th Qtr—Set targets for FY 2010-2019

2020

90% compliance on the three measures tracked


#Key OutputsFY 2004 ActualFY 2005 ActualFY 2006
�Target/Est.
FY 2006
Actual
FY 2007 Target/Est.FY 2007 ActualFY 2008 Target/Est.FY 2009 Target/Est.Out-Year Target/Est.
4.4.5Increase # of systematic reviews (SR) and summary guides availableNANANA

4 Strategic Reviews

1�Summary Guide

NA

4 Strategic Reviews

8 Summary Guides

7 Strategic Reviews

8 Summary Guides

7 Strategic Reviews

8 Summary Guides

2020

12 Strategic Reviews

15 Summary Guides

1.3.25

Increase # of organizations disseminating systematic reviews and summary guides to their constituents

(Developmental)2

NANANANANANAWork with AHRQ Effective Health Care's Eisenberg Center, Scientific Resource Center, and Stakeholder Group to identify methods for systematically identifying organizations that are disseminating systematic reviews and summary guides

1st and 2nd Quarter—Obtain baseline measures

3rd and 4th Quarter—Set targets for FY 2010-2019

2020

In development

1.3.26Increase amount of evidence from the Comparative Effectiveness (CE) Portfolio policymakers use as a foundation for population-based policies

(Developmental)3
NANANANANANAWork with the Medicaid Medical Directors (AHRQ Learning Network) and Health Plans to identify methods for systematically reviewing policy decisions for references to evidence from the Portfolio

1st and 2nd Quarter—Obtain baseline measures

3rd and 4th Quarter—Set targets for FY 2010-2019

2020

In development

 Comparative Effectiveness Portfolio Appropriated Amount
($ Million)
$0$15.0M$15.0M$15.0M$15.0M$15.0M$30.0M$30.0M 

1. Baseline data will be established in FY 2009. Intermediate process measures will be used during the interim.
2. Baseline data will be established in FY 2010. Intermediate process measures will be used during the interim.
3. Baseline data will be established in FY 2010. Intermediate process measures will be used during the interim.

The Effective Health Care Program, launched in September 2005, supports the development of new scientific information through research on the outcomes of health care services and therapies, including drugs. By reviewing and synthesizing published and unpublished scientific studies, as well as identifying important issues where existing evidence is insufficient, the program helps provide providers, clinicians, policy makers and consumers with better information for making informed health care treatment decisions.�In this program, AHRQ seeks an emphasis on timely and usable findings, building on the thoroughness and unbiased reliability that have been hallmarks of efforts so far. Equally important is broad ongoing consultation with stakeholders which helps ensure that the program responds to issues most pressing for health care decisionmakers.�Collaboration is also a key principle of the program and AHRQ works closely with many agencies of HHS to identify topics for research under the program and to communicate findings, including identified research gaps.

One important measure the Effective Health Care Program uses to evaluate its success is the amount of evidence made available to the public.�In FY 2006, the program released four systematic reviews and one summary guide.�In FY 2007, the program released four systematic reviews and eight summary guides. Four new research reports including a user's guide to registries evaluating patient outcomes and a Medical Care journal supplement on emerging methods in comparative effectiveness and safety were also released.� In FY 2008, the program expects to release seven systematic reviews and eight summary guides. In addition, several research topics for systematic reviews and new research reports are in development and approximately twenty will be awarded in FY 2008.

All reports produced by the program are available on the Effective Health Care Web site, http://effectivehealthcare.ahrq.gov. The Web site also includes features for the public to participate in the Effective Health Care Program.�Users can sign up to receive notification when new reports are available. They can also be notified when draft reports and other features are posted for comment, and comments can be submitted through the Web site. The public is also invited to use the Web site to nominate topics for research by the Effective Health Care Program.�

There is growing interest in, and attention to, enhancing the role of the Effective Health Care Program's research in our health care system. For example, Consumer Reports Best Buy Drugs, a public education product of Consumers Union, uses findings from the program to help clinicians and patients determine which drugs and other medical treatments work best for certain health conditions.�The magnitude of the Effective Health Care program's impact is evidenced by the fact that the Consumers Union drug class reviews are downloaded at a rate of 110,000 per month. Over the course of the 2-year project, over 1 million reports have been downloaded. In addition to disseminating the consumer materials and reports via the Web site, Best Buy Drugs has an outreach program that links to existing groups with statewide reach and credibility throughout the medical community.�The National Business Group on Health also uses findings from the Effective Health Care Program in their Evidence-based Benefit Design initiative to provide employers and their employees best available evidence for designing benefits and making treatment choices. Medscape and the American Academy of Family Physicians offers continuing medical education (CME) based on comparative effectiveness reviews and numerous other organizations use the findings in their deliberations on patient care, formulary design, and areas for needed research.�These examples of organizations disseminating evidence from the Effective Health Care Program to their constituents are directly linked to key output (#1.3.25) listed in section D, Outcome and Output Tables.

Going Forward—The Effective Health Care Program of Comparative Effectiveness Research

In order to obtain the necessary information to assess more individualized responses to different treatments, more robust data are needed that include information on multiple chronic conditions, individual characteristics, and diverse populations.�This is health care that works better for individual patients, based on new scientific evidence as well as information and system technologies that enhance care delivery and coordination.�It aims to make complex information useful and readily applicable in clinical decisionmaking and treatment.�It means knowing what works, knowing why it works, knowing who it works for, and applying that knowledge for patients. Comparative effectiveness research, such as the research conducted in the Effective Health Care Program, provides the necessary science base for the realization of personalized health care.�Integrating personalized health care into clinical practice will depend on the development of clinical evidence demonstrating that these approaches work for clinicians and patients. It will also depend on education and support for health care professionals to translate new knowledge into health care decisions.

Comparative effectiveness research is very important to undertake so that trade-offs, benefits and harms, and value of new treatments that are on-label and off-label are recognized.�This information is critical for making informed decisions on what interventions and treatments to cover and use in providing high quality health care.�For many diseases, however, there are differences in how different groups of patients respond to different treatments which require more complex comparative effectiveness studies.�For example, some patients with elevated blood pressure respond to one type of therapy, such as a diuretic, and others respond better to beta-blockers.

Comparative effectiveness research that is undertaken to address individual differences in health outcomes can result in more targeted information about subgroups of patients and their response to different health care treatments. Specific information on how different subgroups improve or don't improve with different treatments will be extremely valuable in shaping health care decisions that yield much better health outcomes and improved value for our health care investments.�This information will increasingly be more valuable in health care decisionmaking because of the rapid development and penetration of genomic related diagnostic testing and treatments into the health care system without specific knowledge of their effectiveness and best application.

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Prevention/Care Management

Long-Term Objective 2: 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 OutcomesFY 2004 ActualFY 2005 ActualFY 2006 Target Est.FY 2006 ActualFY 2007 Target Est.FY 2007 ActualFY 2008 TargetFY 2009 TargetOut-Year Target
2.3.4

Increase percentage of men and women age 50 or older who report having been screened for colorectal cancer (based on National Health Quality and Disparities Reports [NHQR/NHDR]

Developmental1

NANANANANANA

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 Interagency Agreement [IAA] with the Centers for Disease Control and Prevention [CDC]) to electronic format.

2014 increase to 3%
2.3.5

Increase rates of additional Portfolio-prioritized clinical preventive service(s)

Developmental2

NANANANANANA

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 OutputsFY 2004 ActualFY 2005 ActualFY 2006 Target/ Est.FY 2006 ActualFY 2007 Target/ Est.FY 2007 ActualFY 2008 Target/Est.FY 2009 Target/Est.Out-Year Target/Est.
2.3.6Improve integration of Prevention and Care Management activitiesNANANANANANALaunch new Prevention/Care Mgmt Portfolio and create key outcome measures for Care MgmtTBDTBD
 Appropriated Amount
($ Million)
$7.1M$7.1M$7.1M7.1M7.1M7.1M7.1M7.1M 

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.

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Current as of February 2008
Internet Citation: HCQO (Research on Health Care Costs, Quality and Outcomes): Performance Budget Submission for Congressional Justification, Fiscal . February 2008. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/about/mission/budget/2009/opa2.html