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

Budget Estimates for Appropriations Committees, Fiscal Year 2011

This statement summarizes budget information submitted to Congress for fiscal year 2011 by the Agency for Healthcare Research and Quality (AHRQ).
FundingFY 2009
Enacted
FY 2009
Recovery Act
FY 2010
Appropriation Level
FY 2011
President's
Budget
FY 2011
+/- FY 2010
TotalBudget Authority (BA)$—$700,000,000$—$—$—
Public Health Service (PHS) Evaluation Funds$251,631,000$—$270,653,000$478,899,000$208,246,000

Authorization Legislation: Title III and IX and Section 937(c) of the Public Health Service Act and Section 1013 of the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003.
FY 2009 Authorization: Expired
Allocation Method: Competitive Grant/Cooperative Agreement, Contracts, and Other.

Summary

AHRQ requests $478,899,000 for Research on Health Costs, Quality, and Outcomes (HCQO) at the FY 2011 Request level, an increase of $208,246,000 over the FY 2010 Appropriation level. All funds are provided using PHS Act Evaluation Funds.

Research Priorities

Within the HCQO budget activity, AHRQ supports research related to six research priorities. A summary of each research priority is provided below. Additional details related to these priorities can be found beginning on page 23.

  • Patient-Centered Health Research: The FY 2011 Request level provides $286,274,000 for Patient-Centered Health Research ($272,750,000 in HCQO and $13,524,000 in Program Support), an increase of $261,218,000 overall (+$251,750,000 over the FY 2010 Appropriation level for HCQO and an increase of +$9,468,000 within Program Support). Patient-centered health research improves health care quality by providing patients and physicians with state-of-the-science information on which medical treatments work best for a given condition. The FY 2011 Request provides an additional $2,250,000 in Program Support for salaries and benefits associated with an additional 15 FTEs needed to help implement this program.
  • Prevention and Care Management: The FY 2011 Request level for Prevention and Care Management is $15,904,000, the same level of support as the FY 2010 Appropriation level. The purpose of AHRQ's Prevention/Care Management portfolio is to improve the quality, safety, efficiency, and effectiveness of the delivery of evidence-based preventive services and chronic care management in ambulatory care settings. This portfolio seeks to accomplish the mission by: 1. Supporting clinical decision-making for preventive services through the generation of new knowledge, the synthesis of evidence, and the dissemination and implementation of evidence-based recommendations; and, 2. Supporting the evidence base for and implementation of activities to improve primary care and clinical outcomes through: health care redesign; clinical-community linkages; self management support; integration of health information technology; and care coordination.
  • Value Research: The FY 2011 Request level includes $3,730,000 for Value Research, maintaining the FY 2010 Appropriation level. Value research focuses on finding a way to achieve greater value in health care—reducing unnecessary costs and waste while maintaining or improving quality. AHRQ's Value portfolio aims to meet this need by producing the measures, data, tools, evidence, and strategies that health care organizations, systems, insurers, purchasers, and policymakers need to improve the value and affordability of health care. The aim is to create a high-value system, in which providers produce greater value, consumers and payers choose value, and the payment system rewards value.
  • Health Information Technology (Health IT): The FY 2011 Request level for Health IT research is $31,522,000, an increase of $3,877,000 over the FY 2010 Appropriation level. AHRQ's research on health IT is a key element to bring health care into the 21st century by advancing the use of information technology. Established in 2004, the purpose of the Health IT portfolio at AHRQ is to develop and disseminate evidence and evidence-based information tools to inform policy and practice on how health IT can improve the quality of American health care. Through grants and contracts, AHRQ and its partners work to improve the quality of health care by identifying challenges to health IT adoption and use, solutions, and best practices for making health IT work, and developing tools that will help hospitals and clinicians successfully incorporate new IT.
  • Patient Safety Research: The FY 2011 Request level includes $64,622,000 for Patient Safety research, a decrease of $25,963,000 from the FY 2010 Appropriation level. The majority of the decrease is related to the end of a $25,000,000 Medical Malpractice research program. The research grant program was funded using multi-year authority and no additional funds are required in FY 2011. The FY 2011 Request provides $57,622,000 for research related to patient safety threats and medical errors, of which $34,000,000 is for research on health care-associated infections. An additional $7,000,000 will continue to support research related to the Patient Safety and Quality Improvement Act of 2005 and patient safety organizations (PSOs).

    AHRQ's patient safety research priority is aimed at identifying risks and hazards that lead to medical errors and finding ways to prevent patient injury associated with delivery of health care. AHRQ supports research that provides information on the scope and impact of medical errors, identifies the root causes of threats to patient safety, and examines effective ways to make system-level changes to help prevent errors. Dissemination and translation of these research findings and methods to reduce errors is also critical to improving the safety and quality of health care. To make changes at the system level, there also must be an environment, or culture, within health care settings that encourages health professionals to share information about medical errors and ways to prevent them.

  • Crosscutting Activities Related to Quality, Effectiveness, and Efficiency Research: The FY 2011 Request level provides $90,371,000 for Crosscutting Activities Related to Quality, Effectiveness and Efficiency research, a decrease of $21,418,000 from the FY 2010 Appropriation level. Crosscutting Activities includes a variety of research projects that support all of our research portfolios. These activities include investigator-initiated research, data collection, measurement, dissemination and translation, program evaluation, grant review support, and other crosscutting contracts.

5-Year Table Reflecting Dollars

Funding for the HCQO program during the last five years has been as follows below. These levels have been made comparable to reflect the centralization of all staff and administrative overhead costs out of Crosscutting Activities and into Program Support. In addition, please note that all FTEs have been now moved to Program Support. (Please see page 108 for a breakout of Program Support costs by portfolio.)

YearDollars
2006$203,755,000
2007$201,444,000
2008$214,184,000
2009$251,631,000
2010$270,653,000

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Patient-Centered Health Research

ProgramFY 2009
Enacted
FY 2009
Recovery Act
FY 2010
Appropriation Level
FY 2010
President's
Budget
FY 2011
+/- FY 2010
TotalBudget Authority (BA)$—$700,000,000$— $—
Public Health Service (PHS) Evaluation Funds$50,000,000$—$21,000,000$272,750,000$251,750,000

Note: In addition, the following amounts are included within Program Support for Patient-Centered Health Research: $10,420,000 in FY 2009, $4,056,000 in FY 2010, and $13,524,000 in FY 2011. In addition, $300,000,000 was provided in FYs 2009 and 2010 through the Recovery Act.

Authorizing Legislation: Title III and IX and Section 937(c) of the Public Health Service Act and Section 1013 of the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003.
FY 2009 Authorization: Expired
Allocation Method: Competitive Grant/Cooperative Agreement, Contracts, and Other.

A. Program Description and Accomplishments

The Effective Health Care Program, launched in September 2005, supports the development of new scientific information through patient-centered health 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 and undertaking new research, the program helps provide providers, clinicians, policymakers, 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 decision makers. Collaboration is also a key principle of the program and AHRQ works closely with many agencies of the Department of Health and Human Services (HHS) to identify topics for research under the program and to communicate findings, including identified research gaps.

One 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 released 7 systematic reviews and 12 summary guides including 2 guides that were translated into Spanish. In FY 2009, the program released 6 systematic reviews, 16 new research and 13 summary guides with audio files and translated into Spanish. This information is reported in key output #4.4.5 in section D, Outputs and Outcomes Tables. Because the FY 2010 non-Recovery Act appropriation did not include funding for systematic reviews or their translation, the related output in FY 2010 and FY 2011 is expected to be greatly diminished. However, in FY 2010 $25 million in Recovery Act funds will support increased production of systematic reviews which are reflected in Recovery Act performance measure AHRQ ARRA 1 on page 7.

The Effective Health Care Program produces a variety of information products to help patients and their families understand the effectiveness and risks of different treatment options while allowing for choices based on the circumstances of the individual patients. Key output measures #4.4.5 and #1.3.25 focus on the production and dissemination of the information products, systematic reviews and summary guides. The program also produces new research reports, clinical research studies that draw on health care databases, electronic patient registries, and other scientific approaches to explore practical questions about the effectiveness, safety and appropriateness of treatments. AHRQ is working to further develop key output measures #4.4.5 and #1.3.25 in order to capture data on the production and dissemination of all information products produced by the Effective Health Care Program that could help us meet our long-term objective to improve patients' quality of care and health outcomes through informed decision making by patients, providers, and policymakers.

All reports produced by the program are available on the Effective Health Care Web site, http://www.EffectiveHealthCare.ahrq.gov. In FY 2009, the Web site was significantly enhanced to improve usability. 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 key questions for research, 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. The priority conditions which guide the work of the program are targeted to Medicaid, Medicare, and SCHIP (State Children's Health Insurance Program) beneficiaries (go text box below).

Effective Health Care
Priority Conditions

  • Arthritis and non-traumatic joint disorders.
  • Cancer.
  • Cardiovascular disease, including stroke and hypertension.
  • Dementia, including Alzheimer Disease.
  • Depression and other mental health disorders.
  • Developmental delays, attention-deficit hyperactivity disorder, and autism.
  • Diabetes Mellitus.
  • Functional limitations and disability.
  • Infectious diseases including HIV/AIDS.
  • Obesity.
  • Peptic ulcer disease and dyspepsia.
  • Pregnancy including pre-term birth.
  • Pulmonary disease/Asthma.
  • Substance abuse.

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. Over the course of the project, over 1 million reports have been downloaded. In addition to the consumer materials and reports being disseminated via the Web site, they are disseminated by 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.
  • Omnicare, Inc., a leading provider of pharmaceutical care for the elderly, uses Effective Health Care Program summary guides as a tool for its consultant pharmacists and facilities, which are primarily nursing homes. Omnicare serves approximately 1.4 million residents in more than 15,000 long-term care facilities in 47 States, Washington, DC, and Canada.
  • Su Clinica Familiar, a multi-office health clinic in south Texas, uses AHRQ's Effective Health Care Program summary guides for clinicians and patients to better address concerns of patients and as teaching resources for patients.
  • 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.
  • AHRQ executed an agreement with AARP in 2009 that provides for the co-branding of Effective Health Care consumer summary guides on five different topics—treatments for depression, gastroesophageal reflux disease (GERD), osteoarthritis, hypertension, and osteoporosis. AARP has agreed to offer the publications on the "Know Your Rx Options" page of the AARP Web site and on its printed publications order form that is distributed via AARP state offices. The co-branded guides would also be promoted through AARP's employer outreach program. Further promotion may occur through AARP's nationwide "bus tour" co-sponsored by Walgreen's.
  • The Society for Academic Continuing Medical Education (SACME) devoted a session of its 2009 annual meeting to comparative effectiveness and Effective Health Care. The session was promoted in SACME's newsletter, INTERCOM. SACME's meeting prompted medical school CME directors, deans, professors and others to order 11,036 copies of clinician guides on insulin analogs and treatments for osteoarthritis of the knee. Among those placing orders were Duke, University of Pennsylvania, University of Virginia, Dartmouth and University of California, San Francisco. The organization subsequently coordinated with AHRQ to distribute Effective Health Care summary guides and promotional materials to its 300 members through a direct mailing effort in 2009.
  • In 2009, the Johns Hopkins Office of Continuing Medical Education sent e-mails highlighting the Effective Health Care Program to more than 100,000 physicians, nurses, physician assistants, and others who have participated in Hopkins' CME activities. The e-mails, also sent to Hopkins faculty, included promotional information and links to announcements that encourage clinicians to access Effective Health Care summary guides on osteoarthritis and Type 2 diabetes medications. Hopkins has added the Effective Health Care Program link to its resource page.
  • The American Osteopathic Association (AOA) place half-page ads in their April and May 2009 editions of their professional journal. The May ad encourages clinicians to order up to 200 free copies of summary guides. The circulation of the Journal of the American Osteopathic Association is about 65,000. The AOA has also promoted Effective Health Care Program materials through several other channels, including the AOA Executive Director's daily blog and the AOA web site.
  • Winn-Dixie, a grocery chain based in Florida, has agreed to distribute several CE consumer brochures as part of its grassroots community wellness initiative to underserved populations. The brochures on pain medicine for osteoarthritis, antidepressants, and pills for type 2 diabetes also may be part of an in-store giveaway at Winn-Dixie in 2010.
  • The New Mexico Medical Society has agreed to place an Effective Health Care program newsletter announcement, an ad in an upcoming membership publication, and a link on its Web site to announce the availability of clinician summary guides. The society encouraged its 3,000 members, who represent 85 percent of the practicing physicians in the State, to order the guides. In addition, the National Hispanic Medical Association, which represents 36,000 Hispanic physicians in the United States, has alerted its members via e-mail in 2009 that the Effective Health Care program now has Spanish-language consumer guides available on nine topics.

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.

Key output (#1.3.26) in section D, Outcome and Output Tables, increases the amount of evidence from the PCHR portfolio that policymakers use as a foundation for population-based policies and helps guide our relationship with the AHRQ-sponsored Medicaid Medical Director's Learning Network. Twenty three State Medicaid Medical Directors report that they use Effective Health Care Program resources in a variety of ways. For example, they are incorporated into clinical guidelines created and disseminated by the States, incorporated into health plan educations materials, and used to inform coverage decisions and to set criteria for prior authorization.

As written, key output #1.3.26 focuses on one stakeholder group of importance to the Effective Health Care Program. Since AHRQ's long-term objective is to improve decisionmaking by patients, providers, and policymakers, we are working to further develop and expand this measure so that we can capture data on how other important stakeholder groups, specifically clinicians, are using the program's materials to help inform decisions.

Developmental measure #1.3.24 is to decrease mortality from and increase receipt of recommended care for subset of diseases measured and reported on in the National Health Care Quality Report (NHQR). In the process of developing this measure, AHRQ had been working to identify measures from the NHQR and limit them to a ~3 based on priority conditions to track over time. AHRQ is in the process of determining whether these measures will accurately capture the work and impact of the Effective Health Care Program. In addition, AHRQ is exploring whether the data as currently exists will not provide robust data on which to chart this measure. During the FY 2010 and FY 2011 the program will explore the development of an alternate measure to more accurately measure the program's impact on improving patients' quality of care and health outcomes through informed decision making.

B. Funding History

Funding for the Patient-Centered Health Research program during the last five years has been as follows:

YearDollars
2006$15,000,000
2007$15,000,000
2008$30,000,000
2009$50,000,000
2010$21,000,000
2009/10 Recovery Act$300,000,000

C. Budget Request

The FY 2011 Request level provides $286,274,000 for Patient-Centered Health Research ($272,750,000 in HCQO and $13,524,000 in Program Support), an increase of $261,218,000 overall (+$251,750,000 over the FY 2010 Appropriation level for HCQO and an increase of +$9,468,000 within Program Support). The table below details AHRQ's funding for FY 2011 Patient-Centered Health Research. Further details are provided in the narrative section following the table.

Patient-Centered Health Research
(dollars in millions)

ResearchType of
Financial
Award
FY 2009
Enacted
($50 M)
FY 2009 /2010
Recovery Act
($300 M)
FY 2010
Appropriation
($21 M)
FY 2011
Request
($272.75 M)
I. Identification of New and Emerging Issues for Patient-Centered Health Research (Horizon Scanning)Contracts$1.000$9.500$0.000$9.500
II. Evidence SynthesisContracts12.80025.0000.00025.000
III. Evidence Gap IdentificationContracts1.00025.0000.00025.000
IV. Evidence GenerationGrants10.000149.00010.00086.250
Contracts15.10024.0008.50050.000
V. Translation and
Dissemination
Grants1.00029.5001.00020.000
Contracts6.5005.0000.00035.000
VI. Training and Career DevelopmentGrants1.60020.0001.50010.000
VII. Citizen Forum (Stakeholder Engagement)Contracts
1.00010.0000.00012.000
Salaries and Benefits for Temp. ARRA FTEsSalary and Benefits0.0003.0000.0000.000
TOTAL $50.000$300.000$21.000$272.750

Research and Training Grants: The FY 2011 Request provides $116,250,000 for research and training grants, an increase of $103,750,000 from the FY 2010 Appropriation. The increases are discussed in detail, by research component, on the following page.

Research Contracts and IAAs: Research contracts and IAAs are supported at $156,500,000 in the FY 2011 Request, an increase of $148,000,000 over the FY 2010 level. The increases are discussed in detail, by research component, below.

  1. Identification of New and Emerging Issues for Patient-Centered Health Research (Horizon Scanning)—$9.50 million

    Horizon scanning is the identification of current or emerging medical interventions available to diagnose, treat, or otherwise manage a particular condition. Horizon scanning activities are vital for understanding the relevant healthcare context and landscape, as a basis for identifying and beginning to prioritize among research needs.

    In FY 2008 and FY 2009, the Effective Health Care Program's effort employed technical briefs, rapid reports that examine new technologies (e.g. drugs, devices, procedures, diagnostic tests), evaluate the extent of their current use, and assess the amount of evidence supporting these technologies.

    Five technical briefs have been initiated since FY 2008: Particle Beam Radiation Therapies for Cancer, Stereotactic Radiosurgery for Extracranial Solid Tumors, Comparative Effectiveness of Chemotherapy Agents in the Prevention of Primary Breast Cancer in Women, Percutaneous Heart Valves, and Fetal Surgery.

    AHRQ will use FY 2009/2010 Recovery Act funding to establish an infrastructure to identify new and/or emerging issues for research review investments. This program will be dedicated to tracking emerging technologies and investigating their contextual role in health care.

    It will establish and use an efficient approach to investigate and prioritize areas for investigation relevant to the 14 priority conditions that guide AHRQ's Effective Health Care Program and that can be scaled for a national investment in research that compares the effectiveness of different health care interventions. This new activity will track emerging clinical interventions and investigate key issues related to the intervention.

    The FY 2011 Request will support the infrastructure to identify new and/or emerging issues for research reviews investments established with Recovery Act funding and will continue to employ technical briefs. These reports will provide a public framework of pertinent issues and identify significant or controversial questions of effectiveness that may be addressed by undertaking new evidence synthesis or generation and will be presented in formats conducive to priority setting activities.

  2. Evidence Synthesis—$25.00 million

    Evidence syntheses include the review and synthesis of current medical research to provide rigorous evaluation of what is known on the basis of existing research about the effectiveness of alternative approaches to given clinical problems.

    In FY 2008 and FY 2009, AHRQ's Evidence-based Practice Centers (EPC) produced 7 and 10 and research reviews, respectively.

    AHRQ will use FY 2009/2010 Recovery Act funding to increase support for research reviews. Approximately 10 to 30 research reviews are expected to be funded with ARRA funds, depending on the research to be pursued. AHRQ will also strategically build upon the existing strengths of the EPCs to include a focus on capacity-building to create a larger and stronger pool of expertise in systematic review and to advance the scientific methods of systematic review. Recovery Act funding will also allow for continued and enhanced investments in research methods for conducting systematic reviews to answer research questions about the effectiveness of different health care interventions.

    The FY 2011 Request will continue to support the development of research reviews. The goal of this effort will be to increase the information base of research synthesis available to support decisions in the clinical and other health care decision settings. The research reviews will contribute to the identification of patient-centered health research needs and knowledge gaps. This activity is directly linked to key output #4.4.5: Increase # of systematic reviews and summary guides produced per year. Research reviews take, on average, 12-15 months to produce so those reviews initiated in FY 2011 will be made available to the public in FY 2012 and included in the FY 2012 Outputs and Outcomes Tables. Additionally, targets for FY 2010 (23 total products) and FY 2011 (10 total products) are lower than the FY 2009 Actual (35 total products) because the FY 2010 appropriation does not include funding for systematic reviews or their translation. However, in FY 2010 $25 million in Recovery Act funds will support increased production of systematic reviews which are reflected in Recovery Act performance measure AHRQ ARRA 1 on page 7.

    This funding will also support an ongoing strategic enhancement of the EPC Program that will include a focus on capacity-building and advancing the scientific methods of systematic review.

  3. Evidence Gap Identification—$25.00 million

    Evidence gap identification is the identification of areas where new research conducted would contribute to bridging the gap between existing medical research and clinical practice.

    In FY 2008 and 2009, EPCs were charged with identifying evidence gaps in their systematic reviews of the literature. FY 2009/2010 Recovery Act funding will allow AHRQ to put greater emphasis on the identification of evidence needs in the systematic review process, which begins with the identification of evidence gaps that has been the purview of the EPCs. This effort will be designed to produce recommendations that further consider the timing, value and feasibility of research that would fill these gaps and will include coordination with other funders as well researchers able to conduct needed research.

    With FY 2009/2010 With Recovery Act funds, AHRQ will initiate an enhanced capacity for identifying and prioritizing evidence needs. A process will be developed that will involve stakeholders, including clinicians, funding agencies, and researchers, to consider the gaps identified in systematic reviews. This will help shape future research agendas and set priorities for a national investment in new research based on the findings.

    This process will involve bringing together the researchers that worked on the individual review, as well as stakeholders with interest in the topic, clinicians with expertise in the topic area, agencies with funds for potential future research, and researchers with expertise in the clinical area and study design to identify evidence needs and to develop new research based on the findings of the research review. Funding will be used to develop this formal approach to ensure it is transparent, systematic, strategic, and rigorous. This activity will build on and expand current AHRQ Effective Health Care Program efforts to involve stakeholders in the research.

    The FY 2011 Request will support the formal process for identifying evidence gaps developed with ARRA funds. The process will continue to involve stakeholders, including clinicians, funding agencies and researchers to identify evidence needs and set priorities for a national investment in new research based on the findings of individual research reviews. This funding will allow AHRQ to continue to systematically expand the use of research reviews in the identification and prioritization of research needs.

    Funding will be also used to invest in the further development of this approach to assure that it is systematic, transparent, strategic, and methodologically rigorous. In 2011, this effort will begin to produce recommendations that consider the timing, cost, and feasibility of research that would address key questions, in addition to the predicted value of the information generated.

  4. Evidence Generation—$136.25 million

    Evidence generation is the conduct of new research that compares the effectiveness of different health care interventions. It is essential to meeting the needs of clinical and health policy decision makers.

    In FY 2008 and FY 2009, AHRQ supported the DEcIDE (Developing Evidence to Inform Decisions about Effectiveness) Network. This research network conducts practical studies about the outcomes, comparative clinical effectiveness, safety, and appropriateness of health care items and services. The network is comprised of research-based health organizations with access to electronic health information databases and the capacity to conduct research. In FY 2009, the DEcIDE Research Network produced 16 Effective Health Care research reports and a series of methodological tools for researchers. All products are available on the Effective Health Care Web site. In FY 2010, AHRQ will continue to support a DEcIDE Network and will re-compete the DEcIDE contract.

    FY 2009/2010 Recovery Act funding will include both efforts to build the infrastructure for conducting studies that compare the effectiveness of different health care interventions, and underwriting rigorous research with dedicated study designs and data collection to definitively address knowledge gaps that could not otherwise be addressed.

    Evidence generation is the largest investment in AHRQ's Recovery Act funds and is intended to establish a coordinated national investment in practical/pragmatic patient-centered health research. It will focus on important research questions for the health care system and its users, with a concentration in under-represented populations. There are four key areas for investment: Clinical and Health Outcomes Initiative in Comparative Effectiveness (CHOICE) studies, Request for Registries, DEcIDE Consortium Support, and Unfunded Meritorious Applications. CHOICE will represent the first coordinated national effort to establish a series of pragmatic clinical patient-centered health research studies in the United States. These pragmatic studies will measure effectiveness—the benefit the treatment produces in routine clinical practice—and will include novel study designs focusing on real-world populations. Disease registries are databases that collect clinical data on patients with a specific disease or keep track of specific medical tests, devices, or surgical procedures (joint replacements, heart valve replacements, etc.). The Request for Registries will establish or enhance national patient registries that can be used for researching the longitudinal effects of different interventions and collect data on under-represented populations. Finally, the DEcIDE Consortium will expand the DEcIDE Network to expand multi-center research consortia, comprised of academic, clinic, and practice-based centers, to study diabetes, cancer, cardiovascular disease, and other priority conditions, and by funding distributed data network models utilizing clinically rich data from electronic health records. Consortium were developed in diabetes, cancer, and cardiovascular disease because they are among the priority conditions established by the Secretary, they are three leading causes of the burden of disease in the United States, and they represent areas with potential impact for reducing clinically significant variations in the prevention, diagnosis, treatment, or management of a disease or condition, or in the use of a procedure or technology.

    FY 2011 funding will support large research projects in patient-centered health research aimed at generating new knowledge to help inform decision making in priority areas of clinical care. The impact of these studies should have a high likelihood of creating major advancements in clinical care. Emphasis will be placed on projects that define important research gaps, plan to provide actionable results, and employ novel or alternative study designs as appropriate. AHRQ will also fund projects that will effect a substantial improvement in the Nation's capacity to systematically collect prospective data to perform patient-centered health research that compares the effectiveness of diagnostics, therapeutics (drugs and biologics), devices, behavioral interventions, and procedures used in clinical care.

    Clinical research projects will be informed by the information needs and inputs from various stakeholders (e.g., policy-makers, clinicians, and patients) to ensure the most appropriate outcome measures for assessing the effectiveness of the interventions and outcomes of importance to stakeholders are included in the study.

    The FY 2011 Request will also used to fund the out-years of grants awarded in prior years with annually appropriated dollars. In addition, AHRQ will use $6 million in new grants to support at least six Centers for Education & Research on Therapeutics (CERTs) whose work will focus on patient-centered health research.

  5. Translation and Dissemination—$55.0 million

    Dissemination and translation efforts ensure that knowledge synthesized or generated within the patient-centered health research program is available to decision makers to better inform their decisions.

    In FY 2008 and FY 2009, the John M. Eisenberg Clinical Decisions and Communications Science Center translated complex scientific research produced in the Effective Healthcare Program into short, clear and actionable materials and products that can be used by three primary audiences: consumers, clinicians, and policy makers. The Eisenberg Center produced 8 summary guides in FY 2008 and 6 summary guides in FY 2009 and translations into Spanish and audio files for patients.

    With FY 2009/2010Recovery Act funding, AHRQ will increase efforts in this area, expanding the number of clinician- and consumer-oriented summaries of findings produced by the Eisenberg Center (currently operated by Baylor College of Medicine). As the translation and dissemination component of the patient-centered health research initiative, the Eisenberg Center will continue to produce these products in partnership with specific stakeholder groups, including the general public, patients, providers, payers, and policy-makers, to generate information tailored to their circumstances. Recovery Act funds will also enable new investments in innovative research on incorporating patient-centered health research into decision making, such as integrating clinical decision support tools into health information technologies. Approximately 15 to 45 tools including summary guides for consumers, clinicians and policymakers are expected to be funded with Recovery Act funds, depending on the number of research reviews produced and the scope of those reports.

    The Recovery Act funds will primarily be used to support grantees in developing and implementing innovative approaches to integrating patient-centered health research findings into clinical practice and health care decision making. Investments will be in multiple geographically dispersed translation, implementation, and evaluation projects to be carried out by local organizations such as medical societies, state institutions of higher learning, patients, community advocacy organizations and others to promote education, dissemination and application of patient-centered health research.

    The FY 2011 Request will support AHRQ's translation and dissemination activities expanded with Recovery Act funding and will continue to strengthen the infrastructure supporting these activities. These funds will be used to continue to support grantees in developing and implementing innovative approaches to integrating patient-centered health research findings into clinical practice and health care decision making. Funding will also support the John M. Eisenberg Clinical Decisions and Communications Science Center. This activity is directly linked to key output #4.4.5: Increase # of systematic reviews and summary guides produced per year. Summary guides are developed based on research reviews. Research reviews and subsequently summary guides take, on average, 12-15 months to produce so reviews and summary guides initiated in FY 2011 will be made available to the public in FY 2012 and included in the FY 2012 Outputs and Outcomes Tables. Additionally, targets for FY 2010 (6 SG) and FY 2011 (2 SG) are low because the FY 2010 appropriation does not include funding for systematic reviews or their translation. However, in FY 2010 $5 million in Recovery Act funds will support increased production of systematic summary guides which are reflected in Recovery Act performance measure AHRQ ARRA 1 on page 7.

  6. Training and Career Development—$10.00 million

    Research training and career development of researchers and clinicians will strengthen the research infrastructure and build capacity through ensuring a sufficient pool of research expertise for national efforts in research that compares the effectiveness of different health care interventions.

    In FY 2008 and FY 2009, AHRQ invested in patient-centered health research career development awards. These awards were intended to build capacity for, and to support the career development of clinical and research doctorates focusing their research on, patient-centered health research through commitment and investment in training and mentorship.

    AHRQ will use 2009/2010 Recovery Act funding for patient-centered health research capacity building. AHRQ will provide institutional support to increase the intellectual and organizational capacity for larger scale research programs and allow fellowship training opportunities. Through grant mechanisms, funding will support the career development of clinicians and research doctorates focusing their research on the synthesis, generation and translation of new scientific evidence and analytic tools for patient-centered health research. In particular, the goal will be to enhance the research and methodological capacity for conducting and improving the quality of systematic review, retrospective studies, and clinical trials comparing the effectiveness of different health care interventions and the development of data sources and other aspects of the research infrastructure.

    Funding in FY 2011 Request will be used for further capacity building. AHRQ will provide institutional support and will support the career development of clinicians and research doctorates focusing their research on the synthesis, generation and translation of new scientific evidence and analytic tools for patient-centered health research. FY 2011 funding will also be used to fund the out-years of grants awarded in prior years with annually appropriated funds.

  7. Citizen Forum (Stakeholder Engagement)—$12.00 million

    Stakeholder engagement means consistently and comprehensively involving stakeholders in all aspects of the Effective Health Care Program.

    In FY 2008 and FY 2009, there were many ways for stakeholders to get involved in AHRQ's Effective Health Care Program, including: submitting suggestions for research topics, commenting on draft key questions and draft reports, providing expert input/scientific information to inform a report, and participating in a listening session. In addition, the Effective Health Care Program Stakeholder Group supports the work of the Effective Health Care Program.

    AHRQ will use FY 2009/2010 Recovery Act funding to establish and support a Citizen Forum on Effective Health Care to formally engage stakeholders in the entire Effective Health Care enterprise and to continue to open up and make the program inclusive and transparent. This initiative will build on the smaller initiative that has guided AHRQ's Effective Health Care Program until now and will be an important component for a larger and more sustained national initiative in patient-centered health research, translation, and use. Funds may be used to develop formal processes for input, convene citizen panels in accordance with the processes that are developed, and convene a workgroup to provide formal advice and guidance to the Program. Funds may also support programs in citizen awareness addressing the use of evidence on the effectiveness of different health care interventions in health care decision-making. These programs, developed under the guidance of the Citizens Forum, may include town hall meetings, web-based information exchange, and community-based grassroots awareness efforts.

    The FY 2011 Request will support the Citizen Forum on Effective Health Care to be established with Recovery Act funds in FY 2010. Funds will be used to support the formal processes developed to solicit and receive input, convene citizen panels, and convene workgroup(s) to provide formal advice and guidance to the Program.

 

D. Outputs and Outcomes Tables

Program: Patient-Centered Health Research
Long-Term Objective: Improve patient's quality of care and health outcomes through informed decision making by patients, providers and policymakers

Please go to AHRQ's On-Line Performance Appendix for all of the portfolio's measures, including those that have been retired.

MeasureMost Recent ResultFY 2010 Target1FY 2011 TargetFY 2011 +/- FY 2010
1.3.24: Decrease mortality from and increase receipt of recommended care for subset of diseases measured and reported on in the National Health Care Quality Report)

(Developmental)
(Interim Output
)

FY 2009: Measures have been identified and a subset based on priority conditions has been analyzed.
(Target Met)
Initiate development of alternate measure to more accurately measure the program goalsSet BaselineNA

4.4.5: Increase the number of Effective Health Care (EHC) Program products available for use by clinicians, consumers, and policymakers
(Outcome)

FY 2009:
6 SRs
13 SGs
16 EHC
Research Reports
(Target Met)
3 SRs
6 SGs
14 EHC
Research Reports
1 SRs
2 SGs
7 EHC
Research Reports
-13 Products
1.3.25: Increase the dissemination of Effective Health Care (EHC) Program products to clinicians, consumers, and policymakers to promote the communication of evidence about the comparative effectiveness of different medical interventions.
(Output)
FY 2009:
934
Baseline
(Orders for 50+ copies of EHC Program products
981 Orders1030 Orders+49 Orders
1.3.26: Increase the percentage of stakeholders who report they use Effective Health Care (EHC) Program products as a resource
(Output)
FY 2009:
20%
Baseline
 
22%24%+2%
1.3.55: Increase the use of Effective Health Care (EHC) Program products in evidence-based clinical practice guidelines, quality measures, and measure sets in EHC priority areas to enhance decision makingNASet BaselineEstablish TargetsNA
Comparative Effectiveness
(Dollars in Millions)
$50.000$21.000$272.750+$251.750

1. FY 2010 targets reflect activities associated with annually-appropriated dollars. Please go to "Recovery Act Obligations and Performance" for additional performance targets related to this portfolio using Recovery Act funds.
 

E. Mechanism Table for Prevention/Care Management

Prevention/Care Management Mechanism Table
(Dollars in Thousands)

MechanismFY 2009
Actual
FY 2010
Appropriation
FY 2011
Request
NumberDollarsNumberDollarsNumberDollars
Research GrantsNon-Competing34473712,5003310,500
New & Competing4312,10000105105,750
Supplemental 00000
Total, Research Grants4612,5473712,500138116,250
Total Contracts/IAAs 37,453 8,500 156,500
Total, AHRQ 50,000 21,000 272,750

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Current as of February 2010
Internet Citation: Research on Health Costs, Quality, and Outcomes (HCQO): Budget Estimates for Appropriations Committees, Fiscal Year 2011. February 2010. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/about/mission/budget/2011/hcqo11.html