Prevention and Care Management

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).
ProgramFY 2009
Omnibus
FY 2009
Recovery Act
FY 2010
Appropriation Level
FY 2011 President's BudgetFY 2011
+/- FY 2010
TotalBudget Authority (BA)$0$0$0$0$0
Public Health Service (PHS) Evaluation Funds$7,100,000$0$15,904,000$15,904,000$0

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

A. Program Description and Accomplishments

In FY 2008, two portfolios of work were combined to form the new Prevention/Care Management Portfolio (P/CM). The mission of the new 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.

We seek to accomplish our mission by:

  1. Supporting clinical decisionmaking for preventive services through the generation of new knowledge, the synthesis of evidence, and the dissemination and implementation of evidence-based recommendations.
  2. Supporting the evidence base for and implementation of activities to improve primary care and clinical outcomes through:
  3. Health care redesign.
  4. Clinical-community linkages.
  5. Self management support.
  6. Integration of health information technology.
  7. Care coordination.

By 2010, integration of Prevention and Care Management into one Portfolio will be complete and work will continue to support the new strategic goals. Performance measure 2.3.6, which was created to capture activities and outcomes of integrating the two portfolios of work, will be retired.

Research Grants

Optimizing Care for Complex Patients

In FY 2009, the AHRQ Prevention/Care Management Portfolio continued funding for 18 previously awarded grants. These exploratory grants will contribute evidence to help guide the appropriate prioritization, timing, and provision of therapeutic and preventive services in individuals with multiple chronic conditions. This work will improve the ability of clinicians, patients and policy makers to identify those interventions that provide the greatest benefit to patients with multiple conditions and help patients make informed decisions about health care choices.

In FY 2009, we awarded 3 new grants to foster innovative collaborations among existing grantees. One collaboration, for example, addresses the important issue of risk prediction modeling in patients with type 2 diabetes and other co-morbidities and will validate a risk prediction model and extend the model to subgroups of patients including: those with co-morbid conditions such as depression, pulmonary disease and cancer, minorities, and the elderly. Funding for these grants will continue in FY 2010.

This work begins to build the necessary research infrastructure for future investigations on the population of patients with multiple chronic diseases.

Transformation of Primary Care

The patient-centered medical home (PCMH) has been proposed by a broad coalition of providers, employers, insurers and others as a model for improving primary care in the U.S., and numerous health care systems and medical groups are currently attempting to transform their primary care practices into PCMHs. These attempts go beyond incremental quality improvement activities and aim toward whole practice redesign. The Portfolio and AHRQ have identified the need for research that will identify, describe and disseminate the best methods for transforming the structure, characteristics and function of primary care so that practices can improve quality, reduce costs, and better satisfy the needs of patients and families.

In FY 2009, AHRQ published a funding opportunity announcement to support systematic studies of on-going, successful efforts to transform the delivery of primary care in the U.S. The Portfolio anticipates awarding 10-12, two-year grants in FY 2010 with continued funding in FY 2011. The research funded through this announcement will first validate that healthcare quality, as reflected in quantifiable changes in process and outcome measures, has in fact improved subsequent to practice transformation into a PCMH. Investigators will then study in detail how the transformation occurred and its impact on costs of care and actual patient and provider experiences/satisfaction. In addition, investigators will study the organizational and contextual factors within practices that have influenced the success of these efforts.

Other Grants

In response to Agency program announcements, the Portfolio regularly funds investigator-initiated grants for small and large research projects, conferences, and training that support prevention and care management goals. This funding has been provided in FY2009 and will be continued in FY 2010 and FY 2011.

Research Contracts

Goal 1: Support Clinical Decision-making for Preventive Services

The AHRQ Prevention/Care Management Portfolio fulfills AHRQ's congressionally mandated role to convene the United States Preventive Services Task Force (USPSTF). It supports the development of tools, materials and technical assistance to improve the delivery of evidence-based primary care. Other Activities in support of Goal 1 in FY 2009 and FY 2010 are the design of a new Web site that will feature the Agency's work in prevention and care management; and the creation of materials on prevention and chronic care for electronic tools.

Support of the U.S. Preventive Services Task Force

The USPSTF is mandated 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 provider 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.

Support of the U.S. Preventive Services Task Force includes funding for: Evidence-based Practice Centers to conduct systematic evidence reviews; three in-person meetings per year; and support of a rotation for preventive medicine residents to intern with the USPSTF.

In FY 2009, the USPSTF published eleven recommendations on clinical preventive services. USPSTF recommendations are based on evidence reviews conducted by Evidence-based Practice Centers and in-house by AHRQ staff.

In 2009, the Oregon EPC conducted seven systematic evidence reviews and presented the findings to the full Task Force during its in-person meetings. The EPC contract also provides for methodology support to the Task Force. Funds requested in FY 2010 and FY 2011 will support additional systematic reviews and continuing methodology support.

As reflected in key outcome measures for FY 2008 and FY 2009, portfolio staff prioritized knowledge generation and dissemination and implementation work in the area of screening for colorectal cancer. This preventive service was prioritized 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.

In 2009, two reports were published in Annals of Internal Medicine in conjunction with the publication of the updated USPSTF recommendation on Screening for Colorectal Cancer. These included a systematic evidence review conducted by the Oregon Evidence-based Practice Center1 and a decision analysis of colorectal cancer screening tests that focused on age to begin and end screening, and on screening intervals. This work was conducted by the Cancer Intervention and Surveillance Modeling Network (CISNET).2

Based on this evidence, the USPSTF recommended screening for CRC using fecal occult blood testing, sigmoidoscopy, or colonoscopy, in adults beginning at age 50 years and continuing until age 75 years. For the first time, the USPSTF recommended that screening for CRC should stop after age 85, and it recommended against routine screening for adults age 76-85. Finally, the USPSTF found insufficient evidence to assess the benefits and harms of computed tomographic colonography and fecal DNA testing as screening modalities for colorectal cancer.

USPSTF recommendations provide one essential foundation for dissemination, implementation, and integration activities within the portfolio. In FY 2009, portfolio staff worked with The Centers for Medicare & Medicaid Services (CMS) and the National Committee on Quality Assurance (NCQA) to inform national coverage decisions and performance measures on screening for colorectal cancer. For example, portfolio staff, the Chair of the USPSTF, and the principal investigators of the evidence reports referenced above gave several presentations on the evidence regarding screening for CRC using CT colonography and the rationale for the USPSTF recommendations. These presentations were made to staff at The Centers for Medicare & Medicaid Services (CMS) and the Medicare Evidence Development and Coverage Advisory Committee (MEDCAC).

In FY 2009, portfolio staff continued to serve as full and active members of the National Colorectal Cancer Roundtable, and participated in a joint project with Federal and non-Federal partners to translate implementation guidance into more accessible electronic formats to improve the delivery of screening. This electronic tool is available at http://www.nccrt.org/Documents/General/IncreaseColorectalCancerScreeningRates.pdf (Plugin Software Help).

Performance measure 2.3.4 will be retired at the end of FY 2009. This performance measure was created to capture work associated with a prioritized topic area in the no-longer-existing Prevention Portfolio. The new Prevention/Care Management Portfolio has proposed a developmental, composite measure, performance measure 2.3.7 (Increase the percentage of older adults who receive appropriate clinical preventive services), which will look at older adults' receipt of appropriate clinical preventive services; colorectal cancer screening is expected to be included in this composite measure.

In FY 2008, to fulfill performance measure 2.3.5, portfolio staff prioritized a clinical preventive service. P/CM Portfolio staff selected a counseling service, Counseling to Promote a Healthy Lifestyle (which includes diet and physical activity), as a priority area for work in upcoming years. Since this work will support the new strategic goals of the Prevention/Care Management Portfolio, performance measure 2.3.5 will be replaced by performance measure 2.3.9 (Increase rates of adults who report receiving counseling about a healthy diet and physical activity from their primary care practice.)

In FY 2009, AHRQ commissioned a work plan from the Oregon Evidence-based Practice Center to update the USPSTF recommendations on counseling to promote a healthy diet and physical activity. The final work plan approved by the USPSTF is primarily designed to address the effectiveness of primary care-relevant counseling interventions to improve diet and physical activity, with a focus on the reduction of cardiovascular disease and related chronic diseases in adults. In addition to examining behavioral outcomes, the final evidence review will also report on relevant intermediate outcomes (e.g., measures related to diabetes, hypertension, dyslipidemia, and weight), and distal health outcomes (death, and morbidity related to cardiovascular disease). The final evidence reports will be completed in FY 2010. Also, in FY 2010, portfolio staff will complete a dissemination and implementation situational analysis on counseling to promote a healthy diet and physical activity in order to guide portfolio efforts in this area.

Each of the P/CM measures, 2.3.7, 2.3.8, and 2.3.9, is in the developmental stages. During FY 2010 and FY 2011, the targets consist of intermediate outputs representing activities that will support the development of a baseline for each measure and out-year targets.

Portfolio staff have been working with the USPSTF to increase the transparency of its scientific and deliberative processes with the overarching goals of assuring integrity and fidelity of process and of aligning more closely with the processes developed by AHRQ for its Patient-Centered Health Research program. In FY 2010, AHRQ staff will continue and expand this work in coordination with final outcomes of current pending congressional legislation regarding the USPSTF.

Other Activities

In FY 2009 and FY 2010, the Portfolio will support the design of a new Web site that will feature the Agency's work in prevention and care management. Given the enacted budget for FY 2010 and FY 2011, the Portfolio will support other activities related to Goal 1 including the creation of materials on prevention and chronic care for electronic tools.

  • Prevention and Care Management Website—The new Web site will effectively communicate evidence-based clinical preventive services recommendations and provide information on how to implement them in clinical settings, and it will provide information on how to support systems changes that improve the delivery of preventive and chronic care services in primary care. Redesign work began in FY 2009 and will be completed in FY 2011.
  • Prevention and Chronic Care Materials for Electronic Tools—The Portfolio will support contracts to create, enhance or evaluate health content for use in primary care via electronic health records or electronic tools.
  • Improvements and Upgrades to the electronic Preventive Services Selector (ePSS)—The ePSS was developed to make the evidence-based recommendations of the US Preventive Services Task Force available to primary care clinicians at the point of care. Available both as a Web-based tool and in PDA-downloadable form, the ePSS provides clinical decision support in user-friendly formats, allowing clinicians to search for USPSTF recommendations based on specific patient characteristics or to browse recommendations by topic. (http://epss.ahrq.gov/PDA/index.jsp)

    Evaluations of the ePSS indicate that clinicians like it, use it, and want more from it. In particular, clinicians would like to be able to access and print reliable, literacy-level appropriate information for their patients that will help clinicians and patients make decisions about preventive services. In FY 2010 and FY 2011, the Portfolio will invest in formative research, development of new content and possibly new features for the ePSS. New materials are intended for use at the point of care by clinicians and consumers in the process of shared decision-making regarding the use of clinical preventive services. The materials may also be used on the redesigned AHRQ Preventive Services/Care Management Web site.

  • Improving Patient Education Materials for Electronic Health Records—Approximately one-third of American adults have limited health literacy. This means, for example, that they are unable to determine a proper dose of a medication based on an over-the-counter label. Limited health literacy can also affect comprehension of verbal communication. Electronic health records (EHRs) have the capacity to deliver not only print patient education materials, but also to be an educational tool for clinicians to use interactively with patients. For example, the EHR could contain anatomical drawing or interactive visuals that clinicians could use while educating patients about their condition. Furthermore, EHRs can include features that encourage clinicians to confirm patient understanding, such as a field that indicates patient's comprehension level.

    In FY 2010 and FY 2011, the Portfolio will support work to develop a rating system for judging the understandability of patient education materials that includes testing materials with diverse target audience members; to review patient education features of the 15 most prevalent EHRs, including what materials (print and on-screen graphics) are imbedded in the EHR and whether materials are easy to understand, whether the EHR can integrate additional patient education materials, and whether there are any prompts to review and confirm understanding of materials; to identify easy-to-read patient education materials in the public domain on the topics covered by EHRs; and to educate EHR vendors about Americans' health literacy levels, the readability of EHR patient education materials, the availability of easy-to-read materials, and the importance of clinicians' review of materials with patients and confirmation patient.

Goal 2: Support Health System Redesign to Improve Primary Care

The AHRQ Prevention/Care Management Portfolio supports the development of tools, materials and technical assistance to facilitate health systems redesign in primary care settings. Focus areas include: health systems redesign, self management support; linking clinical practices with community resources; and, care coordination. With additional funds made available through the FY 2010 and FY 2011 budgets, the Portfolio will invest in a small number of contracts in these areas. This work will build on projects started in FY 2009.

Health Systems Redesign

In 2010, the Portfolio will invest in expanding work begun in 2009 to support primary care transformation through exploration of the model of the patient-centered medical home. In 2010, the Portfolio will create a national learning network for initiatives using practice coaches to support quality improvement in primary care practices and develop a public Web site on the patient-centered medical home aimed at policy makers and health service researchers.

In FY 2010, the Portfolio also will support projects that focus on understanding and measuring the patient's experience in primary care through the development and validation of two modules of the Consumer Assessment of Healthcare Providers and Systems (CAHPS®). The CAHPS® program develops and supports the use of a comprehensive and evolving family of standardized surveys that ask consumers and patients to report on and evaluate their experiences with health care. These surveys cover topics that are important to consumers, such as the communication skills of providers and the accessibility of services. One new survey module (specific set of questions on a particular topic) will focus on primary care and one will focus on health literacy.

Self Management Support

Self-management support programs are expected to reduce costly health crises and improve health outcomes for chronically ill patients with conditions such as asthma, cardiovascular disease, depression, diabetes, heart failure, and migraine headaches. A successful self-management support program has the potential to change individuals' behavior, improve health outcomes, decrease the burden of chronically ill patients on the health care system, and be a cornerstone of primary care transformation. However, many practicing primary care clinicians have not had the opportunity to develop skills in self-management support or the opportunity to implement this aspect of the Care Model in their work.

In FY 2010, the Portfolio will award a two-year contract to produce multimedia resources for primary care clinicians to help them learn about self-management support, develop their self-management support skills and provide patients with self management guidance. This project will support both prevention and care management related goals, bridging the two parts of the portfolio.

Also, building on work started in FY 2009, the Portfolio will continue work with the Indian Health Service to help understand and test what electronic health record elements can assist in improving the consistent delivery and documentation of self management support. Two challenges related to self management support are what elements can be integrated into the EHR to help prompt and document self management support (e.g., goal setting, action planning, follow-up), and what key measure(s) should be collected from the electronic record to drive performance improvement. In addition, this project will explore the development and use of personal health records to support self management.

Linking Clinical Practices with Community Resources

The Portfolio supports work to develop the evidence base for and implementation of linkages between clinical practices and community/public health resources to promote healthy behaviors and prevent disease. In FY 2008, with the American Medical Association and the Association of State and Territorial Health Officials, AHRQ co-sponsored Linking Clinical Practice and the Community for Health Promotion, a summit aimed at encouraging collaboration, coordination, and integration among health care providers, institutions, and community resources. Participants examined successful partnerships at health system, community, and State levels, and identified strategies to overcome partnership barriers.

In FY 2009, in order to facilitate ongoing collaboration among summit participants and to disseminate their work to a larger audience, a special resource page was added to AHRQ's Web-based Innovations Exchange (http://www.innovations.ahrq.gov). Innovation profiles and tools from the Innovations Exchange collection address promoting healthy behaviors and linkages among health care delivery, public health, and community-based interventions.

In FY 2010, AHRQ will host a national Summit involving stakeholders from public health, community services, and primary care. The Portfolio will make additional investments to advance knowledge in this area using funds available from the enacted FY 2010 and FY 2011 budgets. In FY 2010, the Portfolio will support rapid cycle research using the Practice-based Research Networks to study how primary care practices can best link to community resources to support patients and families in preventing and managing obesity.

Care Coordination

In 2009, in response to stakeholder input, AHRQ began an 18-month foundational phase in a long-term process to develop quality measures for care coordination in ambulatory primary care settings. The work began with development of a measurement framework and a detailed, systematic review of potential existing measures. In late 2010, the first phase of this work will be completed and AHRQ intends to initiate the second planned phase of this work-developing and validating specifications for a small set of measures. In 2011, AHRQ expects to continue work on this project with a goal of launching a measure dissemination initiative in 2011 or 2012. Please note that AHRQ will seek National Quality Forum (NQF) endorsement for the care coordination measures developed through this process. The main role/purpose of NQF is to convene stakeholders to create national consensus/endorsement of evidence-based quality measures. NQF itself, however, does not develop measures. The AHRQ process has been and will continue to be aligned with the NQF process with a long-term goal of seeking NQF endorsement of care coordination measures developed through this process.

B. Funding History

Funding for the Prevention/Care Management program during the last five years has been as follows:

YearDollars
2006$7,100,000
2007$7,100,000
2008$7,100,000
2009$7,100,000
2010$15,904,000

C. Budget Request

The FY 2011 Request level for Prevention and Care Management is $15,904,000, the same level as the FY 2010 Appropriation. These funds will allow AHRQ to continue funding important research on prevention and care management, including the following:

Prevention/Care Management Activities
(in millions of dollars)

 FY 2009 EnactedFY 2010 AppropriationFY 2011 Request
Grants:   
Generating New Knowledge in Prevention and Care Management$3.700$0.458$0.000
Transformation of Primary Care0.0003.2003.200
Other Investigator-initiated Prevention and Care Management Grants0.3280.8421.300
Subtotal, Grants$4.028$4.500$4.500
Contracts:   
Goal 1: Support Clinical Decision-making for Preventive Services   
Support of the Preventive Services Task Force2.1222.7003.700
Other Activities0.3002.9002.300
Goal 2: Support Health System Redesign to Improve Primary Care0.6505.8045.404
Subtotal, Contracts$3.072$11.404$11.404
Total, Prevention/Care Management Activities$7.100$15.904$15.904

Research and Training Grants:

The FY 2011 Request for Prevention/Care Management provides $4,500,000 for research and training grants, the same level of support as the FY 2010 Appropriation. Of this total, $1,300,000 will be directed to new grants. In FY 2011:

  • AHRQ will continue to funds large grants that develop the evidence base for care of patients with multiple chronic conditions as well as other grants that support new knowledge in prevention and care management.
  • AHRQ will provide continuation funding for grants funded in FY 2010 related to systematic studies of on-going, successful efforts to transform the delivery of primary care in the U.S. The Portfolio anticipates awarding 10-12, two-year grants in FY 2010 with continued funding in FY 2011.
  • AHRQ anticipates funding other large and small grants related to prevention and care management research.

Research Contracts and IAAs:

The FY 2011 Request for Prevention/Care Management provides $11,404,000 for research contracts and IAAs, the same level of support as the FY 2010 Appropriation. In FY 2011:

  • The Prevention/Care Management portfolio will devote an additional $1,000,000 to support the U.S. Preventive Services Task Force (USPSTF), including Evidence-based Practice Centers to conduct systematic evidence reviews for use by the USPSTF in making recommendations on clinical preventive services. These additional funds will enable the Task Force to increase the number of annually published recommendations from 9-12 to a total of 15. Support will also be provided to convene the USPSTF 3 times during the fiscal year and will support the training of preventive medicine and primary care residents in evidence-based medicine.
  • Work will be initiated to support the development of tools, materials and technical assistance to improve the delivery of evidence-based primary care.
  • The Prevention/Care Management portfolio will also generate and synthesize knowledge and support implementation activities to improve primary care and clinical outcomes through health care redesign; clinical-community linkages; self management support; and care coordination.

By 2010, the integration of Prevention and Care Management into one portfolio will be complete and work will continue to support the new strategic goals. In FY 2009, work began with Agency sponsored evaluators to establish performance measures and data sources to reflect the work of the new integrated Prevention and Care Management portfolio. We are proposing two new, developmental measures: 2.3.7 To increase the percentage of older adults who receive appropriate clinical preventive services, and 2.3.8 To increase the number of adults with chronic conditions who: 1) experience high quality care coordination; 2) receive self management support; or, 3) have access to clinical care coordinated with resources in the community. Each measure reflects one of the integrated prevention/care management portfolio's strategic goals.

Findings from the grant program, Optimizing Prevention and Healthcare Management in Complex Patients, will be available in 2010. The results may be used to guide the development of a funding opportunity announcement for grants that implement the results of the exploratory studies.

In FY 2010, work will be completed on two systematic evidence reviews for the USPSTF, one on counseling to promote a healthy diet and one on counseling to promote physical activity. These reports will assist the Task Force in making a bundled recommendation on counseling to promote a healthy lifestyle to be implemented in clinical practice. Portfolio staff will finalize the strategic plan for dissemination and implementation work in this topic area. These interim outputs ultimately support the appropriate delivery of this service to Americans.

In FY 2010, AHRQ will continue to support work promoting the development of effective clinical-community linkages. We will sponsor a Summit of stakeholders to identify and share best practices. We also will award 10-12 grants to study processes and characteristics of models of successful primary care transformation.

D. Outputs and Outcomes Tables

Program: Prevention/Care Management

Long-Term Objective:To improve the quality, safety, efficiency, and effectiveness of the delivery of evidence-based preventive services and chronic care management in ambulatory care settings.

Performance Trends: In FY 2008, the USPSTF released 10 recommendations on preventive services. In FY 2009, it released 11 new recommendations. AHRQ will continue to provide a high level of support to the USPSTF in FY 2010 and will increase its support in FY 2011 with the expectation that the USPSTF will increase the number of recommendation statements released in FY 2012.

Please see AHRQ's On-Line Performance Appendix (available at http://www.ahrq.gov/about/cj2011/cj11opa.htm) for all of the portfolio's measures, including those that have been retired.

MeasureMost Recent ResultFY 2010 TargetFY 2011 TargetFY 2011 +/- FY 2010

2.3.7: Increase the percentage of older adults who receive appropriate clinical preventive services

(Developmental)

N/A

Develop specifications for 2 composite measures

Obtain findings from the limited competition grant program, Accelerating the Development of Methods for the Study of Complex Patients

Draft final evidence reports on understanding prevention in older adults: one to focus on patient values and one on geriatric syndromes

NA

2.3.8: Increase the number of adults with chronic conditions who: 1) experience high quality care coordination; 2) receive self management support; or, 3) have access to clinical care coordinated with resources in the community.

(Developmental)

N/A

Develop culturally-appropriate curriculum for clinical teams to support self management

Develop report on current state of knowledge and models linking clinical practices with community resources

Final report on implementation of a toolkit to facilitate change in primary care and the role of practice coaching

NA

2.3.9: Increase rates of adults who report receiving counseling about a healthy diet and physical activity from their primary care practice.

N/A

Develop evidence reports on counseling to promote a healthy diet and physical activity

Develop dissemination and implementation situational analysis for counseling to promote a healthy diet and physical activity

Update USPSTF recommendation(s) on counseling to promote a healthy diet and physical activity

Develop Baseline

NA

Prevention/Care Management (Dollars in Millions) 

$15.904

$15.904

+$0

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-Competing193,4483458103,200
New & Competing3580274,04241,300
Supplemental 00000
Total, Research Grants194,028304,500144,500
Total Contracts/IAAs 3,072 11,404 11,404
Total, AHRQ 7,100 15,904 15,904

 

1 Whitlock EP, Lin JS, Liles E, Beil TL and Fu R. (2008) Screening for colorectal cancer: A targeted, updated systematic review for the U.S. Preventive Services Task Force. AIM 149(9):638-658.
2 Zauber AG, Lansdorp-Vogelaar I, Knudsen AB, Wilschut J, van Ballegooijen M and Kuntz KM. (2008). Evaluating test strategies for colorectal cancer screening: A decision analysis for the U.S. Preventive Services Task Force. AIM 149(9):659-669.

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Current as of February 2010
Internet Citation: Prevention and Care Management: 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/hcqo11a.html