Online Performance Appendix: Performance Detail (by Activity)

Budget Estimates for Appropriations Committees, Fiscal Year 2011

Patient-Centered Health Research

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 By reviewing and synthesizing published and unpublished scientific studies, as well as identifying important issues where existing evidence is insufficient and undertaking new research, the program helps provide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 decisionmakers. 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 9 of the 2011 AHRQ Congressional Justification published at http://www.ahrq.gov/about/cj2011/cjweb11.htm.

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 decisionmaking 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 (see text box).

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, more than 1 million reports have been downloaded. In addition to the consumer materials and reports being disseminated via the Web site, they are disseminated by a Best Buy Drugs 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 car7e 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 research 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, Output and Outcomes Tables.

Key output #1.3.26 in section D, Outputs and Outcomes 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. In the process of developing this measure, AHRQ had been working to identify measures from the National Health Care Quality Report (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 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.

A new measure is under development, #1.3.55, which will track the use of Effective Health Care findings in clinical decision making. Possible data sources for this measure we are exploring are AHRQ's National Guideline Clearinghouse™ and National Quality Measures Clearinghouse™.

Long-Term Objective: Improve patients' quality of care and health outcomes through informed decisionmaking by patients, providers, and policymakers.

¹ FY 2010 targets reflect activities associated with annually-appropriated dollars. Please go to "Recovery Act Obligations and Performance" on page 9 of the 2011 Congressional Justification published at http://www.ahrq.gov/about/cj2011/cjweb11.htm for additional performance targets related to this portfolio using Recovery Act funds.

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