Letter from the Director
I am pleased to present the Agency for Healthcare Research and Quality's (AHRQ's)
Fiscal Year (FY) 2009 Performance Budget. We all benefit from safe, effective,
and efficient health care. Our performance-based budget demonstrates our
continued commitment to assuring sound investments in programs within
these three areas that will make a measurable difference in health care for
all Americans. The Agency's mission is to improve the quality, safety,
efficiency, and effectiveness of health care for all Americans. In support of
this mission, AHRQ is committed to improving patient safety by developing
successful partnerships and generating the knowledge and tools required for long term
AHRQ continues to improve patient care through the Effective Health Care Program. As
authorized by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA), this program has begun a series of state-of-the-science reviews of
existing scientific information on effectiveness and comparative effectiveness of health care
interventions, including prescription drugs. In October 2007, AHRQ released Comparative
Effectiveness of Percutaneous Coronary Interventions and Coronary Artery Bypass Grafting
for Coronary Artery Disease. The report found that patients with mid-range coronary artery
disease are more likely to get relief from painful angina and less likely to have repeat
procedures if they get bypass surgery rather than balloon angioplasty with or without a stent.
The report also found that for mid-range coronary artery disease, bypass surgery and
angioplasty patients had about the same survival rates and similar numbers of heart attacks,
but that bypass surgery presents a slightly higher risk of stroke within 30 days of the
procedure. Coronary artery disease, a common type of heart disease, affects about 15 million
Americans and is the leading cause of death for men and women.
AHRQ released its fourth annual reports on quality and disparities in 2007. These reports
serve as tools for monitoring health care delivery by summarizing information, making clear
where improvement is most needed, and facilitating the use of common measures. We are
seeing results of efforts to improve quality of care. The 2007 Quality Report demonstrates
that we are making steady progress in improving quality of care. For selected aspects of
patient safety in hospitals, improvements over 10 percent were found, with much larger
improvements associated with public reporting efforts by the nation's hospitals and nursing
homes. At the same time, there are still areas in need of major improvements. In contrast,
the 2007 Disparities Report founds that despite some examples of improvement, pervasive
disparities related to race, ethnicity, and socioeconomic status persist.
AHRQ is excited about a new initiative in FY 2009—the Health Insurance Decision Tool.
This initiative will facilitate the development of State-specific affordable health plans for low
income individuals and to provide State decisionmakers with the tools and information they
need to design effective programs and policies for reducing the numbers of uninsured
Americans. This initiative will advance the President's goal to provide access to basic
health insurance at an affordable price. In addition, this initiative will provide Federal
decisionmakers with the information they need for evaluating States' proposals, and could
assist in understanding the impacts of other Federal initiatives, for example, consumer
driven health plans, on the overall U.S. healthcare system.
With our continued investment in successful programs that develop useful knowledge and
tools, I am confident that we will have more accomplishments to celebrate. The end result
of our research will be measurable improvements in health care in America, gauged in terms
of improved quality of life and patient outcomes, lives saved, and value gained for what we
—Carolyn M. Clancy, M.D.
Director, Agency for Healthcare Research and Quality
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