AHRQ Summary of Full Cost

(Budgetary Resources in Millions)

HHS Strategic Plan Goals	FY 2007 Enacted	FY 2008 Pres. Budget	FY 2009 Estimate
1.  Health Care. Improve the safety, quality, affordability and accessibility of health care, including behavioral health care and long-term care.	Total: 258	Total: 272	Total: 265
1.2. Increase health care service and accessibility.	11	11	11
1.3. Improve health care quality, safety, and cost/value.	246	260	253
1.4. Recruit, develop, and retain a competent health care workforce.	1	1	1
2. Public Health Promotion and Protection, Disease Prevention, and Emergency Preparedness. Prevent and control disease, injury, illness, and disability across the lifespan, and protect the public from infectious, occupational, environmental and terrorist threats.	Total: 7	Total: 7	Total: 7
2.3. Promote and encourage preventive health care, including mental health, lifelong healthy behaviors and recovery.	7	7	7
3. Human Services. Promote the economic and social well being of individuals, families and communities.	0	0	0
4. Scientific Research and Development. Advance scientific and biomedical research and development related to health and human services.	Total: 54	Total: 56	Total: 54
4.1. Strengthen the pool of qualified health and behavioral science researchers	10	11	9
4.3. Conduct and oversee applied research to improve health and well-being.	16	16	16
4.4. Communicate and Transfer Research Results into clinical, public health and human service practice.	28	29	29
Total	$319	$335	$326

In developing full cost tables within the agency, AHRQ uses our internal budget database system.  This system allocates AHRQ funds by strategic plan goal and research portfolio of work.  Overhead costs are then shared across the strategic plan goals using a simple proportional allocation method. 

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List of Program Evaluations

Evaluation of AHRQ's Children's Health Activities

The purpose of the study was to address four primary objectives:  1) measure and assess to what extent the Agency contributed and disseminated and/or translated new knowledge; 2) measure and assess to what extent AHRQ's children's healthcare activities improved clinical practice and health care outcomes and influenced health care policies; 3) measure and assess AHRQ's financial and staff support for children's health activities; and, 4) measure and assess to what extent the Agency succeeded in involving children's health care stakeholders and/or creating partnerships to fund and disseminate key child health activities. 

The results of the study showed:  1) "... the Agency has contributed a substantial body of new knowledge as a result of its funding for children's health research (extramural and intramural) and has disseminated this new knowledge effectively in the peer reviewed literature.  This analysis also showed that the child health portfolio has changed over time, reflecting the overall Agency priorities."; 2) "...bibliometric analysis, case studies, and key stakeholder interviews suggested that children's health care activities at AHRQ, along with other child health stakeholders, have played an important role in improving clinical practice and health care outcomes and in influencing specific health care policies."; 3) ...there is a lack of authority or resources devoted to children's health that has limited AHRQ financial and staff support for children's health research."; and, 4) "...AHRQ staff has pursued numerous connections with other agencies, but primarily through participation on committees and task forces, both within and beyond HHS.  AHRQ has had mixed success in involving children's health care stakeholders and/or creating partnerships to fund and disseminate key child health activities."

Further detail on the findings and recommendations of the program evaluations completed during the fiscal year can be found at: http://www.ahrq.gov/about/evaluations/childhealth/.

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Evaluation of the Use of AHRQ and Other Quality Indicators

The purpose of the study was to:  1) provide an overview of the market of AHRQ Quality Indicators (QIs) as well as indicators and quality measurement tools developed by other organizations that are similar to the AHRQ QIs or that incorporate the AHRQ QIs; 2) provide an overview of the range of ways in which the AHRQ QIs are used by various organizations; and, 3) assess the market demand for the AHRQ QIs, identify unmet needs, and discuss implications for future activities for AHRQ. 

The following are the summary of findings:  1) AHRQ QI programs fill a unique niche in the market for QIs since there are no other sources of hospital care quality indicators that represent both a national standard and are also publicly available, transparent, and based on administrative data; 2) QIs range of different uses include public reporting, quality improvement/benchmarking, pay-for-performance, and research; 3) 114 national entities were reported as using the QIs, and a limited review of international uses identified the Organization for Economic Cooperation and Development's (OECD) Health Care Quality Indicators (HCQI) Project as having conducted preliminary discussions that indicated an interest in using the QIs internationally. 

It was recommended that future activities should explore ways to discourage non-transparent alterations to the QI specifications in proprietary measurement tools, and that QIs should receive continued support as they have an important and unique position in quality management.  Also, QI users have expressed that improvements in the current QI product line, addition of new product lines, and improve support for the QI products would meet their unmet needs.

Further detail on the findings and recommendations of the program evaluations completed during the fiscal year can be found at: http://www.ahrq.gov/about/evaluations/qualityindicators/.

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Evaluation of AHRQ's Partnership for Quality Program

The Partnership of Quality (PFQ) program aimed to accelerate the translation of research findings into practice on a broad scale through partnerships lead by organizations well-positioned to reach end users.  The purpose of the evaluation study was to identify:  1) what did PFQ grantees seek to do; 2) to what extent did PFQ grantees succeed; 3) what role did partnerships play in contributing to grantee success in Accelerating the Translation of Research and Evidence-based Guidelines into Practice; and, 4) how did the AHRQ infrastructure and PFQ program components contribute to grantee's success.

The study revealed several important points:  1) The central focus of PFQ was to apply evidence-based practices to improve quality of health care.  PFQ also provided grants to improve the health care system's readiness to address bioterrorism preparedness.  2) PFQ did appear to have made a difference in health care security, quality of safety in some of the targeted health care organizations, and raised quality of care processes and outcomes for many Americans; 3) The success of the PFQ projects depend on effective partnerships and working relationships among the lead grantee organizations, key collaborators and target organizations or providers.  Without effective partnerships, the projects would be unlikely to achieve buy-in to evidence-based changes for improving health care quality, safety, and security; and 4) The PFQ program contained several elements that sought to contribute both to the success of individual grantee efforts and to help the program achieve it overall goals, including overall program oversight by AHRQ leadership, the PFQ program director, the grants management office, meetings and collaborative efforts across project investigators through the AHRQ Council of Partners (AHRQCoPs), working subcommittees, and other cross-grantee communication and networks.

A major lesson learned from the study is that PFQ grantees clearly did not have the scale of impact originally expected by AHRQ's program developers, or promised in the RFA (request for application) or the program announcement.  Such expectations were somewhat unrealistic, given the nature of the grants funded and the scale of the projects' goals.  However, many PFQ grantees were able to attain substantial accomplishments and generate lessons which appear to be highly relevant to AHRQ's priority of translating research into practice.

Further detail on the findings and recommendations of the program evaluations completed during the fiscal year can be found at: http://www.ahrq.gov/about/evaluations/partnerships/.

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Evaluation of a Learning Collaborative's Process and Effectiveness to Reduce Health Care Disparities among Minority Populations

The purpose of the study was to answer how the National Health Plan Collaborative (NHPC) worked enhanced firms efforts to:  (1) pursue work in the area of disparities; (2) collect data or use geocoding/surname analysis to improve their ability to measure disparities or monitor the effects of pilot interventions to reduce disparities; (3) develop and test pilot interventions dealing with patients, providers, or the community to reduce disparities; and (4) communicate the outcomes to others outside the Collaborative.

The results of the study showed that:  1) enhancing efforts by firm leadership or others to pursue work in the area of disparities was supported by the Collaborative through presentations of what leading firms were doing to collect race and ethnicity data directly from their members; however, the Collaborative did not do more to directly support some firms' desire for assistance in modifying national policy to make it easier for them to obtain data on the race and ethnicity of their members.  The Collaborative did not succeed in getting all or most firms to share their data for common Health Plan Employer Data and Information Set (HEDIS®) measures.  Such sharing was very important to sponsors and some support organizations, but firm buy-in appears to have been lacking from the beginning; (2) collecting data or using geocoding/surname analysis to improve a company's ability to measure disparities or monitor the effects of pilot interventions to reduce disparities varied amongst firms in how valid they considered the results of geocoding and surname analysis for their markets.  In general, they reported that they benefited from their involvement in the process.  They perceived a positive benefit/cost ratio or provided examples suggesting as much. 

Overall, most firms involved in geocoding and surname analysis stated that, despite the limitations of the resulting data, the technique was sufficiently robust to support the intended uses of the data.  In some cases, the results provided new and valuable insights that helped firms better conceptualize the issues behind disparities.  In others, the findings confirmed what firms already knew, reinforcing the importance of work in the disparities area, particularly among non-clinical staff who might need more convincing.  Most firms reported that the analyses revealed some disparities.  A few were pleased that disparities were less extensive than they thought or than in the general population.

Firms also found value in analyses showing specific geographic areas that were more or less problematic on different measures; (3) developing and testing pilot interventions dealing with patients, providers, or the community to reduce disparities had begun with some firms as they had already used the data to formulate pilot projects, and several more were in the process of doing so.  Others said that they planned to use the information to help them further identify needs and areas to target.  One of the firms that found the results invalid used its failure as a vehicle for reinforcing its decision to capture primary data on member race and ethnicity; respondents from two other firms similarly commented that limitations in geocoding and surname analysis solidified firm commitment to primary race and ethnicity data collection.  Another firm had not yet found the data useful, but it reported that the process enhanced communication among midlevel staff responsible for such analyses, leading to an ad hoc group that is encouraging further firm investment in analyzing disparities and designing pilot interventions.  This firm said that improved communication and the willingness to consider allocating more resources to disparities work were a direct result of participation in the Collaborative; and, 4) communicating the outcomes to others outside the Collaborative is viewed positively amongst firms, support organizations, and sponsors alike.  They generally had a positive assessment of the communication and dissemination activities of the Collaborative, although many recognized that there was little to communicate or disseminate yet and use of existing communications materials appeared limited.  Nonetheless, the communication work done over the last year—which included the development of the NHPC logo, materials, and standardized messaging—was viewed as an important foundation for Phase II, when NHPC (and perhaps individual firms) will have more to report about their activities in the area of reducing disparities. 

Further detail on the findings and recommendations of the program evaluations completed during the fiscal year can be found at: http://www.ahrq.gov/about/evaluations/learning/.

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