Health Services Research Funding:
Cross Institution Perspectives &
Dialogue About Priorities
Carolyn M. Clancy, MD
Francis Chesley, MD
Agency for Healthcare Research and Quality
AcademyHealth 2009 Annual Research Meeting
Chicago – June 28, 2009
Health Care Reform in the
Current Economic Environment
59%
37%
It is more
important than
ever to take on
h lth care
health
reform now
We cannot
afford to take
on health care
reform right
now
4%
Kaiser Family Foundation
Health Tracking Poll
(Conducted (April 2
2--8, 2009)
Don’t Know/Refused
More Say Reform
Would Help Country
Do you think (you and your family/the country as a whole) would
be better off if the president and Congress passed health care
reform, or don’t you think it would make much difference?
Better Off
Wouldn’t Make
M h Diff
Much
Difference
Worse Off
It Depends
4%
…you
you and
your family
43%
36%
14%
3%
…the country
as a whole
56%
21%
15%
Kaiser Family Foundation Health Tracking Poll (Conducted April 22-8, 2009)
Current Challenges
g
 Concerns
C
about
b
h
health
l h spending
di – about
b
$2
$2.3
3





trillion per year in the U.S. and growing
Large variations in clinical care
A lot of uncertainty about best practices
involving treatments and technologies
Pervasive problems with the quality of care
that people receive
T
Translating
l ti scientific
i tifi advances
d
iinto
t actual
t l
clinical practice
Translating scientific advances into usable
information for clinicians and patients
HSR Perspectives and Priorities
 AHRQ R
Resources & P
Priorities
i ii
 Research Opportunities &
A ti iti
Activities
 Comparative Effectiveness
R
Research:
h Th
The N
New P
Paradigm
di
 Improving Quality & Access
 Q&A
HHS Secretary
y Kathleen Sebelius
“It
It is an honor to lead the
Department of Health and
Human Services and I am
grateful for the opportunity
to serve at such a pivotal
moment in our history”
Kathleen Sebelius
Sworn in as the 21st Secretary of the
Department of Health and Human Services
A il 29
April
29, 2009
AHRQ’s
Q Mission
Improve the quality
quality, safety
safety,
efficiency and effectiveness of
health care for all Americans
AHRQ
Q Priorities
Patient Safety
 Health IT
 Patient Safety
Ambulatory
P ti t Safety
Patient
S f t

 Safety & Quality Measures,

Organizations
N
New
P
Patient
ti t
Safety Grants
Drug Management and
Patient-Centered Care
P ti t Safety
Patient
S f t IImprovementt
Corps
Effective Health
Care Program
 Comparative


Effectiveness Reviews
Comparative Effectiveness
Research
Clear Findings for
Multiple Audiences
Other Research &
Dissemination Activities
Medical Expenditure
Panel Surveys
 Visit-Level Information on  Quality & Cost-Effectiveness, e.g.

Medical Expenditures
Annual Quality &
Disparities Reports


Prevention and Pharmaceutical
Outcomes
U.S. Preventive Services
Task Force
MRSA/HAIs
Updated
p
Portfolios
 Value
– Goal: Support the
development of health care
activities that help reduce
unnecessary waste while
improving quality
 Innovations/Emerging
I
ti
/E
i
Issues
– Goal: Identify
y and support
pp
ideas and projects that
have the potential for
highly innovative solutions
to health care challenges
AHRQ
Q FY 2009 Funding
g
 $372 million
– $37 million more than FY 2008
– $46 million more than the president’s
president s
request
 FY 2009 appropriation includes:
– $50 million for comparative effectiveness
research, $20 million more than FY 2008
research
– $49 million for patient safety activities
– $45 million for health IT
HSR Perspectives and Priorities
 AHRQ R
Resources & P
Priorities
i ii
 Research Opportunities &
A ti iti
Activities
 Comparative Effectiveness
R
Research:
h Th
The N
New P
Paradigm
di
 Improving Quality & Access
 Q&A
Research Opportunities
pp
 Health IT Funding Opportunities
– PAR
PAR--08
08--270 Utilizing Health Information
Technology (IT) to Improve Health Care
Quality (R18)
– PAR
PAR--08
08--269 Exploratory and
Developmental Grant to Improve Health
Care Quality through Health Information
T h l
Technology
(IT) (R21)
– PAR
PAR--08
08--268 Small Research Grant to
I
Improve
Health
H lth C
Care Q
Quality
lit th
through
h
Health Information Technology (IT) (R03)
Research Opportunities
pp
 PA
PA--09
09--071 AHRQ Health Services Research
Demonstration and Dissemination Grants
(R18)
 PA
PA--09
09--070 AHRQ Health Services Research
Projects (R01)
 PAR
PAR--08
08--136 Researching
g Implementation
p
and
Change While Improving Quality (R18)
 PA
PA--06
06--448
448AHRQ
AHRQ Small Research Grant
Program (R03)
2009 Priorities for
K Award Funding
 PAR
PAR--09
09--087 Mentored Research
Scientist Research Career Development
Award (K01)
 PAR
PAR--09
09--086 Independent Scientist
Award (K02)
 PAR
PAR--09
09--085 Mentored Research
Scientist Research Career Development
Award (K08)
Children’s Health Insurance Program
Reauthorization Act of 2009 (CHIPRA)
AHRQ Activities Focus on identifying Initial Core
Health Care Quality Measure Set
 Memorandum of Understanding and OU and IntraIntra-
Agency Agreement with CMS
 Federal Quality Workgroup Established
 AHRQ NAC Subcommittee Established
–
First Meeting July 2222-23, 2009 - PUBLIC
–
Report back to full NAC July 24
24, 2009
–
Second Meeting Sep. 1717-18, 2009 (tentative)
http://www.ahrq.gov/chip/chipraact.htm
CHIPRA: Phase II
 Pediatric quality measures program
– IA with CMS
– Expert meeting on
measure development,
testing validation criteria
testing,
 Evaluation of demos
– IA with CMS
Patient Safety
y Organizations
g
(PSOs)
(
)
 63 PSOs to Date (and growing)
– PSO certification and listing is
implemented by AHRQ.
Compliance and confidentiality
is enforced by the Office for
Civil Rights
 Future Opportunity
– Availability of data for research
www.pso.ahrq.gov
 First Annual PSO Meeting
– September 1616-18, 2009, AHRQ
PSO Privacy Protection Center Launched
Multi--Media Campaigns
Multi
Get Patients Involved
 AHRQ expands Ad Council campaign
with
ith a new series
i off TV and
d radio
di
public service announcements along
with printed consumer resources
http://www.ahrq.gov/questionsaretheanswer
HSR Perspectives and Priorities
 AHRQ R
Resources & P
Priorities
i ii
 Research Opportunities &
A ti iti
Activities
 Comparative Effectiveness
R
Research:
h Th
The New
N
Paradigm
P
di
 Improving Quality & Access
 Q&A
U.S. Landscape for Comparative
Effectiveness Research
 Well intentioned
 Ad hoc except for
AHRQ
AHRQ’ss mandate
 Limited capacity to do
the research and
translate the research
into meaningful
g and
useable applications
Shared Perspectives on
p
Effectiveness
Comparative
 Comparative effectiveness should be a
public good that:
– Gives health care decision makers –
patients, clinicians, purchasers and policy
makers – access to the latest open and
unbiased evidenceevidence-based information
about treatment options
– Informs choices and, where possible, is
closely aligned with the sequence of
decisions patients and clinicians face
The Right Treatment for the Right Patient at the Right Time
Comparative Effectiveness
Research
Comparative effectiveness research serves as a foundation
for evidence on what services work best in health care
 Comparisons of medical options
helps
p clinicians and p
patients make
individualized treatment decisions
 The information base on what
services improve quality
quality, safety and
effectiveness is enhanced
 Consumers play important roles in
d
developing
l i and
d using
i the
h
information as citizens, community
members, participants in policy
deliberations and as patients
Comparative Effectiveness
and the Recovery Act
 The American Recovery and
Reinvestment Act of 2009 includes
$1.1 billion for comparative
effectiveness
ff ti
research:
h
– AHRQ: $300 million
– NIH: $400 million (appropriated to
AHRQ and transferred to NIH)
– Office of the Secretary: $400
$
million
(allocated at the Secretary’s discretion)
www.hhs.gov/recovery
Federal Coordinating
g Council
 Anne Haddix
Haddix, CDC
 Elizabeth Nabel
Nabel, NIH
 Thomas Valuck, CMS
 Jesse Goodman, FDA
 Peter Delany
Delany, SAMHSA
 Michael Marge,
Marge Office on
 Carolyn Clancy, AHRQ
Disability
 Deborah Hopson
Hopson, HRSA
 Neera Tanden,, HHS
 David Hunt, ONC
 Joel Kupersmith, VA
 James Scanlon
Scanlon, HHS
 Michael Kilpatrick,
p
, DoD
 Garth Graham, Office of
 Ezekiel Emanuel, OMB
Minority Health
Other Aspects of
y Act
the Recovery
 Comparative Effectiveness Research conducted with
funds appropriated under the Recovery Act, “shall be
consistent with Departmental policies relating to the
inclusion of women and minorities
minorities.”
 Congress does not intend for the research money to
be used to “mandate
mandate coverage reimbursement or
other policies for any public or private payer.”
 Details about the types of research being funded or
supported must be submitted to Congress every six
months, beginning Nov. 1, 2009
www.hhs.gov/recovery
Meaningful
g Use
 The Recovery Act calls for establishment of
an incentive for providers who become
“meaningful
g users” of electronic health
records
 A Federal Health IT Policy
y Committee
workgroup is developing criteria for a
definition of meaningful use
 The focus: quality outcomes, health status
and cost control
http://healthit.hhs.gov
Meaningful
g Use: AHRQ’s
Q Role
 AHRQ provides Federal partners with the
best available evidence on how proposed
criteria for meaningful
g use might
g help
p to
achieve the ultimate goal of high quality,
high value health care
– AHRQ grantees and contractors have been
significant contributors to the public
di
discussion
i on meaningful
i f l use
– The Agency also participates in internal
Federal discussions about meaningful use
AHRQ’s Role in
Comparative Effectiveness
Using Information to Drive Improvement:
S i tifi IInfrastructure
Scientific
f t t
to
t Support
S
t Reform
R f
Providing information that can be
used on the frontlines of treatment
Helping to make
decisions more
consistent,
transparent and
rational
21st Century
Health Care
Ensuring the effectiveness
data is more widely used
Promoting an open
and collaborative
approach to
comparative
effectiveness
The Effective Health Care
Program at AHRQ
A. Evidence synthesis (EPC program)
–
–
Systematically reviewing, synthesizing, comparing existing
evidence on treatment effectiveness
Identifying relevant knowledge gaps
B. Evidence generation (DEcIDE, CERTs)
–
–
Development of new scientific knowledge to address
knowledge gaps.
Accelerate practical studies
C. Evidence communication/translation
(Eisenberg Center)
–
–
T
Translate
l
evidence
id
iinto iimprovements
Communication of scientific information in plain language
to policymakers, patients, and providers
Transparent Collaborative
Process with New Opportunities
 Expanded infrastructure and capacity for
Comparative Effectiveness Research
 Prospective studies that include under
under-represented populations
 Pushing forward on methods for
Comparative Effectiveness Research
 Increasing
I
i iinvestments
t
t in
i iinnovative
ti
broad dissemination and translation
Moving Forward:
Issues to Consider

Comparative Effectiveness is a useful tool in a
much larger toolkit – it is necessary but not
sufficient

It does
d
nott make
k policy
li or h
health
lth care d
decisions,
i i
tell doctors how to practice medicine or make final
decisions about what kind of treatments insurers
will pay for

It does weigh the evidence and present it in a way
th t helps
that
h l consumers and
d th
their
i d
doctors
t
make
k th
the
best possible decisions about health care choices

It’s
It s also an opportunity to identify what is not
known/areas where research is needed
HSR Perspectives and Priorities
 AHRQ R
Resources & P
Priorities
i ii
 Research Opportunities &
A ti iti
Activities
 Comparative Effectiveness
R
Research:
h Th
The N
New P
Paradigm
di
 Improving Quality & Access
 Q&A
AHRQ’s National Reports on
Quality and Disparities
New Reports
p
Released May
y 9th
 The median annual rate of
change
g for all q
quality
y
measures was 1.4%
– Of 190 measures, 132 (69%)
showed
h
d some iimprovementt
 Some reductions in
disparities of care according
to race, ethnicity, and income
– Disparities persist in health
care quality and access
Quality
Q
y Report:
p
Key
y Findings
g
 Median level of patients receiving needed
care was 59% for core quality measures
 Q
Qualityy improvements
p
spread
p
unevenly
y across
settings of care (hospitals, home care, longlongterm care, ambulatory care)
 Measures of patient safety in the Quality
Report indicate a 1% annual decline
 Need
N d consensus on single
i l core sett off
measures to be used by all payers and
stakeholders to monitor improvement
p
Disparities
p
Report:
p
Key
y Findings
g
 60% of measures of quality are not improving
for Blacks, Asians, American Indians/Alaska
Natives (AI/AN), Hispanics, poor populations;
t d for
trend
f 6 years
 80% of access measures stayed the same or
got worse for Hispanics
 60% of access measures stayed the same or
got worse for Blacks and Asians
 57% of access measures stayed the same or
got worse for p
g
poor p
populations
p
Illinois: Overall Health Care
Quality Performance vs. All States,
O -Year
OneOne
Y
Performance
P f
Change
Ch
Average
Weak
Strong
Very
Weak
Very
Strong
Performance Meter
= Most Recent Year
= Baseline Year
2008 National Healthcare Quality Report, State Snapshots
Illinois Snapshot
p
Measure
% of adult surgery patients who
received prophylactic antibiotics
within 1 hour prior to surgical incision
% of children ages 1919-35 months who
received all recommended vaccines
% of smokers with heart attack who
received smoking cessation
counseling while hospitalized
Performance
Better than
Average
Average
g
Lower than
A
Average
National Healthcare Quality Report, State Snapshots, 2008
Disparities Report: Biggest
Gaps by Population
 Proportion of new AIDS cases was 9
9.4
4 times




as high for Blacks as Whites
Rate of new AIDS cases more than 3 times as
high for Hispanics as for nonnon-Hispanic Whites
AI/AN women more than twice as likely to lack
prenatal care as White women
Asians more likely than Whites to not get
ti l care ffor illness
timely
ill
or iinjury
j
Poor adults more than twice as likely as highhighincome adults not to get timely care for an
illness or injury
Efforts to Address Disparities
Through
g Data,, Research
 Partnerships
p to raise awareness:
– Health Disparities Roundtable (Office of Minority
–
–
–
–
Health, AHRQ, Institute of Medicine)
F d l Collaboration
Federal
C ll b
ti on Health
H lth Disparities
Di
iti
Research (CDC, OMH, AHRQ)
Disparities
p
Reducing
g Advances Project
j
((CDC,,
NCI, ACS, Robert Wood Johnson Foundation,
University of Texas Medical Branch)
CMS Health Disparities Program (OMH,
(OMH NIH
and Administration on Aging)
National Business Group on Health Racial and
Ethnic Health Disparities Advisory Board
(OMH, business, medicine, public health groups)
Moving the Needle
Quality
y Improvement
p
on Q
 Themes emerging from draft
legislation
– New
N
ffocus on USPSTF
– Increased focus on quality
– Comparative Effectiveness
Research and Health IT are
critical
iti l tto any quality
lit
improvement effort
21st Century Health Care:
The Future
 Public
Public--private funding and participation likely a
necessity
 More effort to get better conditional
reimbursement
i b
t study
t d d
designs/protocols
i
/ t
l
 Patients should be engaged as partners at the
local and national levels
 Need to tackle important issues
–
–
–
–
Ethical
When to know when the evidence is sufficient
Transparency
Setting priorities
2009 AHRQ
Q Annual Conference
“Research to Reform:
A hi i
Achieving
H
Health
lth S
System
t
Ch
Change”
”
September 1313-16, 2009
Bethesda North Marriott Convention Center
Bethesda, MD
S
Sessions
i
on topics
t i including
i l di the
th following:
f ll i
- Increased Funding for Comparative Effectiveness
- AHRQ
AHRQ’s
s Rapidly Expanding Health IT Portfolio
- Implementation of Research Findings into Changes
in Practice and Policyy
MARK YOUR CALENDARS!
HSR Perspectives and Priorities
 AHRQ R
Resources & P
Priorities
i ii
 Research Opportunities &
A ti iti
Activities
 Comparative Effectiveness
R
Research:
h Th
The N
New P
Paradigm
di
 Improving Quality & Access
 Q&A