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Appendix 3. Linkage to HHS Strategic Plan
AHRQ is guided by and supports the strategic plan goals of the Department of Health and Human Services (HHS).
The Agency's activities contribute to five of the six HHS goals:
HHS Goal 2: Improve the Economic and Social Well-Being of Individuals, Families, and Communities in the United States—for example, through the Agency's research on children's health.
HHS Goal 3: Improve Access to Health Services and Assure the Integrity of the Nation's Health Entitlement and Safety Net Programs—for example, through the activities of the Agency's Center for Primary Care Research.
HHS Goal 4: Improve the Quality of Health Care and Human Services—for example, through numerous Agency activities including quality measurement research and data development.
HHS Goal 5: Improve the Public Health System—for example, through the Agency's data development and monitoring activities and investments.
HHS Goal 6: Strengthen the Nation's Health Sciences Research Enterprise and Enhance Its Productivity—for example, through the Agency's research, data development, translation, and dissemination activities
A detailed summary of AHRQ's contributions to the HHS strategic plan follows. However, the Agency's contributions to Goals 4 and 6 are of particular note.
AHRQ is the Department's lead Agency for health care quality activities and is a major contributor to HHS Goal 4. Research on the determinants of health care quality, effective and cost effective ways to improve health care quality, and how to measure health care quality will be instrumental in achieving success in the goal's objectives. Additionally, the new information developed, and then implemented in the health care system, from research on outcomes and effectiveness of care, as well as access to, cost, and use of health care, will help close the gaps between what we know and what we need to know, on the one hand, and what we know and what we do in health care, on the other hand. AHRQ also supports HHS Goal 4 through leadership of the Secretary's quality initiative, support of the Quality Interagency Task Force, contributions to the HHS Race and Health Disparities Initiative, and close working relationships with other HHS Agencies and the Office of the Secretary.
Within Goal 6, AHRQ's expanding portfolio in outcomes and effectiveness, quality, primary care, and other practice-based research, as well as extramural and intramural studies of issues pertaining to access, cost, organization, and delivery of health care, will contribute to achieving HHS Objective 6.4. Additionally, AHRQ's substantial investment in the development of data bases will enable others to perform research and analyses to answer questions critical to understanding the dynamics of the health care system.
AHRQ maintains its commitment to building the infrastructure needed to continue to conduct high-quality, cutting-edge health care research for the next century through national training programs (including the National Research Service Awards program), service fellows and summer intern programs, mentoring programs, and the provision of technical assistance to a variety of its audiences. AHRQ will continue to support and expand efforts to attract trainees from racial and ethnic minorities into the field of health services research. These activities are aligned with Objective 6.6.
For the Nation's investment in research to reach its full potential, the results must be widely disseminated (Objective 6.7) and implemented. The AHRQ Cycle of Research presented in this plan illustrates the important role that dissemination will play in all areas of activity within the Agency. This focus aligns with Objective 6.7.
Examples of AHRQ's Contributions to the HHS Strategic Plan
HHS Goal 2: Improve the Economic and Social Well-Being of Individuals, Families, and Communities in the United States
HHS Objective 2.5: Increase Opportunities for Seniors to Have an Active and Healthy Aging Experience
HHS Objective 2.6: Expand Access to Consumer-Directed, Home and Community-Based Long-term Care and Health Services
AHRQ will conduct research in areas relevant to improving the aging experience in such areas as:
- Conditions of particular importance to the Medicaid population.
- Quality measurement issues and tool development for institutional settings.
In Fiscal Year 2001, AHRQ will support important new initiative to improve the knowledge and tools to improve health care quality for Older Americans and optimize their functional outcomes.
HHS Goal 3: Improve Access to Health Services and Assure the Integrity of the Nation's Health Entitlement and Safety Net Programs
HHS Objective 3.2: Increase the Availability of Primary Health Care Services
To test the effectiveness of health care improvement approaches, AHRQ will study such topics as:
- The implementation of evidence-based information in diverse health care settings to determine effective strategies for enhancing practitioner behavior change and improving patient behavior, knowledge and satisfaction.
- The factors which determine the success of quality improvement strategies and to what extent these vary by the nature of the problem addressed and the target population.
- The factors which influence access to primary care services, and transitions between primary and specialty services.
Projects to evaluate the impact of managed care will constitute a systematic effort to determine the impact of managed care and other changes in the organization of care on health care quality; outcomes; and cost, use and access.
HHS Objective 3.3: Improve Access to and the Effectiveness of Health Care Services for Persons with Specific Needs
AHRQ will examine how various clinical and system characteristics affect the health outcomes, quality access, and satisfaction, for the elderly and chronically ill. In Fiscal Year 2001, added emphasis will be given to research and tool development to improve care for persons with chronic conditions, including mental health conditions, and disabilities.
HHS Objective 3.4: Protect and Improve Beneficiary Health and Satisfaction with Medicare and Medicaid
AHRQ activities supporting Medicare and Medicaid beneficiaries will include:
- Research on conditions that are common, costly, and for which there is substantial variation in practice, conditions that represent major Medicare or Medicaid expenditures.
- Providing objective, science-based, timely information to health care decisionmakers—patients and clinicians, health system leaders, and policymakers.
- Health care surveys, such as CAHPS® and MEPS, that provide information supporting health plan choices and coverage decisions.
- New tools to assist beneficiaries to choose the most appropriate care for their needs.
- New tools to measure and improve quality of life for Medicare and Medicaid beneficiaries; and 4) studying the national impact public programs on access and cost of care for children.
HHS Goal 4: Improve the Quality of Health Care and Human Services
HHS Objective 4.1: Promote the Appropriate Use of Effective Health Services
AHRQ is implementing a growing portfolio of evaluations that will show over time the outcomes of the investments of Agency funds. The Agency will evaluate the use and usability of the Medical Expenditure Panel Survey (MEPS) databases for their intended purposes. Other evaluations will assess:
- Evidence reports and technology assessments of evidence-based practice centers.
- Products that advance methods to measure and improve health-care quality, including clinical quality improvement software (CONQUEST), the Consumer Assessment of Health Plans survey, and the Expansion of Quality of Care Measures project (Q-SPAN).
In Fiscal Year 2001, added emphasis will be placed on developing the tools, systems, and partnerships that enable quality improvement strategies to be effective in diverse settings, including public providers.
HHS Objective 4.2: Reduce Disparities in the Receipt of Quality Health Care Services
AHRQ will expand its commitment to conducting health services research that will help reduce disparities that exist for racial and ethnic minorities. In particular, the Agency will sponsor research to understand the contribution that racial discrimination makes to existing patterns of care for minority Americans. The Agency will also focus on building infrastructure for relevant research by training minority and other investigators to address issues for minority populations.
HHS Objective 4.3: Increase Consumers Understanding of Their Health Care Options
The Consumer Assessment of Health Plans (CAHPS®) is a tool for surveying members of health plans about their experience with and assessment of the quality of health care they receive, and for reporting the results to other consumers who are choosing a plan. AHRQ will continue its efforts to enhance CAHPS® and evaluate its use. In Fiscal Year 2001, additional research will be sponsored to better understand how consumers use quality information.
HHS Goal 5: Improve the Public Health System
HHS Objective 5.1: Improve the Public Health Systems' Capacity to Monitor The Health Status and Identify Threats to the Health of the Nation's Population
AHRQ will develop a fully integrated strategy to create the national capacity to monitor the quality of care, particularly for populations of national interest, including the chronically ill, poor, racial/ethnic minorities, and children. This includes an increase in the scope of the Medical Expenditure Panel Survey (MEPS) and partnerships with other Federal Agencies and the private sector.
AHRQ will complete the redesign and expansion of the Healthcare Cost and Utilization Project (HCUP) that will provide State and community decisionmakers a powerful set of linked databases they can use to:
- Monitor the impact of major system changes on access, quality, outcomes and cost in their states and communities.
- Compare these against the progress of other states and communities.
AHRQ will build on past investments in tool development by focusing on expanding the toolbox. These tools will enable purchasers, policymakers, health plans, providers, and patients to improve care.
Goal 6: Strengthen the Nation's Health Sciences Research Enterprise and Enhance Its Productivity
HHS Objective 6.2: Improve the Prevention, Diagnosis, and Treatment of Disease and Disability
AHRQ will fund research on the prevention of functional decline in the elderly, the quality of clinical preventive services, and the prevention of medication and other medical errors.
HHS Objective 6.4: Increase the Understanding of and Response to the Major Issues Related to the Quality, Financing, Cost, and Cost-Effectiveness of Health Care Services
There are many gaps in knowledge in all areas of health care. New questions emerge as:
- New technologies are developed.
- The population's demographics change.
- Areas of inquiry previously under-emphasized take on greater importance.
- Research previously undertaken identifies further areas that need attention.
Therefore, AHRQ will continue to focus on creating new knowledge and assessing the findings that result from completed projects.
HHS Objective 6.6: Improve the Quality of Medical and Health Science Research by Strengthening the Base of Highly Qualified Scientific Investigators
AHRQ will invest in a number of programs to further the training of health services researchers to address the research and analytic needs of the changing health care system. These priorities will build on prior efforts to make both curricula and practical research experiences more relevant to decision makers' concerns about the effectiveness of health care and issues of cost, quality, and access. In addition, an added emphasis is being made on increasing the number of minority investigators at both majority and minority institutions.
HHS Objective 6.7: Ensure That Research Results Are Effectively Communicated to the Public, Practitioners, and the Scientific Community
Building on the previous 10 years of research findings, AHRQ will identify ongoing gaps between what we know now and what we do in health care and will begin to close those gaps through research and demonstrations that develop and test implementation strategies in different settings in the health care system. A major focus within this is identifying existing implementation strategies in use in health care settings and demonstrating their applicability to wide spread dissemination in other areas of the system.
AHRQ places considerable focus on developing tools and products that facilitate the transfer of research findings into practice. The Agency has a well-developed dissemination system that includes publications development, the Publications Clearinghouse, and an award-winning Web site. This emphasis is critical to the Agency's success. Ongoing plans include incorporating regular customer feedback into our operations to continue to improve our efforts.
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Appendix 4. Performance Measurement Linkages with Budget, Cost Accounting, Information Technology Planning, Capital Planning and Program Evaluation
The performance goals and measures are linked directly to two of the Agency's three budget lines. As described previously, the budget line for Research on Health Care Costs, Quality, and Outcomes has five of the six performance plan goals tied to it. The budget line for the Medical Panel Expenditure Survey is represented in the sixth goal. The Introduction to Part 2 of this document describes these alignments in detail.
The third budget line, Program Support, has been removed from the performance goals in the AHRQ performance plan. The measures previously reported for Program Support focused on internal management issues for contracts management and information system development. We are dropping the measures because they do not rise to the level of being one of the "critical few" measures that should be reported by the Agency in the GPRA plan. The measures continue to be important, however, and remain in place for internal accountability in the Office of Management Operations Plan and performance plans for the managers and staff.
This year the Agency has provided, both in the body of the performance plan and in the table in the Summary, to crosswalk the specific measures that are related to the new initiatives proposed in the budget document. Many of the measures are for projects and initiatives that were started in past years and are continuing. This has been noted by identifying the budget connection as "Commitment Base."
AHRQ allocates the full cost of all associated research activities, including overhead costs, by our three budget activities: Research on Health Costs, Quality and Outcomes; Medical Expenditure Panel Survey; and Program Support.
Information, Technology, Planning
AHRQ is currently completing the infrastructure for a new integrated information system, the Agency Management Information System (AMIS). The goal of AMIS is to provide access to an integrated set of project information that includes the information currently input through multiple systems. When the AMIS is fully operational, all Agency staff will have on-demand access to current information for the entire AHRQ research grant, contract, intramural project, and IAA portfolio. This system is one of the major methods the Agency will use to collect data to document its success in meeting its GPRA goals.
Does not apply to AHRQ.
Goal 4 in the AHRQ annual performance plan is devoted to reporting the evaluations that the Agency will do in Fiscal Year 2001. The evaluations are focused on demonstrating the use of Agency research and products and the resulting impact on organizations within the health care system. The focus in Fiscal Year 2001 are the Evidence-based Practice Centers, the National Guideline Clearinghouse™, research findings, quality measurements, and Agency-sponsored training programs. Each represent significant investments of Agency resources and are expected to be in wide use throughout the health care system in Fiscal Year 2001.
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Proceed to Appendix 5