Agency for Healthcare Research and Quality

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The Agency for Healthcare Research and Quality [1] (AHRQ; pronounced "ark" by initiates and often "A-H-R-Q" by the public) is 1 of 12 agencies within the United States Department of Health and Human Services (HHS). [2] The agency is headquartered in North Bethesda, Maryland, a suburb of Washington, D.C. (with a Rockville mailing address). It was established as the Agency for Health Care Policy and Research (AHCPR) as a constituent unit of the Public Health Service (PHS) under the Omnibus Budget Reconciliation Act of 1989 (103 Stat. 2159), December 19, 1989, to enhance the quality, appropriateness, and effectiveness of health care services and access to care by conducting and supporting research, demonstration projects, and evaluations; developing guidelines; and disseminating information on health care services and delivery systems.

United States Department of Health and Human Services Department of the US federal government

The United States Department of Health & Human Services (HHS), also known as the Health Department, is a cabinet-level department of the U.S. federal government with the goal of protecting the health of all Americans and providing essential human services. Its motto is "Improving the health, safety, and well-being of America". Before the separate federal Department of Education was created in 1979, it was called the Department of Health, Education, and Welfare (HEW).

North Bethesda, Maryland Census-designated place in Maryland, United States

North Bethesda is an unincorporated, census-designated place in Montgomery County, Maryland, United States, located just north-west of the U.S. capital of Washington, D.C. Among its 14 neighborhoods, the centrally-located, urbanizing district of White Flint is the commercial and residential hub of North Bethesda. The WMATA White Flint metro station and Grosvenor-Strathmore metro station serve the region. Four of the National Institutes of Health as well other federal agencies, including the Nuclear Regulatory Commission, the Health Resources and Services Administration, and the United States Public Health Service Commissioned Corps, are headquartered in North Bethesda. A number of corporate headquarters are headquartered in North Bethesda, as well as nonprofits such as the American Kidney Fund, the Society of American Foresters and United States Pharmacopeia (USP).

Washington, D.C. Capital of the United States

Washington, D.C., formally the District of Columbia and commonly referred to as Washington or D.C., is the capital of the United States. Founded after the American Revolution as the seat of government of the newly independent country, Washington was named after George Washington, the first president of the United States and a Founding Father. As the seat of the United States federal government and several international organizations, Washington is an important world political capital. The city, located on the Potomac River bordering Maryland and Virginia, is one of the most visited cities in the world, with more than 20 million tourists annually.

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However, AHCPR became controversial when it produced several guidelines that some thought would reduce medical drugs and procedures. This included concern from ophthalmologists on a cataract guideline and concern by the pharmaceutical industry over a reduction in the use of new drugs. When the agency produced a guideline that concluded that back pain surgery was unnecessary and potentially harmful, a lobbying campaign aided by Congressmen whose backs had been operated on changed the name of the agency and scaled back the guidelines program, which now exists as the National Guideline Clearinghouse. [3] AHCPR was reauthorized December 6, 1999, for Healthcare Research and Quality (AHRQ) under the Healthcare Research and Quality Act of 1999, [2] which amended Title IX of the Public Health Service Act (42 U.S.C. 299 et seq).

Ophthalmology Field of medicine treating eye disorders

Ophthalmology is a branch of medicine and surgery which deals with the diagnosis and treatment of eye disorders. An ophthalmologist is a specialist in ophthalmology. The credentials include a degree in medicine, followed by additional four to five years of ophthalmology residency training. Ophthalmology residency training programs may require a one year pre-residency training in internal medicine, pediatrics, or general surgery. Additional specialty training may be sought in a particular aspect of eye pathology. Ophthalmologists are allowed to use medications to treat eye diseases, implement laser therapy, and perform surgery when needed. Ophthalmologists may participate in academic research on the diagnosis and treatment for eye disorders.

National Guideline Clearinghouse (NGC) is a database of evidence-based clinical practice guidelines and related documents. As of July 2, 2018, it will no longer be updated with new content, and it will no longer be available online as of July 18, 2018. As stated on its announcement page on June 18, 2018, federal funding is no longer available for it but other stakeholders are currently exploring options for hosting it. Should that happen, it will return to the web.

History

During its early years, the Agency for Healthcare Policy and Research implemented large multidisciplinary, multi-institutional projects that focused on patient results in certain medical conditions in an effort to improve clinical practice. This has included basic health IT research, patient safety research on wrong site surgery, medical teamwork, and hospital acquired conditions such as MRSA and VRE.

Information technology (IT) is the use of computers to store, retrieve, transmit, and manipulate data, or information, often in the context of a business or other enterprise. IT is considered to be a subset of information and communications technology (ICT). An information technology system is generally an information system, a communications system or, more specifically speaking, a computer system – including all hardware, software and peripheral equipment – operated by a limited group of users.

Methicillin-resistant <i>Staphylococcus aureus</i> bacterium responsible for difficult-to-treat infections in humans

Methicillin-resistant Staphylococcus aureus (MRSA) refers to a group of Gram-positive bacteria that are genetically distinct from other strains of Staphylococcus aureus. MRSA is responsible for several difficult-to-treat infections in humans. MRSA is any strain of S. aureus that has developed, through horizontal gene transfer and natural selection, multiple drug resistance to beta-lactam antibiotics. β-lactam antibiotics are a broad-spectrum group that include some penams and cephems such as the cephalosporins. Strains unable to resist these antibiotics are classified as methicillin-susceptible S. aureus, or MSSA.

Vancomycin-resistant <i>Enterococcus</i> Bacterial strains of Enterococcus that are resistant to the antibiotic vancomycin

Vancomycin-resistant Enterococcus, or vancomycin-resistant enterococci (VRE), are bacterial strains of the genus Enterococcus that are resistant to the antibiotic vancomycin.

Funding

The Trump administration proposes to merge the Agency for Healthcare Research and Quality with the National Institutes of Health. The President's FY 2018 Request to Congress for the Agency was for $378.5 million.

The 2015 budget for AHRQ is US$440 million, [4] $24 million less than FY 2014. Within this total, the budget includes $334 million in Public Health Service (PHS) Evaluation Funds, a decrease of $30 million from FY 2014, and $106 million from the Patient-Centered Outcomes Research Trust Fund, an increase of $13 million above FY 2014.

The FY 2015 budget is intended to ensure the Agency continues its progress on health services research to improve outcomes, affordability, and quality. The budget also supports the collection of information on health care spending and use through the Healthcare Cost and Utilization Project (HCUP) and Medical Expenditure Panel Survey (MEPS).

The FY 2015 budget provides $73 million, an increase of $1 million from FY 2014, for AHRQ's patient safety research and dissemination projects that prevent, mitigate, and decrease the number of medical errors, patient safety risks and hazards, and quality gaps. The budget includes $23 million, a $6 million decrease from FY 2014, for health information technology (health IT) research, and the development and dissemination of evidence and evidence-based tools to inform policy and practice on how health IT can improve the quality of American health care. In FY 2015, AHRQ will provide $20 million to support 40 grants for foundational health IT research to inform and support the meaningful use of health IT.

In July 2018, the National Guideline Clearinghouse (NGC) and the National Quality Measures Clearinghouse (NQMC), [5] two longtime online resources from the AHRQ, were shut down because federal funding ceased to be available to them. [6] [7] [8] [9] Other stakeholders were exploring options for hosting the NGC [10] ]; should that happen, it will return to the web.

Leadership

Gopal Khanna, MBA was appointed as Agency director on May 9, 2017. Prior to that, Dr. Andrew Bindman was the director of AHRQ from April 2016 until January 2017. Prior to joining AHRQ, Dr. Bindman served as faculty of UCSF School of Medicine. [11] Sharon Arnold Ph.D. was acting director from February - April 2016, replacing Richard Kronick in February 2016. Richard Kronick, Ph.D. was director from 2013 to March 2016. Carolyn Clancy M.D. was the director from 2002- 2014.

Divisions

The Agency has multiple offices and centers including the Center for Evidence and Practice Improvement (CEPI), the Center for Financing, Access and Trends, the Center for Delivery, Organization and Markets, the Center for Quality and Patient Safety, the Office of Management Services, the Office of Extramural Research and Priority Populations, and the Office of Communications. The Office of Communications was previously known as the Office of Communications and Knowledge Transfer. [12]

Within CEPI, the Evidence-Based Practice Centers [13] (EPCs) develop evidence reports and technology assessments on topics relevant to clinical and other health care organization and delivery issues—specifically those that are common, expensive, and/or significant for the Medicare and Medicaid populations. With this program, AHRQ serves as a "science partner" with private and public organizations in their efforts to improve the quality, effectiveness, and appropriateness of health care by synthesizing the evidence and facilitating the translation of evidence-based research findings. Topics are nominated by Federal and non-Federal partners such as professional societies, health plans, insurers, employers, and patient groups. [14]

Related Research Articles

Evidence-based medicine (EBM) is an approach to medical practice intended to optimize decision-making by emphasizing the use of evidence from well-designed and well-conducted research. Although all medicine based on science has some degree of empirical support, EBM goes further, classifying evidence by its epistemologic strength and requiring that only the strongest types can yield strong recommendations; weaker types can yield only weak recommendations. The term was originally used to describe an approach to teaching the practice of medicine and improving decisions by individual physicians about individual patients. Use of the term rapidly expanded to include a previously described approach that emphasized the use of evidence in the design of guidelines and policies that apply to groups of patients and populations. It has subsequently spread to describe an approach to decision-making that is used at virtually every level of health care as well as other fields.

Medical guideline A document with the aim of guiding decisions and criteria regarding diagnosis, management, and treatment in specific areas of healthcare.

A medical guideline is a document with the aim of guiding decisions and criteria regarding diagnosis, management, and treatment in specific areas of healthcare. Such documents have been in use for thousands of years during the entire history of medicine. However, in contrast to previous approaches, which were often based on tradition or authority, modern medical guidelines are based on an examination of current evidence within the paradigm of evidence-based medicine. They usually include summarized consensus statements on best practice in healthcare. A healthcare provider is obliged to know the medical guidelines of his or her profession, and has to decide whether to follow the recommendations of a guideline for an individual treatment.

The American College of Radiology (ACR), founded in 1923, is a professional medical society representing more than 38,000 diagnostic radiologists, radiation oncologists, interventional radiologists, nuclear medicine physicians and medical physicists.

Patient safety

Patient safety is a discipline and responsibility that emphasizes safety in health care through the prevention, reduction, reporting, and analysis of medical error that often leads to adverse effects. The frequency and magnitude of avoidable adverse events experienced by patients was not well known until the 1990s, when multiple countries reported staggering numbers of patients harmed and killed by medical errors. Recognizing that healthcare errors impact 1 in every 10 patients around the world, the World Health Organization calls patient safety an endemic concern. Indeed, patient safety has emerged as a distinct healthcare discipline supported by an immature yet developing scientific framework. There is a significant transdisciplinary body of theoretical and research literature that informs the science of patient safety. At the same time, efforts are being made to anchor patient safety more firmly in medical education. The resulting patient safety knowledge continually informs improvement efforts such as: applying lessons learned from business and industry, adopting innovative technologies, educating providers and consumers, enhancing error reporting systems, and developing new economic incentives.

A patient safety organization (PSO) is a group, institution or association that improves medical care by reducing medical errors. In the 1990s, reports in several countries revealed a staggering number of patient injuries and deaths each year due to avoidable adverse health care events. In the United States, the Institute of Medicine report (1999) called for a broad national effort to include the establishment of patient safety centers, expanded reporting of adverse events and development of safety programs in health care organizations. The organizations that developed ranged from governmental to private, and some founded by industry, professional or consumer groups. Common functions of patient safety organizations are data collection and analysis, reporting, education, funding and advocacy.

In 2004, the Agency for Healthcare Research and Quality of the United States Department of Health and Human Services created the AHRQ National Resource Center for Health Information Technology to support over 125 federal grants and contracts that are demonstrating the value and implementation of information technology in health care.

The medical home, also known as the patient-centered medical home (PCMH), is a team-based health care delivery model led by a health care provider to provide comprehensive and continuous medical care to patients with a goal to obtain maximal health outcomes. It is described in the "Joint Principles" as "an approach to providing comprehensive primary care for children, youth and adults."

Health services research (HSR) became a burgeoning field in North America in the 1960's, when scientific information and policy deliberation began to coalesce. Also known as health systems research or health policy and systems research (HPSR), is a multidisciplinary scientific field that examines how people get access to health care practitioners and health care services, how much care costs, and what happens to patients as a result of this care. Health Services Research utilizes all qualitative and quantitative methods across the board to ask questions of the healthcare system. It focuses on performance, quality, effectiveness and efficiency of health care services as they relate to health problems of individuals and populations, as well as health care systems. Health Services Research addresses wide-ranging topics of structure, processes, and organization of health care services; their use and people’s access to services; efficiency and effectiveness of health care services; the quality of healthcare services and its relationship to health status, and; the uses of medical knowledge.

German Agency for Quality in Medicine organization

The German Agency for Quality in Medicine (AEZQ) - in German "Ärztliches Zentrum für Qualität in der Medizin (ÄZQ)", established in 1995 and located in Berlin, co-ordinates healthcare quality programmes with special focus on evidence-based medicine, medical guidelines, patient empowerment, patient safety programs, and quality management.

Günter Ollenschläger German physician and medical editor

Günter Ollenschläger is a German physician, medical editor, and professor of internal medicine and clinical decision making at the University of Cologne, Faculty of Medicine.

ECRI Institute organization

ECRI Institute is an independent nonprofit organization authority on the medical practices and products that provide the safest, most cost-effective care.

Collaborative Care is a healthcare philosophy and movement that has many names, models, and definitions that often includes the provision of mental health, behavioral health and substance use services in primary care. Similar ideas include: Integrated care, Primary Care Behavioral Health, Integrated care systems, and shared care.

Integrated care, also known as integrated health, coordinated care, comprehensive care, seamless care, or transmural care, is a worldwide trend in health care reforms and new organizational arrangements focusing on more coordinated and integrated forms of care provision. Integrated care may be seen as a response to the fragmented delivery of health and social services being an acknowledged problem in many health systems.

The U.S. Agency for Healthcare Research and Quality (AHRQ) created the Health Care Innovations Exchange to speed the implementation of new and better ways of delivering health care and reducing health disparities nationwide. The AHRQ Health Care Innovations Exchange offers health care professionals and researchers opportunities for sharing, learning about, and adopting evidence-based innovations and tools suitable for health care settings and patient populations. Each of the innovation profiles on the site contains an evidence rating that describes how strong the relationship is between the innovation and the reported results.

Patient-centered outcomes are results of health care that can be obtained from a healthcare professional's ability to care for their patients and their patient's families in ways that are meaningful, valuable and helpful to the patient. Patient-centered outcomes focus attention on a patient's beliefs, opinions, and needs in conjunction with a physician's medical expertise and assessment. In the United States, the growth of the healthcare industry has put pressure on providers to see more patients in less time, fill out paperwork in a timely manner, and stay current on the ever-changing medical advancements that occur daily. This increased pressure on healthcare workers has put stress on the provider-patient relationship. The Patient-Centered Outcomes Research Institute (PCORI) is a United States Government funded research institute that funds studies that compare healthcare options to find out what options and situations work best for patients of different circumstances. PCORI uses their research to increase the quality of healthcare and push the healthcare system towards a more patient-centered approach. The Beryl Institute, a non-profit institute dedicated to the improvement of patient experience through Evidence-based research, released data that found that over 90% of patients believe patient-centered outcomes to be "extremely important" to their healthcare experience. Individuals that participated in this study by the Beryl Institute claimed that the aspects of healthcare that they see as most influential to their healthcare experience include effective communication, pain management, a clear and well-explained plan of care and a clean and comfortable environment. In addition to this data, women were found to have the largest issues with lack of patient-centered care, reporting higher rates of pain and less empathy than men.

Consumer Assessment of Healthcare Providers and Systems (CAHPS) refers to a set of surveys that ask patients to report on their health care experiences. The surveys are available in the public domain and focus on healthcare quality aspects that patients find important and are well equipped to assess.

Health care quality is a level of value provided by any health care resource, as determined by some measurement. As with quality in other fields, it is an assessment of whether something is good enough and whether it is suitable for its purpose. The goal of health care is to provide medical resources of high quality to all who need them; that is, to ensure good quality of life, cure illnesses when possible, to extend life expectancy, and so on. Researchers use a variety of quality measures to attempt to determine health care quality, including counts of a therapy's reduction or lessening of diseases identified by medical diagnosis, a decrease in the number of risk factors which people have following preventive care, or a survey of health indicators in a population who are accessing certain kinds of care.

The Comparative Effectiveness Research Translation Network (CERTAIN) is a learning healthcare system in Washington State focused on patient-centered outcomes research (PCOR) and comparative effectiveness research (CER), leveraging existing healthcare data for research and healthcare improvement, incorporating patient and other healthcare stakeholder voices into research, and facilitating dissemination and implementation of research evidence into clinical practice.

Richard Gray Kronick is an American health policy researcher and professor of family and preventive medicine at the University of California, San Diego (UCSD), where he is also an adjunct professor of political science.

References

  1. "Agency for Healthcare Research and Quality home page". United States Department of Health and Human Services.
  2. 1 2 "Healthcare Research and Quality Act of 1999". Agency for Healthcare Research and Quality. United States Department of Health and Human Services.
  3. Avorn J. Powerful Medicines: The Benefits, Risks, and Costs of Prescription Drugs, pp. 277–288. Random House.
  4. 2015 Department of Health and Human Services Budget-in-Brief Archived 2014-07-23 at the Wayback Machine , pg 10, United States Department of Health and Human Services, Accessed 2015-07-14
  5. "National Quality Measures Clearinghouse (NQMC)". Ahrq.gov. Retrieved 26 November 2018.
  6. "AHRQ: National Guideline Clearinghouse to Shut Down July 16". Aafp.org. Retrieved 26 November 2018.
  7. "HHS eliminates 20 years of evidence-based medical guidelines". Healthcareitnews.com. 12 July 2018. Retrieved 26 November 2018.
  8. "Federal clinical guidance database to shut down because of funding cuts". Healthdatamanagement.com. Retrieved 26 November 2018.
  9. "HIT programs at risk as AHRQ faces elimination". Healthdatamanagement.com. Retrieved 26 November 2018.
  10. "AHRQ Shutters Guideline Site, But ECRI to Carry the Torch". Medpagetoday.com. 20 July 2018. Retrieved 26 November 2018.
  11. "Archived copy". Archived from the original on 2016-06-30. Retrieved 2016-05-24.CS1 maint: archived copy as title (link)
  12. "Statement of Organization, Functions, and Delegations of Authority". federalregister.gov. 15 April 2016.
  13. "Archived copy". Archived from the original on 2016-05-23. Retrieved 2016-05-24.CS1 maint: archived copy as title (link)
  14. "Evidence-based Practice Centers (EPC) Program Overview". Agency for Healthcare Research and Quality. Retrieved 29 April 2016.PD-icon.svgThis article incorporates text from this source, which is in the public domain.