Twenty years ago, two seminal events helped set the nation’s healthcare agenda and formed the legacy of quality improvement that AHRQ carries forth today.
The first was publication in November, 1999 of To Err is Human, the landmark Institute of Medicine report that concluded between 44,000 and 98,000 people die each year from preventable medical errors. The report’s jarring findings helped launch myriad efforts, many led by AHRQ, to end avoidable harms inflicted on American healthcare consumers.
The second event occurred on December 6, 1999, the day that the Healthcare Research and Quality Act became law. That bipartisan legislation, sponsored by Sen. Bill Frist, M.D., (R-TN) with support from Sen. Ted Kennedy (D-MA), Congressman Michael Bilirakis (R-FL), and former Rep. Henry Waxman (D-CA), was signed into law by President Bill Clinton, establishing AHRQ as the lead Federal agency for improving the Nation’s healthcare.
John Eisenberg, M.D., AHRQ’s director at that time, skillfully guided AHRQ as it sponsored new, groundbreaking research into how to make healthcare safer, more affordable, and higher quality. Carolyn Clancy, M.D., Rick Kronick, Ph.D., and Andy Bindman, M.D., all nurtured and extended the legacy that John established.
As we begin to put in place exciting plans for AHRQ’s future initiatives, we are mindful of the agency’s impressive track record. Since 1999, AHRQ has awarded more than $3.1 billion for nearly 3,900 research grants aimed at making care better. The funding has supported more than 3,000 principal investigators at many of the Nation’s premier research institutions. The agency’s data resources have been cited in more than 27,000 peer-reviewed research articles, and AHRQ has published more than 680 research reviews and 770 statistical briefs.
These investments over the last two decades have included groundbreaking work in patient safety, quality improvement, and increasing the value of healthcare services. For instance, AHRQ funded Dr. Peter Pronovost’s efforts to develop and test the Comprehensive Unit-based Safety Program, or CUSP, leading to a 91 percent decline in central line bloodstream infections nationwide between 2010 and 2015. In addition, AHRQ supported Dr. Sanjeev Arora’s first clinic in the Extension for Community Healthcare Outcomes initiative, or Project ECHO, helping primary care doctors across the country treat rural and underserved patients. Further, the Agency also funded Dr. Brian Jack’s Re-Engineered Discharge Toolkit, providing a standardized approach for ensuring that patients receive follow-up primary care appointments after hospital discharge.
But, like other organizations in healthcare, we recognize that the agency is at a crossroads. The healthcare landscape is changing—the way it’s delivered, paid for, and regulated. The population is aging. Mergers, acquisitions, and consolidations are accelerating. Networked medical devices are proliferating. And we are witnesses to a digital revolution that is upending the volume, variety, and velocity of healthcare data.
Given these realities, we at AHRQ have asked ourselves: What is our posture for the future? How can we advance President Trump’s directive to improve the quality of care that patients receive and enhance patients’ ability to make fully informed decisions about their care? How can we best support the vision articulated by Department of Health and Human Services Secretary Alex Azar, whose commitment to protecting the health and well-being of all Americans is reflected in his priority to bring greater value to healthcare?
These are timely questions that speak to critical needs. An estimated 275 million Americans receive healthcare services of some kind each year. Plus, we spend more than $2.5 trillion on the delivery of health services. Within that care delivery continuum, there are many pain points and unmet needs that must be resolved.
The grand challenge before us is to identify how the agency can position itself to react and contribute to a rapidly changing healthcare ecosystem.
As AHRQ moves into its third decade, we can make the greatest difference by ensuring that research on cures are translated into improving care. Fundamental to our work is the belief that cure and care are two sides of the same coin. While science and research for cures is needed, science, research and implementation for improving delivery of care is imperative.
After spending the last 18 months listening to patients, systems leaders, researchers, policymakers, and other stakeholders, we have identified the following three challenges that are front and center in the minds of healthcare experts, and which require long-term strategies to address.
Improving care for Americans living with multiple chronic conditions (MCC)
More than 25 percent of Americans live with MCCs, including 80 percent of Medicare beneficiaries. Care for these patients is often fragmented, leading to poor outcomes and increased costs. We stand ready to support a multifaceted initiative designed to augment primary care and leverage AHRQ’s core competencies in health systems research, practice improvement, and data and analytics.
Providing data and analytics to policymakers to empower informed decision making
Many policymakers still make decisions based largely on expert opinion rather than tapping into the explosive potential of new data resources and analytic strategies. We plan to transform the delivery of vital information by establishing an integrated data and analytics platform, one to help Federal, State, and local policymakers get access to timely and accurate data and analytic resources to make informed policy decisions. Central to this effort will be continued expansion of AHRQ’s premier data resources—the Medical Expenditure Panel Survey and the Healthcare Cost and Utilization Project.
Reducing diagnostic errors
An estimated 12 million people per year are affected by diagnostic errors, including 4 million suffering serious harm. Research suggests the cost to the U.S. healthcare system exceeds $100 billion annually. Our initial work should focus on the three largest areas of diagnostic errors: cancer, vascular conditions, and infections.
In coming weeks, as we move closer to AHRQ’s 20th anniversary, we’ll be revisiting some of AHRQ’s most important contributions to healthcare improvement. But, more important, my colleagues and I will be sharing how those achievements have positioned the agency to make an even greater impact in the future.
We live in the digital age, a time when Americans expect—and deserve—“21st Century Care.” As we look ahead, AHRQ fully intends to be a driving force behind future innovations that provide healthcare that’s safer, higher quality, and of greater value to all Americans. Exciting times are ahead!
This article was originally published on AHRQ Views Blog and is republished here with permission.