Creating an Integrated Framework for Reducing Disparities in Health Care Quality Francis D. Chesley, Jr., MD Director Office of Extramural Research, Education.

Creating an Integrated Framework for Reducing Disparities in Health Care

Quality

Francis D. Chesley, Jr., MD

Director

Office of Extramural Research, Education and Priority PopulationsAHRQ Annual Conference

September 28, 2010

The Change/Evolution of AHRQ

1989 1995

FY 1990 Budget:

$97 million

2000 2005

AHRQ begins

sponsorship of U.S.

Preventive Services

Task Force activities

Agency for Health Care Policy and Research

(AHCPR) is established

Recovery Act

Funding in 2009: $300

million to AHRQ

2010

President’s FY 2011 AHRQ budget

proposal: $611

million

1998

FY 1995 Budget:

$154 million

“Near-death experience”

AHCPR becomes the Agency for Healthcare Research

and Quality (AHRQ)

Effective Health Care

(EHC) Program created

FY 2003 Budget: $318.7 million

FY 2010 Budget:

$397 million

EHC Program launched, includes

dissemination and application function by the

Eisenberg Center

Setting the Context

The Healthcare Research and Quality Act of 1999 directed AHRQ to conduct and support research with respect to the delivery of health care for Priority Populations

AHRQ published its Priority Population Inclusion Policy in February 2003

Established an AHRQ functional unit to assist in carrying out policy requirements

AHRQ Priority Populations

Inner city and rural areas (including frontier areas)

Low income groups Racial and ethnic minority groups Women and children The elderly Individuals with special health care needs,

including individuals with disabilities and those who need chronic care or end-of-life health care

The Policy

Provides one of the cornerstones for studying and eliminating health care disparities

Intended to ensure inclusion in AHRQ’s overall portfolio of research

Intended to foster inclusion such that research designs explicitly allow for valid analyses – including subgroup analyses where relevant

Investigators should consider inclusion of one or more priority populations

The Policy (cont)

Encourages development of specific outreach plans to reach participant recruitment goals

Encourages subgroup analyses to provide specific research results relevant to one or more priority population

Requires explicit justification of exclusion, such as inappropriate with respect to the health of subjects or purpose of research

Inclusion in Real Time

Core Business– Knowledge Creation– Synthesis & Dissemination– Implementation & Use

Measurement Data Training & Research Infrastructure Research Portfolios

AHRQ Portfolios

Value– Goal: Support the

development of health care activities that help reduce unnecessary waste while improving quality

Innovations/Emerging Issues– Goal: Identify and support

ideas and projects that have the potential for highly innovative solutions to health care challenges

Value

Prevention and Care Management

Comparative Effectiveness

Innovations/Emerging Issues

Patient Safety

Health IT

AHRQ

AHRQ Priorities

Effective HealthCare Program

Medical ExpenditurePanel Surveys

AmbulatoryPatient Safety

Patient Safety

Health IT Patient Safety

Organizations New Patient

Safety Grants Comparative Effectiveness Reviews

Comparative Effectiveness Research

Clear Findings for Multiple Audiences

Quality & Cost-Effectiveness, e.g.Prevention and PharmaceuticalOutcomes

U.S. Preventive ServicesTask Force

MRSA/HAIs

Visit-Level Information on Medical Expenditures

Annual Quality & Disparities Reports

Safety & Quality Measures,Drug Management andPatient-Centered Care

Patient Safety ImprovementCorps

Other Research & Dissemination Activities

Lessons Learned

Common application statement – priority populations will be included in our study to extent that they exist in our study population

How do I comply when I am using secondary data and subgroup numbers are small?

But also, AHRQ should be explicit about specific priorities for priority populations research in each Funding Opportunity Announcements

Are there “points” in peer review and funding decision making?

Lessons Learned

Policy of encouragement difficult to understand and implement

True inclusion and subgroup analyses require resources

Specific role for peer review Factoring inclusion as a component of funding

decisionmaking is not easy We need a framework!

Why Is This Important?

Health care disparities persist and in many cases are worsening

Ongoing and enhanced focus & activities within the DHHS

Recognized importance of quality improvement must include strategies for eliminating disparities

The ACA requires establishment of offices of minority health in HHS and focus on eliminating health disparities

The ACA calls for National Quality and Prevention Strategies – each includes eliminating disparities as a core principle

ACA Provisions Related to AHRQ

Community Health Team to Support Patient-Centered Model Home

Medication Management Services Improving the Emergency Care System Shared Decision Making Collecting Data on Health Disparities Health Care Workforce Primary Care Extension Service Medical Liability*

*Only item on the list with an appropriation. All other items authorized.

Thank You

AHRQ MissionTo improve the quality, safety, efficiency, and effectiveness of health care for all Americans

AHRQ VisionAs a result of AHRQ’s efforts, American health care will provide services of the highest quality, with the best possible outcomes, at the lowest cost

http://www.ahrq.gov