AHRQ in the Lead
What exactly is the Agency for Healthcare Research and Quality (AHRQ), and why are hospitalists urged to increase its portion of the federal budget pie each year?
According to its mission statement, the AHRQ is “the lead federal agency charged with improving the quality, safety, efficiency, and effectiveness of healthcare for all Americans.” This includes supporting high-quality, impartial research that specifically improves healthcare quality, reduces costs, advances patient safety, decreases medical errors, eliminates healthcare disparities, and broadens access to essential services.
“Supporting AHRQ is supporting an unbiased government organization that’s clearly on the side of patient safety, and that gets important information out fast,” says Andrew Fishmann, MD, FCCP, FACP, a member of AHRQ’s National Advisory Council and director of intensive care at Good Samaritan Hospital in Los Angeles. “Where’s the argument?”
Fight over Funding
The argument is over money, plain and simple. Each year, medical associations like SHM push for increased federal funding for AHRQ so the agency’s research can be expanded. And each year, Congress refuses those increases. Lawmakers have granted a slight boost in funding: Since 2002, AHRQ’s budget has increased by $2 million, or 6.7%.
Proponents of AHRQ believe precarious funding levels threaten the agency’s ability to achieve its essential mission. Last year, SHM lobbied for an increase in federal funding for AHRQ to $350 million in fiscal year 2008—$31 million more than the agency’s fiscal 2007 budget. By late 2007, Congress was weighing an increase of $329 million, plus $5 million targeted for comparative-effectiveness research.
“Think of AHRQ compared to the $28 billion that NIH gets,” says Dr. Fishmann. “[AHRQ’s] is a small budget relative to what they do.”
How much does AHRQ need to provide adequate research information? The answer is, apparently, as much as they can get. There are countless areas in healthcare the agency could address.
“If they got $500 million, could they spend it?” asks Dr. Fishmann. “Yes. They could look at the top 20 diseases instead of the top 10.”
What AHRQ Does
Regardless of the final budget amount they receive, AHRQ spends roughly 80% on grants and contracts focused on improving healthcare.
“AHRQ doesn’t do its own research or create its own data,” explains Dr. Fishmann. Rather, AHRQ conducts and supports health services research in leading academic institutions, hospitals, and other settings. In 2005, two hospitalists received separate grants for projects that have already had an effect on hospital medicine. Greg Maynard, MD, MS, division chief of hospital medicine at University of California San Diego School of Medicine, used AHRQ funds for an intervention project to prevent hospital-acquired venous thromboembolism (VTE). Dr. Maynard’s project continued to grow since that grant and has yielded key findings such as a risk-assessment model for VTE. Data and lessons learned are available in the VTE Resource Room on SHM’s Web site at www.hospitalmedicine.org/ResourceRoomRedesign/RR_LandingPage.cfm.
