With its own future put in doubt by proposed budget legislation in Congress, the Agency for Healthcare Research and Quality (AHRQ) recently announced three grants totaling $52 million to create centers of excellence to study how high-performing health care systems promote evidence-based practices in delivering care.
Speaking at AcademyHealth's Annual Research Meeting in Minneapolis on June 15, Richard Kronick, Ph.D., director of AHRQ, said, "New evidence is valuable only if it is used," said Dr. Kronick. "We expect this effort will give us a better understanding of how successful health care delivery systems disseminate new evidence so we can enable the rapid adoption of best practices throughout the health care system and improve patient outcomes."
Kronick said the funding would be spread out over five years to study how complex delivery systems disseminate evidence-based findings and provide lessons learned to inform the dissemination of findings in other settings. This project is funded by the Patient-Centered Outcomes Research Trust Fund, which was created by the Affordable Care Act.
The three Centers of Excellence carrying out this work, their principal investigators, and their area of focus are:
• Dartmouth College (Principal Investigator: Elliott Fisher, M.D., M.P.H.), in collaboration with the University of California at Berkeley, Harvard University and the High Value Healthcare Collaborative (18 systems). This center will use mixed methods involving existing and ongoing claims-based data, conduct a national survey of health care organizations and systems to understand the inner workings of systems, and in particular, how market and organizational factors influence the implementation of biomedical, delivery system and patient engagement innovations.
• National Bureau of Economic Research (NBER) (Principal Investigator: David Cutler, Ph.D., Harvard University and NBER), in collaboration with the Health Research & Educational Trust and the Network of Regional Healthcare Initiatives. This center will create a large national database to identify health systems in the United States and their characteristics and outcomes, as well as the evolving consolidation and integration of systems over time, and to use those data to study health systems nationally, with a focus on cancer care, pediatric health care delivery, dialysis and post-acute care.
• RAND Corp. (Principal Investigator: Cheryl Damberg, Ph.D.), in collaboration with Pennsylvania State University. This center will examine health systems in five regions with the goal of understanding the role of incentives, use of health IT and organizational integration within systems and its impact on performance and evidence dissemination.
In addition, AHRQ will fund a coordinating center to help facilitate collaboration between the three centers in the development of a national compendium of the performance of health care systems across the United States.
AHRQ also recently announced another PCOR dissemination initiative, EvidenceNow, which is focused on helping small- and medium-sized primary care practices in 12 states improve the heart health of their nearly 8 million patients.
Despite its role in patient safety initiatives, the use of health IT, and patient-centered outcome research, AHRQ has become a target of Republican legislators who argue its work could be handled by other areas of The Department of Health & Human Services and who want to eliminate or reduce funding for continued deployment of the Affordable Care Act.
On June 16, the House Labor, Health and Human Services, Education and related agencies Appropriations Subcommittee released its fiscal year 2016 spending bill. A coalition of 250 organizations, Friends of AHRQ, is sponsoring a letter-writing campaign to members of Congress to advocate for the organization’s importance. Academy Health notes that “among the many assaults on public health and health research (e.g., slashing mandatory funding for patient-centered outcomes research by $100 million and banning the use of discretionary funds on this research and cutting $6.2 billion from the Center for Medicare and Medicaid Innovation), the bill 'terminates' the Agency for Healthcare Research and Quality (AHRQ) — the only agency with the sole mission to conduct health services research, the research that tells us what works, for whom, under what circumstances, and at what cost.”