Find Federal Agency

• WHAT IS ITS MISSION?
• HOW IS IT STRUCTURED?
• PRIMARY FUNCTIONS
• PROGRAMS
• BUDGET INFORMATION
• HISTORY
• CURRENT POLITICAL ISSUES
• FAST FACTS
• SUCCESSES AND FAILURES
• FUTURE DIRECTIONS
• AGENCY RESOURCES
• AGENCY PUBLICATIONS
• BIBLIOGRAPHY

PARENT ORGANIZATION: Department of Health and Human Services
ESTABLISHED: December 31, 1995
EMPLOYEES: 250 (1997)

Contact Information:

ADDRESS: 2101 E. Jefferson St. Rockville, MD 20852
PHONE: (301) 594-6662
TDD (HEARING IMPAIRED): (888) 586-6340
FAX: (301) 594-2800
E-MAIL: info@ahcpr
URL: http://www.ahcpr.gov
ADMINISTRATOR: John M. Eisenberg

WHAT IS ITS MISSION?

According to the agency, the mission of the Agency for Health Care Policy and Research (AHCPR) is "to generate and disseminate information that improves the quality, medical effectiveness, and cost of health care and the health care system." The AHCPR is a relatively new agency and as such, is still exploring the parameters and scope of its mission. The AHCPR aids in informed decision making by providing consumers, health care providers, and policymakers with objective, up-to-date information on health care issues.

HOW IS IT STRUCTURED?

The Agency for Health Care Policy and Research (AHCPR) is an operating division within the U.S. Department of Health and Human Services (HHS), a cabinet-level department. An administrator, appointed by the president and approved by the Senate, directs the AHCPR. Six AHCPR offices handle the policy, financial, grant-making, planning, and other administrative work of the agency. Eight centers conduct and support health care and health services research in the areas of health care technology, outcomes and effectiveness, primary care, organization and delivery, cost, financing and access, quality measurement and improvement, information technology, and health information dissemination.

The National Advisory Council for Health Care Policy, Research, and Evaluation provides the administrator with advice and recommendations on priorities for the national health services research agenda. The 24-member

BUDGET: Agency for Health Care Policy and Research

panel is composed of 17 private-sector experts representing health care plans, providers, purchasers, consumers, and researchers, and seven representatives of federal agencies that address health care issues. Privatesector members are appointed by the HHS secretary and serve three-year terms.

PRIMARY FUNCTIONS

The Agency for Health Care Policy and Research (AHCPR) carries out its mission by conducting and supporting, through grants, research that creates the science base to guide improvements in health care practices, policies, plan choices, insurance, and costs. The AHCPR also conducts and supports research designed to determine health care needs of consumers, and the agency helps policymakers make decisions regarding the quality and type of health care systems. The AHCPR also measures, monitors, and evaluates the quality and delivery of health care.

The AHCPR is the health services research arm of the Public Health Service. It works closely with other federal health agencies including the National Institutes of Health, which is the biomedicai research arm of the Public Health Service. The AHCPR funds research projects of federal, state, and local governments; educational institutions; and individual fellows.

PROGRAMS

The eight centers within the Agency for Health Care Policy and Research (AHCPR) conduct and fund dozens of research programs related to their particular fields of research. For example, the Center for Health Care Cost, Financing, and Access generates information on issues related to the cost and financing of health care, health insurance coverage, and access to care. The center identifies barriers to services and suggests ways to improve quality of care. The agency is guided by its studies, like its HIV Cost and Service Utilization Study, a national survey that provides estimates of the cost of medical and related services for persons with HIV/AIDS.

The Center for Health Information Technology promotes greater use of computers to improve the quality and effectiveness of medical care and to reduce its cost by using computerized decision-support systems in everyday clinical practice. Projects in this area include designing, implementing, and evaluating a drug-monitoring system and testing a computerized system to facilitate information exchanges between bone marrow transplant experts and the primary care physicians who provide follow-up care to transplant patients.

One of the AHCPR's highest priorities is providing consumers with science-based, easily understandable information that will help them make decisions about their own health care, including choosing quality health plans and services. Through its Guidelines program, the AHCPR's Center for Health Information Dissemination publishes free pamphlets for consumers on health care issues including elective surgery, prescription medicines, health care plans, and treatment options for a number of diseases and conditions.

BUDGET INFORMATION

The 1998 budget for the Agency for Health Care Policy and Research was approximately $90 million. The AHCPR's budget is allocated entirely by Congress. Some AHCPR research projects involve partnerships with private-sector organizations, but AHCPR's share of costs are paid for by these organizations. About two percent of AHCPR's budget is spent on administration and program support cost. The remaining funds are divided roughly into thirds and allocated to research on health care systems cost and access, research on health insurance and expenditures, and research on health care outcomes and quality.

HISTORY

Before 1989 the National Center for Health Services Research was the federal government's source for information related to health care. But in the mid- to late-1980s, public concern over health care cost and quality and policymakers' need to address these concerns exceeded the scope of that agency's services. The Agency for Health Care Policy and Research (AHCPR) was created in 1995 by absorbing the National Center's programs and establishing new research initiatives in all areas of health care including technology and information dissemination. The reorganized agency was created to serve policymakers, consumers, health care providers, health plan providers, researchers, and health plan purchasers like employers and unions.

CURRENT POLITICAL ISSUES

Despite its newness, the Agency for Health Care Policy and Research (AHCPR) and its programs have been at the center of controversies resulting from the conflicting interests of its clients. Consumers want high-quality, effective care and comprehensive health care coverage plans. But while health care coverage providers want to offer this, they are businesses, ultimately concerned with generating profits. As such, they must balance the coverage they offer with their own financial needs. Health maintenance organizations (HMOs) particularly have been accused of compromising high-quality care by limiting the amount of tests and treatments approved under HMO plans, a cost-cutting measure designed to increase profits. Government policymakers, too, must balance interests, those of their grassroots-level voters with those of the major campaign donors whose businesses and organizations operate in their districts or states.

At the center of such issues is the AHCPR. The agency is charged with conducting science-based research and providing factual information to its clients. Yet the AHCPR relies on government funding, allocated by consumers' representatives, often for partnership programs that rely on the participation of health care providers and health plan providers. The agency strives to provide objective, honest, and scientifically sound information, however AHCPR's information is often publicized by its clients to serve their own purposes. For example, consumer advocate groups will publicize an AHCPR study that indicates health care quality is dropping, while a health care provider will publicize a study that puts providers in a more favorable light.

Case Study: The AHCPR Back Pain Study

In 1995 the AHCPR published a report on the findings of a study involving more than four thousand back pain cases, with several findings contradicting long-held beliefs about treatment of acute back pain. Specifically, the report indicated that ibuprofen and aspirin were as effective in treating back pain as prescription muscle relaxants, cost less, and had fewer side effects. The report recommended moderate exercise instead of bed rest, and the AHCPR suggested doctors wait four weeks before ordering tests unless signs of nerve injury or bone disease were present. Traction, massage, acupuncture, and supportive back belts were found to have no proven value in eliminating back pain. Finally, the study pointed out that eighty percent of patients suffering from lower back pain recovered with or without an operation, indicating that back surgery is overused in treating back pain.

Publication of the report resulted in a flurry of compliments and criticisms. Consumer advocates saw the results as justification for health plan providers to refuse to cover the more expensive back pain treatments. Health care providers and health plan providers were justified in their belief that money and time spent on treating back pain could be reduced with no adverse effects for patients. Manufacturers of products recommended in the report widely publicized the findings. Producers of products found to be of little use in treating back pain criticized the study as being too limited or inconclusive.

Only time can determine the long-term validity of the AHCPR's study, but at the very least the agency fulfilled its mission of generating and disseminating health care information. Consumers, health care providers, and insurers now have more information about back pain treatment options, possibly offering a way for sufferers of back pain to avoid unnecessary drugs and surgery. But insurers would suffer a mountain of negative publicity if the study were used to back up decisions not to cover back pain treatments.

SUCCESSES AND FAILURES

The Agency for Health Care Policy and Research (AHCPR) has enjoyed several notable successes, especially in the area of reducing health care costs. For example, in 1995 the agency published a report on the impact on cost and quality of health services research. The three central findings of the report indicated that AHCPR products have reduced costs, that lower costs often mean higher quality because they are the result of efforts to identify costs that can be cut without affecting quality, and that information can serve as a substitute for regulation by encouraging better and more cost-effective care without the burden of government regulation.

Assuming they affect one patient in five, the AHCPR claims its recommendations can result in annual savings of $132 million in regard to stroke prevention therapies, $8.5 million in regard to preconception and prenatal care for diabetic women, and $27 million in regard to on-call medical care to terminally ill patients living at home. The agency has disseminated more than 25 million copies of clinical practice guidelines which address symptom assessment, testing recommendations, and treatment options. When Utah's Intermountain Health Care tested AHCPR ulcer-prevention guidelines in one of its hospitals for six months, it found that using the guidelines saved $240,000.

FUTURE DIRECTIONS

Because it is a relatively new agency, many Agency for Health Care Policy and Research (AHCPR) projects are still in the developmental stage or in early phases of implementation. One AHCPR priority is to establish a comprehensive Internet source for clinical practice guidelines. The new National Guideline Clearinghouse is to make available a full range of guidelines on treatments for specific medical conditions. It will also compare and contrast the recommended treatment guidelines as well as provide summaries of areas of agreement and disagreement.

Another priority for the AHCPR is to develop "report cards" for consumers requesting information on quality, service, and cost issues. This will help consumers evaluate health care systems and plans. In 1997 the AHCPR initiated the first phase of a five-year project by sending surveys to consumers to determine what they want to know when choosing health care providers and insurance plans. Later phases of the project will include translating consumer questions into measurable objectives and developing a process for monitoring, evaluating, and publicizing report card measurements.

AGENCY RESOURCES

The Agency for Health Care Policy and Research (AHCPR) research portfolio on topics such as managed care, physician practices, computers and health care, and primary care issues is available on-line at http.//www. ahcpr.gov :80/research/. Information on AHCPR research can also be requested by calling (301) 594-6662.

The AHCPR operates the Computerized Needs-Oriented Quality Measurement Evaluation System (CONQUEST), a quality-improvement software tool that helps users identify, understand, evaluate, and select measures to assess and improve clinical performance. CONQUEST diskettes and user's guides are available free-of-charge from the AHCPR Publications Clearing-house, PO Box 8547, Silver Spring, MD 20907, or call 1-800-358-9295.

AGENCY PUBLICATIONS

The Agency for Health Care Policy and Research (AHCPR) publishes free consumer guides about the benefits and risks of treatments for specific medical conditions. Topics include smoking cessation, pain management, heart failure, post-stroke rehabilitation, and lower back pain. Guides may be viewed on-line at http://www. ahcpr.gov:80/guide or they may be ordered by calling 1-800-358-9295. The agency also publishes other consumer information including Checkup on Health Insurance Choices, designed to help consumers select health insurance plans and Questions to Ask Your Doctor Before You Have Surgery, designed to help consumers make decisions about surgery. These publications and a list of other titles can be ordered by calling 1-800-358-9295.