by Judith Effken, Senior Editor
Effken, J. (2013). Preventing the Demise of AHRQ. Online Journal of Nursing Informatics (OJNI), 17 (2), Available at http://ojni.org/issues/?p=2659
The U.S. Agency for Health Research and Quality (AHRQ) may be defunded if the current budget proposed by the House of Representatives is enacted. During AMIA (American Medical Informatics Association) Hill Day this spring, one group making the annual trek to Washington DC spoke with the Minority Staff Director for the LHHS (Legislative Health & Human Services) Appropriations Committee. One of the pearls he shared with the group was that funding for AHRQ is at risk in the latest budget bill. This probably should not come as a surprise because a similar cut was proposed in the House of Representatives last year. Whether this bill will ultimately be enacted is anyone’s guess. However, those of us in the health care system and/or informatics have a vested interest in ensuring that it doesn’t pass.
Based on the AMIA HILL Day meeting, the House Appropriations Committee views AHRQ’s work as duplicative. This is indeed unfortunate because it is the primary agency that looks at health care organizations’ safety and quality—and if there is ever any issue that deserved to be examined, it is this. Over the years AHRQ has funded many research studies on quality and safety and more recently has begun to fund comparative effectiveness studies. The outcomes of those studies are regularly collated and collected on the AHRQ website for others to use. Sometimes those studies have resulted in new tools that later are made freely available to others on the website because their development and tested has been funded by the government.
For those of us in informatics who are engaged in some area of implementing electronic health records, personal health records, etc., as part of the Affordable Health Act defunding AHRQ seems incredibly short sighted. Who better to fund the evaluation studies that will be needed to ensure that the health care system continues to improve and needed changes are made, given that this is the agency that has worked long and hard to have researchers engage in theoretically sound evaluations of systems and technology?
AHRQ has always been a friend of informatics—and their leaders (e.g., its director, Carolyn Clancy) “get it.” These leaders understand both the potential of health information technology—and its risks. They have been able to support researchers and, at the same time, ask the tough questions that need to be asked. A quick trip through their expansive website (www.ahrq.gov) tells only part of their story: there is information for the public, researchers, health care professionals, as well as a wealth of research and evaluation tools that researchers and quality staff can use to evaluate and improve care. AHRQ also promulgates evidence-based clinical guidelines. It’s difficult to imagine how other agencies could possibly pick up the slack. Even if the portfolio that AHRQ now has could actually be decentralized to other agencies, it is even harder to see how the coordination that AHRQ currently provides, the “one-stop shopping” for anyone interested in quality and safety in healthcare, could continue.
Maintaining funding for healthcare system research is never easy. It is easier to sell basic, disease-based research to our elected officials—and even to the public at large–because who doesn’t want to save lives by curing cancer, heart disease, diabetes, or AIDS? And who doesn’t want to fund genetic and genomic studies that are showing so much promise? It’s hard for healthcare system research to compete. I get it.
But politics is likely playing the major role here as some are trying to defund the Affordable Care Act through 1000 cuts in related budgetary programs. AHRQ encourages and supports comparative effectiveness studies—and some legislators equate these with the feared “death panels” that were railed against when the Affordable Care Act was under discussion. But research shows that we have huge variation in practices, as well as costs of care, in the United States. Too much care is given based on provider preferences or tradition, rather than on the evidence. Too often, we lack the evidence to determine which of several available treatments is more beneficial and/or cost effective. Continuing this research is critical if we are to have an effective, financially sustainable healthcare system for all our people.
Our healthcare system remains unsafe despite being the most expensive in the world. If hospitalized, we are warned by health care professionals in that hospital to make sure staff members wash their hands before touching us (I find it fascinating that that this is now OUR jobs). We are warned by friends and family to be sure we have a “health buddy” to watch for potential errors in the hospital and stop them before they occur. Clearly, continued vigilance is needed, as well as new ideas for how to improve clinical outcomes and patient safety.
Health information technology has a lot to offer in terms of ensuring effective, timely communication, reduction in duplicated services, decreased fraudulent prescriptions, and safer care. At the same time, there have been many reported unanticipated consequences of health information technology (e.g., new types of errors, overbilling, erroneous drug orders, and delays due to interruptions in work flow).
Fixing these problems and preventing others is what AHRQ is all about. Where will the support for this kind of research come from in the future if AHRQ should cease to exist? Given the competing priorities, will there be funding for health care systems and informatics at all? I urge readers to work with your healthcare organizations (or on your own) to contact legislators and inform them of the important work AHRQ is doing and why that work needs to continue before it is too late.