In light of congressional mandates for the Agency for Healthcare Research and Quality to focus its resources on health information technology and "comparative effectiveness," questions are being asked about the future direction of the federal agency charged with doing the nuts-and-bolts research on how healthcare is delivered.
The agency's budget request for fiscal year 2006 is basically identical to its budget for 2005: Out of a total of $318.7 million, $84 million is earmarked for patient safety efforts with $50 million of that going toward health IT.
Earlier this month, AHRQ released an $8 million package of patient safety research grants. While the money was welcome, the fact that no grant was for more than $300,000 annually and that most of the grants appeared to be for hospital-based research left some observers wondering if the AHRQ was becoming less interested in patient safety in general and primary care in particular.
"I'd like to see more emphasis on ambulatory medicine," said Bruce Bagley, M.D., medical director of quality improvement for the American Academy of Family Physicians. "A lot more healthcare is given in the outpatient setting."
Bagley added that researching systematic improvements in primary-care offices or implementing IT in primary care "will have a greater effect on the population's health than preventing deaths in the hospital."
This point was echoed by James Mold, M.D., with the Oklahoma Physicians Resource/Research Network, who said he agreed with limiting grants to $300,000 in order to help spread AHRQ's limited resources, but he disagreed with how these grants were allocated.
"My biggest concern is not the size of the grants, but that they are almost all hospital-based," Mold said, adding that the research projects that won grants "are not going to make a dent in the problems we have in primary care."
William Munier, M.D., acting director of AHRQ's Center for Quality Improvement and Patient Safety, defended the grants, saying they will generate information useful to physicians in both hospitals and primary care offices.
"They deal with direct patient care, and the lessons we learn from them we hope will be transferable to different sites," he said. "We'll use the information we gain to magnify the dollars we are putting in."
Munier added that the goal of these projects is to develop tool kits that others -- including primary-care physicians -- can use. It was also noted that half the projects deal with reducing medication errors and other grants will fund research to improve communication on healthcare teams, two areas of concern for all medical professionals.
Munier defended the amount being spent as well. He said that people get jaded looking at a government "where large amounts of money roll off the table without much effect," but that $300,000 -- spent correctly - can do a lot of good.
The AHRQ doesn't have a bias toward funding health IT projects, Munier said, and the money being spent in that area can enhance rather than diminish the work of researchers involved in patient-safety and quality-improvement efforts.
Munier concluded that, with a war going on, Medicare being expanded, and the government operating at a budget deficit, it was unlikely that the agency's budget would be significantly increased any time soon.
Leading efforts to boost funding, Friends of AHRQ, a group of 130 organizations coordinated by the Coalition for Health Services Research, has asked Congress to boost the agency's budget to $440 million. The coalition is the advocacy arm of AcademyHealth, a professional society for the fields of health services research and health policy.
AcademyHealth President and Chief Executive Officer W. David Helms said he agrees that IT research can help patient safety and quality improvement. But he added that Congressional funding whims cause instability that hurts efforts to "build the field" of health services research, which consequently slows that improvement.
"I think the concern we do have is that Congress moves rather quickly through these priorities," Helms said, explaining that yesterday's priority was patient safety, today's is IT and tomorrow's may be comparative effectiveness. "We go from hot issue to hot issue."
Mold, whose article championing primary-care practice-based research networks appeared in the May/June issue of the Annals of Family Medicine, advocated for the AHRQ's budget to have fewer congressional earmarks and more discretionary money available for research initiated by physician-investigators.
"Practice-based, bubble-up research is based on the needs of physicians -- not the government," he said.