The U.S. government will spend about as much on researching how to improve patient safety, healthcare quality and efficiency as it will on scientific research in the Arctic and Antarctic regions in fiscal 2006: about $319 million, according to the budget President Bush approved Dec. 30.
The $319 million Congress appropriated for the U.S. Polar Research Programs for 2006 represented a 15.4% increase from the $277 million those programs received last year. In contrast, the $319 million 2006 budget for the Agency for Healthcare Research and Quality is the same amount it received in 2005. Within that amount, almost $50 million was allocated for information-technology patient-safety initiatives -- the same amount that was funded for 2004 and 2005.
"Funding is remaining flat, and that typically means you're getting less because of inflation," said Jim Conway, a senior fellow at the Institute for Healthcare Improvement and a senior consultant with the Dana Farber Cancer Institute. When asked if $319 million was sufficient to pay for the "bread and butter" quality-improvement and patient-safety research AHRQ is charged with conducting, Conway replied: "The easy answer is absolutely not."
Health IT adoption will also be promoted through the Office of the National Coordinator for Health Information Technology. Led by David Brailer, M.D., ONCHIT will have a $75 million budget for 2006.
Paul Keckley, executive director of the Vanderbilt Center for Evidence-based Medicine in Nashville, agreed with Conway and noted how Congress and the Bush administration have championed patient safety, quality improvement and the adoption of health information technology, but have failed to adequately fund the research needed to push those issues forward.
Although the first goal listed in President Bush's HHS budget message is "promoting national healthcare information technology, with the goal of most Americans having an electronic health record with proper medical privacy protection by 2014," Keckley said the government's investment doesn't match its rhetoric.
'Fundamental policy disconnect'
"I think there is a fundamental policy disconnect between what is said and what is done," he said, adding that appropriating $319 million to improve patient safety, healthcare quality and efficiency was like "using chewing gum to repair a hole in a boat the size of a football."
More "root-cause research" needs to be done to attack problems associated with the substantial misuse and overuse of medical treatments, Keckley said, and "IT is a way to get at that."
AHRQ spokeswoman Karen Migdail, however, pointed out that AHRQ's 2006 budget represents an 18% increase over the $270 million it received in 2001.
The largest allocation in AHRQ's budget is $84 million earmarked for identifying risks and hazards that lead to medical errors and to developing strategies to prevent patient injury. Of that amount, just under $49.89 million will go toward accelerating the development, adoption and diffusion of interoperable information technology in a range of healthcare settings.
Community, rural emphasis
HHS budget documents state that AHRQ's IT-related patient-safety initiatives will have "an emphasis on small community and rural hospitals/healthcare systems," and are designed to encourage the "uptake" of technologies such as computerized order entry, handheld devices that hold prescription information and computerized patient records.
For example, last October, AHRQ awarded $22.3 million in health IT implementation grants that was split between 16 organizations, 11 of which were in rural communities. This included a $500,000 grant for Franklin (La.) Foundation Hospital to help safety-net providers in areas rebuilding after Hurricane Katrina to develop a system to manage chronic diseases, improve patient safety and eliminate duplication of efforts.
In 2006, AHRQ has committed to spending $10 million from its IT patient safety budget on developing clinical terminology and messaging standards in order to remove significant barriers to the interoperability of electronic medical records, according to an HHS budget brief.
Other major budget allocations include $55 million to continue collecting data in its Medical Expenditure Panel Surveys, which are used to develop AHRQ's annual national reports on healthcare quality and disparities. Another $15 million will be used to fund research authorized by the Medicare Prescription Drug, Improvement and Modernization Act of 2003 to compare the effectiveness of prescription drugs and other interventions on the top 10 conditions affecting Medicare beneficiaries.
A special notice posted on the Internet on Dec. 29, 2005, stated that, in 2006, AHRQ will focus its research efforts on "gaps in patient-centered care for the complicated patient with multiple conditions and risk factors" and that research grants will be limited to a maximum of $300,000 per year.
Need for more funding seen
While offering praise for the work it does do, both Keckley and Conway said AHRQ needs more funding to expand its focus.
Keckley said that AHRQ needs to step up its research efforts into how more quality-improvement programs can be integrated into the healthcare system and on medical costs in general because "Right now, healthcare is eating the rest of the economy."
Conway said AHRQ has to study how the healthcare system can better transition from a culture of secrecy to one of transparency and it must provide national "bench to bedside" dissemination of medical breakthroughs.
"Unfortunately, as we go down the pipeline, many good things get lost," he said. "I don't begrudge (AHRQ's) technology component, but there are so many other questions in so many other areas that need to be studied."
Read the AHRQ budget brief: http://www.hhs.gov/budget/06budget/agency.html .
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