Medicine saves funding for research arm

A lobbying effort by physicians maintains a budget for "front-line" health care quality research.

By Andis Robeznieks, amednews staff. March 24/31, 2003.

What do you call a federal agency that shows primary care physicians how to save lives and tells politicians how to save billions of dollars? Some call it the Agency for Healthcare Research and Quality, but many doctors call it "underfunded."

In its 2001 report "Crossing the Quality Chasm," the Institute of Medicine recommended spending up to $1 billion on the type of front-line, primary care research AHRQ conducts and finances. But reports are one thing and reality is another. The agency received just $300.3 million in 2002 and was targeted for a $48.6 million budget cut this year.

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Health care organizations appreciate AHRQ because much of its research is designed to be of immediate and practical use to the primary care doctor. So 130 medical, academic and business organizations (including the American Academy of Family Physicians, American College of Physicians and the AMA) joined under the "Friends of AHRQ" umbrella to lobby Congress. They helped turn a significant 16% budget cut into a modest 1.6% increase for fiscal year 2003.

"Our final budget number is $303.7 million, and we also received an additional $5 million from the bioterrorism emergency preparedness fund," said AHRQ spokeswoman Karen Migdail. "It restores the cuts and gives us a little bit more on top of it."

According to David Helms, PhD, the president of Washington, D.C.-based AcademyHealth and leader of the Friends of AHRQ coalition, one reason politicians are warming up to the agency is that it shows how money can be spent more wisely. For example, Dr. Helms said an AHRQ study found $29 billion was spent on "preventable hospital admissions" in 1999.

"For a small agency, they're doing a heck of a lot," said Herbert F. Young, MD, the AAFP's director of scientific activities. "It's an agency that's responding to the questions that doctors face daily in their practices. Their work pays off quickly."

Physician efforts helped turn a budget cut into an increase for the Agency for Healthcare Research and Quality.

The key, according to James Mold, MD, an AAFP member and director of the Oklahoma Physicians Resource/Research Network, is that research is being done for primary care physicians by primary care physicians.

"If we really want to get these goods to people, we have to involve them in the research," said Dr. Mold, who has received three AHRQ infrastructure grants to support his network. "It's a new type of research. It assumes there are answers out there if we could just find them, instead of finding answers from academic clinicians conducting basic research."

A recent example of such research involved identifying and interviewing doctors with "exemplary" records of treating diabetes, "tapping into their wisdom," and then distilling it into six principles that appear to make a difference in diabetes care.

It's believed that it takes up to 17 years for clinical improvements to travel from researcher to physician, and Dr. Mold said part of AHRQ's mission is to reduce that time.

"It even has it's own acronym for this now: TRIP, Translating Research Into Practice," he said.

Despite the recent good news on the budget front, Dr. Helms warned that -- even with its funding restored -- the agency still has some tough decisions to make.

AHRQ found $29 billion was spent on "preventable hospital admissions" in 1999.

"To continue everything they were doing, they needed $330 million," Dr. Helms said. "But if it would have been $250 million, they would have had to cut current grants by about 50%. They would have retained their research on patient safety, but that meant a lot of other things would have had to be significantly cut."

More tough decisions may be necessary. Budget documents indicate AHRQ will receive only $270 million in federal funding in fiscal year 2004.

Founded in December 1989, AHRQ is a "sister agency" of the National Institutes of Health and Centers for Disease Control and Prevention. Its mission is to support research designed to improve health care quality, outcomes, cost and access.

Most of this research is done outside the agency and funded through AHRQ grants and contracts. It spans the health care spectrum to include heart attacks, pneumonia, diabetes, ear infections and night sweats.

The only real criticism Dr. Mold has of AHRQ is that he believes Congress may be tying too many strings to its research grants.

"One problem is that it can be too compartmentalized into sections like bioterrorism or patient safety," he said. "Ideas should bubble up from the investigators, and there should be more money for investigator-initiated research."