AHCPR Fiscal Year 2000 Performance Plan

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Goal 5: Support Department-wide Initiative to Improve Health Care Quality through Leadership and Research. (HCQO)

The President mandated the establishment of the Quality Interagency Coordination Task Force (QuIC) as a vehicle for promoting collaboration among the Federal Agencies with health care responsibilities to improve the quality of care in America. Secretaries Shalala and Herman are co-leading this activity, but have asked the AHCPR Administrator to serve as operating chair. The QuIC is working to improve patient and consumer information, quality measurement systems, the workforce's ability to deliver high quality care, and the information systems needed to support the analysis of the care provided.

The recommendations for assuring and advancing the quality of health care released by the President's Advisory Commission on Consumer Protection and Quality in the Health Care Industry have contributed significantly to the development of quality-related research being proposed by AHCPR.

Strategy

The work the Agency is doing to support this initiative is woven into the three priority areas that are proposed in the fiscal year 2000 budget. Both objectives represent aspects of other programs that will directly contribute to the goals of the Initiative to Improve Health Care Quality.

Previous Successes

AHCPR created the Liaison Office on Quality, which coordinated the responses from the Department to specific questions asked by the President's Advisory Commission on Consumer Protection and Quality. The staff focused on providing factual information to the Commission when requested and assisting Federal policymakers in understanding the effect of the Commission's recommendations on Federal programs.
The Liaison Office authored background papers for the Advisory Commission (access to emergency services, participation in treatment decisions, choice of plans and providers, centers of excellence, clinical trials); prepared briefings and recruited Department-wide expertise for the Commission's work; provided testimony on several occasions to the Advisory Commission; established a downtown Resource Center with Agency publications; and partnered with the White House, HHS staff, and other departments to prepare the Federal Agencies to respond to the report of the Advisory Commission entitled "Quality First: Better Health Care for All Americans."
The Agency, largely through the efforts of the Liaison Office, developed a report for the Vice President documenting the business case of for quality. It was entitled, "The Challenge and Potential for Assuring Quality in the 21st Century," and was used to successfully launch the group that is developing the Forum on Quality Measurement and Reporting. The Forum is a public-private partnership to identify a core set of quality measures and methods for reporting information.

Goal 5 Fiscal Year 1999 Objectives and Indicators

Fiscal Year 1999 Objective 5.1: Provide leadership for the Executive Branch's Quality Interagency Coordination Task Force (QuIC)

Indicators
1. Collaborative work groups are established under the QuIC under take projects with direct application to improving quality of care.

2. In addition to the work on specific projects chosen by the QuIC, communication is facilitated on common issues such as: (1) Implementation of the Bill of Rights and Responsibilities from the President's Commission on Consumer Protection and Quality in the Health Care Industry; and 2) organization or management strategies to improve quality of care.

Indicators Summary
Numerator—Number of projects under taken.
Numerator—Number of patients with a chosen condition for whom quality is being addressed.
Denominator—Number of patients with a relevant condition.

Type and Significance
The QuIC will engage in projects on quality measurement and improvement, communications with consumers and providers, and expediting the movement of research into practice. The QuIC will draw on staff from virtually all areas of the Federal Government to engage in projects that improve health care quality in the federal sector. Providing a framework in which the work of the QuIC can be done, coordinating the work of the staff across all agencies and departments, and coordinating with the quality activities outside the Federal Government is the responsibility of AHCPR.

Data Collection
Data Issues: The AHCPR grant management and budget data systems collect data on grants from the moment the application has been received until the grant is completed and the final report is received. Careful coordination with other Federal agencies will result in a comprehensive data collection effort. Dissemination strategies will be tracked through printing, mailing, clearinghouse, and Web site data.

Progress toward these goals can be tracked through the minutes of the routine workgroup meetings and/or periodic reports to the Secretary or Secretaries.

Fiscal Year 1999 Objective 5.2: Conduct research to expand the tool box of measures and risk adjustment methods available help to measure the current status of quality in the Nation.

Indicators
1. Inventory of measures and risk adjustment methods currently in use by Federal Agencies will be developed.
2.Assessment of measures and risk adjustment methods needed by Federal Agencies will be conducted.

Indicators Summary
Numerator—Number of measures collected and assessed.
Numerator— Number of "best" measures adopted by participating Agencies.
Denominator—Number of measures added or replaced.

Type and Significance
Several methods and data collection and reporting tools exist that provide clues about the quality of care for specific populations or that indicate whether specific services (e.g., immunizations, thrombolytic therapies, cancer screening) are provided, they are inadequate for three reasons: (1) Measures do not exist to help assess the quality of care for all conditions or populations of interest, (2) risk adjustment methods that account for factors outside the sphere of influence of the providers being measured are crude, at best, and, (3) there is currently no way to assess quality of the health care that is provided throughout the Nation.

Within the context of the QuIC, AHCPR will support research that will expand and improve the measures and risk and regulators adjustment factors needed by Federal providers, purchasers and regulators to assess the care provided to the populations for which they are responsible. AHCPR will also provide technical assistance to Agencies that would like assistance in putting these measures and risk adjustment methods to use.

Fiscal Year 1999 Objective 5.3: Inform health care organizational leaders and others how to design quality into their systems.

Indicators
1.Review research conducted that identifies appropriate ways of redesigning health care delivery systems to reduce errors.

Indicators Summary
Numerator—Number of patients potentially affected by avoidable errors reviewed.
Denominator—Number of estimated of avoidable errors for population covered in Federal health programs.

Type and Significance
Beyond the specific information on clinical issues that need to be improved, it is clear from a variety of research that many factors affect or have the potential to affect quality. This is not unique to health care. Many manufacturing and service organizations have discovered that quality can be designed into the work they do. AHCPR currently has research projects that examine aspects of the organization and delivery system to identify which aspects influence quality, including how various structures of managed care organizations have any affect on the quality of services provided to patients, and this work provides a is vital perspective on quality. However, under this Initiative, we will engage in research that will enable us to learn not just if organizational structures affect quality, but if health care processes, facilities and delivery systems can be redesigned to maximize the potential for a high quality outcome.

Fiscal Year 1999 Objective 5.4: Improve understanding of how to ensure that research affects clinical practice as appropriate

Indicators
1. Research on effective dissemination of information to decisionmakers including patients, clinicians, organizational leaders, purchasers, and public policymakers conducted.

Type and Significance
Finally, little is known about effective methods for getting clinicians to alter their practices based on clinical evidence from research. Much more information is needed to enable us to understand whether clinicians are getting the information and why they are not adapting their practices as a result so that we can minimize the gaps between what is known and what is done in the future.

Fiscal Year 2000 Objective 5.1: Conduct research to help to measure the current status of health care quality in the Nation.

Indicators
1. Data sources identified that will contribute information as part of the mosaic picture of quality of care in the Nation.
2. Develop and begin to test some questions to be added to existing data collection activities to provide a better picture of quality.
3. Develop framework for the First Secretary's Annual Report to the Nation on Quality and Opportunities for Improvements produced.

Indicators Summary
Number of sources identified.
Number of questions tested for inclusion in extant surveys.

Type and Significance
Process: Under the auspices of this Initiative, this Agency will conduct and support research that will help to enable the Department to provide this comprehensive picture of national health care quality. To undertake the measurement of national health care quality, it is necessary to create the infrastructure that will provide the necessary data. AHCPR conducts two major data collection efforts—the 10,000-household Medical Expenditure Panel Survey and the Healthcare Cost and Utilization Project. Both of these need to be amended to collect additional data that can be combined with information from other HHS data sources to form a picture of existing health care quality.

Data Collection
The process of completing the changes to the MEPS surveys will be documented through contract management activities.

Fiscal Year 2000 Objective 5.2: Facilitate use of quality information to improve health care in the Nation

Indicators
Development of at least one tool that can be used by large group purchasers in assisting their beneficiaries to choose the health care plan, provider, or hospital that best meets their needs.

Indicators Summary
Numerator—Number of large group purchasers reporting that tools are useful and relevant.

Type and Significance
Output: Consumers want information on quality to use in making choices about their health care. Research has shown that a core set of factors and issues affect the quality of care individuals receive and must be considered. By preparing a reference guide or workbook for consumers to use, AHCPR can facilitate consumers' use of that information.

Data Collection
OMB clearance for customer survey received in December 1998.

Fiscal Year 2000 Objective 5.3: Improve quality measurement

Indicators
Sponsor research to fill existing gaps in needed measures will be supported.

Indicators Summary
Numerator—Number of research projects sponsored to develop measures to fill identified gaps.

Type and Significance
AHCPR in collaboration with its partners in the QuIC will sponsor research to develop measures and risk adjustment methods to meet the needs of the Federal Agencies for information on quality of care provided. They may also meet the needs of the Forum on Quality Measurement and Reporting, which was recommended by the President's Advisory Commission. The Forum will seek to measure aspects of quality that are key to consumers' and purchasers' decisions and provide reliable information in a useful format so that decisions can be made on quality.

Data Collection
Data will be collected through the Agency Management Information System.

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Goal 6: Collect current data and create data tapes and associated products on health care use and expenditures for use by public and private-sector decisionmakers and researchers. (Medical Expenditure Panel Survey) (MEPS)

AHCPR's Medical Expenditure Panel Survey collects detailed information regarding the use and payment for health care services from a nationally representative sample of Americans. No other surveys supported by the Federal Government or the private sector provide this level of detail regarding: the health care services used by Americans at the household level and their associated expenditures(for families and individuals); the cost, scope, and breadth of private health insurance coverage held by and available to the U.S. population; and the specific services that are purchased through out-of-pocket and/or third-party payments.

This level of detail enables public and private-sector economic models to develop national and regional estimates of the impact of changes in financing, coverage, and reimbursement policy and estimates of who benefits and who bears the cost of a change in policy. No other survey provides the foundation for estimating the impact of changes on different economic groups or special populations of interest, such as the poor, elderly, veterans, the uninsured, or racial/ethnic groups.

Strategy

AHCPR will continue to assess the essential components of the MEPS program: development of new, updated, or otherwise enhanced databases; creation of products for use by researchers and policymakers outside AHCPR; and facilitation of the use of MEPS-related products.

Previous Successes

In fiscal year 1998, the MEPS program:

Released four major data files, averaging less than a year from the end of the relevant data collection to researcher availability.
Released four Findings, with nearly twice that number currently in draft, a chartbook (with two more in preparation), and six Highlights.
Released three methods reports on MEPS nursing home and household components.

Additionally:

The MEPS project provides technical assistance to more than 70 persons per month—usually within 2 working days of the request.
The MEPS Web site is fully operational.
MEPS staff have conducted presentations and user workshops at several national meetings, and are planning a "data center" to begin operation during fiscal year 1999.

Indicators
1. Core MEPS public use files (PUFs) available through Web site and CD-ROM within 9-12 months after data collection completed.

Not applicable in 1998. Baseline will be collected in fiscal year 1999.

Indicators Summary
Numerator—Number of PUFs available within 9-12 mos.
Denominator—Total number of PUFs available.

Type and Significance
Output: One of the ultimate purposes of MEPS is to provide data and data products for use by other groups. The indicators above represent the major outputs for MEPS in fiscal year 1999.

Data Collection
This is a yes/no measure that will be tracked by documenting the dates involved with the data collection and availability of core PUFs (point-in-time files and full-year use and expenditure files) as part of day-to-day program management.

Indicators
2. Specific products due in fiscal year 1999:
          2a. 1997 point-in-time file.
          2b. 1996 full-year expenditure file.
          2c. 1996 full-year event, job, and condition files.
          2d. 1998 point-in-time file.

Indicators Summary
Products successfully made available.

Type and Significance
Output

Data Collection
AHCPR maintains records on when products become available in hard copy and/or electronically.

Indicators
3. Research findings and survey reports developed and disseminated for use by policymakers and researchers including MEPS Research Findings, MEPS Highlights, chartbooks, peer-reviewed journal articles, book published on contributions of expenditure surveys to policy making, publications oriented toward non-researchers.)

Baseline in fiscal year 1998: Total of 27 findings or reports produced.

Indicators Summary
Number of publications disseminated.

Type and Significance
Output

Data Collection
Distribution will be tracked through the AHCPR Publications Clearinghouse and through Web-site statistics.

Indicators
4. Customer satisfaction data from use of MEPS tapes and products rated at 85 percent.

Baseline to be developed in fiscal year 1999.

Indicators Summary
Numerator—Number of satisfied respondents.
Denominator—Number of total respondents.

Type and Significance
Output

Data Collection
OMB Clearance to do satisfaction survey obtained December 1998.

Indicators
5. Requests received from policymakers, purchasers and plans for MEPS data tapes, analyses, and/or reports responded to within promised time frames 85 percent of the time.

Baseline: Data will be collected in fiscal year 1999.

Indicators Summary
Numerator—Number of requests responded to in 2 working days.
Denominator—Total number of requests.

Type and Significance
Output

Data Collection
These statistics will be collected by an internal tracking system which captures the request receipt date, promised time frame, and response date.

Fiscal Year 1999 Objective 6.2: Facilitate use of MEPS data and associated products as tools by extramural researchers, policymakers, purchasers, and plans.

Indicators
1. Inclusion of MEPS data in extramural research grants with AHCPR and other funders.

Baseline: 1999 is the first year where the MEPS data have been available in time to be included in research applications.

Indicators Summary
Number of grants using MEPS data.

Type and Significance
Output

Data Collection
Count of grants using MEPS data will be maintained by the Agency Information Management System.

Indicators
2. Plan for extramural researcher access to MEPS data fully implemented.

Indicators Summary
Data Centers established.

Type and Significance
The data centers will make data that will not be available on public use files available to researchers in a secure environment. The data are intended for use by sophisticated data users who could work with MEPS data with little documentation and minimal support from the Agency. These data centers will enable AHCPR to provide rapid access to targeted data users.

Data Collection
Mechanisms for tracking needed data are part of the Data Center program development and evaluation.

Fiscal Year 1999 Objective 6.3: Modify and enhance MEPS to enable reporting on the quality of health care in America.

Indicators
1. MEPS Household Survey: Interviews with 9,000 previously surveyed families to obtain calendar year 1998 health care data, and with 5,600 new families.

Indicators Summary
Data collection successfully completed.

Type and Significance
Output: The MEPS HC is a nationally representative survey of the U.S. civilian noninstitutionalized population which collects medical expenditure data at both the person and household levels. The HC collects detailed data on demographic characteristics, health conditions, health status, use of medical care services, charges and payments, access to care, satisfaction with care, health insurance coverage, income, and employment.

Data Collection
The data for this objective is tracked through contract management records including monthly activity reports and the schedule of deliverables.

Indicators
2. MEPS Medical Provider Survey: Interviews with approximately 3,000 facilities, 12,000 office-based providers, 7,000 hospital-identified physicians, and more than 500 home health providers.

Indicators Summary
Data collection successfully completed.

Type and Significance
Output: The MEPS MPC supplements and validates information on medical care events reported in the HC by contacting medical providers identified by household respondents. The MPC sample includes hospitals, hospital physicians, home health agencies, pharmacies and office based physicians.

Data Collection
The data for this objective is tracked through contract management records including monthly activity reports and the schedule of deliverables.

Indicators
3. MEPS Insurance Component (MEPS-IC): Interviews with more than 40,000 employers and 1,000 insurance carriers.

Indicators Summary
Data collection successfully completed.

Type and Significance
Output: The MEPS IC collects data on health insurance plans obtained through employers, unions, and other sources of private health insurance. Data obtained in the IC include the number and types of private insurance plans offered, benefits associated with those plans, premiums, contributions by employers and employees, and employer characteristics.

Data Collection
The data for this objective is tracked through contract management records including monthly activity reports and the schedule of deliverables.

Indicators
4. MEPS data collection successfully moved to ongoing survey mode from data collection every 10 years.

Indicators Summary
Ongoing data collection fully implemented as evidenced by the data collection being completed according to schedule.

Fiscal Year 2000 Objective 6.1: Release and disseminate MEPS data and information products in timely manner for use by researchers, policymakers, purchasers, and plans. (MEPS)

Indicators
Core MEPS public use files (PUFs) available through Web site and CD-ROM within 9-12 months after data collection completed.

Indicators Summary
Numerator—Number of PUFs available within 9 -12 months.
Denominator—Total number of PUFs available.

Type and Significance
Output

Data Collection
This is a yes/no measure that will be tracked by documenting the dates involved with data collection and availability of PUFs as part of day-to-day program management.

Indicators
Specific products due in fiscal year 2000:

Files to conduct time-series analysis.
1999 point-in-time file.
1997 expenditure data available.
1996 full panel file available.

Indicators Summary
Products successfully made available.

Type and Significance
Outcome

Data Collection
The data for this objective is tracked through contract management records including monthly activity reports and the schedule of deliverables.

Indicators
Customer satisfaction data from use of MEPS tapes and products rated at least 90 percent. Baseline data still under development.

Indicators Summary
Numerator—Customer satisfaction in fiscal year 2000.
Denominator—Customer satisfaction in fiscal year 1999.

Type and Significance
Outcome

Data Collection
Part of customer survey plan submitted for OMB clearance, approved in December 1998.

Indicators
Response time for requests received from policymakers, purchasers and plans for MEPS data tapes, analyses, and/or reports responded to within promised time frames 85 percent of time. Baseline data under development, data available at the end of fiscal year 1999.

Indicators Summary
Numerator—Number of requests responded to within promised time frames.
Denominator—Total number of requests responded to.

Type and Significance
Output: One of the main purposes of MEPS is to supply data and data products to outside users. Thus, their satisfaction with those products is the ultimate outcome.

Data Collection
These statistics will be collected by an internal tracking system which captures the request receipt date, promised time frame, and response date.

Fiscal Year 2000 Objective 6.2: Facilitate use of MEPS data and associated products as tools by extramural researchers, policymakers, purchasers, and plans.

Indicators
Data centers operational.

xx requests for use of the centers.
xx user-days at the data centers.
xx projects completed.

These are the categories AHCPR will track in the beginning of the data centers program to illustrate that the program has been established successfully and is fully operational. Baseline to be established in fiscal year 1999 when the data centers program begins.

Indicators Summary
Numerator—Numbers in each category in fiscal year 2000.
Denominator—Numbers in each category in fiscal year 1999.

Type and Significance
Output: The data centers will provide rapid access to targeted data users of data not available on public use files in a secure environment. The data are intended for use by sophisticated data users who can work with MEPS data with little documentation and minimal support from the Agency.

Data Collection
Data centers are under development. Collection of the needed data is designed into the program management.

Fiscal Year 2000 Objective 6.3: Modify and enhance MEPS to enable reporting on the quality of health care in America as part of fiscal year 2000 Priority (3), "New Tools for a New Century."

Indicators
Expansion of databases to collect data related to quality of care, cost of care, burden of disease, and vulnerable populations (chronically ill, elderly, poor and near poor, low-income children, and minority groups ) completed by February 2000, i.e., data collection will be fully operational.

Indicators Summary
Data bases expanded and fully operational.

Type and Significance
Output: The proposed major expansion of the MEPS database will provide background data essential to measuring the quality of care for particular populations, such as the chronically ill, elderly, poor and near poor, and children. The first step in implementing this plan is to complete logistical arrangements and begin data collection. These are significant tasks.

Data Collection
The data for this objective is tracked through contract management records including monthly activity reports and the schedule of deliverables.

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