Congress should provide no less than the current funding level of $334 million in appropriated funds for the Agency for Healthcare Research and Quality (AHRQ) to support research vital to primary care in the 2017 fiscal year.
The agency is still at risk. AHRQ survived last year because the final budget agreement raised the total funding caps. This year, House would cut over $50 million from the agency and the Senate would cut $10 million. We need to work even harder to ensure AHRQ maintains its funding this year, at least to its former fiscal year 2016 spending level of $334 million.
One of the consequences of reduced funding was the halting of research to optimize care for patients with multiple chronic conditions (MCC). The initiative would have provided clinicians with evidence-based tools to develop comprehensive, integrated care plans that reflect the patients' health conditions, values, preferences, and relevant life circumstances. The tools would have also shown how new care models and services may better serve their patients' needs.
Without maintaining current funding levels, AHRQ will continue to have to halt or postpone the production of tools primary care health professionals need. Should the proposed cuts go forward, we will be entering a climate of "death by a thousand cuts."
AHRQ is the federal agency charged with producing evidence to support clinical decision-making, reduce costs, advance patient safety, decrease medical errors and improve health care quality and access. AHRQ’s mission helps to provide the critical evidence reviews needed to answer questions on the common acute, chronic, and comorbid conditions that family physicians care for on a daily basis. AHRQ supports important investigation in areas which are not the focus of investigation anywhere else in the biomedical research community. Evidence-based family medicine practice requires AHRQ-supported primary care research in areas such as practice-based research networks (PBRNs), practice transformation, patient quality and safety in non-hospital settings, multi-morbidity research, as well as the delivery of mental and behavioral health services in communities by primary care practices. Also important to successful primary care research is AHRQ’s support future primary care investigators. We believe there is a need to deliberately promote this training as a way to aid in the development of all the areas we have emphasized. AHRQ has researcher training mechanisms in place, which we believe are important, and need to be expanded.
Primary care research includes: translating science into the active practice of medicine and caring for patients, understanding how to better organize health care to meet patient and population needs, evaluating innovations to deliver the best health care to patients, and engaging patients, communities, and practices to improve health. AHRQ is uniquely positioned to support this sort of best practice research and to help advance its dissemination to improve primary care nationwide.
Some examples regarding the utility of AHRQ-funded grants:
“Three AHRQ grants supported the development of patient centered personal health records in 2007, 2009, and 2010, and studied whether these tools increased prevention. In our studies we found increases in important tests like colon and breast cancer screening as well as immunizations, blood pressure and cholesterol control. In addition, we were able to leave the functionality in place – permanently – for 191 doctors and now 60,000 patients. One result is that the practices are now using the AHRQ-created portal as their sole patient portal and abandoned the commercial portal that did not work as well.”
—Alex Krist, MD, MPH, Virginia Commonwealth University
“The AHRQ-sponsored series of grants on Multiple Chronic Condition research were transformative for that field. They also sponsored regular meetings among grantees and established the Multiple Chronic Conditions Research Network, which has fostered many collaborations between researchers with shared expertise.”—Elizabeth A. Bayliss, MD, MSPH, Kaiser Permanente Colorado