• Agency for Healthcare Research and Quality on Chopping Block

Agency for Healthcare Research and Quality on Chopping Block

The US House of Representatives Appropriations committee has aimed to get rid of the Agency for Healthcare Research and Quality (AHRQ), long disliked by some members of Congress.

Last month, the House committee approved a spending bill that would give the NIH a $1.1 billion raise next year. However, some of the new money would come from elimination of funding for AHRQ, which funds studies to improve health care delivery.

The HHS spending bill from the Senate Appropriations committee, approved 25 June, would reduce AHRQ’s $364 million budget by 35%.

The Agency was established in1989 to enhance the quality, appropriateness, and effectiveness of health care services and access to care by conducting and supporting research, demonstration projects, and evaluations. The AHRQ also develops guidelines and disseminates information on health care services and delivery systems.

Those who now want to trim or eliminate AHRQ say that it overlaps with NIH research. According to Science Insider, Representative Andy Harris (R–MD) said that the NIH already spends $1.37 billion each year on health services research and $1 billion for studies of patient safety.

Others say AHRQ overlaps with the Patient-Centered Outcomes Research Institute (PCORI)—a nonprofit supported by a trust fund that was created by the 2010 Affordable Care Act. PCORI spends about $500 million a year on comparative effectiveness research.

Supporters of the AHRQ say that all these agencies focus on different aspects of health care. Whereas NIH agencies focus on efficacy (does it work in a clinical trial?), the AHRQ was created to study effectiveness (does it work in the real world, or only in specific groups of patients?).

MedPage Today wrote that only about a quarter of AHRQ’s budget goes to health research. The agency also looks at patient safety (especially in hospitals), funds health information technology-related research, provides research and administrative support for the US Preventive Services Task Force, and also administers the Medical Expenditure Panel Survey.

The titles of some NIH projects sound similar to those supported by AHRQ and PCORI. Science Insider explained that NIH-funded research tends to focus on specific diseases, whereas AHRQ looks at broader questions, such as how to best organize primary care practices, or how practices could be affected by factors such as access or out-of-pocket costs.

According to MedPage Today, Rep. Rosa DeLauro (D-Conn.), a supporter of AHRQ, argued at the House hearing that AHRQ has a unique role that needs to be continued, in that it looks at the delivery of healthcare.

DeLauro noted that some members had suggested moving AHRQ’s functions to the Office of the National Coordinator for Health Information Technology , “but the bill doesn’t provide additional resources to [that] office to pick up the mission. It would be a mistake to shut down this agency,” she said.

AHRQ also funds annual reports on the quality of US health care, supports training of health services researchers, and works to disseminate research findings on best treatments. Those activities make it stand out from the pack, Ann Bonham, chief scientific officer of the Association of American Medical Colleges, told Science Insider. “NIH doesn’t get up every morning thinking about improving practice and patient safety at the practitioner level. PCORI doesn’t, either,” Bonham said.

Science Insider wrote that AHRQ has attracted critics because its work can threaten the financial interests of some groups. In the 1990s, Republicans tried to shut down the agency after spine surgeons objected to a report that found rest and pain medications worked as well as surgery for back pain.

The same House committee proposed in 2012 to abolish AHRQ, but the corresponding Senate panel did not concur. It will probably be several months before AHRQ knows whether it will remain in business.

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