Keep health info coming

"Assaults on health-services research raise a more fundamental question: Why is objective information so threatening?" - Jeffrey C. Lerner
"Assaults on health-services research raise a more fundamental question: Why is objective information so threatening?" - Jeffrey C. Lerner

Federal agency's closing would dry up a valuable research source.

Posted: August 08, 2012

Buried in the road to cost reduction for the federal government, in Section 227 of the House Subcommittee on Appropriations Bill for Fiscal Year 2013, is a plan to defund the Agency for Healthcare Research and Quality (AHRQ).

If this bomb goes off undetected, the nation will lose its greatest source for funding research on health-care quality, effectiveness, and patient safety.

AHRQ funds the studies and systematic reviews that objectively evaluate how well clinical procedures, quality approaches, and consumer satisfaction work.

But AHRQ's approximately $400 million annual budget does more than pay for studies. It helps fund what has been the missing link of American health care: what treatments work best and how errors can be prevented.

It creates tools such as the National Guideline and National Quality Measures Clearinghouses, and databases such as the Cost and Utilization Project, which captures research on many issues, including cost and quality of services, medical practice patterns, access to care, and treatment outcomes.

AHRQ translates that data into information to help inform decision making and improve health-care delivery.

AHRQ also disseminates research that identifies the root causes of threats to patient safety, provides information on the scope and impact of medical errors, and examines effective ways to make system-level changes to help prevent errors.

AHRQ initiatives include preventing health-care-associated infections and creating the legal structure for Patient Safety Organizations, which collect and analyze patient safety adverse events that providers report and give feedback to help clinicians and organizations improve quality.

The list of AHRQ's contributions to health-care delivery goes on and on, and you can find out more about AHRQ's mission and budget at http://www.ahrq.gov/about/budgtix.htm#report

So the question remains: Why did the legislators plant a hidden roadside bomb to blow up this agency?

Providing objective information through federal agencies has long been open to attack.

Funding for these types of agencies has been threatened several times since their inception in the late 1960s. In the 1990s, the Office of Technology Assessment was the only federal agency to be stripped of its funding.

That decade also saw an attempt to zero out the budget of AHRQ (then called the Agency for Health Care Policy and Research) by a determined group of back surgeons. They objected to a clinical practice guideline recommending that many patients wait six weeks before undergoing surgery because 90 percent of conditions are resolved without it. AHRQ survived, but it stopped producing guidelines and instead hosted a website called the National Guideline Clearinghouse that compares guidelines developed by others.

Newt Gingrich was speaker of the House in the mid-1990s when the agency had its first near-death experience. Gingrich eventually came to appreciate the agency's value and later served on its advisory board.

To be sure, defunding AHRQ would cause havoc in medical research. About 42 percent of academic research organizations that are members of Academy Health, a leading umbrella group for research, report receiving funding from AHRQ, as does ECRI, where I work. That, however, is a side issue.

Assaults on health-services research raise a more fundamental question: Why is objective information so threatening?

The answer is that objective information shakes up the status quo. Many constituencies think objective information is information that supports their perspective, and are resistant to change, no matter what the evidence shows.

So, truly objective information is a very dangerous weapon.

But it is tough to argue publicly that objectivity is bad, so a time bomb is buried in this House bill in an attempt to avoid having to first openly engage the public in a national debate on the best ways to improve quality and reduce unnecessary expenditures.

How will we find out what quality is and how will we find out what unnecessary expenditures are? Without AHRQ, we won't.

So here is the bottom line: If we, the health-care community, are serious about moving toward greater transparency, improved patient safety, better understanding and use of research for evidence-based medicine and evidence-based management, then let's not let AHRQ be derailed by the proposed cuts.


Jeffrey C. Lerner is president and chief executive of the ECRI Institute, which researches ways to improve the safety, quality, and cost-effectiveness of patient care. He can be reached at jlerner@ecri.org

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