Performance Plans for FY 2003 and 2004 and Performance Report for FY 2002

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Part 2. Goal-By-Goal Performance Measurement

2.1: Budget Line 1—Research on Health Care Cost, Quality and Outcomes (Tables)
2.2: Budget Line 2—Medical Expenditure Panel Surveys (MEPS) (Table)
2.3: Budget Line 3—Program Support (Table)
2.1: Budget Line 1—Research on Health Care Cost, Quality and Outcomes (Narrative)
2.2: Budget Line 2—Medical Expenditure Panel Surveys (MEPS) (Narrative)
2.3: Budget Line 3—Program Support (Narrative)

The FY 2004 Performance Plan continues AHRQ's transition from a plan focused on outputs to a plan more focused on outcomes. The impact of research on health outcomes is rarely immediate or direct. The results of AHRQ's investments, and its impact on the quality, safety, cost, use or access to health care should be measured as a whole, rather than as a single component. As a result, the outcome measures we have chosen reflect the outcomes we expect to achieve over a span of several Fiscal Years.

The indicators chosen to report are often the results of programs of research that have been underway for several years and reflect investments in building new knowledge. The key is translation of that knowledge into information that is useful to our users. For example, in FY 2003-04 AHRQ will track preventable hospitalizations for complications of pediatric asthma, the number of hospitalizations for elderly patients that could be prevented through the use of influenza immunizations and the number of premature infants who develop Respiratory Distress Syndrome (RDS) as a measure of success in improving health care outcomes. Each of these indicators reflect the impact of investments which AHRQ has made in developing new knowledge and developing useful tools which providers can use to take the theoretical and make it practical. In the Final FY 2004 Performance Plan AHRQ will use the National Healthcare Quality Report and the National Healthcare Disparities Report to identify other indicators to report the success of AHRQ's programs.

In addition, AHRQ identified program outputs for each goal for the Fiscal Year. These program outputs will be used to show progress the programs are making to achieve the overall outcome goal. For example, while reporting the number of hospitalizations for complications of pediatric asthma as a program output, AHRQ is committed to producing evidence reports on topics that will form the basis for future translation and implementation projects. Reporting the Agency's program activities in this way will provide a clearer picture of where the agency is going and it's progress towards meeting its goals.

Finally, in future Performance Plan submissions, an analysis of the program will be incorporated into the goal-by-goal discussion. For this report, FY 2002 results are addressed in Appendix II, Fiscal Year 2002 Performance Report Summary.

The following tables present, by budget line, a selection of the long-term performance goals and Fiscal Year targets for AHRQ. Some measures come from the results of OMB Program Assessment Rating Tool (PART) reviews of the following AHRQ programs:

Healthcare Cost and Utilization Project (HCUP).
Consumer Assessment of Health Plans (CAHPS®).
Translating Research Into Practice (TRIP).
Medical Expenditure Panel Survey (MEPS).

Budget Line 2.1—Research on Health Care Cost, Quality and Outcomes

Goal 1: To have measurable improvement in the outcomes, quality and safety of health care for Americans

Performance Goal	FY Targets	Actual Performance	Reference
By 2010, at least 5 organizations will use HCUP databases, products or tools to improve health care quality for their constituencies by 10%, as defined by the AHRQ Quality Indicators. Baseline: FY 2000—quality indicators developed.	FY 2004 Two new organizational users of HCUP will develop interventions using AHRQ QIs. One organizational user will implement an intervention based on the QIs. FY 2003 Two organizational users of HCUP will develop interventions using HCUP QIs. Measure New in FY 2003		1 (1.1)
By 2008, CAHPS® data will be more easily available to the user community and the number of consumers who use information from CAHPS® to make choices about their healthcare will increase by 20% (Baseline FY 2002).	FY 2004 Produce a CAHPS® module for consumer assessments of hospital quality. Establish baseline for number of consumers using Nursing Home CAHPS®. FY 2003 Produce a CAHPS® module for consumer assessments of health and services received in nursing homes. FY 2002 New Measure Obtain baseline number of people with access to CAHPS® data.	Baseline developed: Access—90 million Americans.	5 (5.3)
By 2010, evidence, translation tools and implementation strategies exist for improving the overall quality and safety of health of the American public so that: By 2010, reduce to 105,613 admissions, the rate of hospitalizations for pediatric asthma in persons under age 18. By 2010, reduce to 520,441 the number of immunization-preventable pneumonia hospital admissions of persons aged 65 and older. By 2010, reduce to 11,570 the number of immunization-preventable influenza hospital admissions of persons aged 65 and older. By 2010, reduce to 500 per live births the number of premature babies who develop Respiratory Distress Syndrome (RDS).	FY 2004 Reduce by 5% below the baseline: The rate of hospitalizations for pediatric asthma in persons under age 18. The number of admissions for immunizations-preventable pneumonia for persons aged 65 or older. The number of admissions for immunization-preventable influenza for persons aged 65 or older. The number of premature babies who develop RDS. FY 2003 Establish Validated Baselines. Following are FY 2000 baseline estimates: Pediatric Asthma—150,876 Pneumonia—743,487 Influenza—16,529 RDS—5,707		1 (1.)
Report on national trends in health care quality.	FY 2004 Report on progress in core measure set. Identify private sector data to be used in future reports. FY 2003 Produce first annual quality report. Establish baseline data in core set of measures.
By 2004, 6 health facilities or regional initiatives to implement interventions and service models on patient safety improvements will be in place.	FY 2004 6 Teams will be in place. FY 2003 Awards to be made to at least 6 facilities or initiatives.		5 (5.1)
By 2004, at least 10 States or major health care systems will have on-site Patient Safety Improvement Corp (PSIC) staff in place.	FY 2004 10 States or major health care systems will have on site experts in Patient Safety. FY 2003 A Patient Safety Improvement Corp training program will be established. FY 2002 Planning study completed.	Completed.	5 (5.1)
Identify the number and types of adverse events, no-harm events, and near miss events reported in demonstration projects.	FY 2004 Report on the number and types of adverse events. FY 2003 Develop reporting mechanism and data structure for Demonstration projects.		5 (5.1)
By 2006, six national message format and clinical vocabulary standards would be identified/recommended by HHS as ready for voluntary adoption and deployment.	FY 2004 3 message format and clinical vocabulary standards will be recommended by HHS as ready for voluntary adoption and deployment. FY 2003 Develop Consensus on standards.		5 (5.5)
By 2008, nursing homes will have evidence-based information needed to make informed purchasing strategies related to IT.	FY 2004 5 technologies currently shown to be effective in other clinical settings will be tested in nursing homes to evaluate the impact on safety, quality and cost of care.		5 (5.5)

Goal 2: To develop the evidence base for policymakers and health systems to use in making decisions about what services to pay for, how to structure those services, and how those services are accessed.

Performance Goal

FY Targets

Actual Performance

Reference

Increase the number of partners contributing data to the HCUP databases by 5% above FY2000 baseline.

FY 2004
5% increase over FY00 baseline.

FY 2003
Increase the number of partners required.

4(4.1)

Goal 3: To build the capacity for improving the Quality of Health Care Delivery through Research and Training

Performance Goal

FY Targets

Actual Performance

Reference

Increase the number of minority researchers trained as health services researchers by 5% annually.

FY 2004
5% increase over FY 2003 baseline.

FY 2003
New Measure Establish baseline.

4 (4.2)

Support training programs for junior-level researchers and mid-career scientists.

FY 2004
Maintain baseline

FY 2003
Establish Baseline # programs.

4 (4.2)

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Budget Line 2.2—Medical Expenditure Panel Survey (MEPS)

Goal 4: To provide comprehensive, relevant and timely data on health care use and expenditures for use by public and private sector decisionmakers and researchers

Performance Goal	FY Targets	Actual Performance
By 2008, point in time data from the MEPS survey will be available within 12 months.	FY 2004—12 months FY 2003—12 months FY 2002—12 months FY 2001—12 months FY 2000—12 months	12 months 12 months 12 months
Insurance Component tables will be available within 6 months of collection.	FY 2004—7 months FY 2003—7 months FY 2002—7 months FY 2001—7 months FY 2000—7 months	7 months 7 months 7 months
MEPS Use and Demographic Files will be available 12 months after final data collection.	FY 2004—15 months FY 2003—17 months FY 2002—19 months FY 2001—23 months FY 2000—28 months	19 months 23 months 28 months
Full Year Expenditure Data.	FY 2004—12 months FY 2003—18 months FY 2002—21 months FY 2001—24 months FY 2000—33 months	21 months 24 months 33 months

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Budget Line 2.3—Program Support

Goal 5: Maximize the value of AHRQ by developing efficient and responsive business processes, aligning human capital policies and practices with AHRQ's mission, building an integrated and reliable information technology infrastructure

Performance Goal	FY Targets	Actual Performance	Reference
By FY 2007, Get to Green on the Presidents Management Agenda Initiatives —Human Capital	FY 2004 Develop a plan to recruit new or train existing staff to acquire skills necessary to fill identified gaps. FY 2003 Identify gaps in agency skills and abilities. Integrate competency models into organizational processes. Finalize the identification of technical competencies. Engage a consultant to evaluate options and develop a plan for vertically & horizontally collapsing organizations. Continue to reduce organizational levels. FY 2002 Develop a model for leadership and core competencies in AHRQ. Reduce the Number of Managers. Reduce Organizational Levels. Redeploy Staff to Mission-Critical Positions.	Completed. — # of supervisory positions eliminated: 7 — # of organizational levels eliminated: 2 — # of administrative FTE's redeployed to support program functions: 12	Presidential Management Initiative
Expanded E-Government. Increase IT Organizational Capability.	FY 2004 Complete implementation of the control review cycle. Implement the evaluation cycle. Integrate capital planning processes with enterprise architecture processes. FY 2003 Implement the planning cycle. Implement the select review cycle. Initiate efforts for the control review cycle. FY 2002 Establish IT project accountability. Establish IT capital planning governance. Stand up the IT Investment Review Board. Develop integrated business transactions with contracts and budget. Define operating procedures for capital planning's four cycles.	Completed.
Improve IT Security/Privacy.	FY 2004 Continue risk assessments on AHRQ's second tier systems. Implement the business continuity and contingency program plans. FY 2003 Continue risk assessments on AHRQ's mission critical systems. Implement incident response plans and procedures. Develop network security plans. Develop anti-virus program plan. Develop authentication program plan. FY 2002 Establish security and privacy governance. Complete the second cycle of NIST self assessments. Complete risk assessments of seven of AHRQ's mission critical systems.	Completed.	Presidential Management Initiative
Establish IT Enterprise Architecture.	FY 2004 Develop the target architecture. Create the migration plan. Integrate enterprise architecture processes with capital planning processes FY 2003 Continue to carry out business process assessments of key business lines. Establish enterprise architecture governance. Develop the baseline architecture. Develop the technical reference model. Establish technical standards. Implement general desktop and network upgrades to reflect the technical architecture. FY 2002 Stand up the enterprise architecture program office. Implement the Enterprise Architecture Management System.	Completed.	Presidential Management Initiative
Budget and Performance Integration	FY 2004 Implement planning system. Complete initial PART reviews on all major agency programs. FY 2003 Develop and test planning system that links budget and performance. Conduct initial PART Reviews on selected agency programs. FY 2002 Conduct initial PART reviews on selected agency programs.	Completed PART reviews on 5 agency programs.	Presidential Management Initiative

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