AHCPR News and Notes

AHCPR reorganizes to streamline operations

The Agency for Health Care Policy and Research has been reorganized to strengthen its role as the nation's focal point for health services research, according to Clifton R. Gaus, Sc.D., AHCPR's Administrator. The reorganization reduces the Agency's operational units from 34 to 13 and redraws its organizational chart to "flatten" the organization, with all major operating units reporting directly to the Administrator. This new structure creates direct lines of communication between the Agency's leadership and its operations, permitting more efficient and effective management of resources.

The reorganization streamlines the Agency's operations, eliminates redundant and unnecessary management and operational levels, and helps to ensure that appropriate priority is given to all of the Agency's program goals and objectives, notes Dr. Gaus. As part of the reorganization, Dr. Gaus named Lisa Simpson, M.B., B.Ch., M.P.H., as Acting Deputy Administrator.

The Agency's 13 operational units and their responsibilities are:

• Office of the Administrator, Clifton R. Gaus, Sc.D.—directs the activities of the Agency to ensure achievement of strategic objectives.
• Office of Management, Willard B. Evans, Jr., director—coordinates Agency-wide administrative activities.
• Office of Planning and Evaluation, Phyllis M. Zucker, director—coordinates the agency's strategic planning and program evaluation and coordinates research activities focusing on special populations.
• Office of Policy Analysis, Larry Patton, director—provides support and technical assistance in the analysis and synthesis of health care research, serves as AHCPR's legislative liaison, and facilitates the activities of AHCPR's National Advisory Council.
• Office of Scientific Affairs, Linda K. Demlo, Ph.D., acting director—manages the scientific review process for grants and contracts and the assignment of projects to Agency centers, manages Agency research training programs, and evaluates the medical and scientific contributions of proposed and ongoing research, demonstrations, and evaluations.
• Office of the Forum for Quality and Effectiveness in Health Care, Douglas B. Kamerow, M.D., director—sponsors development of and research on methods and materials to promote evidence-based clinical practice.
• Center for Health Information Dissemination, Christine G. Williams, acting director—designs, develops, implements, and manages programs for disseminating the results of Agency activities.
• Center for Information Technology, J. Michael Fitzmaurice, Ph.D., director—conducts and supports studies of health information systems, computerized patient record systems, and medical decision analysis.
• Center for Outcomes and Effectiveness Research, Carolyn M. Clancy, M.D., acting director—conducts and supports studies of the outcomes and effectiveness of diagnostic, therapeutic, and preventive health care services and procedures.
• Center for Health Care Technology, Thomas V. Holohan, M.D., director—conducts and supports a comprehensive program of health care technology assessment.
• Center for Quality Measurement and Improvement, Sandra Robinson, acting director—conducts and supports research on the measurement and improvement of the quality of health care.
• Center for Primary Care Research, Carolyn M. Clancy, M.D., director—conducts and supports studies on primary care and clinical, preventive, and public health policies and systems.
• Center for Cost and Financing Studies, Ross H. Arnett III, director—conducts and supports studies of the cost and financing of health care and develops data sets to support policy and behavioral research and analyses.
• Center for Organization and Delivery Studies, Irene Fraser, Ph.D., director—conducts, supports, and manages studies of the structure, financing, organization, behavior, and performance of the health system and providers within it.

One of the guiding principles behind the reorganization is to enhance the Agency's ability to respond more quickly to the needs and demands of the rapidly changing private sector. Dr. Gaus wants AHCPR to be able to anticipate and respond quickly and efficiently to the research and information needs of the marketplace so the Agency can provide the science-based tools to help the private sector control health care costs while improving quality.

AHCPR receives $125.3 million in FY 1996 funding

Congress has passed a fiscal year 1996 spending bill that includes $125.3 million for the Agency for Health Care Policy and Research. The final resolution of the FY 1996 budget allows Agency officials and the health services research community to proceed with pending projects.

At this level of funding, AHCPR will be able to continue its support of existing grantees and assure the continued health of the field by funding some new awards. Decisions on awards will be announced shortly. In addition, AHCPR will restore nearly half of the reductions in awards made to grantees since September 1995, when AHCPR's FY 1996 funding level was in doubt.

In addition, AHCPR recently released several requests for applications (RFAs), soliciting applications for projects to compare the effectiveness and outcomes of hysterectomy, study patient referrals from primary care to specialty care, and develop and test new health care quality measures. Awards made in response to these RFAs will be announced in September 1996.

Administrator testifies in support of AHCPR's FY 97 budget

The Agency for Health Care Policy and Research's Administrator, Clifton R. Gaus, Sc.D., presented the President's FY 1997 budget request for AHCPR to the House Labor/HHS/Education Appropriations Subcommittee on April 30, 1996. The request totals $143.8 million. Highlights of AHCPR's FY 1997 program as presented by Dr. Gaus include:

• AHCPR will serve as a "science partner" for provider societies, managed care organizations, purchasing groups, and other private sector entities by supplying the scientific evidence they need to produce and implement their own clinical practice guidelines. AHCPR will provide support for Centers for Evidence-based Practice to respond to requests from these groups but will no longer be directly involved in clinical practice guideline development.
• AHCPR will work with key groups to cosponsor an online database of clinical practice guidelines through a National Guideline Clearinghouse.
• AHCPR will continue its research and evaluation efforts and broaden dissemination to promote incorporation of scientific knowledge into day-to-day clinical practice.
• AHCPR will implement the full data collection phase of the Medical Expenditure Panel Survey (MEPS), an interrelated series of surveys that replaces the National Medical Expenditure Survey (NMES).
• AHCPR will continue to support outcomes research in areas such as hysterectomy and heart disease.
• AHCPR will continue efforts to construct tools for measuring quality of care.
• AHCPR will continue to support research on computerized decision support systems (CDSS) to assist providers' decisionmaking and promote cost-effective health care.
• AHCPR will continue to focus on ways to help consumers select high quality health plans and services.
• AHCPR will continue to seek a better understanding of trends in the health care marketplace, including the implications of these trends for quality of care and access to care. Special attention will be given to the impact of changes in health care organization on referrals from primary care to specialty care.
• AHCPR will support an ongoing initiative on market forces to examine how changes in the structure of defined markets have affected the way health care providers produce and deliver care and the price, distribution, and quality of services available.

Dr. Gaus concluded his testimony by stressing the important role AHCPR plays in helping consumers, providers, purchasers, and policymakers determine what works and what doesn't work in medical care.

AHCPR, Duke University, and DuPont Merck agree on joint project to continue stroke prevention research

The Agency for Health Care Policy and Research has signed a landmark agreement with Duke University and DuPont Merck Pharmaceutical Company to extend the work of the AHCPR-funded Patient Outcomes Research Team (PORT) to examine the most effective way to prevent stroke in high-risk patients.

Under the agreement, Duke University will conduct a 3-year randomized clinical trial to evaluate the effectiveness of a comprehensive strategy for educating patients and physicians about the appropriate use of stroke-preventing therapy using the anticoagulant drug warfarin. The study will be conducted in various managed care organizations and will involve 2,500 patients with atrial fibrillation, a condition characterized by rapid and erratic beating of the heart which increases the risk of stroke. The project will be headed by David Matchar, M.D., principal investigator of AHCPR's stroke prevention PORT, and will receive up to $1.5 million from DuPont Merck, which manufactures warfarin, to supplement AHCPR's funding.

The stroke prevention PORT was originally funded by AHCPR in 1991. The study has produced a number of key findings about preventing stroke in persons who have experienced minor strokes, as well as in individuals who have not had these transient attacks but who may have clogged arteries.

Last fall the investigators announced that, based on a synthesis of the best scientific evidence available, increasing use of warfarin could prevent as many as 40,000 strokes a year in persons with atrial fibrillation and save nearly $600 million a year in health care costs. It is generally acknowledged that warfarin is underutilized in atrial fibrillation patients.

According to AHCPR Administrator Clifton R. Gaus, Sc.D., Duke University will provide the clinical and research expertise, AHCPR will provide scientific oversight and financial support, and DuPont Merck will provide technical assistance and financial support for the project, which will be called the Managing Anticoagulation Services Trial (MAST).

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