sues of organization, delivery, financing, utilization, patient and provider behavior, quality, outcomes, effectiveness, and cost. It evaluates both clinical services and the system in which these services are provided” (Agency for Healthcare Research and Quality, 2002e, Para. 2). This chapter focuses particular attention on research regarding the development of standardized performance measures, the reporting of comparative quality data, and the provision of financial or other incentives to providers to improve quality.

While AHRQ is the primary engine for this type of research, the Centers for Medicare and Medicaid Services (CMS), the Veterans Health Administration (VHA), CDC, the Health Resources and Services Administration (HRSA), and NIH also engage in relevant applied health services research and demonstration activities. Rather than providing a chronicle of past research that has formed the basis for ongoing quality activities, this section highlights some of the salient research activities currently under way in these agencies. This is not intended to be an exhaustive review of every current quality-related project, but to provide a flavor of the range and types of initiatives being undertaken that are relevant to this report.

Agency for Healthcare Research and Quality

Created by statute in 1989 as the Agency for Health Care Policy and Research, AHRQ administers programs and activities across a range of policy concerns, from access, to care, to cost-effectiveness, to quality of care. Its activities are organized under six separate research centers: the Center for Cost and Financial Studies, Center for Organization and Delivery Studies, Center for Primary Care Research, Center for Practice and Technology Assessment, Center for Outcomes and Effectiveness, and Center for Quality Improvement and Patient Safety. Much of the work related to the development of performance measures and tools, a small part of AHRQ’s overall mission, is conducted by the last center (Agency for Healthcare Research and Quality, 2001).

AHRQ funds both commissioned and investigator-initiated research efforts designed to enhance quality measurement and improve care. The quality-related research ranges from outcomes research, to performance measurement, to patient safety initiatives. For example, included in the safety agenda are 24 projects examining different methods of collecting and analyzing data to identify factors that create a higher risk of medical errors, 22 projects analyzing how computer technology can be used to reduce errors and improve the quality of care, 8 projects exploring the effects of working conditions on patient safety, and 23 projects focusing on the development of new strategies to improve patient safety at health care facilities (Agency for Healthcare Research and Quality, 2001).

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