For AHRQ in 2020, an Unforgettable Year of Daunting Challenges and Vital Accomplishments

In 2020, one healthcare story eclipsed all others: COVID-19. The pandemic delivered the cruelest of blows to American families, decimated our economy, and revealed lethal vulnerabilities in the Nation’s public health safety net.

AHRQ, like every element of government, urgently revised its priorities. Existing research projects were refocused on COVID-19. New projects were launched to explore strategies for controlling the virus’ spread. Evidence-based information aimed at halting the pandemic was made available to physicians, nurses, and others battling the virus first hand.

Yes, the challenges of battling COVID-19 were daunting. But AHRQ’s all-hands-on-deck approach to the pandemic was only part of our 2020 story. The Agency also maintained its commitments to address other vital areas, including efforts to end opioid misuse, protect patient safety, improve care for people with multiple chronic conditions, and provide essential data for researchers, policymakers, and others who need reliable information to track trends in the rapidly changing healthcare ecosystem.

When I look back on 2020, I am immensely proud of the contributions by Agency scientists, AHRQ grantees, and countless others who supported the goal of advancing a truly 21^st century healthcare system. Allow me the chance to highlight a few:

COVID-19 Response

When the realities of the pandemic became apparent, AHRQ quickly released three new grant funding opportunities to shed light on vital questions about the expanded use of telemedicine, the safety and value of health systems’ response to COVID-19, and how healthcare systems were addressing healthcare disparities. The Agency plans to award 29 research grants totaling up to $17 million in a combination of new efforts and supplemental funding for current grantees to pivot and expand current research to examine responses to COVID-19.  While much additional research is needed, collectively, these grants will serve as a down payment that will help care delivery be more resilient in the future.

At the same time, AHRQ’s Evidence-based Practice Centers conducted rapid evidence reviews to inform providers’ decisionmaking on the use of masks, the allocation of scarce resources, and no-touch strategies for disinfecting in hospitals and acute care settings. Publications by AHRQ’s Patient Safety Network, meanwhile, explored several timely topics, including the use of human factors engineering to reduce patient safety risks, patient safety challenges facing older adults living in nursing homes, and improving telehealth safety. These reviews continue to help professional societies provide up-to-date guidance to their members about important aspects of the evolving pandemic.

In the spring, AHRQ’s Healthcare Cost and Utilization Project (HCUP) team responded to a Department of Health and Human Services (HHS) request for data on hospital occupancy rates, the availability of intensive care unit beds, and ventilator capacity. By summer, Agency researchers used AHRQ’s Medical Expenditure Panel Survey (MEPS) to publish an analysis that showed disproportionate rates of COVID-19 among racial and ethnic minorities were most likely linked to exposure in work and home environments.  These are two examples of how AHRQ data and analytics advance evidence-based policy making.

In September, as part of a multi-pronged initiative to support nursing homes, the Agency invested $237 million and launched the AHRQ ECHO National Nursing Home COVID-19 Action Network to provide free training and local mentorship to accelerate the implementation of evidence-based infection and safety practices.  One hundred training centers are now providing support to more than 7,000 nursing homes in every state and the District of Columbia. The network is addressing critical areas that include best practices in the use of personal protective equipment, infection control, COVID-19 testing, and addressing social isolation. Given the success of the project, nursing home recruitment has been extended through January to allow additional nursing homes to participate.

AHRQ’s Consumer Assessment of Healthcare Providers and Systems (CAHPS) program rapidly developed a revised version of its patient experience survey that allows health systems to access patient experience of care across new settings, including telehealth visits.  The healthcare delivery ecosystem will continue to evolve after the explosion of telehealth use this year.  With this new tool, patients’ voices will help chart the course.

And as a strategy for providing access to the latest evidence on COVID-19, AHRQ established an online resource with links to new AHRQ-funded research, information to support practice improvement, data and analytics, and other tools.

Addressing the Opioid Crisis

AHRQ’s unique capabilities to collect and analyze healthcare data added significantly to the Nation’s efforts to curb the opioid epidemic. Three statistical briefs by our HCUP team in 2020 provided vital information to policymakers and others, including one that described how social determinants of health (SDOH) have contributed to the crisis. Another analysis quantified the burden of opioid hospitalizations in both urban and rural communities.  Our MEPS team published a statistical brief that provided important baseline information on total expenses, use, and payment sources of outpatient prescription opioids.  Data and analysis are critical tools for understanding how healthcare delivery needs to improve and for discovering how innovations are and are not affecting care and outcomes.

Seven comprehensive reports developed by our EPC program were used to update Federal opioid-prescribing guidelines.  While clinical guidelines need to be refined through the experience of real-world implementation, we at AHRQ believe that they must be built on the best available evidence.

Additionally, AHRQ supported development of the Medication-Assisted Treatment (MAT) for Opioid Use Disorder Playbook, a comprehensive guide for implementing MAT in primary care and other settings. The online, interactive playbook contains the latest guidance, tools, and resources to address MAT implementation. Primary care is foundational to equitable, accessible, high-quality healthcare.  Tools like these empower primary care professionals and practices to serve their communities.

Improving Patient Safety

AHRQ co-chaired the 27-member National Steering Committee for Patient Safety, which developed Safer Together: A National Action Plan to Advance Patient Safety. This report provides a blueprint for safer care and reduction of harm to patients and caregivers. The report and a companion implementation resource guide provided the latest tactics, tools, and resources for immediate implementation.

In addition, AHRQ’s comprehensive Making Healthcare Safer III volume catalogs 47 practices that include medication management, diagnostic errors, healthcare-associated infections, and safe nursing practices that target patient safety improvement in hospitals, primary care practices, and long-term care facilities.  The compendium’s richness is in large part due to two decades of patient safety research and implementation at AHRQ.

We released new data reporting tools for the national Network of Patient Safety Databases (NPSD). Developed as part of the Patient Safety and Quality Improvement Act of 2005, the NPSD contains non-identifiable data submitted by Patient Safety Organizations from across the country. This rich data source makes it possible to identify and track patient safety concerns and sets the stage for learning how to mitigate risks and reduce harm.  To make the data accessible and useful to the public, AHRQ published three data reporting tools. The most recent NPSD Dashboards and Chartbooks reflect more than 1.7 million non-identifiable hospital patient safety reports. 

Advancing Health Services Research

As a national leader in funding health services research, we were gratified to publish the independent, comprehensive Health Services and Primary Care Research Study. The Congressionally mandated report, commissioned by AHRQ and conducted by RAND Corp., affirmed that minimal research overlap exists between Federal agencies and, importantly, suggested steps for improving the relevance, timeliness, and impact of health services and primary care research.  AHRQ will use the report’s recommendations as we continue to explore how to increase the impact of our work.

As part of AHRQ’s ongoing effort to provide researchers with the best possible tools to answer healthcare’s most pressing questions, the Agency released a new Beta version of a database on SDOH. The database is designed for easy use and provides linkable SDOH-focused data to inform research and cutting-edge approaches to address emerging health issues and, ultimately, improve health outcomes.

Providing Data and Analytics to Advance Evidence-based Decision Making

In 2020, for the first time, AHRQ posted same-year, State-level monthly data on hospital utilization. Making this recent data available to researchers and policy makers represents a significant step forward to achieving a deeper understanding of the effect of the COVID-19 pandemic on hospital care in the U.S.

In 2020, AHRQ answered more than 1,000 requests from policy makers, researchers, and the public for MEPS data and analytic findings related to financing, coverage, and access to care in the U.S. healthcare system. This ongoing dissemination of data occurred as AHRQ took important strides toward developing an Insight Platform to provide Federal, State, and local policy makers with essential data in areas such as medical claims, physician supply, and social determinants of health.

Inspiring Innovation

Just this month we announced five winners in our challenge competition aimed at improving postpartum mental health among women in rural communities. Top prize winners developed innovative plans to identify women at risk and provide needed support. It was our fifth successful challenge and followed others that yielded creative advances in areas such as advancing care through patient self-assessments, predictive analytics, SDOH, and digital solutions to support transitions of care. All told, AHRQ has awarded more than $1 million in prize money since 2019 through challenge competitions.

As I’ve noted in this space before, we are at a cross-roads in healthcare delivery. Our collective efforts to improve the well-being of the American people come at a unique moment—an unprecedented period of enormous demographic changes, rapid restructuring across health systems, shifts from in-hospital care to new care settings, and the explosion of data and new technologies.

But as we look back on 2020, I could not be prouder in knowing that AHRQ’s many accomplishments were the result of selfless collaborations and a commitment to AHRQ’s broad mandate: to advance a 21^st century healthcare system.

Gopal Khanna is director of AHRQ.

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