AHRQ at 20, AHRQ in 20: Looking Back to Look Ahead
NOV
20
2019
As we look toward the 20th anniversary of AHRQ on December 6, 2019, I want to share some thoughts about where the Agency has been and where we are headed.
I could talk about the 3,860 grants AHRQ has awarded, the 3,030 researchers we have supported, or the more than $3.1 billion in funding we have awarded over the past two decades. But to me, what’s more important are the changes we have made in the healthcare ecosystem over the past 20 years—and the innovations that we have planned for the next 20.
Let me take you back to 1999. As we were entering a new century, many were in denial about the U.S. healthcare system’s problems. There was little discussion of patient safety until the publication of To Err is Human: Building a Safer Health System 
(PDF) in late 1999. Even then, most healthcare CEOs thought that any problems that existed were in other facilities, not theirs.
(PDF) in late 1999. Even then, most healthcare CEOs thought that any problems that existed were in other facilities, not theirs.But AHRQ, explicitly established as the Nation’s patient safety agency, took a closer look at the safety and quality of the healthcare system. We established the Surveys on Patient Safety Culture on the belief that patient safety culture can be quantified, measured, and improved. And when research showed that teamwork and communication were problems, we worked with the Department of Defense and borrowed and adapted tenets from the aviation industry to apply them to health care and create TeamSTEPPS.
Back in 1999, healthcare-associated infections (HAIs) were considered an unavoidable consequence of care. Now, thanks to AHRQ's Comprehensive Unit-based Safety Program (CUSP), we have shown that HAIs can be greatly reduced by combining bundles of evidence-based practices with improvement in safety culture, teamwork, and communication. Data released earlier this year, meanwhile, showed that reductions in hospital-acquired conditions, including HAIs, helped prevent 20,500 hospital deaths and save $7.7 billion in healthcare costs from 2014 to 2017. This follows national reductions with this same magnitude dating back to 2010. Time, attention, and resources dedicated to addressing patient safety are producing results.
This list goes on. Years ago, the medical field thought of prevention as an issue for public health. AHRQ provided scientific support to the independent U.S. Preventive Services Task Force, which changed the paradigm by bringing evidence-based screening and counseling into healthcare. AHRQ became the driving force for evidence-based healthcare practice with our Evidence-based Practice Centers seeking nominations of priority topics from those on the front lines of healthcare to help answer their most challenging questions. AHRQ not only funds the research and synthesizes the evidence, we ensure evidence is understood and used. AHRQ's work with Project ECHO showed it was possible to deliver high-quality specialized services to rural patients by providing telementoring to primary care practices.
In 1999, many people doubted we could track data from all payers on the costs of hospital care or see how much Americans spent out of their own pockets for health insurance or prescription drugs. Today, AHRQ's signature data tools, HCUP (the Healthcare Cost and Utilization Project) and MEPS (the Medical Expenditure Panel Survey) have led the way in answering those questions and more.
You can see that AHRQ has moved the needle. We’ve changed the language of healthcare itself. It is on that foundation that we now look forward to the next 20 years and beyond.
AHRQ was created 20 years ago to make healthcare safer and higher quality—for all Americans. Under the leadership of its initial director, the late Dr. John Eisenberg , AHRQ fostered a spirit of innovation—of trying new things, anticipating where the field was going next, and asking the hard questions.
, AHRQ fostered a spirit of innovation—of trying new things, anticipating where the field was going next, and asking the hard questions.In that spirit, I want to start the next 20 years by asking: how do we position health services research for the future?
As regular readers of this blog know, I’ve outlined my vision for the future. My three priorities align with Department of Health and Human Services Secretary Alex Azar's goal of strengthening the U.S. healthcare system and emphasize safety, quality, and value over volume. They include improving care for patients with multiple chronic conditions, leveraging data and analytics, and improving diagnostic safety.
As we approach AHRQ's 20th anniversary, I often ask: how can we fulfill the dream of a safer and higher quality healthcare system? How can we remake health services research into an enterprise that recognizes and responds to today’s pain points and anticipates and prepares to meet tomorrow's unmet needs? How much more can AHRQ do in 20 more years?
We believe we're only at the beginning of an exciting journey. I look forward to working with you to articulate the dream and then catalyzing the field to achieve it.
Gopal Khanna is the Director of AHRQ.
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