Health Affairs, 22, no. 2 (2003): 7-8 doi: 10.1377/hlthaff.22.2.7 © 2003 by Project HOPE	New Online   Pay Cuts For Medicare Docs   Access To Care Woes   Public Coverage More Efficient   Empowering Consumers

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From the Editor

A Daunting Challenge: The Quest For Quality

For the past decade there has been considerable interest, particularly among purchasers, in assessing and improving quality of care—and in being able to know in clear terms the value of what they are buying. The IOM reports revealed that quality is a complex, multidimensional issue that won’t necessarily be solved in piecemeal steps. A strength of these reports has been demonstrating the extent of the challenge ahead; this volume of Health Affairs shines a spotlight on this important policy issue. At the time of President Clinton’s call to arms, he charged the Agency for Healthcare Research and Quality (AHRQ), a component of the Department of Health and Human Services (HHS), with leading the government’s efforts to improve quality of care. Sen. Bill Frist (R-TN), now Senate majority leader, applauded the move and has been a champion of the agency on Capitol Hill. When the Bush administration took office, it agreed with Clinton’s designation of AHRQ and has sought to promote the agency’s agenda, although not by increasing its budget. The agency has long faced the challenge of large expectations and a modest budget. In 2002 its budget was $300 million to improve a health care system with an overall budget of more than $1.4 trillion. AHRQ’s fragile political standing is perhaps best depicted by the fact that its budget is less than 1 percent of the annual spending level of the National Institutes of Health.

Beyond its modest budget, AHRQ must cope with a health care delivery system that is highly decentralized and shaped by local autonomy. In the last paper he wrote, John M. Eisenberg underscored the tension between the translation of the best scientific evidence into improved care at the local level (Health Affairs, May/June 2002, p. 166). AHRQ’s agenda also is complicated by the murky pathways upon which the science of implementing change is built. In short, AHRQ’s track record on promoting better quality reflects that of the health care system as a whole: moving forward for certain but on a painfully slow route, with potholes at nearly every step.

There are certainly bright spots that are worthy of noting. In general, there is greater awareness of the quality chasm, and that is leading to growing demand that providers be held to account for their professional actions. On the organizational front, the insistence of HHS Secretary Tommy Thompson that HHS operate as one cohesive department rather than a set of separate silos is leading to greater interagency cooperation. In the fall of 2003 AHRQ will publish two new reports (the National Healthcare Quality Report and the National Healthcare Disparities Report) that will tap resources from across the department. Thompson’s organizational strategy also has compelled AHRQ and the much larger Centers for Medicare and Medicaid Services (CMS) to work more cooperatively on the quality agenda. (See the Perspective by the presiding officers of the two agencies, pp. 113–115). The agencies also are working together to implement a voluntary program of public reporting of ten measures of hospital quality performance, an initiative proposed by the American Hospital Association.

One of AHRQ’s objectives is to support publication and research that relates to its quality agenda and to convene conferences that bring disparate stakeholders to the table. In this context, AHRQ gave financial support to Health Affairs to publish this issue, but the task of commissioning papers, subjecting them to external peer review, and selecting the best among them fell (as it always does) to the journal’s staff. On a separate note, Health Affairs has stepped up its publication of Web-exclusive papers to once a week because of the positive response to them. Many private foundations support the journal, but fewer philanthropies have recognized the value of the journal’s Web-based publishing. We gratefully acknowledge those that have (the California HealthCare Foundation, Commonwealth Fund, Robert Wood Johnson Foundation, and Merck Foundation) for their early support of this new channel of communication.

John K. Iglehart

Founding Editor

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