Part A—Establishment and General Duties
§299. Mission and duties
(a) In general
There is established within the Public Health Service an agency to be known as the Agency for Healthcare Research and Quality, which shall be headed by a director appointed by the Secretary. The Secretary shall carry out this subchapter acting through the Director.
(b) Mission
The purpose of the Agency is to enhance the quality, appropriateness, and effectiveness of health services, and access to such services, through the establishment of a broad base of scientific research and through the promotion of improvements in clinical and health system practices, including the prevention of diseases and other health conditions. The Agency shall promote health care quality improvement by conducting and supporting—
(1) research that develops and presents scientific evidence regarding all aspects of health care, including—
(A) the development and assessment of methods for enhancing patient participation in their own care and for facilitating shared patient-physician decision-making;
(B) the outcomes, effectiveness, and cost-effectiveness of health care practices, including preventive measures and long-term care;
(C) existing and innovative technologies;
(D) the costs and utilization of, and access to health care;
(E) the ways in which health care services are organized, delivered, and financed and the interaction and impact of these factors on the quality of patient care;
(F) methods for measuring quality and strategies for improving quality; and
(G) ways in which patients, consumers, purchasers, and practitioners acquire new information about best practices and health benefits, the determinants and impact of their use of this information;
(2) the synthesis and dissemination of available scientific evidence for use by patients, consumers, practitioners, providers, purchasers, policy makers, and educators; and
(3) initiatives to advance private and public efforts to improve health care quality.
(c) Requirements with respect to rural and inner-city areas and priority populations
(1) Research, evaluations and demonstration projects
In carrying out this subchapter, the Director shall conduct and support research and evaluations, and support demonstration projects, with respect to—
(A) the delivery of health care in inner-city areas, and in rural areas (including frontier areas); and
(B) health care for priority populations, which shall include—
(i) low-income groups;
(ii) minority groups;
(iii) women;
(iv) children;
(v) the elderly; and
(vi) individuals with special health care needs, including individuals with disabilities and individuals who need chronic care or end-of-life health care.
(2) Process to ensure appropriate research
The Director shall establish a process to ensure that the requirements of paragraph (1) are reflected in the overall portfolio of research conducted and supported by the Agency.
(3) Office of Priority Populations
The Director shall establish an Office of Priority Populations to assist in carrying out the requirements of paragraph (1).
(July 1, 1944, ch. 373, title IX, §901, as added
Editorial Notes
Prior Provisions
A prior section 299, act July 1, 1944, ch. 373, title IX, §901, as added
Another prior section 299, act July 1, 1944, ch. 373, title IX, §900, as added Oct. 6, 1965,
A prior section 901 of act July 1, 1944, was classified to
Statutory Notes and Related Subsidiaries
Transitional and Savings Provisions
Construction
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"(2)
IOM Reports on Best Practices for Developing Clinical Protocols
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"(B)
IOM Study on Drug Safety and Quality
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"(A) The study shall develop a full understanding of drug safety and quality issues through an evidence-based review of literature, case studies, and analysis. This review will consider the nature and causes of medication errors, their impact on patients, the differences in causation, impact, and prevention across multiple dimensions of health care delivery-including patient populations, care settings, clinicians, and institutional cultures.
"(B) The study shall attempt to develop credible estimates of the incidence, severity, costs of medication errors that can be useful in prioritizing resources for national quality improvement efforts and influencing national health care policy.
"(C) The study shall evaluate alternative approaches to reducing medication errors in terms of their efficacy, cost-effectiveness, appropriateness in different settings and circumstances, feasibility, institutional barriers to implementation, associated risks, and the quality of evidence supporting the approach.
"(D) The study shall provide guidance to consumers, providers, payers, and other key stakeholders on high-priority strategies to achieve both short-term and long-term drug safety goals, to elucidate the goals and expected results of such initiatives and support the business case for them, and to identify critical success factors and key levers for achieving success.
"(E) The study shall assess the opportunities and key impediments to broad nationwide implementation of medication error reductions, and to provide guidance to policy-makers and government agencies (including the Food and Drug Administration, the Centers for Medicare & Medicaid Services, and the National Institutes of Health) in promoting a national agenda for medication error reduction.
"(F) The study shall develop an applied research agenda to evaluate the health and cost impacts of alternative interventions, and to assess collaborative public and private strategies for implementing the research agenda through AHRQ and other government agencies.
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Health Care That Works for All Americans: Citizens Health Care Working Group
Executive Documents
Executive Order No. 13017
Ex. Ord. No. 13017, Sept. 5, 1996, 61 F.R. 47659, as amended by Ex. Ord. No. 13040, Mar. 25, 1997, 62 F.R. 14773; Ex. Ord. No. 13056, July 21, 1997, 62 F.R. 39415, which established the Advisory Commission on Consumer Protection and Quality in the Health Care Industry, was revoked by Ex. Ord. No. 13138, §3(a), Sept. 30, 1999, 64 F.R. 53880, formerly set out as a note under
§299a. General authorities
(a) In general
In carrying out
(1) the quality, effectiveness, efficiency, appropriateness and value of health care services;
(2) quality measurement and improvement;
(3) the outcomes, cost, cost-effectiveness, and use of health care services and access to such services;
(4) clinical practice, including primary care and practice-oriented research;
(5) health care technologies, facilities, and equipment;
(6) health care costs, productivity, organization, and market forces;
(7) health promotion and disease prevention, including clinical preventive services;
(8) health statistics, surveys, database development, and epidemiology; and
(9) medical liability.
(b) Health services training grants
(1) In general
The Director may provide training grants in the field of health services research related to activities authorized under subsection (a), to include pre- and post-doctoral fellowships and training programs, young investigator awards, and other programs and activities as appropriate. In carrying out this subsection, the Director shall make use of funds made available under section 288(d)(3) 1 of this title as well as other appropriated funds.
(2) Requirements
In developing priorities for the allocation of training funds under this subsection, the Director shall take into consideration shortages in the number of trained researchers who are addressing health care issues for the priority populations identified in
(c) Multidisciplinary centers
The Director may provide financial assistance to assist in meeting the costs of planning and establishing new centers, and operating existing and new centers, for multidisciplinary health services research, demonstration projects, evaluations, training, and policy analysis with respect to the matters referred to in subsection (a).
(d) Relation to certain authorities regarding social security
Activities authorized in this section shall be appropriately coordinated with experiments, demonstration projects, and other related activities authorized by the Social Security Act [
(e) Disclaimer
The Agency shall not mandate national standards of clinical practice or quality health care standards. Recommendations resulting from projects funded and published by the Agency shall include a corresponding disclaimer.
(f) Rule of construction
Nothing in this section shall be construed to imply that the Agency's role is to mandate a national standard or specific approach to quality measurement and reporting. In research and quality improvement activities, the Agency shall consider a wide range of choices, providers, health care delivery systems, and individual preferences.
(July 1, 1944, ch. 373, title IX, §902, as added
Editorial Notes
References in Text
The Social Security Act, referred to in subsec. (d), is act Aug. 14, 1935, ch. 531,
The Social Security Amendments of 1967, referred to in subsec. (d), is
Prior Provisions
A prior section 299a, act July 1, 1944, ch. 373, title IX, §902, as added
Another prior section 299a, act July 1, 1944, ch. 373, title IX, §901, as added Oct. 6, 1965,
A prior section 902 of act July 1, 1944, was classified to
Amendments
2000—Subsec. (g).
Statutory Notes and Related Subsidiaries
Reducing Administrative Health Care Costs
Executive Documents
Demonstration Grants for the Development, Implementation, and Evaluation of Alternatives to the Current Medical Liability System
Memorandum of President of the United States, Sept. 17, 2009, 74 F.R. 48133, provided:
Memorandum for the Secretary of Health And Human Services
As part of my Administration's ongoing effort to reform our health care system, we have reached out to members of both political parties and listened to the concerns many have raised about the need to improve patient safety and to reform our medical liability system. Between 44,000 and 98,000 patients die each year from medical errors. Many physicians continue to struggle to pay their medical malpractice premiums, which vary tremendously by specialty and by State. The cost of insurance continues to be one of the highest practice expenses for some specialties. And although malpractice premiums do not account for a large percentage of total medical costs, many physicians report that fear of lawsuits leads them to practice defensive medicine, which may contribute to higher costs.
We should explore medical liability reform as one way to improve the quality of care and patient-safety practices and to reduce defensive medicine. But whatever steps we pursue, medical liability reform must be just one part of broader health insurance reform—reform that offers more security and stability to Americans who have insurance, offers insurance to Americans who lack coverage, and slows the growth of health care costs for families, businesses, and government.
In recent years, there have been calls from organizations like The Joint Commission and the Institute of Medicine to begin funding demonstration projects that can test a variety of medical liability models and determine which reforms work. These groups and others have identified several important goals and core commitments of malpractice reform that should serve as a starting point for such projects. We must put patient safety first and work to reduce preventable injuries. We must foster better communication between doctors and their patients. We must ensure that patients are compensated in a fair and timely manner for medical injuries, while also reducing the incidence of frivolous lawsuits. And we must work to reduce liability premiums.
In 1999, the Congress authorized the Agency for Healthcare Research and Quality, which is located within the Department of Health and Human Services, to support demonstration projects and to evaluate the effectiveness of projects regarding all aspects of health care, including medical liability. I hereby request that you announce, within 30 days of this memorandum, that the Department will make available demonstration grants to States, localities, and health systems for the development, implementation, and evaluation of alternatives to our current medical liability system, consistent with the goals and core commitments outlined above.
This memorandum is not intended to, and does not, create any right or benefit, substantive or procedural, enforceable at law or in equity by any party against the United States, its departments, agencies, or entities, its officers, employees, or agents, or any other person.
You are authorized and directed to publish this memorandum in the Federal Register.
Barack Obama.
1 See References in Text note below.
§299a–1. Research on health disparities
(a) In general
The Director shall—
(1) conduct and support research to identify populations for which there is a significant disparity in the quality, outcomes, cost, or use of health care services or access to and satisfaction with such services, as compared to the general population;
(2) conduct and support research on the causes of and barriers to reducing the health disparities identified in paragraph (1), taking into account such factors as socioeconomic status, attitudes toward health, the language spoken, the extent of formal education, the area or community in which the population resides, and other factors the Director determines to be appropriate;
(3) conduct and support research and support demonstration projects to identify, test, and evaluate strategies for reducing or eliminating health disparities, including development or identification of effective service delivery models, and disseminate effective strategies and models;
(4) develop measures and tools for the assessment and improvement of the outcomes, quality, and appropriateness of health care services provided to health disparity populations;
(5) in carrying out
(6) beginning with fiscal year 2003, annually submit to the Congress a report regarding prevailing disparities in health care delivery as it relates to racial factors and socioeconomic factors in priority populations.
(b) Research and demonstration projects
(1) In general
In carrying out subsection (a), the Director shall conduct and support research and support demonstrations to—
(A) identify the clinical, cultural, socioeconomic, geographic, and organizational factors that contribute to health disparities, including minority health disparity populations, which research shall include behavioral research, such as examination of patterns of clinical decisionmaking, and research on access, outreach, and the availability of related support services (such as cultural and linguistic services);
(B) identify and evaluate clinical and organizational strategies to improve the quality, outcomes, and access to care for health disparity populations, including minority health disparity populations;
(C) test such strategies and widely disseminate those strategies for which there is scientific evidence of effectiveness; and
(D) determine the most effective approaches for disseminating research findings to health disparity populations, including minority populations.
(2) Use of certain strategies
In carrying out this section, the Director shall implement research strategies and mechanisms that will enhance the involvement of individuals who are members of minority health disparity populations or other health disparity populations, health services researchers who are such individuals, institutions that train such individuals as researchers, members of minority health disparity populations or other health disparity populations for whom the Agency is attempting to improve the quality and outcomes of care, and representatives of appropriate tribal or other community-based organizations with respect to health disparity populations. Such research strategies and mechanisms may include the use of—
(A) centers of excellence that can demonstrate, either individually or through consortia, a combination of multi-disciplinary expertise in outcomes or quality improvement research, linkages to relevant sites of care, and a demonstrated capacity to involve members and communities of health disparity populations, including minority health disparity populations, in the planning, conduct, dissemination, and translation of research;
(B) provider-based research networks, including health plans, facilities, or delivery system sites of care (especially primary care), that make extensive use of health care providers who are members of health disparity populations or who serve patients in such populations and have the capacity to evaluate and promote quality improvement;
(C) service delivery models (such as health centers under
(D) innovative mechanisms or strategies that will facilitate the translation of past research investments into clinical practices that can reasonably be expected to benefit these populations.
(c) Quality measurement development
(1) In general
To ensure that health disparity populations, including minority health disparity populations, benefit from the progress made in the ability of individuals to measure the quality of health care delivery, the Director shall support the development of quality of health care measures that assess the experience of such populations with health care systems, such as measures that assess the access of such populations to health care, the cultural competence of the care provided, the quality of the care provided, the outcomes of care, or other aspects of health care practice that the Director determines to be important.
(2) Examination of certain practices
The Director shall examine the practices of providers that have a record of reducing health disparities or have experience in providing culturally competent health services to minority health disparity populations or other health disparity populations. In examining such practices of providers funded under the authorities of this chapter, the Director shall consult with the heads of the relevant agencies of the Public Health Service.
(3) Report
Not later than 36 months after November 22, 2000, the Secretary, acting through the Director, shall prepare and submit to the appropriate committees of Congress a report describing the state-of-the-art of quality measurement for minority and other health disparity populations that will identify critical unmet needs, the current activities of the Department to address those needs, and a description of related activities in the private sector.
(d) Definition
For purposes of this section:
(1) The term "health disparity population" has the meaning given such term in
(2) The term "minority", with respect to populations, refers to racial and ethnic minority groups as defined in
(July 1, 1944, ch. 373, title IX, §903, as added
Editorial Notes
Prior Provisions
A prior section 299a–1, act July 1, 1944, ch. 373, title IX, §903, as added
A prior section 903 of act July 1, 1944, was classified to
Prior sections 299a–2 and 299a–3 were omitted in the general amendment of this subchapter by
Section 299a–2, act July 1, 1944, ch. 373, title IX, §904, as added
Section 299a–3, act July 1, 1944, ch. 373, title IX, §905, as added
Amendments
2010—Subsec. (d)(1).