US Public Health Alphabet Soup Explained: What is the AHRQ?

“What is the AHRQ?” was the question I asked when I suddenly realized that there was an agency that funds studying how healthcare kills you – er, I mean healthcare quality in the United States (US). I was observing a rise in medical error and nosocomial infections in the early 2000s, and one of the groups I was working with suggested submitting a grant to study this from the AHRQ – prompting me to ask, even though I was well into my public health career, “What is the AHRQ?”

What is the AHRQ?

The AHRQ is the US Agency for Healthcare Research and Quality. Their main goal is to promote healthcare quality at the federal level, and what that amounts to is giving away grants to study ways to improve it.

What does the AHRQ do?

Because AHRQ is mainly focused on funding research, they are a lot like NIH in that they are mainly a big infrastructure geared toward giving away money aimed at researching better ways to run healthcare so patients are safe and services are efficient. The agency puts out grant solicitations, reviews grants, awards money, tracks funded projects, and reports on the results of the research.

From my perspective, the most useful thing about the AHRQ is that it publishes information about what healthcare policy should be based on what the findings are from the healthcare quality research they fund. The operative phrase is “should be” – since they are a federal agency, they really have little control over anything that actually happens at the state level, such as actual healthcare. I challenge you to read any recommendations from AHRQ, and then go to your local academic medical center, and see if they are actually implemented.

And like DHHS, NIH, the CDC, and all these other places, there is no “teeth” in the authority for oversight. So what if Brigham and Women’s Hospital along with five other US academic medical centers had over 300 cases of sepsis and 198 sepsis deaths over the period of January 1, 2017, to March 31, 2018? Just publish it, get promoted, and call it a day!

My Take on the AHRQ

This is one of those agencies that I term as “deliberately underfunded”. Given the danger we know about in current US healthcare delivery, the AHRQ should have a budget the size of NIH or the CDC. Instead, in fiscal year (FY) 2021, AHRQ is slated to get about $440 million, compared to $41 billion (with a “b”) for the entire NIH. And unfortunately, much of AHRQ’s funding is for the ill-advised and inartful quasi-think tank called the Patient-Centered Outcomes Research Institute (PCORI), which is a line item in AHRQ’s budget.

To make a fair comparison, I tried to find an office at NIH that was funded comparably to AHRQ, and it was hard to find one funded at less than $1 billion. The closest one I could find was the National Institute of Biomedical Imaging and Bioengineering, which is funded at about $410 million. The fact that AHRQ gets less than $1 billion tells you a lot about how important it is for the government to prevent you from knowing how US healthcare is endangering your life or possibly killing you or your loved ones.

Because of this severe underfunding, when AHRQ makes recommendations, you feel like you can’t trust them, because they weren’t given enough money to do the job. You feel that their demonstration projects are done on the cheap, and there’s no way to know how well things would have worked if they had been funded properly. I’d like to go through that NIH budget and shift entire line items over to AHRQ – but that’s not going to happen anytime soon!

So my answer to the question, “What is AHRQ?” is basically that it’s the most underfunded public health agency in the federal government. Remember, AHRQ is not even supposed to be about public health, but now that it funds studies of one of the US’s top people-killers, which is the healthcare system, I see it as essentially a public health agency.

Updated July 21, 2021. Added banner October 24, 2022.