[Congressional Record Volume 144, Number 146 (Wednesday, October 14, 1998)]
[Senate]
[Page S12591]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                 THE HEALTHCARE QUALITY ENHANCEMENT ACT

  Mr. FRIST. Mr. President, I rise today to express my continued 
support for S. 2208, the Healthcare Quality Enhancement Act, which 
seeks to reform and improve the Agency for Healthcare Policy and 
Research (AHCPR).
  Studies show that health care quality is dictated more by where you 
live than by scientific evidence or what is the best practice in 
medicine. Today, we have more biomedical research results than ever 
before, yet we are falling short in our success to disseminate our 
findings and to influence practice behavior. In 1843, Dr. Holmes 
published his famous article on hand washing for the prevention of 
puerperal fever in the New England Quarterly Journal of Medicine and 
Surgery. While it is an accepted and expected practice today, it took 
several decades before his recommendation became a universally accepted 
practice.
  The landmark Early Treatment Diabetic Retinopathy Study was published 
in 1985. Then, three years later, the American Diabetes Association 
published its eye care guidelines for patients with diabetes. 
Unfortunately, however, today the national rates for annual diabetic 
eye exam is still only 38.4 percent. Clearly, the practical application 
of scientifically sound diabetic eye care recommendations has not fared 
much better than the highly beneficial and very important hand washing 
theory. While there are more scientific discoveries than ever before, 
the practical introduction of these new scientific discoveries does not 
appear to be much faster today than it was more than 100 years ago.
  Through S. 2208, I am seeking to close the gap between what we know 
and what we do in health care. The expired statute of AHCPR represented 
an outdated approach to health care quality improvement. S. 2208 would 
establish the Agency for Healthcare Quality Research (AHQR), whose 
mission is the overall improvement in health care quality.
  Built upon the current AHCPR, the Agency for Healthcare Quality 
Research is refocused and enhanced to become both the hub and driving 
force of federal efforts to improve quality of health care in all 
practice environments. The Agency will assist, not burden physicians in 
four specific ways. First, it will aggressively support state-of-the-
art information systems for health care quality. Improved computer 
systems will advance quality scoring and facilitate quality-based 
decision making in patient care. Next, it will support research in 
areas of primary care delivery, priority populations and access in 
under served areas. The Agency's authority is expanded to support 
health care improvement in all types of office practice--both solo 
practitioners and managed care. In addition, it will promote data 
collection that makes sense. Physicians want information on quality to 
enable them to compare their outcomes with their peers. Statistically 
accurate, sample-based national surveys based on existing structures 
will efficiently provide reliable and affordable data. And finally, the 
Agency will promote quality by sharing information with doctors, not 
the federal government. While proven medical advances are made daily, 
patients wait too long to benefit from these discoveries. We must get 
the science to the people who use it--physicians.
  I would like to point out that S. 2208 does not create a new 
bureaucracy, nor does it expand the federal government. Rather, it 
refocuses an existing agency, the AHCPR, on a research mission that can 
better serve the health and health care of all Americans. The 
reauthorization of the AHCPR and the creation of the Agency for 
Healthcare Quality Research enjoys broad-based support. By taking 
leadership in supporting research on health care quality improvement, 
eight Senators, including myself, are co-sponsoring this bill. They are 
Senators Collins, Faircloth, Jeffords, Inouye, Mack, Breaux, and 
Lieberman. In addition, S. 2208 was later incorporated in another bill 
which received co-sponsorship from 49 Senators. Also, I am pleased to 
report that 44 leading organizations, consisting of health care 
professionals, patient advocates, major health care organizations and 
health services researchers, have also lent their support for this 
measure.
  Americans want and deserve better health care. For this compelling 
reason, I will reintroduce S. 2208 in the 106th Congress. I urge my 
colleagues to support health care quality improvement and to refocus 
the federal government's role in this vitally important area of 
research.

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