AHRQ: A Brief History

The Agency for Healthcare Research and Quality (AHRQ) was created when Congress passed, and President Clinton signed, the Healthcare Research and Quality Act of 1999.

AHRQ's predecessor agency, the Agency for Health Care Policy and Research (AHCPR), had been created a decade earlier as a unit of the U.S. Public Health Service to conduct and support research, demonstration projects, evaluations, and clinical guidelines development—all aimed at improving the delivery of healthcare.

By the late 1990s, efforts to examine the quality and effectiveness of healthcare intensified, and the healthcare community was galvanized by publication of "To Err Is Human," a landmark report from the Institute of Medicine (now the National Academy of Medicine) that identified medical error as a major cause of death in the United States.

"To Err Is Human" was followed by publication of "Crossing the Quality Chasm," which called for fundamental reforms to improve healthcare quality. These two reports provided impetus for the blossoming healthcare quality improvement movement and AHRQ’s current role as the agency devoted to enhancing the quality and safety of healthcare for all Americans.

Since its establishment in 1999, AHRQ has been a home for health services research, the field of study that examines healthcare as it is delivered to patients. It is also the nation’s lead federal agency supporting patient safety research and supports state-of-the-art data analytics tools to analyze and improve the U.S. healthcare system.

Leadership

AHCPR was initially led by J. Jarrett Clinton, M.D., M.P.H., and Clifton Gaus, Sc.D. John M. Eisenberg, M.D., a renowned health services researcher and patient safety advocate, was named director of AHCPR in 1997 and guided the agency through its transition to AHRQ. He led the agency until 2002, mentoring a generation of physician researchers.

Dr. Eisenberg was succeeded by Carolyn M. Clancy, M.D., who directed AHRQ from 2003 to 2014 and solidified many of the agency's enduring projects and programs. It was under Dr. Clancy's leadership that AHRQ introduced the Patient Safety Network, the TeamSTEPPS® training program, and the Comprehensive Unit-based Safety Program to combat healthcare-associated infections (HAIs).

Dr. Clancy was followed by Richard Kronick, Ph.D. (2014–2016), who oversaw the Agency when it launched the EvidenceNOW primary care support network; Andrew Bindman, M.D. (2016–2017), who expanded AHRQ's patient safety portfolio into diagnostic safety; Gopal Khanna, M.B.A. (2017–2020), who expanded AHRQ's data and analytics portfolio; and Robert Otto Valdez, Ph.D., M.H.S.A. (2022–2025), who launched the National Action Alliance for Patient and Workforce Safety, the AHRQ Long COVID Care Network, and the Healthcare Extension Service: State-based Solutions for Healthcare Improvement.

How AHRQ's Work Is Organized

AHRQ has organized its work to concentrate on major areas of competency: patient safety research, tools and resources, and data analytics.

Patient Safety

Laying the foundation for its role as the nation’s lead patient safety research agency, AHRQ published "Making Healthcare Safer" in 2001, listing 73 practices that improve patient safety. (This report was updated in 2013, in 2020, and in 2024.) Four years later, AHRQ initiated PSNet, an online portal for patient safety information.

In 2009, AHRQ embarked on some of its most important patient safety work when it announced $17 million to fight HAIs. This led to development of the Comprehensive Unit-based Safety Program (CUSP), a life-saving initiative initially piloted in Michigan intensive care units. AHRQ's HAI Program has since funded groundbreaking research in combating HAIs, promoting antibiotic stewardship, and supporting the Department of Health and Human Services' (HHS') National Action Plan to Prevent Health Care-Associated Infections.

In 2016, AHRQ embarked on a new frontier of patient safety by convening a summit on diagnostic safety and reducing errors in diagnosis. In 2022, AHRQ established the National Action Alliance for Patient and Workforce Safety on behalf of HHS and in partnership with other federal agencies and private stakeholders. The National Action Alliance helps to advance safety by applying known harm reduction strategies and sharing best practices and lessons learned.

Tools and Resources

In 2006, AHRQ introduced TeamSTEPPS®, a team-training curriculum developed in partnership with the Department of Defense that provides healthcare organizations with evidence-based training techniques for effective communication and team building. Two years later, the agency released the Re-Engineered Discharge Program, known as Project RED, a toolkit to help hospitals redesign the discharge process and curtail costly and preventable readmissions.

The agency has developed dozens of additional tools and resources to assist clinicians, providers, hospitals, and health systems provide safer, higher-quality care. One example is EvidenceNOW, a primary care support network launched in 2015 to advance heart health. EvidenceNOW has subsequently expanded to help primary care practices implement the best evidence related to managing unhealthy alcohol use and urinary incontinence. Other notable resources include ePROs in Clinical Care, a toolkit developed in 2020 and funded by AHRQ's Digital Healthcare Research Program to help healthcare systems govern, integrate, and report electronic patient-reported outcomes (ePROs) data for clinical care delivery. In 2024, the agency boosted its efforts to reduce HAIs by releasing the Toolkit for MRSA Prevention in ICU & Non-ICU Settings.

Data Analytics

A pair of data initiatives that originated with AHCPR remain AHRQ signature programs today:

• The Medical Expenditure Panel Survey (MEPS) is a set of large-scale surveys of individuals and families, their medical providers, and employers. This national survey is the nation’s most complete source of data on both the cost and use of healthcare and health insurance coverage. MEPS data have been collected annually since 1996.
• The Healthcare Cost and Utilization Project (HCUP) is a group of databases that capture information from hospital administrative data. The data cover 90 percent of all U.S. hospital discharges, making HUCP the nation's largest repository of hospital care data. The first of the HCUP databases has been active since 1988.

Other major AHRQ data analytics products include:

• The National Healthcare Quality and Disparities Report, mandated by Congress in 2003, provides annual updates on measures related to access to care, affordability, care coordination, effective treatment, healthy living, patient safety, and person-centered care.
• The Network of Patient Safety Databases (NPSD), established under the Patient Safety and Quality Improvement Act of 2005, develops informational tools, including dashboards and chartbooks to make the data available for meaningful, national learning purposes.
• The Social Determinants of Health Database, an easy-to-use, easily linkable database tracking factors that affect health. This database is used in patient-centered outcomes research, informing approaches to address emerging health issues.

AHRQ Today … and Tomorrow

From its headquarters in Rockville, Maryland, AHRQ works closely with sister agencies within HHS as well as with other federal and state entities to respond to new challenges and improve the quality of healthcare.