AHRQ letters end at least 104 grants as agency shifts funding

Health department says awards were not terminated but lacked continued funding

The Agency for Healthcare Research and Quality sent researchers around the country nearly identical letters on July 15 ending at least 104 grants, according to an essay in The Guardian by Robert B Shpiner. Senator Tammy Baldwin counts 150 awards cut off, worth $94 million. Congress appropriated $345 million for the agency this fiscal year, while AHRQ has spent under $15 million on grants, the essay said.

The health department disputes how the grant decisions should be described. It says nothing was terminated and that the awards were “not awarded continued funding.” Shpiner wrote that AHRQ has not issued a new grant in more than a year and that about three-quarters of its staff have been fired or have quit since Donald Trump took office. The essay said the agency’s office responsible for grant review was eliminated last summer.

The agency’s director, Roger Klein, told grantees that AHRQ was redirecting resources toward patient safety, antibiotic resistance, overmedication of children and measurable health outcomes, according to Shpiner. KFF Health News examined about 20 canceled grants and found that nearly all pursued those objectives, the essay said.

The decisions are being challenged in court. The Society of General Internal Medicine and the North American Primary Care Research Group sued Robert F Kennedy Jr and Klein last August over the frozen grant-making. The case is pending in Maryland, according to the essay. The Government Accountability Office is also examining whether the agency’s conduct amounts to an unlawful impoundment. A federal judge in Boston ruled July 17 that agencies may not cancel awards based on priorities they adopted after making them, Shpiner wrote.

The cuts affect research and training programs involving medical care. The essay described canceled work training physicians, nurses and paramedics to manage high-risk pregnancies; studying unnecessary CT scans for children in community emergency rooms; detecting lung cancer earlier; and providing telehealth services to rural patients. One canceled grant studied antibiotic resistance. A Michigan pediatrician who lost the final two years of her award said, “none of it makes any sense,” according to the essay. Shpiner wrote that her research concerned a field that Kennedy’s “Make America healthy again” agenda claims to champion.

The essay also described AHRQ functions beyond grant-making. The agency built the patient-experience surveys Medicare uses to help set hospital payments, while regulators use its quality indicators to identify hospitals that may be harming patients. AHRQ also worked with the Defense Department to produce team-communication training used in operating rooms and emergency departments. AHRQ’s own accounting credits its broader work on hospital-acquired harm with preventing 20,500 deaths and saving $7.7 billion from 2014 through 2017, Shpiner wrote. The essay said the agency’s spending amounts to about a dollar per American each year and roughly 0.3% of the health department’s discretionary spending.

One AHRQ-funded effort began in 2008 across more than 1,000 adult intensive care units. It used a checklist, a sterile insertion protocol and a workplace practice allowing a nurse to stop a surgeon. Central-line bloodstream infections fell by 41%, from 1.915 to 1.133 per 1,000 catheter days, and the agency estimated that the effort prevented between 290 and 605 deaths.

Klein has held no agency-wide meetings and has published no plan, according to the essay. He has said little publicly since January, when he co-wrote a Newsweek essay arguing that “scientific neutrality” had given way to “moral signaling.” Klein has reportedly told staff that artificial intelligence can replace much of the work done by AHRQ scientists. Shpiner also wrote that a White House science report released July 22 urged the government to support individual scientists over legacy institutions, move beyond slow consensus peer review and build the future on AI.

Shpiner is an internist and clinical professor of medicine at the David Geffen School of Medicine at UCLA. He wrote that he has practiced and taught intensive care medicine for more than 40 years.