The Trump administration's efforts to downsize the Agency for Healthcare Research and Quality (AHRQ) are causing alarm among public health workers as well as researchers who study patient safety and diagnostic errors.

"Words like 'catastrophic' come to mind," David Newman-Toker, MD, PhD, director of the Armstrong Institute Center for Diagnostic Excellence at Johns Hopkins University in Baltimore, said in a phone interview Wednesday. "From the perspective of diagnostic safety and quality and diagnostic excellence, AHRQ is really the only substantive funder of this work. It is a tiny investment for the return."

At the time Newman-Toker was speaking, rumors were circulating that AHRQ, which had a fiscal year 2024 budget of $369 million and a staff of about 300 employees, was going to be headed for some big cuts, including staff reductions of 80-90%, according to STAT. Then on Thursday, HHS announced that the entire agency was undergoing a restructuring and as part of that effort, "HHS will merge the Assistant Secretary for Planning and Evaluation (ASPE) with AHRQ to create the Office of Strategy to enhance research that informs the secretary's policies and improves the effectiveness of federal health programs."

HHS did not respond by press time to an emailed question about whether that merger will involve large layoffs of AHRQ staff. MedPage Today also asked AHRQ the same question and was told the agency had no comment.

It's hard to say whether the merger will be good or bad for AHRQ, Newman-Toker said in an email Thursday. "Not necessarily bad on its face, but the devil is in the details," he wrote. "If it means deep cuts to safety research or resources for assessing the state of healthcare in America (e.g. HCUP), then it will be bad. These things need expansion, not reduction, in order to ensure the safety of patients and maximize value in healthcare." HCUP refers to AHRQ's Healthcare Cost and Utilization Project, a database which includes the largest collection of longitudinal hospital care data in the United States.

Why is AHRQ so valuable? "The agency is really critical to work we do in infection control and patient safety," Carol McLay, DrPH, MPH, RN, president of the Association for Professionals in Infection Control and Epidemiology, said in a phone interview Wednesday. "When patients come into the hospital, they have an increased risk of infections -- surgical site infections, patients get pneumonia a lot [which] has a high mortality rate ... We also look at bloodstream infections that turn into sepsis, often caused by the type of catheters that we're inserting into patients. Also, urinary tract infections (UTIs) caused by catheters and not caused by catheters."

One way AHRQ helps in this area is in communication-driven tools like TeamSTEPPS that providers can use to improve communication and teamwork skills. And it has developed lots of practical tools for healthcare workers for things like preventing central line infections. "They are very good at translating research into strategies healthcare workers can use," said McLay.

For example, a couple of years ago research came out showing that bathing patients with chlorhexidine can prevent central line infections and UTIs. "That's all well and fine, but it's sitting in a journal somewhere," said McLay. "How does that get to the bedside? That's always been a huge gap. That's what AHRQ does -- they take that literature and they develop information to share so healthcare workers can access that and easily implement it into practice." If AHRQ goes away, that situation will be as it was before, where the research gets done but nothing gets implemented, she said.

The reorganization announcement raises several concerns, McLay said in an email Thursday. "By merging AHRQ with the ASPE, the administration effectively eliminates AHRQ as a distinct entity," she wrote. "This raises urgent questions about how AHRQ's essential functions -- particularly its research and resources aimed at reducing healthcare-associated infections and improving patient safety -- will be maintained and protected. Can they provide any assurance that the critical work that AHRQ conducts will not be deprioritized or discontinued?"

AHRQ's demise would cause unnecessary suffering, according to Patricia McGaffigan, RN, MS, CPPS, senior advisor for patient and workforce safety at the Institute for Healthcare Improvement.

"Any cuts to AHRQ's funding will erase decades of progress and have devastating consequences including unnecessary deaths and harms to patients and the workforce ... and critical reductions in patient safety research funding," McGaffigan said in an email to MedPage Today. "Today's news raises urgent questions and concerns about the preservation and continuation of key taxpayer funded initiatives and resources that are vital lifelines for patient safety."

"While this is early news, any abrupt elimination of [AHRQ's] freely available resources will have monumental cascading impacts to the on-the-ground work and efficiencies of healthcare organizations that depend on AHRQ's offerings, especially those that are already at risk of financial sustainability," she added.

Research into diagnostic errors would also suffer with any drastic cuts, said Newman-Toker. "There are not that many diagnostic safety and quality researchers because there isn't that much funding," he said. "If you essentially kill [off the careers of] all the young researchers that have started to accelerate interest in going into the field, that takes a whole generation out of the research marketplace ... It's potentially a devastating blow and not easily filled by NIH or PCORI [the Patient-Centered Outcomes Research Institute] or other agencies and organizations, because the work is so particular to safety and quality, and AHRQ has that as a singular focus."

Right now AHRQ is funding 10 centers around the country devoted to achieving diagnostic excellence, he said, noting that it took "a decade of sustained effort" to get that to happen. "If the centers disappear they'll lose all of the effort ongoing to try to save lives through the process of research ... That would be a huge loss for patients and families." Misdiagnosis is also a financial issue; Newman-Toker estimates that $50-$100 billion is wasted each year on inappropriate or unnecessary diagnostic testing.