2026-07-29T05:00:08-0400 / https://www.cbsnews.com/news/trump-healthcare-safety-agency-ahrq/
特朗普政府实际上已叫停医疗保健研究与质量局的大部分业务，切断了联邦资助渠道。过去27年来，该机构通过改进医疗实践，预计挽救了数千条生命、节省了数十亿美元开支。
7月15日的一封信中，这个隶属于卫生与公众服务部的小型机构——即众所周知的AHRQ——告知研究人员，将暂停至少104项拨款，其中多项旨在提升患者安全。据联邦记录审查显示，尽管国会本财年为AHRQ拨款3.45亿美元，但该机构仅在拨款上花费了不到1500万美元，且已有一年多未发放新的拨款。据HHS透露，自唐纳德·特朗普总统去年就职以来，该机构约75%的员工已被解雇或主动辞职。
特朗普和卫生与公众服务部部长小罗伯特·F·肯尼迪一直寻求削减联邦在生物医学研究上的投入，终止了多项拨款，并将科学家赶出卫生部门各机构。不过，AHRQ的被削弱被一些政府批评者视为尤其短视，因为该机构专注于患者安全，本就没有争议，且整体上与特朗普和肯尼迪的“让美国人更健康”慢性疾病防治运动理念相符。
“当你想到美国人对医疗体系不满的所有点——费用太高、看不上病、治疗不当、病历信息有误——所有这些都是AHRQ的研究范畴，”支持AHRQ工作的健康服务研究组织美国健康科学院首席执行官亚伦·卡罗尔说道。
前AHRQ项目官员布伦特·桑德迈耶表示，特朗普和肯尼迪对AHRQ的调整似乎是永久性的。该机构所有拨款管理人员都已被解雇，因此AHRQ将无法直接监督未来的拨款。“你不禁会质疑本届政府打击欺诈的决心，”他说。
HHS发言人艾米丽·希利亚德表示，AHRQ打算建立新的拨款“框架”。她未回应进一步提供细节的请求。
收到AHRQ主任罗杰·克莱因来信的研究人员表示困惑，因为他们的大部分工作目标与克莱因强调的该机构当前优先事项一致。
“AHRQ是唯一一个专注于安全与质量的联邦机构，”休斯顿卫理公会安全、质量与福祉研究所主任哈迪普·辛格说道。他的研究此前一直由AHRQ资助，旨在减少因软件设计缺陷导致的医疗错误。
克莱因指出，AHRQ的研究兴趣包括患者安全、预防抗生素耐药性、应对儿童过度用药、推广数字健康工具，以及“专注于科学有效、可衡量的健康结果，以及解决健康差异问题的解决方案导向研究”。
KFF健康新闻审查了约20项被取消的拨款，发现几乎所有拨款的目标都与克莱因概述的优先事项重叠。
“如果他们有某种意识形态，不妨明确说出来。但现在完全没有任何清晰度，”克利夫兰凯斯西储大学家庭医学与社区健康系主任戈塔姆·拉奥说道。AHRQ已经资助拉奥的工作长达16年，并终止了他所在部门的三项当前拨款。
作为自2010年起接受AHRQ资助的研究员，拉奥的研究成果催生了针对门诊常见问题的新解决方案，例如如何应对老年体弱患者的体重下降问题。他的工作帮助减少了老年人的诊断检查，并改进了儿童高血压筛查。
“他们在信中列出的优先事项让我觉得，他们甚至都没看过我们在做什么，”康涅狄格大学妇产科医生安德里亚·希尔兹说道，她的AHRQ拨款也被取消了。
希尔兹开发并实施了针对非专科医生、护士和急诊医疗人员的培训，以应对高风险妊娠。美国农村地区女性在妊娠期间死亡的概率是其他地区的两到三倍。
悠久的历史遗产
AHRQ资助的研究对于提升患者安全、构建医疗信息技术体系，以及将以患者为中心的护理理念引入医疗系统发挥了关键作用。
该机构最知名的工作或许是遏制医院感染。据该机构开展的一项分析显示，仅在2014年至2017年间，因AHRQ资助的研究而推行的相关措施就避免了约20500例死亡，并节省了77亿美元的医疗成本。
苏珊·埃德格曼-莱维坦自1995年起参与相关项目，近期却失去了资助。她表示，哈佛大学、耶鲁大学和加州圣莫尼卡兰德公司的团队开发了一项全国性标准化患者调查，HHS和医疗系统利用该调查结合患者视角来改进医疗实践。她和同事制定的以患者和家庭为中心的护理定义，成为了医疗评估的支柱之一。美国医疗保险与医疗补助服务中心的部分支付标准就基于她的团队设计的医院调查结果。
获得AHRQ五年期拨款的研究人员通常会在每年夏季或秋季收到确认拨款的信件。埃德格曼-莱维坦表示，去年他们没有收到任何消息和拨款。他们给克莱因写了信，但得到的回应是“毫无音讯”。随后，在7月15日下午5点左右，他们收到了一封电子邮件形式的终止通知。她每年100万美元的拨款原本用于开发关于分娩和行为健康服务的医院调查。
“我的薪水没了。我所有研究助理、调查科学家的薪水也都没了。这太糟糕了，”她说，“但我已临近职业生涯尾声，薪水方面的损失倒不如我视为至关重要的工作和对改善分娩护理及整体患者护理的支持损失来得打击大。”
据一位现任和一位已离职的AHRQ官员透露，去年7月上任的分子病理学家、联邦主义者协会附属律师克莱因曾告诉员工，人工智能可以取代AHRQ科学家完成的大部分证据审查和分析工作。KFF健康新闻同意不透露他们的身份以保护其工作。
此类言论与白宫科学顾问迈克尔·克拉齐奥西斯7月22日发布的一份报告相符。该报告称，政府应“将支持重心重新放在个体科学家身上，而非 legacy 机构，除了缓慢的共识同行评审之外，多元化资助机制，并借助人工智能构建未来”。
克莱因未回应置评请求。HHS发言人希利亚德也未回应有关AHRQ计划或目标的具体问题。
针对7月15日的信件，希利亚德表示：“根据法律规定，AHRQ主任必须确定继续拨款是否符合联邦政府的最佳利益。AHRQ认定，某些非竞争性续期拨款和联合资助项目将不会获得续期拨款。”
希利亚德表示，这些拨款并非被终止，而是“未获得续期资助”。美国健康科学院发言人劳伦·亚当斯表示，这种细微差别可能对打算起诉政府的受助者具有法律意义。
“这一切都毫无意义”
普通内科学会去年8月就AHRQ未发放新拨款一事起诉了克莱因和卫生部长肯尼迪。该诉讼目前处于待审状态，其辩称，根据1974年一项旨在保护国会钱包权力的法律，不使用AHRQ2025财年3.69亿美元拨款的大部分资金是非法的。
“这一切都毫无意义，”密歇根大学医学院的儿科医生诺拉·贝克尔说道，她失去了一项为期五年的培训与研究拨款的最后两年资金，该研究聚焦于经济困难与健康结果之间的关系。“‘让美国人更健康’议程完全可以契合AHRQ的优先事项——我们关注慢性疾病、护理质量、减少用药、识别过度用药的危害。”
她补充道：“说实话，感觉这一切都不是本着诚意做的。我有时会想，他们的目标是不是就是摧毁AHRQ。但我不知道为什么AHRQ会成为这样的目标。”
希利亚德表示：“特朗普政府仍致力于负责任地管理纳税人的钱。”
2025年3月，肯尼迪宣布计划将AHRQ和其他HHS机构的部分部门合并为一个新的战略办公室。但国会对该重组计划毫无兴趣。
自今年1月克莱因与一名助手共同撰写的《新闻周刊》专栏文章发表以来，他尚未公开评论过AHRQ的整体目标或计划。该文章辩称，前几届政府下，“科学中立”已让位于关于多样性与公平的“道德信号”。但克莱因写道，如今特朗普政府已将AHRQ的重心纠正为“生成改善医疗服务提供方式的证据”。
据现任和前任AHRQ员工透露，克莱因从未召开过全机构会议，拒绝与AHRQ的支持者和受助者会面，也从未公布过该机构的蓝图。他们表示，很少有人在该机构位于马里兰州罗克维尔的办公室见过他。
希利亚德表示，目前员工人数为74人，低于2025年初的约300人。根据美国健康科学院的统计，该机构已暂停了本年度约1亿美元对受助者的承诺资金，这占国会批准预算的很大一部分。
“关于克莱因博士的这些说法完全是虚假的，”希利亚德说道，“AHRQ正在加强其拨款流程，审查机构工作的质量，与其法定使命保持一致，并专注于研究以改善患者结果。”
她未回应有关拨款资金的具体信息请求。
AHRQ仍在开展一些数据收集工作，并维持了医疗支出面板调查，该调查衡量美国人如何使用和支付医疗保健、保险以及自付费用。不过，发表速度已大幅放缓，因为克莱因会审查该机构发布的每一份数据或报告，伊丽莎白·加藤说道。她在AHRQ工作了16年，于4月从高级职位辞职。
AHRQ还运营着美国预防服务工作组，该小组对药物、疫苗和程序的价值评估决定了保险公司是否必须覆盖这些项目。
该工作组自2025年3月以来就未召开过会议。特朗普解雇了该小组的两名高级领导，目前其16名成员中仅剩下6名。“他们越久不开会，我们就越会失去证据与医保覆盖之间的联系，”前AHRQ官员桑德迈耶说道。
希利亚德表示，该工作组的会议定于8月底召开。
儿科医生考特尼·曼格斯在一项为期五年的项目中途失去了拨款，该项目旨在通过使用软件工具，减少因腹痛前往急诊室的儿童接受的CT扫描数量，从而降低癌症风险。在农村和社区急诊室，儿童因阑尾炎接受扫描的可能性远高于设备更完善的儿童医院。每一次扫描都会增加癌症风险。
曼格斯想知道，AHRQ作为资金来源的消失会对她的职业生涯产生何种影响。“我需要一些资金来完成已启动的工作，”她说，“这样我才能申请能够真正推动这一问题解决的更大奖项。”
她已向小型基金会申请资助，也可能寻求美国国立卫生研究院的支持，但她的工作“确实最适合由AHRQ来资助”。
在过去两年中，随着NIH、AHRQ和其他联邦资助机构削减拨款，新的申请如潮水般涌向私营生物医学基金会。
“AHRQ拒绝资助国会依法拨款且总统已签署的研究，这让我困惑不已，”卡罗尔说道，“我不明白为什么政府里的其他人都不为此抓狂。”
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Trump administration has quietly throttled an agency devoted to the safety of American healthcare
2026-07-29T05:00:08-0400 / https://www.cbsnews.com/news/trump-healthcare-safety-agency-ahrq/
The Trump administration has effectively shut down most of the Agency for Healthcare Research and Quality’s activities, closing the spigot on federal funding estimated to have saved thousands of lives and billions of dollars over the past 27 years by improving medical practice.
In a July 15 letter, the small Department of Health and Human Services agency known as AHRQ told researchers it was halting at least 104 grants, many aimed at improving patient safety. Although Congress appropriated $345 million for AHRQ for this fiscal year, the agency has spent less than $15 million on grants and hasn’t issued a new one in over a year, according to a review of federal records. About 75% of agency staffers have been fired or quit since President Donald Trump took office last year, according to HHS.
Trump and HHS Secretary Robert F. Kennedy Jr. have sought to slash the federal government’s investment in biomedical research, terminating grants and forcing scientists out of agencies across the health department. The gutting of AHRQ strikes some of the administration’s critics as particularly shortsighted, though, because of the agency’s noncontroversial focus on patient safety and its overall alignment with Trump and Kennedy’s “Make American Healthy Again” campaign against chronic illness.
“When you think about everything Americans hate about our health care system — that it costs too much, that you can’t get in to see a physician, that the treatment isn’t right, that the records contain wrong information — all that is what AHRQ studies,” said Aaron Carroll, chief executive of AcademyHealth, a health services research group that supports AHRQ’s work.
The Trump and Kennedy changes to AHRQ appear intended to be permanent. All of AHRQ’s grant managers have been fired, so there would be no way for AHRQ to directly oversee future grants, said Brent Sandmeyer, a former AHRQ program officer. “You wonder about this administration’s commitment to fighting fraud,” he said.
HHS spokesperson Emily Hilliard said AHRQ intended to establish a new “framework” for grants. She did not reply to requests for further details.
Researchers who received the letter from AHRQ Director Roger Klein expressed bewilderment because much of their work has the same objectives that Klein highlighted as the agency’s current priorities.
“AHRQ is the only federal agency that’s focused on safety and quality,” said Hardeep Singh, director of the Houston Methodist Safety, Quality and Well-Being Institute. His research, funded until recently by AHRQ, has aimed to reduce medical errors introduced by inadequate software design.
Klein stated that AHRQ’s research interests include patient safety, preventing antibiotic resistance, countering overmedication of children, promotion of digital health tools, and research “focused on scientifically valid, measurable health outcomes and solution-oriented approaches in health disparities research.”
KFF Health News examined about 20 of the canceled grants and found that nearly all had objectives that overlapped with the priorities Klein outlined.
“If there’s an ideology, lay it out clearly. But there’s no clarity whatsoever,” said Goutham Rao, chairman of the Department of Family Medicine and Community Health at Case Western Reserve University in Cleveland. AHRQ has funded Rao’s work for 16 years and ended three of his department’s current grants.
As an AHRQ-funded researcher since 2010, Rao has produced work that led to new approaches for common problems seen in doctors’ offices, such as how to respond to weight loss in aged and frail patients. His work has helped reduce diagnostic tests in the elderly and improve hypertension screening of children.
“The priorities they lay out in that letter make me think they didn’t even look at what we were doing,” said Andrea Shields, a University of Connecticut OB-GYN whose AHRQ grant was also eliminated.
Shields developed and implemented training of nonspecialist doctors, nurses, and emergency medical technicians to deal with high-risk pregnancies. Women in rural areas are two to three times as likely to die during pregnancy as those elsewhere in the U.S.
A long legacy
AHRQ-funded research has been key to improving patient safety, structuring medical information technology, and introducing the concept of patient-centered care into the health system.
The agency is perhaps best known for its work on curbing hospital infections. Practices introduced because of AHRQ-funded studies prevented an estimated 20,500 deaths and saved $7.7 billion in healthcare costs from 2014 to 2017 alone, according to an analysis the agency conducted.
Teams at Harvard, Yale, and Rand in Santa Monica, California, developed a national standardized patient survey that HHS and healthcare systems use to refine healthcare practices with patient perspectives in mind, said Susan Edgman-Levitan, who has worked on that project since 1995 but recently lost her funding. She and her colleagues developed a definition of patient- and family-centered care that became a pillar of healthcare evaluation. The Centers for Medicare & Medicaid Services bases some of its payments on hospital surveys her group designed.
AHRQ researchers working on five-year grants typically get letters confirming their award in the summer or fall each year. Last year, Edgman-Levitan said, they got no word and no money. They wrote a letter to Klein but heard “not a peep” in response. Then, around 5 p.m. on July 15, an emailed termination notice arrived. The $1 million annual grant was for developing hospital surveys regarding childbirth and behavioral health services.
“My salary is gone. The salaries of all my research assistants, survey scientists, all lost. It’s terrible,” she said. “But I’m near the end of my career. The salary piece is not as devastating as the loss of what I view as really critical work and support for improving childbirth care and patient care in general.”
Klein, a molecular pathologist and Federalist Society-affiliated lawyer who took over the agency last July, has told staff that artificial intelligence can replace much of the evidence review and analytics done by AHRQ scientists, according to one current and one recently departed AHRQ official, whom KFF Health News agreed not to name to protect their jobs.
Such comments align with a report issued July 22 by White House science adviser Michael Kratsios, which said the government should “refocus support on individual scientists rather than legacy institutions, diversify funding mechanisms beyond slow consensus peer review,” and build the future with AI.
Klein did not respond to requests for comment. HHS spokesperson Hilliard also did not respond to specific questions about AHRQ’s plans or objectives.
Of the July 15 letter, Hilliard said: “Under statute, the AHRQ director must determine whether continuation funding is in the best interest of the federal government. AHRQ determined that certain non-competing continuation grants and jointly funded grants would not receive continuation awards.”
Hilliard said the grants were not terminated but rather were “not awarded continued funding.” This subtlety may have legal relevance for grantees planning to sue the administration, said Lauren Adams, a spokesperson for AcademyHealth.
“None of it makes any sense”
The Society for General Internal Medicine sued Klein and health secretary Kennedy last August over AHRQ’s failure to issue new grants. The lawsuit, which is pending, argues that failure to use most of AHRQ’s $369 million fiscal 2025 appropriation is illegal under a 1974 law intended to protect Congress’ power of the purse.
“None of it makes any sense,” said Nora Becker, a pediatrician at Michigan Medicine who lost the last two years of a five-year training and research grant on the relationship between financial difficulty and health outcomes. “The MAHA agenda could fit nicely with AHRQ priorities — we focus on chronic conditions, the quality of care, deprescribing, identifying harms of overmedication.”
She added: “To be honest, it doesn’t feel like any of this is being done in good faith. Part of me just wonders whether the goal was to destroy AHRQ. But I don’t know why AHRQ was such a target.”
Hilliard said that “the Trump Administration remains committed to the responsible stewardship of taxpayer dollars.”
In March 2025, Kennedy announced plans to fold AHRQ and parts of other HHS agencies into a new Office of Strategy. But Congress has shown no interest in the reorganization plan.
Klein hasn’t publicly commented about AHRQ’s overall objectives or plans since attacking previous AHRQ activities in a Newsweek opinion piece he co-wrote with an assistant that was published in January.
The article argued that under previous administrations, “scientific neutrality” had given way to “moral signaling” on diversity and equity. But now, Klein wrote, the Trump administration had righted AHRQ’s focus to “generate evidence that improves how health care is delivered.”
Klein has held no agency-wide meetings, has declined to meet with AHRQ supporters and grantees, and never announced a blueprint for the agency, according to current and former AHRQ employees. They said he is infrequently seen at the agency’s Rockville, Maryland, offices.
Staff members currently number 74, Hilliard said, down from about 300 in early 2025. The agency has halted about $100 million in this year’s commitments to grantees, a substantial chunk of its congressionally approved budget, according to a tabulation by AcademyHealth.
“These claims about Dr. Klein are pointedly false,” Hilliard said. “AHRQ is strengthening its grants process, reviewing agency work for quality, aligning with its statutory mission, and focusing on research to improve patient outcomes.”
She did not respond to a request for specific information on grant funding.
AHRQ continues to conduct some data collection and has kept up its Medical Expenditure Panel Survey, which measures how Americans use and pay for medical care, insurance, and out-of-pocket costs. However, publication has slowed to a trickle because Klein reviews every piece of data or report issued by the agency, said Elisabeth Kato, who worked at AHRQ for 16 years before resigning from a senior position in April.
AHRQ also runs the U.S. Preventive Services Task Force, a panel whose assessments on the value of drugs, vaccines, and procedures determine whether insurers are required to cover them.
The task force hasn’t met since March 2025. Trump fired two of the group’s senior leaders and currently has only six of the 16 members it had when he took office. “The longer they don’t meet, the longer we’re losing connection between evidence and coverage,” said Sandmeyer, one of the former AHRQ officials.
A meeting of the task force is set for the end of August, Hilliard said.
Pediatrician Courtney Mangus lost her grant in the middle of a five-year project aimed at reducing cancers by using a software tool to help reduce the number of CT scans done on children who come to emergency rooms with abdominal pain. In rural and community emergency rooms, children are much more likely to be scanned for appendicitis than they are in better-equipped children’s pediatric hospitals. Each scan contributes to cancer risk.
Mangus wonders how AHRQ’s disappearance as a funding source will affect her career. “I need some funding to finish what I’ve started,” she said, “so then I could apply for bigger awards that can move the needle on this issue.”
She has applied to smaller foundations and may seek support from the National Institutes of Health, but her work was “really best suited for AHRQ.”
As NIH, AHRQ, and other federal funders have cut grants over the past two years, new applications have flooded private biomedical foundations.
“It’s baffling to me why AHRQ refuses to fund research that has legally been appropriated by Congress and signed by the president,” Carroll said. “I don’t understand why everyone else in government isn’t going out of their mind about this.”
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism.