Health care has a problem. Trump is making it worse.

Dr. Jeffrey L. Schnipper is a hospitalist and health services researcher in the Boston area.

There is a “last mile” problem in health care. The United States spends billions of dollars on basic science research, drug development, and clinical trials, but after that, it leaves it up to the health care system to make sure that effective treatments get in the hands of patients who need them.

It can take 17 years for research evidence to make it into routine clinical practice. In the meantime, patients needlessly suffer. Moreover, it is a waste of those billions of dollars spent on medical research. As an example, despite the known effectiveness of medications such as buprenorphine to treat opioid use disorder, only a quarter of patients who need such medications receive them.

There is, however, one branch of science dedicated to solving the last mile problem in health care. It is called health services research, and it examines and seeks to improve the effectiveness of health care delivery, i.e., the extent to which it provides care based on the best evidence available. It also seeks to improve the quality of health care delivery in other ways, making sure it is safe, efficient, equitable, timely, and patient-centered.

The Agency for Healthcare Research and Quality, or AHRQ, is the federal agency that funds health services research, but the Trump administration has proposed defunding it or eliminating 80 to 90 percent of its workforce, similar to what it has done to the US Agency for International Development. This will cripple the agency’s ability to improve the health care system, which is in dire need of improvement.

I am a physician and health services researcher, and AHRQ has been the major funder of my research for the past 25 years. As a hospitalist — a general internist who cares for acutely ill medical patients in the hospital — my concern is the quality of health care for patients regardless of the disease they have. Indeed, most of my patients have multiple chronic diseases, and often new conditions as well. Unlike the various institutes of the National Institutes of Health, which concern themselves with one disease at a time, AHRQ focuses on patients as a whole and acknowledges that many patients have more than one condition.

Over the years, AHRQ has funded my research in a number of areas, such as how to make sure patients take their medications safely and correctly when they leave the hospital, how to improve electronic medical records so they make care better and not worse, how to improve handoffs in the hospital (such as when a medical resident goes home for the night), and how to reduce diagnostic errors and delays in the hospital.

Most of my colleagues depend on AHRQ funding as well. Over the past decade, AHRQ has funded some of the most significant health services research conducted in the United States, from how to prevent hospital-acquired infections to how best to treat opioid use disorders in rural populations, how to improve communication among health care workers, how to improve patients’ health literacy, and how to speed time to admission from the emergency department. It is estimated that implementing just one AHRQ-funded study on reducing hospital-acquired conditions prevented an estimated 20,500 deaths and saved $7.7 billion in health care costs from 2014 to 2017.

So if the administration’s stated goal is to “Make America Healthy Again,” why cut the only federal agency whose sole mission it is to improve the quality and safety of health care delivery?

AHRQ has in fact been a target of Republican administrations for years, and the reasons have varied over time. This time, it could be part of broader anti-DEI efforts (since some health services research focuses on disparities in care by race, ethnicity, and gender). Or it could be part of a general attack on federally funded medical and scientific research.

Most likely, it is the false belief that studies of what works in health care will lead to rationing and government overreach. It is true that some AHRQ-funded research concerns itself with identifying care that is ineffective or inferior to other alternatives. As for rationing, well, insurance companies ration health care all the time by not covering certain medications and procedures or by denying care. Wouldn’t it be better if decisions about what care is worth receiving were based on the best evidence of what works and who benefits? Regardless of political affiliation, we can agree that patient safety and effective health care should be protected — not politicized.

The Trump administration may cynically assume that no one will miss AHRQ if it’s gone. After all, most people have never heard of it. And its half a billion dollar budget is small potatoes compared with $50 billion for NIH. But you will indeed miss it if the quality and safety of health care delivery deteriorates because of a lack of knowledge of how to improve them.

Congress must step in and safeguard AHRQ’s funding, and citizens should speak out, urging their representatives to support this vital resource. Given the current state of health care in this country, AHRQ’s budget should be increased, not eliminated. By protecting AHRQ, Americans can choose a health care system driven by evidence, guided by safety, and committed to the best outcomes for all.