The U.S. health care system continues to face challenges in improving the safety and quality of health care, ensuring access to care, increasing value for health care, reducing disparities, increasing the use of health information technology, and finding new avenues for translating research into practice. As reflected in the 2007 National Health Care Quality Report and National Healthcare Disparities Report, the rate of quality improvement appears to be slowing. Overall, the quality of health care improved by an average of 1.5 percent per year between the years 2000 and 2005. This represents a decline when compared with the 2.3 percent average annual rate between 1994 and 2005. Quality in some areas has improved such as counseling to quit smoking. There has been some progress in reducing disparities as reflected in the elimination of the disparity between the rates of black and white hemodialysis patients who had adequate dialysis and reduced disparities in childhood vaccinations. However, measures of patient safety showed an average annual improvement of only 1 percent. As 1 of 12 agencies within the Department of Health and Human Services (HHS), the mission of the Agency for Healthcare Research and Quality (AHRQ) is to improve the quality, safety, efficiency, effectiveness, and cost effectiveness of health care for all Americans. The Agency fulfills this mission by developing and working with the health care system to implement information that: Reduces the risk of harm from health care services by using evidence based research and technology to promote the delivery of the best possible care; Transforms the practice of health care to achieve wider access to effective services and reduce unnecessary health care costs; Improves health care outcomes by encouraging providers, consumers, and patients to use evidence based information to make informed treatment decisions. Ultimately, the Agency's goal is to improve the quality and safety of health care. It achieves this goal by translating research into improved health care practice and policy. Health care providers, patients, policymakers, payers, administrators, and others use AHRQ research findings to improve health care quality, accessibility, and outcomes of care. Disseminating AHRQ's research findings helps support a nation of healthier, more productive individuals and an enhanced return on the Nation's substantial investment in health care. This report presents key accomplishments, initiatives, and research findings from AHRQ's research portfolio during fiscal year 2008. The Agency's mission helps HHS achieve its strategic goals to improve the safety, quality, affordability, accessibility of health care; public health promotion and protection, disease prevention, and emergency preparedness; promote the economic and social wellbeing of individuals, families, and communities; and advance scientific and biomedical research and development related to health and human services. The Agency has a broad scope that touches on nearly every aspect of health care including: Clinical practice; Outcomes of care and effectiveness; Evidence based medicine; Primary care and care for priority populations; Health care quality; Patient safety/medical errors; Organization and delivery of care and use of health care resources; Health care costs and financing; Health care system and public health preparedness; Health information technology; Knowledge transfer.