Fiscal year 2009 (FY09) was an exciting year for the American health care system. An infusion of funding from the American Recovery and Reinvestment Act (Recovery Act) and the debate over health reform brought new attention to the opportunities and the challenges the system faces in improving the safety and quality of health care, ensuring access to care, increasing the value of health care, reducing disparities, and increasing the use of health information technology. The Agency for Healthcare Research and Quality's (AHRQ) Effective Health Care (EHC) Program has successfully grown into a program that is collaborative, transparent, stakeholder-driven, relevant, and timely. Our goal is to develop evidence-based information that is both rigorous and relevant to clinical decisions and is available when decisions are made. We have learned that to achieve that goal, ongoing dialogue with public and private sector stakeholders is essential. In order to gain and maintain the trust of all stakeholders, comparative effectiveness research (CER) must be fully transparent to all. Transparency has been a hallmark of the EHC Program. The transparency begins with an open process for setting research priorities, which the secretary of the Department of Health and Human Services (HHS) sets through discussion with and extensive input from stakeholders. Within the boundaries of those priorities, the public and other interested stakeholders have the opportunity to comment on the framing of specific research questions and to critique draft reports. In addition to the open invitation to comment, manufacturers are notified when a comparative effectiveness review begins on one of their products and are invited to submit relevant studies and data. Efforts to encourage outside input ensure that all stakeholders have equal and fair access to the process. Comparative effectiveness research aims to improve health outcomes by developing and disseminating evidence-based information to patients, providers, and health care decision-makers about the effectiveness of treatments relative to other options. AHRQ's comparative effectiveness research considers the effectiveness of treatments in specific subpopulations and the clinical utility and validity of genetic tests. Additionally, AHRQ supports research on the way patients and physicians receive and access the latest health care information. This research, along with information about each individual patient, can be used to optimize care for the individual and can help us achieve the vision of personalized medicine. 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 achieves its goals 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. This report presents key accomplishments, initiatives, and research findings from AHRQ's research Portfolios during FY09. The Agency's mission helps HHS achieve its strategic goals to improve the safety, quality, affordability, and accessibility of health care; promote public health, disease prevention, and emergency preparedness; contribute to the economic and social well-being of individuals, families, and communities; and advance scientific and biomedical research and development related to health and human services.