decision-based evidence making mark d. smith, md mba national health policy conference washington,...
TRANSCRIPT
![Page 1: Decision-based Evidence Making Mark D. Smith, MD MBA National Health Policy Conference Washington, DC February 7 th, 2006](https://reader031.vdocuments.us/reader031/viewer/2022032722/56649f435503460f94c6442e/html5/thumbnails/1.jpg)
Decision-basedEvidence Making
Mark D. Smith, MD MBA
National Health Policy ConferenceWashington, DC
February 7th, 2006
![Page 2: Decision-based Evidence Making Mark D. Smith, MD MBA National Health Policy Conference Washington, DC February 7 th, 2006](https://reader031.vdocuments.us/reader031/viewer/2022032722/56649f435503460f94c6442e/html5/thumbnails/2.jpg)
![Page 3: Decision-based Evidence Making Mark D. Smith, MD MBA National Health Policy Conference Washington, DC February 7 th, 2006](https://reader031.vdocuments.us/reader031/viewer/2022032722/56649f435503460f94c6442e/html5/thumbnails/3.jpg)
![Page 4: Decision-based Evidence Making Mark D. Smith, MD MBA National Health Policy Conference Washington, DC February 7 th, 2006](https://reader031.vdocuments.us/reader031/viewer/2022032722/56649f435503460f94c6442e/html5/thumbnails/4.jpg)
![Page 5: Decision-based Evidence Making Mark D. Smith, MD MBA National Health Policy Conference Washington, DC February 7 th, 2006](https://reader031.vdocuments.us/reader031/viewer/2022032722/56649f435503460f94c6442e/html5/thumbnails/5.jpg)
Translating Research Into Practice ConferenceWashington, DC
July 24th, 2003
Mark Smith, MD, MBAThe California HealthCare Foundation
TRIP Funding Priorities, or:An odd analogy from the provinces
![Page 6: Decision-based Evidence Making Mark D. Smith, MD MBA National Health Policy Conference Washington, DC February 7 th, 2006](https://reader031.vdocuments.us/reader031/viewer/2022032722/56649f435503460f94c6442e/html5/thumbnails/6.jpg)
0
5,000
10,000
15,000
20,000
25,000
30,000
NIH AHRQ
2004 Annual Budget, in Millions
Translating Research Into Practice ConferenceFederal funding of basic and clinical science
swamps HSR
![Page 7: Decision-based Evidence Making Mark D. Smith, MD MBA National Health Policy Conference Washington, DC February 7 th, 2006](https://reader031.vdocuments.us/reader031/viewer/2022032722/56649f435503460f94c6442e/html5/thumbnails/7.jpg)
An odd analogy `
2003 payroll: $50 million 2003 payroll: $150 million
Dollars spent per win, 2000-2003
A’s: $446,000 Yankees: $1,396,000
ratio: 1 / 3.13 Sources: MLB.com and USA Today baseball salary database
Translating Research Into Practice Conference
![Page 8: Decision-based Evidence Making Mark D. Smith, MD MBA National Health Policy Conference Washington, DC February 7 th, 2006](https://reader031.vdocuments.us/reader031/viewer/2022032722/56649f435503460f94c6442e/html5/thumbnails/8.jpg)
The secrets of the As’ success
• Fast
• Cheap
• Fanatically devoted to practical R & D
• Cunning
Translating Research Into Practice Conference
![Page 9: Decision-based Evidence Making Mark D. Smith, MD MBA National Health Policy Conference Washington, DC February 7 th, 2006](https://reader031.vdocuments.us/reader031/viewer/2022032722/56649f435503460f94c6442e/html5/thumbnails/9.jpg)
The A’s v. HSR
• Fast
• Cheap
• Practical R&D
• Cunning
• Sloooowwwwww• Expensive• Uncontaminated
experiments• Field of Dreams
A’s success Incentives to HS Researchers
Translating Research Into Practice Conference
![Page 10: Decision-based Evidence Making Mark D. Smith, MD MBA National Health Policy Conference Washington, DC February 7 th, 2006](https://reader031.vdocuments.us/reader031/viewer/2022032722/56649f435503460f94c6442e/html5/thumbnails/10.jpg)
Ford makes … Cars
![Page 11: Decision-based Evidence Making Mark D. Smith, MD MBA National Health Policy Conference Washington, DC February 7 th, 2006](https://reader031.vdocuments.us/reader031/viewer/2022032722/56649f435503460f94c6442e/html5/thumbnails/11.jpg)
The health care system makes …Visits
![Page 12: Decision-based Evidence Making Mark D. Smith, MD MBA National Health Policy Conference Washington, DC February 7 th, 2006](https://reader031.vdocuments.us/reader031/viewer/2022032722/56649f435503460f94c6442e/html5/thumbnails/12.jpg)
Tenure
Health Services Research makes …
![Page 13: Decision-based Evidence Making Mark D. Smith, MD MBA National Health Policy Conference Washington, DC February 7 th, 2006](https://reader031.vdocuments.us/reader031/viewer/2022032722/56649f435503460f94c6442e/html5/thumbnails/13.jpg)
What do we need more of ?
• Meaningful definitions when framing research questions
• Quick turnaround• Research questions driven more by operational
stakeholders’ priorities• Expertise in the management sciences as applied
to health care• Permanent research infrastructure
Translating Research Into Practice Conference
![Page 14: Decision-based Evidence Making Mark D. Smith, MD MBA National Health Policy Conference Washington, DC February 7 th, 2006](https://reader031.vdocuments.us/reader031/viewer/2022032722/56649f435503460f94c6442e/html5/thumbnails/14.jpg)
What drives selection of research topics and methods?
• Money
• Researcher interest and skills
• Researcher incentives
• Data availability
• Potential for publication of findings.
![Page 15: Decision-based Evidence Making Mark D. Smith, MD MBA National Health Policy Conference Washington, DC February 7 th, 2006](https://reader031.vdocuments.us/reader031/viewer/2022032722/56649f435503460f94c6442e/html5/thumbnails/15.jpg)
Problematic Researcher Attitudes
• Modeled on biochemical research – researchers’ muse
• Observational Arrogance towards delivery system– town/gown ; “LMD”– “only 65% of patients got …”
![Page 16: Decision-based Evidence Making Mark D. Smith, MD MBA National Health Policy Conference Washington, DC February 7 th, 2006](https://reader031.vdocuments.us/reader031/viewer/2022032722/56649f435503460f94c6442e/html5/thumbnails/16.jpg)
Typical Research Incentives
• Big
• Long
• Expensive
• Dedicated staff–Neutron bomb – nothing left of
value to the clinical enterprise
Are for projects to be:
![Page 17: Decision-based Evidence Making Mark D. Smith, MD MBA National Health Policy Conference Washington, DC February 7 th, 2006](https://reader031.vdocuments.us/reader031/viewer/2022032722/56649f435503460f94c6442e/html5/thumbnails/17.jpg)
What data on patients are available?
• Age
• Sex
• “Race”
• Income proxies (e.g. zipcode)
• Co-morbid conditions …
• Etc.
![Page 18: Decision-based Evidence Making Mark D. Smith, MD MBA National Health Policy Conference Washington, DC February 7 th, 2006](https://reader031.vdocuments.us/reader031/viewer/2022032722/56649f435503460f94c6442e/html5/thumbnails/18.jpg)
What patient attributes are meaningful?
• Risk aversion
• Where on diffusion curve
• Assertiveness
![Page 19: Decision-based Evidence Making Mark D. Smith, MD MBA National Health Policy Conference Washington, DC February 7 th, 2006](https://reader031.vdocuments.us/reader031/viewer/2022032722/56649f435503460f94c6442e/html5/thumbnails/19.jpg)
What clinician attributes are meaningful?
• Risk aversion
• Where on diffusion curve
• Income elasticity
![Page 20: Decision-based Evidence Making Mark D. Smith, MD MBA National Health Policy Conference Washington, DC February 7 th, 2006](https://reader031.vdocuments.us/reader031/viewer/2022032722/56649f435503460f94c6442e/html5/thumbnails/20.jpg)
Research topics: ask the users
• Medical Directors• Chiefs of staff• Department Chairs• Benefits purchasers• State/local legislators and
regulators• Clinicians
![Page 21: Decision-based Evidence Making Mark D. Smith, MD MBA National Health Policy Conference Washington, DC February 7 th, 2006](https://reader031.vdocuments.us/reader031/viewer/2022032722/56649f435503460f94c6442e/html5/thumbnails/21.jpg)
The Role of Health care IT
IT: the new silver bullet?
![Page 22: Decision-based Evidence Making Mark D. Smith, MD MBA National Health Policy Conference Washington, DC February 7 th, 2006](https://reader031.vdocuments.us/reader031/viewer/2022032722/56649f435503460f94c6442e/html5/thumbnails/22.jpg)
The current state ofhealth care IT
Fast, cheap machines
Connected by
Slow, expensive people
![Page 23: Decision-based Evidence Making Mark D. Smith, MD MBA National Health Policy Conference Washington, DC February 7 th, 2006](https://reader031.vdocuments.us/reader031/viewer/2022032722/56649f435503460f94c6442e/html5/thumbnails/23.jpg)
The greatest contribution of modern IT in health care:
The ability to measure and report quality and the outcomes of policy decisions in speedily and economically
![Page 24: Decision-based Evidence Making Mark D. Smith, MD MBA National Health Policy Conference Washington, DC February 7 th, 2006](https://reader031.vdocuments.us/reader031/viewer/2022032722/56649f435503460f94c6442e/html5/thumbnails/24.jpg)
What do we need?
• Relevance
• Speed
• “good enough” precision
• Analytical attributes and skills unfamiliar to many epidemiologists, health services and policy researchers
• Integrated care/research IT platforms
![Page 25: Decision-based Evidence Making Mark D. Smith, MD MBA National Health Policy Conference Washington, DC February 7 th, 2006](https://reader031.vdocuments.us/reader031/viewer/2022032722/56649f435503460f94c6442e/html5/thumbnails/25.jpg)
Decision-basedEvidence Making
Mark D. Smith, MD MBA
National Health Policy ConferenceWashington, DC
February 7th, 2006