Translating Research into Translating Research into Practice: Making Today’s Goals Practice: Making Today’s Goals

Tomorrow’s RealityTomorrow’s Reality

Carolyn Clancy, M.D.Carolyn Clancy, M.D.DirectorDirector

Agency for Healthcare Research and QualityAgency for Healthcare Research and Quality

Oregon Health & Science University Grand RoundsOregon Health & Science University Grand Rounds

Portland – January 14, 2008Portland – January 14, 2008

Excellence & MediocrityExcellence & Mediocrity

““A society which scorns A society which scorns excellence in plumbing excellence in plumbing simply because it is simply because it is plumbing, but rewards plumbing, but rewards mediocre philosophy simply mediocre philosophy simply because it is philosophy will because it is philosophy will soon become a society in soon become a society in which neither its pipes nor its which neither its pipes nor its theories will hold water.”theories will hold water.”

John W. Gardner (1961)John W. Gardner (1961)

‘‘Consider This Recent Case’Consider This Recent Case’

Coordination of CareCoordination of Care

Turning Evidence Into Action: Turning Evidence Into Action: AHRQ Resources and PrioritiesAHRQ Resources and Priorities

Comparative Effectiveness: Comparative Effectiveness: Effective Health CareEffective Health Care

Current and Future Directions for Current and Future Directions for Health ITHealth IT

2121stst Century Health Care Century Health Care Q&AQ&A

Making Today’s Goals Making Today’s Goals Tomorrow’s RealityTomorrow’s Reality

AHRQ’s MissionAHRQ’s Mission

Improve the quality, safety, Improve the quality, safety, efficiency and effectiveness of efficiency and effectiveness of health care for all Americanshealth care for all Americans

FY 2008 FundingFY 2008 Funding

$334.6 million $334.6 million – FY 2008 Request – $329.6 millionFY 2008 Request – $329.6 million– FY 2007 Appropriation – $318.7 millionFY 2007 Appropriation – $318.7 million

FY 2008 appropriation includes:FY 2008 appropriation includes:– $30 million for comparative effectiveness research$30 million for comparative effectiveness research

Double the $15 million designated in FY 2007Double the $15 million designated in FY 2007– $5 million for research and activities to reduce Methicillin Resistant $5 million for research and activities to reduce Methicillin Resistant

Staphylococcus aureusStaphylococcus aureus (MRSA) and related infections (MRSA) and related infections The first such federal grant to AHRQ for MRSA/HAIsThe first such federal grant to AHRQ for MRSA/HAIs

Congress also encouraged AHRQ to:Congress also encouraged AHRQ to:– Consider proposals to detect medical errors and preemptively Consider proposals to detect medical errors and preemptively

control injury via compact medical devicescontrol injury via compact medical devices– Investigate the feasibility of an open-source, no-cost license Investigate the feasibility of an open-source, no-cost license

computer model capable of predicting the effects of health care computer model capable of predicting the effects of health care policy alternatives to improve quality and cost-effectivenesspolicy alternatives to improve quality and cost-effectiveness

FY 2008 PrioritiesFY 2008 Priorities

Effective HealthEffective HealthCare ProgramCare Program

Medical ExpenditureMedical ExpenditurePanel SurveysPanel Surveys

AmbulatoryAmbulatoryPatient SafetyPatient Safety

PatientPatient Safety Safety

Health IT Patient Safety

Organizations New Patient

Safety Grants Comparative Effectiveness

Network of Research Centers

Clear Findings for Multiple Audiences

Quality & Cost-Effectiveness, e.g.Prevention and PharmaceuticalOutcomes

U.S. Preventive ServicesTask Force

MRSA/HAIs

Visit-Level Information on Medical Expenditures

Annual Quality & Disparities Reports

Safety & Quality Measures,Drug Management andPatient-Centered Care

Patient Safety ImprovementCorps

Other Research & Other Research & Dissemination ActivitiesDissemination Activities

The Promise of Genomics: The Promise of Genomics: Recent ActivitiesRecent Activities

AHRQ is funding a Randomized Control Trial to clarify the added AHRQ is funding a Randomized Control Trial to clarify the added value of genetic testing to improve warfarin dosing.value of genetic testing to improve warfarin dosing.

AHRQ is funding a DEcIDE project to review databases focusing AHRQ is funding a DEcIDE project to review databases focusing on utilization and outcomes ofon utilization and outcomes of gene-based tests and therapiesgene-based tests and therapies

EPC Reports:EPC Reports:

– Genomic testing in ovarian cancer Genomic testing in ovarian cancer (completed)(completed)

– CYP450 testing in depression CYP450 testing in depression (completed)(completed)

– HNPCC testing in colorectal HNPCC testing in colorectal patients (completed)patients (completed)

– Horizon scan on cancer genetic Horizon scan on cancer genetic tests for CMS (completed)tests for CMS (completed)

– BRCA testing in breast and BRCA testing in breast and ovarian cancers (w/USPSTF ovarian cancers (w/USPSTF recommendation)recommendation)

– HER-2-Neu testing in breast HER-2-Neu testing in breast cancer (ongoing)cancer (ongoing)

– Expression profile tests in breast Expression profile tests in breast cancer (ongoing)cancer (ongoing)

– Family history in breast, ovarian, Family history in breast, ovarian, colorectal and prostate cancers colorectal and prostate cancers (ongoing)(ongoing)

– Screening for hemochromatosis Screening for hemochromatosis (w/USPSTF recommendation)(w/USPSTF recommendation)

Patient Involvement CampaignPatient Involvement Campaign

AHRQ’s campaign with the Ad Council uses a series of AHRQ’s campaign with the Ad Council uses a series of TV, radio and print public service announcementsTV, radio and print public service announcements

Web site features a “Question Builder” for patients to Web site features a “Question Builder” for patients to enhance their medical appointmentsenhance their medical appointments– www.ahrq.gov/questionsaretheanwserwww.ahrq.gov/questionsaretheanwser

Transforming Hospitals: Transforming Hospitals: Designing for Safety and QualityDesigning for Safety and Quality

A DVD that demonstrates how A DVD that demonstrates how evidence-based design can evidence-based design can improve the quality and safety of improve the quality and safety of hospital services while improving hospital services while improving staff satisfaction and retention. staff satisfaction and retention.

Case studies of three hospitals Case studies of three hospitals illustrateillustrate the benefit of the benefit of incorporating evidence-based incorporating evidence-based design principles into new design principles into new construction or renovation construction or renovation projects.projects.

http://www.ahrq.gov/qual/transform.htm

AHRQ’s National Reports on AHRQ’s National Reports on Quality and DisparitiesQuality and Disparities

2007 editions pending2007 editions pending– New efficiency chapterNew efficiency chapter

– Disability data addedDisability data added

– More on health literacyMore on health literacy

2006 National Reports – 2006 National Reports – The Good News The Good News

Good (but not perfect) Good (but not perfect) newsnews– 6% of patients reported 6% of patients reported

communication communication problems with doctorsproblems with doctors**

– 7% of patients reported 7% of patients reported communication communication problems with nursesproblems with nurses

*CAHPS Hospital Survey, 2006 National Healthcare Disparities Report*CAHPS Hospital Survey, 2006 National Healthcare Disparities Report

Oregon: Overall Care Oregon: Overall Care Quality vs. All States, Quality vs. All States,

One-Year Performance Change One-Year Performance Change

== Most Recent Year Most Recent Year = Baseline Year= Baseline Year

Performance MeterPerformance Meter

Very Very WeakWeak

WeakWeak

AverageAverage

StrongStrong

Very Very StrongStrong

2006 National Healthcare Quality Report, State Snapshots2006 National Healthcare Quality Report, State Snapshots

Oregon Snapshot

MeasureMeasure PerformancePerformance

% of Medicare AMI patients administered % of Medicare AMI patients administered aspirin within 24 hours of admission aspirin within 24 hours of admission

Better than Better than AverageAverage

% of Medicare AMI patients with beta % of Medicare AMI patients with beta blocker prescribed at dischargeblocker prescribed at discharge

AverageAverage

% of adults age 18 and over on Medicare % of adults age 18 and over on Medicare managed care whose health providers managed care whose health providers always listened carefully, explained things always listened carefully, explained things clearly, showed respect for what they had to clearly, showed respect for what they had to say and spent enough time with them say and spent enough time with them

Lower than Lower than AverageAverage

National Healthcare Quality Report, State Snapshots, 2006National Healthcare Quality Report, State Snapshots, 2006

Turning Evidence Into Action: Turning Evidence Into Action: AHRQ Resources and PrioritiesAHRQ Resources and Priorities

Comparative Effectiveness: Comparative Effectiveness: Effective Health CareEffective Health Care

Current and Future Directions Current and Future Directions for Health ITfor Health IT

2121stst Century Health Care Century Health Care Q&AQ&A

Making Today’s Goals Making Today’s Goals Tomorrow’s RealityTomorrow’s Reality

Comparative Effectiveness:Comparative Effectiveness:Effective Health Care ProgramEffective Health Care Program

Uses current, unbiased evidence in Uses current, unbiased evidence in making head-to-head comparisons to making head-to-head comparisons to show which health interventions:show which health interventions:

– Add ValueAdd Value

– Offer minimal benefit above current Offer minimal benefit above current choiceschoices

– Fail to reach their potentialFail to reach their potential

– Work for some patients, but not othersWork for some patients, but not others Builds on years of experience gained Builds on years of experience gained

through AHRQ’s Evidence-based Practice through AHRQ’s Evidence-based Practice CentersCenters

Goal: to develop and disseminate better evidence Goal: to develop and disseminate better evidence about benefits and risks of alternative choicesabout benefits and risks of alternative choices

Brigham and Women’s Hospital Health IT

Children’s Hospital - Cincinnati Pediatric care

Duke University Medical Center Therapies for heart and blood vessel disorders

HMO Research Network Multiple population-based delivery systems

Houston Area CERT Consumer education and patient adherence

KP Ctr for Health Research, Portland Coordinating Center

Rutgers University Mental health therapeutics

University of Alabama - Birmingham Musculoskeletal disorders

University of Arizona & C-Path Drug interactions/Women’s health

University of Chicago Clinical, economic issues in hospital settings

University of Illinois - Chicago Prescribing tools, including formularies

University of Iowa Elderly and aging

University of Pennsylvania Anti-infective use and resistance

Vanderbilt University Therapeutic issues in Medicaid and VA system

Weill Medical College - Cornell Therapeutic medical devices

CERTs CentersCERTs Centers

NEW

DEcIDE Research NetworkDEcIDE Research Network

Outcome Science Cambridge, MA

Brigham & Women’s Hospital Boston, MA

U of Colorado Aurora, CO

U of Pennsylvania Philadelphia, PA

Harvard Pilgrim Boston, MA

Acumen, LLC Palo alto, CA

U of Illinois Chicago

Duke University Durham, NC

U of Maryland Baltimore, MD

Vanderbilt U Nashville, TN

U of North Carolina Chapel Hill, NC

RTI International RTP, NC

Johns Hopkins Baltimore, MD

Network of institutions and partner Network of institutions and partner organizations with access to de-identified organizations with access to de-identified data of some 50 million patientsdata of some 50 million patients

Evidence-Based Practice CentersEvidence-Based Practice Centers

Promote evidence-Promote evidence-based practice and based practice and decision-makingdecision-making

Generate comparative Generate comparative effectiveness reviews effectiveness reviews on medications, devices on medications, devices and other interventionsand other interventions

User-driven, with public User-driven, with public and private-sector and private-sector partnerspartners

• Blue Cross and Blue Shield Association, Technology Evaluation Center (TEC), Chicago, IL

• Duke University, Durham, NC• ECRI, Plymouth Meeting, PA• Johns Hopkins University, Baltimore, MD• McMaster University, Hamilton, Ontario• Oregon Evidence-Based Practice Center• RTI International-University of North

Carolina at Chapel Hill, NC• Southern California Evidence-based Practice

Center-RAND, Santa Monica, CA• Tufts University-New England Medical

Center, Boston, MA• University of Alberta• University of Connecticut • Minnesota Evidence-based Practice Center• University of Ottawa• Vanderbilt University

AHRQ Created the EPC Program in 1997AHRQ Created the EPC Program in 1997

Effective Health Care Program: Effective Health Care Program: Reviews to DateReviews to Date

Nine comparative effectiveness Nine comparative effectiveness reviews released to date, including:reviews released to date, including:– ACEIs or ARBS:ACEIs or ARBS: These two common These two common

classes of blood pressure pills are classes of blood pressure pills are equally effective at controlling high equally effective at controlling high blood pressure, November 2007 blood pressure, November 2007

– PCI vs. CABGPCI vs. CABG:: Bypass surgery is more Bypass surgery is more likely than balloon angioplasty (with or likely than balloon angioplasty (with or without a stent) to bring relief from without a stent) to bring relief from angina in patients with mid-range angina in patients with mid-range coronary artery disease, October 2007coronary artery disease, October 2007

All reviews available at: All reviews available at: effectivehealthcare.ahrq.goveffectivehealthcare.ahrq.gov

Oregon Evidence-based Oregon Evidence-based Practice CenterPractice Center

The Center supports The Center supports The The Guide to Clinical Preventive Guide to Clinical Preventive Services: Recommendations Services: Recommendations of the U.S. Preventive of the U.S. Preventive Services Task ForceServices Task Force by by preparing systematic preparing systematic evidence reviews and evidence reviews and evidence summaries as evidence summaries as resources on topics under resources on topics under consideration by the Task consideration by the Task ForceForce

Emerging Methods in Emerging Methods in Comparative Effectiveness & SafetyComparative Effectiveness & Safety

A series of 23 articles by AHRQ A series of 23 articles by AHRQ researchers on new approaches researchers on new approaches in comparative effectiveness in comparative effectiveness methods are compiled in a special methods are compiled in a special October edition of October edition of Medical CareMedical Care

A valuable new resource for A valuable new resource for scientists committed to advancing scientists committed to advancing the comparative effectiveness and the comparative effectiveness and safety researchsafety research

The Resource Center in Oregon The Resource Center in Oregon led the development process, led the development process, helped draft the document and helped draft the document and manage work groups, and manage work groups, and handled public commenthandled public comment

DEcIDE program http://effectivehealthcare.ahrq.gov/reports/med-care-report.cfm

Eisenberg Clinical Decisions and Eisenberg Clinical Decisions and Communications CenterCommunications Center

The knowledge is used to maximize the benefits of The knowledge is used to maximize the benefits of health care, minimize harm and optimize the use of health care, minimize harm and optimize the use of health care resourceshealth care resources

Presents evidence synthesized Presents evidence synthesized by the Evidence-Based Practice by the Evidence-Based Practice Centers and generated by the Centers and generated by the DeCIDE Network in actionable DeCIDE Network in actionable formats for stakeholders formats for stakeholders including patients, providers, including patients, providers, policymakers and the publicpolicymakers and the public Oregon Health & Oregon Health &

Sciences UniversitySciences University

Program OutputsProgram Outputs

Research Research ReportsReports

Systematic Systematic ReviewsReviews

Consumer Consumer GuidesGuides

AHRQ Research from the Grants AHRQ Research from the Grants On-line Database (GOLD)On-line Database (GOLD)

Findings published January ‘08 Findings published January ‘08 in in Medical CareMedical Care show a show a “concerning association” “concerning association” between privately insured between privately insured parents and uninsured childrenparents and uninsured children

Overall, the findings suggest Overall, the findings suggest that even when parents that even when parents successfully gain employment successfully gain employment with private health coverage with private health coverage and raise their families out of and raise their families out of poverty, health care for their poverty, health care for their children remains out of reachchildren remains out of reach

A study of how gaps in A study of how gaps in health insurance coverage health insurance coverage for low-income Oregon for low-income Oregon children affect their children affect their medical, prescription and medical, prescription and dental healthdental health

The findings are scheduled The findings are scheduled to be published in the to be published in the March/April issue of March/April issue of Ambulatory PediatricsAmbulatory Pediatrics

Oregon Health & Science UniversityOregon Health & Science University

Turning Evidence Into Action: Turning Evidence Into Action: AHRQ Resources and PrioritiesAHRQ Resources and Priorities

Comparative Effectiveness: Comparative Effectiveness: Effective Health CareEffective Health Care

Current and Future Directions Current and Future Directions for Health ITfor Health IT

2121stst Century Health Care Century Health Care Q&AQ&A

Making Today’s Goals Making Today’s Goals Tomorrow’s RealityTomorrow’s Reality

Health IT: Where We’ve Been; Health IT: Where We’ve Been; Where We’re GoingWhere We’re Going

Long-term agency priorityLong-term agency priority– Since 2004, AHRQ has Since 2004, AHRQ has

supported about 200 projects supported about 200 projects and demonstrations to and demonstrations to improve the safety, quality improve the safety, quality and efficiency of health care and efficiency of health care in virtually every statein virtually every state

Special attention to best Special attention to best practices that can improve practices that can improve quality of care in rural, small quality of care in rural, small community, safety net and community, safety net and community health center care community health center care settingssettings– New focus on ambulatory New focus on ambulatory

safety and qualitysafety and quality

AHRQ Health IT AHRQ Health IT Investment: $216 Investment: $216

MillionMillion

Ambulatory Safety and Ambulatory Safety and Quality Program (ASQ)Quality Program (ASQ)

Over 60 Grants (in 29 states and the District of Over 60 Grants (in 29 states and the District of Columbia) and Task Orders in 3 areas: Columbia) and Task Orders in 3 areas: – Enabling Quality Measurement through Health ITEnabling Quality Measurement through Health IT

– Improving Quality through Clinician Use of Health ITImproving Quality through Clinician Use of Health IT

– Enabling Patient-Centered Care through Health ITEnabling Patient-Centered Care through Health IT

Health IT CERT awarded to Brigham & Women’sHealth IT CERT awarded to Brigham & Women’s EPC Report on the Elderly, Chronically Ill and EPC Report on the Elderly, Chronically Ill and

Underserved’s use of health ITUnderserved’s use of health IT Consumer Engagement Focus GroupsConsumer Engagement Focus Groups Contract for Technical Assistance for Medicaid Contract for Technical Assistance for Medicaid

and SCHIP programsand SCHIP programs

Impact of Health IT on Outcomes in Impact of Health IT on Outcomes in Ambulatory Settings and Across Ambulatory Settings and Across High-Risk Transitions of CareHigh-Risk Transitions of Care

Using Precision Performance Using Precision Performance Measurement to Conduct Focused Measurement to Conduct Focused Quality Improvement – Northwestern Quality Improvement – Northwestern UniversityUniversity– Type of health IT: Quality of Care Type of health IT: Quality of Care

Decision Support, Vocabulary/Coding Decision Support, Vocabulary/Coding StandardsStandards

– Designed to create systems that improve Designed to create systems that improve quality data and seamlessly link it to quality data and seamlessly link it to practice-level quality improvement practice-level quality improvement programs and point of care interventionsprograms and point of care interventions

Estimated Total Funding – $1.2 millionProject Start – Sept. 30, 2007Project End – Sept. 29, 2010

The Relationship Between The Relationship Between Health IT and Workflow DesignHealth IT and Workflow Design

Medication Safety in Primary Care Practice: Medication Safety in Primary Care Practice: Translating Research into Practice – Medical Translating Research into Practice – Medical University of South CarolinaUniversity of South Carolina– The project will develop a set of medication safety The project will develop a set of medication safety

measures relevant for primary care, incorporate them measures relevant for primary care, incorporate them in quarterly practice performance reports and assess in quarterly practice performance reports and assess the impact of the intervention on the incidence of the impact of the intervention on the incidence of medication errorsmedication errors

– Type of Health IT: Quality of Care Decision SupportType of Health IT: Quality of Care Decision Support

Estimated Total Funding: $1.2 millionProject Start – Sept. 30, 2007Project End – Sept. 29, 2010

Care for Patients with Multiple Care for Patients with Multiple Chronic ConditionsChronic Conditions

RxSafe: Shared Medication RxSafe: Shared Medication Management and Decision Support Management and Decision Support for Rural Clinicians – Oregon Health for Rural Clinicians – Oregon Health & Science University& Science University– Oregon Health & Science University is using Oregon Health & Science University is using

previously developed technology to support previously developed technology to support shared medication management for persons shared medication management for persons with chronic conditions.with chronic conditions.

– Type of Health IT: Clinical/Operational Type of Health IT: Clinical/Operational Decision Support (provider-focused)Decision Support (provider-focused)

Estimated Total Funding: $1.2 millionProject Start – Sept. 30, 2007Project End – Sept. 29, 2010

Oregon Health & Science University

WomenWomen

Harnessing Health IT to Prevent Harnessing Health IT to Prevent Medication-Induced Birth Defects – Medication-Induced Birth Defects – University of PittsburghUniversity of Pittsburgh– This project will develop and evaluate This project will develop and evaluate

ways computers may be able to help ways computers may be able to help doctors counsel women about doctors counsel women about preventing birth defects caused by use preventing birth defects caused by use of certain medications. of certain medications.

– Type of Health IT: Clinical Decision Type of Health IT: Clinical Decision Support (provider-focused), Support (provider-focused), Human/Machine InterfaceHuman/Machine Interface

Estimated Total Funding: $1.19 million Project Start – Sept. 30, 2007Project End – Sept. 29, 2010

Chronic IllnessChronic Illness

The BLUES Project: Improving The BLUES Project: Improving Diabetes Outcomes in Mississippi Diabetes Outcomes in Mississippi with Health IT – Delta Health with Health IT – Delta Health Alliance, Jackson, MSAlliance, Jackson, MS– Demonstrating the effects of diabetes Demonstrating the effects of diabetes

management practices at several management practices at several ambulatory clinics throughout Mississippi ambulatory clinics throughout Mississippi when utilizing well-designed, when utilizing well-designed, comprehensive health ITcomprehensive health IT

– Type of Health IT: Electronic Medical Type of Health IT: Electronic Medical RecordRecord

Estimated Total Funding: $1.16 million Project Start – Sept. 30, 2007Project End – Sept. 29, 2010

Other ASQ Grants in OregonOther ASQ Grants in Oregon

Automating Assessment Automating Assessment of Asthma Car Quality – of Asthma Car Quality – Kaiser Foundation Kaiser Foundation Research InstituteResearch Institute– Type of Health IT: Quality Type of Health IT: Quality

of care decision support, of care decision support, data electronic transform & data electronic transform & loadload

– Estimated total funding: Estimated total funding: $871,711 from 9/30/2007 – $871,711 from 9/30/2007 – 9/29/20099/29/2009

Improving Quality in Cancer Improving Quality in Cancer Screening: The Excellence Screening: The Excellence Report for Colonoscopy – Report for Colonoscopy – Oregon Health & Science Oregon Health & Science UniversityUniversity– Type of Health IT: Operational Type of Health IT: Operational

decision support – quality of decision support – quality of carecare

– Estimated total funding: Estimated total funding: $616,207 from 9/30/2007 – $616,207 from 9/30/2007 – 9/29/20099/29/2009

New ASQ RFANew ASQ RFA

AHRQ has published an RFA soliciting AHRQ has published an RFA soliciting research projects that focus on using research projects that focus on using health IT to improve the quality of health IT to improve the quality of management for people with complex management for people with complex health care needshealth care needs– Application deadline of February 21 for Application deadline of February 21 for

submissions that address linkages across submissions that address linkages across service providers, as well as those that service providers, as well as those that focus on the affected individualfocus on the affected individual

– Tools and processes to be implemented in Tools and processes to be implemented in a variety of settings, including small and a variety of settings, including small and rural practices, in a cost-effective manner rural practices, in a cost-effective manner

– Projects may be funded for a period of up Projects may be funded for a period of up to three yearsto three years

– $3M in funding, approx. 8-10 awards$3M in funding, approx. 8-10 awards

Turning Evidence Into Action: Turning Evidence Into Action: AHRQ Resources and PrioritiesAHRQ Resources and Priorities

Comparative Effectiveness: Comparative Effectiveness: Effective Health CareEffective Health Care

Current and Future Directions Current and Future Directions for Health ITfor Health IT

2121stst Century Health Care Century Health Care Q&AQ&A

Making Today’s Goals Making Today’s Goals Tomorrow’s RealityTomorrow’s Reality

Getting to Value-Driven Getting to Value-Driven Health Care Health Care

““The mantra of competition based The mantra of competition based on value is that there is no such on value is that there is no such thing as a national health care thing as a national health care market. What we have is a network market. What we have is a network of local markets."of local markets."

Michael O. Leavitt, SecretaryMichael O. Leavitt, SecretaryUS Dept. of Health and Human ServicesUS Dept. of Health and Human Services

November 5, 2007November 5, 2007

Quality StandardsQuality StandardsDesign systems to collect quality Design systems to collect quality

of care information and define of care information and define what constitutes quality health carewhat constitutes quality health care

IncentivesIncentivesReward those who provide and Reward those who provide and

purchase high-quality and purchase high-quality and competitively priced health carecompetitively priced health care

Price StandardsPrice StandardsAggregate claims information to Aggregate claims information to

enable cost comparisons between enable cost comparisons between specific doctors and hospitalsspecific doctors and hospitals

InteroperabilityInteroperabilitySet common technical standards Set common technical standards

for quick and secure for quick and secure communication and data exchangecommunication and data exchange

Cornerstones of Cornerstones of Value-Driven Health CareValue-Driven Health Care

Value-Driven Health Care:Value-Driven Health Care: Core Principles Core Principles

All healthcare is local All healthcare is local Broad access to information Broad access to information

will improve value by: will improve value by: – stimulating provider stimulating provider

improvementimprovement– engaging consumers in engaging consumers in

provider selection, provider selection, treatment choicestreatment choices

– enabling purchasers to align consumer, enabling purchasers to align consumer, provider incentivesprovider incentives

Nationwide learning network will foster market-Nationwide learning network will foster market-based health care reformbased health care reform

Value-Driven Health Care Value-Driven Health Care and Health ITand Health IT

How does Health IT affect How does Health IT affect patient safety culture? patient safety culture?

Adopting and using Health IT Adopting and using Health IT remains a huge cultural remains a huge cultural change for many clinicians change for many clinicians

Change requires commitment Change requires commitment to achieving and sustaining to achieving and sustaining evolution in cultureevolution in culture

What’s Missing in Health CareWhat’s Missing in Health Care

Delivery System DesignDelivery System Design

Real-time informationReal-time information – Clinical effectivenessClinical effectiveness

– Delivery to patientsDelivery to patients

– Impact on patientsImpact on patients

Evidence-based managementEvidence-based management– Shared attention to dataShared attention to data

– Shared strategies for improvementShared strategies for improvement

Policy adjustments for improvementPolicy adjustments for improvement

Growing Demand for Growing Demand for Comparative InformationComparative Information

Comparative Comparative effectiveness effectiveness information can help information can help establish the value of establish the value of medicines, procedures medicines, procedures and servicesand services

It can also stimulate the It can also stimulate the development of development of important advances in important advances in health care, and health care, and enhance value and enhance value and transparencytransparency

Better comparative Better comparative information will not information will not address issues such as address issues such as aging populations and aging populations and increases in chronic increases in chronic diseasedisease

Studies could be used Studies could be used to limit treatment to limit treatment options rather than help options rather than help target the right target the right treatments to the right treatments to the right patientspatients

Potential BenefitsPotential Benefits Potential DrawbacksPotential Drawbacks

How Can We How Can We Enhance Our Efforts?Enhance Our Efforts?

The Evolution of Translational Research

The Social Case: Potential lives The Social Case: Potential lives saved through quality improvementsaved through quality improvement

Woolf and Johnson,

2121stst Century Health Care Century Health Care

Improving quality by promoting a culture of safety Improving quality by promoting a culture of safety through Value-Driven Health Care through Value-Driven Health Care

21st Century Health Care

Information-rich, patient-Information-rich, patient-focused enterprisesfocused enterprises

Information and Information and evidence transform evidence transform

interactions from interactions from reactive to reactive to

proactive (benefits proactive (benefits and harms)and harms)

Evidence is Evidence is continually refined continually refined as a by-product of as a by-product of

care deliverycare delivery

Actionable information available – to Actionable information available – to clinicians AND patients – “just in time”clinicians AND patients – “just in time”

Connecting ‘Achievability’ Connecting ‘Achievability’ and Reliability… and Reliability…

A robust health care A robust health care system must include system must include capacity for:capacity for:– Rapid translation of Rapid translation of

beneficial advances or beneficial advances or breakthroughsbreakthroughs

– Connectivity with the Connectivity with the biomedical enterprisebiomedical enterprise

Achievability:Achievability: What can work under What can work under ideal circumstances for some peopleideal circumstances for some people

Reliability:Reliability: Getting it right for all Getting it right for all patients every time – the first timepatients every time – the first time

Turning Evidence Into Action: Turning Evidence Into Action: AHRQ Resources and PrioritiesAHRQ Resources and Priorities

Comparative Effectiveness: Comparative Effectiveness: Effective Health CareEffective Health Care

Current and Future Directions Current and Future Directions for Health ITfor Health IT

2121stst Century Health Care Century Health Care Q&AQ&A

Making Today’s Goals Making Today’s Goals Tomorrow’s RealityTomorrow’s Reality