AHRQ’s Patient-Centered Outcomes Research Dissemination and Implementation Activities

1. Jean R. Slutsky, PA, MSPH, AHRQ Howard E. Holland, AHRQ Barry Patel, PharmD, TTM, Inc. National Advisory Council Meeting November 4, 2011 AHRQ’s Patient-Centered Outcomes Research Dissemination and Implementation Activities

2. Presentation Topics Overview of PCOR Framework, Dissemination Goals, and Effective Health Care Program ARRA-Funded Dissemination, Translation, and Implementation Grants and Contracts Academic Detailing Project

3. A Framework for Patient-Centered Outcomes Research Evidence Generation Strategies Interventions Conditions Populations Improvements in Health Care Horizon Scanning Translation Dissemination Implementation Evidence Need Identification Evidence Synthesis Research Platform Infrastructure – Methods Development – Training Stakeholder Engagement

4. PCOR Dissemination, Translation, and Implementation Goals Foster awareness and use of PCOR findings, products, and tools by a wide range of audiences Inform professional and consumer audiences about AHRQ’s Effective Health Care (EHC) Program and its processes and products Drive toward greater degree of shared decisionmaking between clinicians and patients and caregivers

5. Target Audiences Physicians, nurses, pharmacists, and other health professionals Consumers, patients, and their caregivers Health care system decisionmakers and business leaders Regional, State, and Federal policymakers Advocates for improvements of health care systems and patient outcomes

6. Effective Health Care Program AHRQ’s Effective Health Care Program created by Medicare Modernization Act of 2003 From 2005-2009, AHRQ received $129 million from Congress for patient-centered outcomes research plus $300 million from ARRA Program has published more than 100 products, including guides for clinicians and consumers, with plans for 75 more over the next two years Emphasis on user-driven synthesis of existing evidence, creation of new evidence, and evidence translation

7. Where the Eisenberg Center Sits Within the Effective Health Care Program Components Secondary Research Evidence-based Practice Centers (15 Centers) Comparative Effectiveness Reviews Feedback Primary Research DEcIDE Network (11 Centers) Outcomes Effectiveness, Safety and Methods Clinicians Translate/Disseminate Eisenberg Center Translate/Disseminate Consumers Primary Research CERTs (14 Centers) Education Research in Therapeutics Translate/Disseminate Policymakers Primary Research Investigator-InitiatedResearch Comparative Effectiveness Research

8. What Does the Eisenberg Center Do? Translate findings into actionable guides & products EisenbergCenter Redesign, maintain and expand the EHC Program Web site Disseminate findings electronically and through partnerships Offer CME and educational resources Create online patient decision aids Provide Glossary Organize and facilitate annual conference on decision, translation, dissemination science

9. www.effectivehealthcare.ahrq.gov

10. Eisenberg Center Translation and Dissemination Products

11. Reaching the Target Audience Presentation of Treatment Options Using Graphics and Plain Language

12. Presentation Topics Overview of PCOR Framework, Dissemination Goals, and Effective Health Care Program ARRA-Funded Dissemination, Translation, and Implementation Grants and Contracts Academic Detailing Project

13. ARRA Dissemination, Translation, and Implementation Grants • Announced in September 2009 • Total of $29.5M ARRA funds allocated • Build a portfolio of research demonstration projects • 3 year projects • Sought to: • Extend reach of CER Summary Guides from the EHC Program • Innovative adaptations • Customization of content presentation • Customization of delivery mechanism

14. Importance of iADAPT • Avoid direct translation of health information or health promotion materials • Audience-centered activities are most effective when using the audience’s preferred formats, channels, and contexts

15. Intervention Types • Clinical Decision Support Systems • Interactive computer program to assist physicians and/or patients with decision making tasks at the point of care • Linked medical record to decision support • Culturally Tailored/Health Literacy • Ensure that the message is appropriate for the audience • Community Health Workers, Videos, Print • Communication/Marketing • Focus on delivery • Patient portals, Web sites • Academic Detailing/CME • Education of prescribers by trained health professionals • Face-to-face educational sessions

16. 21 Grants ($30.3M) Funded iADAPT Grants

17. ARRA-Funded Community Forum Project • Expand and systematize public andstakeholderinvolvementin AHRQ’s Effective Healthcare Program • Part One: Public • Help the Program to identify more systematic and effective approaches for obtaining public views • Part Two: Stakeholders • Ensure consistent and comprehensive stakeholder involvement in all aspects of AHRQ’s expanded EHC Program

18. Community Forum: Support, Expand Current Activities • Tools for researchers • Focus on improving engagement of patients and consumers • Focus on innovative methods for involving stakeholders • Deliberative methods • Activities for EHC programs: • EPC Program: Communicating systematic review results to policy users • Support stakeholder involvement in Electronic Data project portfolio • EHC Stakeholder Group - 2010-2012

19. Community Forum: Tools for Researchers • Contacts Database for EHC Program staff • EHC Program Stakeholder Guide (to provide to stakeholders) • Stakeholder Engagement Training Modules • Organize and Improve Access to available tools and materials

20. Community Forum: Focus on Innovative Methods for Involving Stakeholders • Literature review on Innovative Methods for Engaging Stakeholders • Conference, Oct 21, 2011 • Online Collaborative Platforms and Product Development Challenges • Online Communities • Grassroots Community Organizing • Collaborative Research

21. Engaging the Community -- EHC Program Portfolio on Electronic Data for CER • Projects are developing and enhancing electronic data systems to collect prospective, patient-centered outcomes data as a basis for comparative effectiveness research • Includes PROSPECT, Electronic Data Methods (EDM) Forum, enhanced registries, and distributed research networks (DRNs) • CF will work with grantees to help identify ways to engage patients and other members of the community in these projects to enhance research relevance and project sustainability

22. EHC Stakeholder Group: 2010-2012 Focus Areas • Comparative effectiveness of delivery systems • Presenting uncertainty

23. ARRA Dissemination Contracts(September 2010-September 2013) • National Initiative – $18M • Regional Offices – $8.6M • Online Continuing Education – $4M • Academic Detailing – $11.7M • Systematic Program Evaluation – $2.4M

24. National Initiative for Promoting Evidence-based Health Information Formative Research Strategic Plan Integrated Approach Media & Marketing Strategic Partnerships Virtual Centers Evaluation & Metrics

25. Media and Marketing • Multimedia Awareness Campaign • To promote evidence-based medical comparison information among consumers. • To promote PCOR among health professionals • Single Product Marketing • Efforts ongoing • “Bundled” Product Marketing • Pregnancy, Diabetes, Arthritis, Cardiovascular Conditions

26. National Partnerships • Goal: 100 national-level partnerships • Early focus on partnerships with professional and consumer groups • Physicians, PAs, RNs and NPs, Pharmacists, educators and community health workers, hospital associations, health associations and professional groups, clinical researchers, health plans and integrated health systems, and federal agencies • Patient advocacy organizations, consumer organizations, civic organizations, faith based organizations, minority organizations, disease-niche groups

27. Virtual Centers • Presence on highly trafficked Web sites that engage audiences and drive them to Effective Health Care Web site • Goal: 40 virtual centers • Identify target Web sites through systematic assessment and process of information gathering

28. Purpose:Enhance awareness, understanding, and use of PCOR and EHC Program products in health care decisionmaking at the regional, State, and local levels Focus:The most prevalent health disparities in each region (diabetes  heart conditions  mental health  cancer) Strategy: Targeted Partnerships Create collaborative, ongoing and robust dissemination partnerships Outreach to local and regional consumer and health care organizations, businesses, unions, consumer, and other organizations Target audiences: clinicians, patients, and the intermediaries who reach them Regional Partnership Development Offices

29. Opportunities for Involvement • Obtain, disseminate and use slides, guides and other materials; make continuing education modules available to members • Create customized or co-branded materials based on Effective Health Care Program content • Feature the Effective Health Care Program and existing and new products on organization’s Web site, social media channels, or newsletters • Participate in the research process • Host webinars or exhibit materials at organization events • Sign up for the Effective Health Care Program e-mail list

30. Number of Partners by State

31. Early Partnership Results • 107 partnerships established • 26 organizational meetings • 37 newsletter articles • 51 organizations have linked to the EHC site or specific products • 47 print publications distributed • 50,000 copies of publications and related ordered

32. Online Continuing Education • Expand on the continuing education activities already developed for physicians by the Eisenberg Center • 39 online continuing education modules and 6 academic detailing modules • Additional target audiences will include: • Pharmacists • Nurses • Nurse practitioners • Physician assistants • Other allied health professionals

33. Online Continuing Education • As of September 30, 2011 • 10 online modules released • 2 Academic Detailing modules accredited • Metrics • 64,496 page views since April 1, 2011 • 19, 076 visits representing 12,513 unique viewers (some viewers visit 2, 3, and 4 times) • 4,169 certificates awarded • Clinicians from all 50 States and Puerto Rico

34. Online Continuing EducationCertificates Awarded by Discipline • Physician 557 13.4% • Physician Assistant 240 5.6% • Pharmacist 778 18.7% • Nurse Practitioner 580 13.9% • Nurse 840 20.2% • Case Manager 932 22.4% • Dietician 14 0.3% • Medical Assistant 67 1.6% • Health Education Specialist 44 1.0% • Other 106 2.5%

35. Online Continuing Education Evaluation • Responded “4” or “5” on 1-5 Likert Scale • Aspects of the Program • User Friendly/Very User Friendly 85% • Extent Program Met Learning Objectives • Met/Exceeded Beyond Met 84% • Able to Deliver Objective/Balanced Program • Able/Very Able 88% • Met Principles of Adult Learning • Met/Exceeded Beyond Met 86% • Scientific Rigor • Rigorous/Very Rigorous 87% • Faculty Knowledge and Expertise • Slightly/Very Knowledgeable 88% • Faculty Able to Convey Subject Matter Effectively • Able/Very Able 86%

36. Systematic Evaluation Academic Detailing National Initiative Regional Offices Continuing Education l Evaluate the effectiveness of the four varied, but complementary, dissemination methods to inform current and future dissemination of the Effective Health Care Program Determine the level of awareness, understanding, behavior change/use, and benefits of patient-centered outcomes research among targeted audiences

37. Phase 1 Activities • Collect and analyze quarterly metrics from the four contracts • Administer surveys to clinicians, consumers, and patients • Follow-up focus groups with clinicians, as well as consumers and patients • In-depth interviews with health system decisionmakers, purchasers, and policymakers • Baseline and annual analysis of AHRQ Web site and Clearinghouse data

38. Phase 2 Activities • Collect and analyze quarterly metrics from dissemination contracts • Administrative/claims data analysis • Gauge awareness and use of PCOR findings and tools through surveys of clinicians and health system decisionmakers and conduct follow-up focus groups • Continue analysis of AHRQ-provided Web site data, including AHRQ Clearinghouse requests and Web site metrics

39. Patient Centered Outcomes Research Dissemination Framework • Example: • New Diabetes CER • Media campaign • Outreach to national orgs (i.e. ADA, AADE, Endocrine Society, AACE) • Outreach to consumers • Integrate message into Diabetes package • Promote via regional/State chapters of national orgs, local advocacy orgs, and regional health systems • Integrate clinical message into Diabetes AD package • Promote/discuss in individual practice settings • Create and promote CE modules based on individual findings Prioritization and Message Development National awareness of CER and specific findings National Initiative Deeper awareness of CER and findings at regional, local, or system level Evaluation Regional Offices Individual clinician education and practice-level implementation Academic Detailing & Online CE

40. Presentation Topics Overview of PCOR Framework, Dissemination, Goals, and Effective Health Care Program ARRA-Funded Dissemination, Translation, and Implementation Grants and Contracts Academic Detailing Project

41. About TTM Founded in 1995; have conducted over 360 quality improvement programs Carried out over 375,000 medical chart reviews Worked with over 50,000 physician provider offices Provided evidence based education to physicians via academic detailing over the last 16 years Conducted in collaboration with managed care organizations and health systems as part of quality improvement initiatives

42. Academic Detailing Definition Onsite, interactive educational outreach sessions Clinician to clinician Dissemination of Comparative Effective Reviews 42

43. Project Overview Dissemination of key messages from Effective Health Care Program Face-to-face visits to 1,300 primary care providers and 200 health system directors nationwide One visit every 6 months over 3 years (6 total visits to each provider system) 9,000 total visits over 3 years

44. Topics for Details Diabetes Topic 1: Comparative Effectiveness, Safety and Indications of Pre-mixed Insulin Analogues for Adults with Type 2 Diabetes Topic 2: Comparative Effectiveness and Safety of Oral Antidiabetic Drugs Heart and Blood Vessel Conditions Topic 3: Comparative Effectiveness of Angiotensin-Converting Enzyme Inhibitors (ACEIs), Angiotensin II Receptor Antagonists (ARBs), and Direct Renin Inhibitors for Treating Essential Hypertension Muscle, Bone, and Joint Conditions Mental Health All content available on AHRQ Web site and developed into academic detailing material that is accredited for continuing education certification through ACCME

45. Target Audience Primary care providers, physicians, PAs, nurse practitioners, nurses, and other health professionals Large physician group practices Small and individual physician group practices Health system decisionmakers Health plans Large and small integrated delivery systems Community hospitals

46. Recruitment and Hiring of Academic Detailers Process includes recruitment, screening, interviews, and checks on background and conflict of interest Health care professionals Physicians Pharmacists Nurses (RN/NP) Physician Assistants 14 positions in 4 regions

47. Academic Detailers

48. Training • Academic detailing process • Clinical content and collateral materials • Communicating key messages in a variety of settings • Role playing • Video-taped sessions • Field training and continuous support by clinical resource manager • Journal clubs

49. Project Started Fall 2010 Staff hired and trained as of Feb 2011 Outreach and scheduling support started Jan 2011 Collaboration with health plans/systems Academic details One-on-one interactive session eligible for CME if session lasts at least 30 minutes Follow-up communication E-mail Telephone/Fax Letter Documentation of activities in CRM database Scheduling of 2nd visit

50. Status and Update • 1,562 visits with 1,612 audience members conducted as of October 28th, 2011 in 35 states • 1,485 (92%) of the audience members reached reported that they had never used EHCP materials • 1,290 (80%) of the audience members reached reported that they intended to use the EHCP materials in the future