1 / 20

From Comparative Effectiveness to Optimal Health: Implementation Research

From Comparative Effectiveness to Optimal Health: Implementation Research. Robert Wood Johnson Foundation Synergy Working Group June 18, 2009. IT in Data…. USA. Develop. Switzerland. Synthesize. Canada. Interpret. UK. Learn. Source: Anderson and Frogner, Health Affairs 2009. Use.

lluvia
Download Presentation

From Comparative Effectiveness to Optimal Health: Implementation Research

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. From Comparative Effectiveness to Optimal Health: Implementation Research Robert Wood Johnson Foundation Synergy Working Group June 18, 2009

  2. IT in Data… USA Develop Switzerland Synthesize Canada Interpret UK Learn Source: Anderson and Frogner, Health Affairs 2009 Use

  3. Variation in medical expenses McAllen, Texas Source: Fisher, et al. NEJM 2009

  4. The Problem McGlynn NEJM 2003 • US spends more than any other country • Only 60% of recommended care is utilized in practice • 61% of post-MI candidates received aspirin, a nearly-free treatment that reduces MI by 30% • Large practice variation exists • Many major guidelines and trials have no effect on clinical care How can we use CER to encourage good choices in health care?

  5. Evidence from Development to Practice Data Development Data Generation and Synthesis Data Interpretation Help Stakeholders Learn the Data Encouraging Data Use

  6. Rationale CER without implementation is of no value X Help Stakeholders Learn the Data Encouraging Data Use

  7. Error Data reliability (Internal validity) Generalizability (External validity) Knowledge Resource limitation - time Patient preferences (perceived or real) Why data are not used? Develop Synthesize Interpret Learn Use

  8. Public Press on Clinical Action – The Katie Couric Effect Cram et al. Archives of Internal Medicine, 2003

  9. Why data are not used? Develop • Error • Data reliability (Internal validity) • Generalizability (External validity) • Knowledge • Resource limitation - time • Patient preferences (perceived or real) • External Pressures Synthesize Interpret Learn Use

  10. Culture and Social Environment: McAllen vs Mayo Gawande New Yorker 2009

  11. Why data are not used? Develop • Error • Data reliability (Internal validity) • Generalizability (External validity) • Knowledge • Resource limitation - time • Patient preferences (perceived or real) • External Pressures • Social Environment • Consumer pressure • Fear of Litigation • Perverse Incentives: reimbursement, approval • Heuristics Synthesize Interpret Learn Use

  12. How to make CER work? Develop • Data quality varies • Data translation can be a stopping point Synthesize Interpret Learn Use

  13. Encouraging Appropriate Data Use Develop • Education-based • Payment reform-based • Social Environment Synthesize Interpret Learn Use

  14. Encouraging Appropriate Data Use Develop • Education-based • Make research simple and usable • Evidence-based decision-support • Clinical Registries • Strengthen certification Synthesize Interpret Learn Use

  15. Encouraging Appropriate Data Use Develop • Payment reform-based • Pay-for-performance • Value-Based Insurance Design: Florida’s Medicaid Enhanced Benefits, cheaper data-based drugs • Accountable Healthcare System • Refusal of reimbursement • Tort Reform Synthesize Interpret Learn Use

  16. Encouraging AppropriateData Use Develop • Social Environment-based • VA, Mayo, Geisinger • Safeway • Smoking access Synthesize Interpret Learn Use

  17. Unintended consequences Develop • A dollar saved is a dollar lost • Overreliance on available data could make practitioners lose the art of medicine • Mutually-incompatible recommendations • Better care sometimes costs more • Perception of rationing • Effects on liability unclear • Punishes those who need help • Cherry-Picking Synthesize Interpret Learn Use

  18. Any CER policy must include an implementation plan Bridging Research and Practice: Policy Statement Develop Synthesize Interpret Learn Use

  19. Stakeholders for implementation Develop • Consumers/Patients • Providers • Researchers • Foundations/Nonprofits/Faith-based Organizations • Professional Associations • 3rd Party Payers • Health Plans • Hospitals and Care Organizations • Device Manufacturers/Pharma Synthesize Interpret Learn Use

  20. Plan of Action Develop • Federal Regulatory Approach • Involve professional societies for support and implementation • Convene IOM panel on implementation research, financial incentives and tort reform • Establish research emphasis on implementation • Allow Medicaid waivers for comparative implementation research • Encourage small-scale Medicare Demonstration projects Synthesize Interpret Learn Use

More Related