AHRQ’s Effective Health Care Program: Integrating Comparative Effectiveness Research into Everyday Practice

1. AHRQ’s Effective Health Care Program: Integrating Comparative Effectiveness Research into Everyday Practice Tuesday, October 12, 2010 2:00-3:30 p.m. ET

2. Questions To submit a question: • Press the “Ask a Question” button located at the bottom of the screen. • When you click on the button, a box will appear at the bottom of your screen requesting that you enter your e-mail address and your question. • Once completed, press the “Send” button. 2

3. Agenda • Introduction- Stephanie Chang, M.D. (Facilitator) • Integrating Comparative Effectiveness Research into Practice-Carolyn M. Clancy, M.D. • Q&A from Audience • Patient-Centered Outcomes Research and the Effective Health Care Program- Jean Slutsky, P.A., M.S.P.H. • Q&A from Audience • Physician Implementation-Amir Qaseem, M.D., Ph.D., M.H.A., FACP- American College of Physicians • Nurse Practitioner Implementation-Mary Jo Goolsby, Ed.D., M.S.N., ANP-C- American Association of Nurse Practitioners • Patient Implementation-Nilay Shah, M.S., Ph.D.- Mayo Clinic • Q&A from Audience 3

4. Questions To submit a question: Press the “Ask a Question” button located at the bottom of the screen. When you click on the button, a box will appear at the bottom of your screen requesting that you enter your e-mail address and your question. Once completed, press the “Send” button. 4

5. Integrating Comparative Effectiveness Research into Practice • Carolyn M. Clancy, M.D. • AHRQ Director 5

6. AHRQ’s Mission Improve the quality, safety, efficiency and effectiveness of health care for all Americans 6

7. AHRQ Portfolios 7

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10. Keeping the Patient at the Center Patients are more involved in their care. Each patient is different. Patients need reliable, relevant, and understandable information. 10

11. Comparative Effectiveness Research • Focuses on patient-centered outcomes • Unbiased and practical, evidence-based information • Compares drugs, devices, tests and surgeries, and approaches to health care • benefits and harms • what is known and what isn’t • Descriptive, not prescriptive Harms Benefits 11

12. What can comparative effectiveness research do for you? Help make decisions more consistent, transparent and rational Clarify nature of disputes over practice and policy Help inform quality improvement efforts Help patients make decisions about their own care 12

13. An Unprecedented Investment in Comparative Effectiveness Research • 2005-2009 - AHRQ received $129 million from Congress for comparative effectiveness research • 2009 - The American Recovery and Reinvestment Act contained $1.1 billion for comparative effectiveness research, including $300 million to AHRQ • Stakeholder Input and Involvement • Horizon Scanning • Evidence Synthesis • Evidence Gap Identification • Evidence Generation • Research Training and Career Development 13

14. Patient Protection and Affordable Care Act • Section 6301: Patient-Centered Outcomes Research • Name change: Comparative Effectiveness Research = Patient-Centered Outcomes Research • Patient-Centered Outcomes Research Institute • Independent, nonprofit Institute with public- and private-sector funding • Sets priorities and coordinates with existing agencies that support patient-centered outcomes research • Prohibits findings to be construed as mandates on practice guidelines or coverage decisions and contains patient safeguards 14

15. Improving Health Care is a Team Sport 15

16. Questions To submit a question: Press the “Ask a Question” button located at the bottom of the screen. When you click on the button, a box will appear at the bottom of your screen requesting that you enter your e-mail address and your question. Once completed, press the “Send” button. 16

17. Patient-Centered Outcomes Research and the Effective Health Care Program Jean Slutsky, P.A., M.S.P.H. Director, AHRQ’s Center for Outcomes and Evidence 17

18. AHRQ’sEffective Health Care Program Created in 2005, authorized by Section 1013 of the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003 To improve the quality, effectiveness, and efficiency of health care delivered through Medicare, Medicaid, and children’s programs by focusing on What is known now What research gaps are critical to fill Clinical effectiveness 18

19. A Framework for Patient-Centered Outcomes Research 19

20. Research Focus: 14 Priority Conditions Arthritis and non-traumatic joint disorders Cancer Cardiovascular disease, including stroke and hypertension Dementia, including Alzheimer’s Disease Depression and other mental health disorders Developmental delays, ADHD and autism Diabetes mellitus Functional limitations and disability Infectious diseases, including HIV/AIDS Obesity Peptic ulcer disease and dyspepsia Pregnancy including preterm birth Pulmonary disease/asthma Substance abuse 20

21. Research Focus: Priority Populations • Low-income groups • Minority groups • Women • Children • The elderly • Individuals with special health-care needs, such as those with disabilities, those who need chronic care or end-of-life care, or those who live in inner-city and rural areas 21

22. Effective Health Care Program Research • Since 2005… • 25 Research Reviews • 16 Research Reports • 36 Methods Research Reports and Guidance documents • 36 Consumer, Clinician Guides • and counting… 22

23. Effective Health Care Program Translation Products 23

24. Consumer Guides Paired with clinician guides to promote shared decision making Guides available in: Print Online Audio podcasts Spanish translations 24 http://effectivehealthcare.ahrq.gov/

25. Get involved! • Nominate topics online • Comment via the Web on draft key questions and reports • Share with colleagues and patients 25

26. Spreading the Word Get updates about the Effective Health Care Program and alerts when new reports or guides are available. Share the reports, guides, or other tools with your colleagues and patients. Add buttons or widgets to your Web site. 26

27. Focus on the Findings • Comparative Effectiveness of ACEIs or ARBs Added to Standard Medical Therapy for Treating Stable Ischemic Heart Disease • Comparative Effectiveness and Safety of Oral Diabetes Medications for Adults with Type 2 Diabetes 27

28. The comparative effectiveness of different combination treatments: ACEI or ARB + Standard Therapy vs Standard Therapy Alone ACEI + ARB + Standard Therapy vs ACEI + Standard Therapy ACEI or ARB + Standard Therapy vs Standard Therapy Alone Close to a Revascularization Procedure The benefits and harms associated with each treatment modality. The differences in the benefits or harms between various subpopulations of patients. Key Questions for Evidence Synthesis: ACEI and ARBs for Stable Ischemic Heart Disease and Preserved Left Ventricular Systolic Function 28 Coleman CI, et al. AHRQ Comparative Effectiveness Review No. 18. October 2009.

29. Adding an ACEI or an ARB can provide additional clinical benefits for some patients. Adding an ACEI may increase the risk of cough, syncope, or hyperkalemia. Adding an ARB may increase the risk of hyperkalemia. Adding an ACEI does not impact cardiovascular mortality in patients with end-stage renal disease and left ventricular hypertrophy. Results of Evidence Synthesis: ACEI and ARBs for Stable Ischemic Heart Disease and Preserved Left Ventricular Systolic Function 29 Coleman CI, et al. AHRQ Comparative Effectiveness Review No. 18. October 2009

30. Comparative Effectiveness Review: Oral Diabetes Medications for Adults With Type 2 Diabetes • Major Finding: Metformin, a blood glucose drug prescribed for type 2 diabetes, is less likely to cause weight gain and may be more likely than other treatments to decrease bad cholesterol • First analysis to summarize evidence on the effectiveness and adverse events for all approved oral medications commonly used in the U.S. for type 2 diabetes AHRQ Comparative Effectiveness Review No. 8, Comparative Effectiveness and Safety of Oral Diabetes Medications for Adults with Type 2 Diabetes, July 2007, Available at www.effectivehealthcare.ahrq.gov 30

31. In the Pipeline • More than 100 topics • Evidence Synthesis • Future Research Needs • Original Research • Methods Research 31

32. How to Access Products AHRQ Web site: www.effectivehealthcare.ahrq.gov Full reports and summary guides for patients and clinicians Opportunities to nominate research topics or comment on research questions and draft reports Audio files Spanish translations for consumer guides CE Activities Faculty slides AHRQ Publications Clearinghouse: (800) 358-9295 Request FREE, printed summary guides 32

33. How to Stay Informed EHC Program Web site: www.effectivehealthcare.ahrq.gov E-mail notices: http://www.effectivehealthcare.ahrq.gov/index.cfm/join-the-email-list1/ EHC Program newsletter, Comparative Effectiveness News 33

34. Questions To submit a question: Press the “Ask a Question” button located at the bottom of the screen. When you click on the button, a box will appear at the bottom of your screen requesting that you enter your e-mail address and your question. Once completed, press the “Send” button. 34

35. Agenda Introduction- Stephanie Chang, M.D. (Facilitator) Integrating Comparative Effectiveness Research into Practice-Carolyn M. Clancy, M.D. Q&A from Audience Patient-Centered Outcomes Research and the Effective Health Care Program- Jean Slutsky, P.A., M.S.P.H. Q&A from Audience Physician Implementation-Amir Qaseem, M.D., Ph.D., M.H.A., FACP- American College of Physicians Nurse Practitioner Implementation-Mary Jo Goolsby, Ed.D., M.S.N., ANP-C- American Association of Nurse Practitioners Patient Implementation-Nilay Shah, M.S., Ph.D.- Mayo Clinic Q&A from Audience 35

36. Physician Implementation: Clinical Practice Guidelines Amir Qaseem, M.D., Ph.D., M.H.A., FACP Director, Clinical Policy American College of Physicians 36

37. Who We Are Largest medical specialty organization in the U.S. 130,000 members Internists Internal medicine sub-specialists Residents/fellows training in internal medicine or its subspecialties Medical students Headquarters in Philadelphia and an office in Washington, D.C. 37

38. History of ACP Clinical Guidelines Program was established in 1981 Early ACP guidelines addressed diagnostic tests and technologies Screening, Dx, and Rx 38

39. ACP Clinical Policies Clinical Policies Clinical Guidelines Guidance Statements High-Value Cost Conscious Care Advice Evidence Reviews ACP sponsored AHRQ’s Evidence-based Practice Centers (EPC)- Nation’s top medical schools, universities, or medical centers that conduct AHRQ’s research reviews. Collaboration with other societies 39

40. ACP & AHRQ Working together since1999 AHRQ Evidence-based Practice Centers (EPC) & Effective Health Care Program 66% of our guidelines based on EPC evidence reports 40

41. ACP’s Guidelines Coverage Top three most valued products Most common reason to visit ACP’s Web site 25 of the top 100 most read articles ever in the Annals of Internal Medicine Top most read article in Internal Medicine on Medscape All ACP Guidelines are regularly covered by print, TV, radio, and online stories 41

42. ACP Guidelines Coverage 42

43. AHRQ Reports Comparative Effectiveness of Treatments to Prevent Fractures in Men and Women With Low Bone Density or Osteoporosis Comparative Effectiveness of Second-Generation Antidepressants in the Pharmacologic Treatment of Adult Depression Diagnosis and Treatment of Erectile Dysfunction Pharmacological Treatment of Dementia Use of Spirometry for Case Finding, Diagnosis, and Management of COPD 43

44. ACP Membership Feedback High quality guidelines Based on scientific evidence Helpful source of advice Not rigid or difficult to apply Not difficult to understand or use 44

45. Upcoming Guidelines based on EHC Program Research Reports Management of Patients with Chronic Kidney Disease Diagnosis and Management of Obstructive Sleep Apnea Diagnosis and Management of Urinary Incontinence CE & Safety of Oral Diabetes Medications Off-label use of Atypical Antipsychotics Treatments to Prevent Fractures in Patients with Osteoporosis 45

46. Nurse Practitioner Implementation: Continuing Education Programming Mary Jo Goolsby, Ed.D., M.S.N., NP-C, FAANP Director of Research and Education American Academy of Nurse Practitioners 46

47. Background 2009 AANP promoted awareness of the Effective Health Care (EHC) Program resources Goal to inform nurse practitioners (NPs) of resources to integrate comparative effectiveness research findings into clinical practice Accredited CE identified as vehicle to enhance uptake of CER resources Introduced select Clinician Guides as CE modules Summaries of research review findings comparing benefits/harms associated with treatment options Relevant, practice-oriented

48. The NP Role NPs are licensed independent practitioners NP Scope of Practice includes: Diagnosis and management of both acute and chronic conditions Emphasis on health promotion and disease prevention Services include, but not limited to: ordering, conducting, supervising, and interpreting diagnostic studies prescription of pharmacologic and non-pharmacologic therapies Prescriptive authority in all 50 States/DC

49. NPs Growing Resource for Health Care Delivery NP Growth2 • Over 679 million annual visits to NPs in 2008 • In 20041: • 10.8% of adults had seen an NP within the past year • 18.5% of seniors had seen an NP within the past year 1Ferrer (2007) Pursuing Equity: Contact with Primary Care and Specialist Clinicians by Demographics, Insurance, and Health Status. Annals of Family Medicine. 2AANP (2010) National NP Database.

50. AANP CE Center History The mission of the American Academy of Nurse Practitioners includes promotion of excellence in NP practice, education, and research CE is consistently rated by members as most valuable AANP service AANP CE Center launched mid-2007 Approximately 16,000 registered users Approximately 65 programs available 6,500 program “accesses” in August 2010