Evidence-Based Medicine: Making Today’s Goals Tomorrow’s Reality

1. Evidence-Based Medicine: Making Today’s Goals Tomorrow’s Reality Carolyn M. Clancy, MD Director Agency for Healthcare Research and Quality Washington, DC Health Policy Seminar Washington, DC – April 21, 2009

2. Current Challenges • Concerns about health spending – about $2.3 trillion per year in the U.S. and growing • Large variations in clinical care • A lot of uncertainty about best practices involving treatments and technologies • Pervasive problems with the quality of care that people receive • Translating scientific advances into actual clinical practice • Translating scientific advances into usable information for clinicians and patients

3. According to Yogi Berra • “If you don't know where you are going, you might wind up someplace else.”

4. Evidence-Based Medicine • Comparative Effectiveness and the American Recovery Reinvestment Act of 2009 (ARRA) • AHRQ’s Role in Comparative Effectiveness • How Can We Further Enhance Our Efforts? • Q&A

5. AHRQ Priorities Patient Safety • Health IT • Patient SafetyOrganizations • New PatientSafety Grants Effective HealthCare Program AmbulatoryPatient Safety • Comparative Effectiveness Reviews • Comparative Effectiveness Research • Clear Findings for Multiple Audiences • Safety & Quality Measures,Drug Management andPatient-Centered Care • Patient Safety ImprovementCorps Other Research & Dissemination Activities Medical ExpenditurePanel Surveys • Visit-Level Information on Medical Expenditures • Annual Quality & Disparities Reports • Quality & Cost-Effectiveness, e.g.Prevention and PharmaceuticalOutcomes • U.S. Preventive ServicesTask Force • MRSA/HAIs

6. AHRQ FY 2009 Funding • $372 million • $37 million more than FY 2008 • $46 million more than the president’s request • FY 2009 appropriation includes: • $50 million for comparative effectiveness research, $20 million more than FY 2008 • $49 million for patient safety activities • $45 million for health IT

7. Comparative Effectiveness and the Recovery Act • The American Recovery and Reinvestment Act of 2009 includes $1.1 billion for comparative effectiveness research: • AHRQ: $300 million • NIH: $400 million (appropriated to AHRQ and transferred to NIH) • Office of the Secretary: $400 million (allocated at the Secretary’s discretion) Funding for health IT, prevention and other areas could have implications for the Agency

8. Recovery Act Timeline: AHRQ May 1: Due date for Agency wide and program-specific Recovery Act plans July 30: AHRQ to submit FY ’09 Operations Plan December 31, 2010: All Recovery Act funding to be obligated February 17: The American Recovery and Reinvestment Act of 2009 is signed into law 2009 January April July October 2010 November 1: AHRQ FY ‘10 operations plan due March 19: Establishment of Federal Coordinating Council for Comparative Effectiveness Research June 30: Due date for IOM submission of a list of national priority conditions* * Stakeholder input required

9. Federal Coordinating Council • Established by the Office of the Secretary to offer guidance and coordination to achieve maximum use of the funding • Members include representatives from agencies involved in comparative effectiveness research • The Council will consider the needs of populations served by federal programs and opportunities to build and expand on current investments and priorities • The Council will not recommend clinical guidelines for payment, coverage or treatment

10. Other Aspects of the Recovery Act • Includes significant funding for health IT, prevention and other activities • HHS-wide Recovery Act Implementation Team to address all aspects of implementing bill • Specific subgroups for comparative effectiveness research, health IT and prevention; AHRQ and NIH co-lead comparative effectiveness workgroup • Detailed reporting requirements as outlined by the Office of Management and Budget and Health & Human Services

11. Effective Health Care Program • Evidence synthesis (EPC program) • Systematically reviewing, synthesizing, comparing existing evidence on treatment effectiveness • Identifying relevant knowledge gaps • Evidence generation (DEcIDE, CERTs) • Development of new scientific knowledge to address knowledge gaps. • Accelerate practical studies • Evidence communication/translation (Eisenberg Center) • Translate evidence into improvements • Communication of scientific information in plain language to policymakers, patients, and providers

12. The Future • Public-private funding and participation likely a necessity • More effort to get better conditional reimbursement study designs/protocols • Patients should be engaged as partners at the local and national levels • Need to tackle important issues • Ethical • When to know when the evidence is sufficient • Transparency • Setting priorities

13. Evidence of Progress • Wal-Mart • Plans to sell electronic medical records to doctors • Geisinger Health Systems • Building the capability to push specific types of information to select patient populations • Marriott • Launched a preventive health campaign to help address multiple languages and diverse backgrounds of employees

14. Progress (Cont.)

15. T1 T2 T3 How Can We Further Enhance Our Efforts? The “3T’s” Road Map to Transforming U.S. Health Care Improved health care quality and value and population health Basic biomedical science Clinical efficacy knowledge Clinical effectiveness knowledge Key T1 activity to test what care works Clinical efficacy research Key T2 activities to test who benefits from promising care Outcomes research Comparative effectiveness Research Health services research Key T3 activities to test how to deliver high-quality care reliably and in all settings Measurement and accountability of health care quality and cost Implementation of Interventions and health care system redesign Scaling and spread of effective interventions Research in above domains Source: JAMA, May 21, 2008: D. Dougherty and P.H. Conway, pp. 2319-2321. The “3T’s Roadmap to Transform U.S. Health Care: The ‘How’ of High-Quality Care.”

16. Future Challenges Downstream effects of policy applications Making sure that comparative effectiveness is “descriptive, not prescriptive” Creating a level playing field among all stakeholders Ensuring that information is presented to clinicians and consumers so they can actually use it

17. Funding Opportunities • Opportunities for the field to become involved will be made available as soon as possible: • To sign up for updates, visit http://effectivehealthcare.ahrq.gov • To review AHRQ’s standing program and training award announcements http://www.ahrq.gov/fund/grantix.htm

18. 2009 AHRQ Annual Conference “Research to Reform: Achieving Health System Change” September 13-16, 2009 Bethesda North Marriott Convention Center Bethesda, MD • Sessions on topics including the following: • Increased Funding for Comparative Effectiveness • AHRQ’s Rapidly Expanding Health IT Portfolio • Implementation of Research Findings into Changes in Practice and Policy MARK YOUR CALENDARS!

19. Health Policy Research in the 21st Century • Comparative Effectiveness and the American Recovery Reinvestment Act of 2009 (ARRA) • AHRQ’s Role in Comparative Effectiveness • Comparative Effectiveness Research and IT: The Future? • Q&A