Post on 07-May-2017
Introduction to Healthcare and Public Health in the USThe Evolution and Reform of
Healthcare in the USLecture c
This material (Comp1_Unit9c) was developed by Oregon Health & Science University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number IU24OC000015.
The Evolution and Reform of Healthcare in the USLearning Objectives
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• Describe evidence-based medicine, clinical practice guidelines, and quality indicators in medicine (Lecture a, b, c)
• Describe the patient-centered medical home model (Lecture d)
• Discuss the key issues driving healthcare reform in the US (Lecture e)
Health IT Workforce Curriculum Version 3.0/Spring 2012
Introduction to Healthcare and Public Health in the US The Evolution and Reform of Healthcare in the US
Lecture c
Quality Indicators In Medicine
3Health IT Workforce Curriculum Version 3.0/Spring 2012
Introduction to Healthcare and Public Health in the US The Evolution and Reform of Healthcare in the US
Lecture c
• What is quality?• "the degree to which health services for
individuals and populations increase the likelihood of desired health outcomes, in a manner that is consistent with current professional knowledge.“ (Institute of Medicine, 2001)
What Does Quality Mean?
• Better patient outcomes (patient health)• Better system performance (patient care)• Better professional development (clinician
learning)• Scientific evidence + particular context =
measured performance improvement
4Health IT Workforce Curriculum Version 3.0/Spring 2012
Introduction to Healthcare and Public Health in the US The Evolution and Reform of Healthcare in the US
Lecture c
Agency for Healthcare Research and Quality (AHRQ)
5Health IT Workforce Curriculum Version 3.0/Spring 2012
Introduction to Healthcare and Public Health in the US The Evolution and Reform of Healthcare in the US
Lecture c
• Part of Department of Health and Human Services
• Mission: “to improve quality, safety, efficiency, and effectiveness of healthcare for all Americans”– Safety and quality: Reduce risk of harm– Effectiveness: Improve healthcare outcomes– Efficiency: Transform research into practice
Methods To Promote Quality
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Introduction to Healthcare and Public Health in the US The Evolution and Reform of Healthcare in the US
Lecture c
• Metrics for measuring quality– Process measures– Outcome measures
• Role of EHR in improving quality– Data collection– Data analysis
• Plan-Do-Study-Act (PDSA) cycle• Organizational standards
Comparative Effectiveness Research (CER)
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Introduction to Healthcare and Public Health in the US The Evolution and Reform of Healthcare in the US
Lecture c
• In 2008 the Institute of Medicine noted that patient care “should be based on the conscientious, explicit, and judicious use of current best evidence”
• In 2009 the IOM defined CER as “…evidence that compares the benefits and harms of alternative methods…”
Comparative Effectiveness
8Health IT Workforce Curriculum Version 3.0/Spring 2012
Introduction to Healthcare and Public Health in the US The Evolution and Reform of Healthcare in the US
Lecture c
• Generate evidence from research studies • Compare drugs, tests, healthcare delivery
methods, etc.• Researchers may look at existing studies,
or devise new studies• They may develop or use different
methods and sources of data
Steps in Comparative Effectiveness Research (CER)
9Health IT Workforce Curriculum Version 3.0/Spring 2012
Introduction to Healthcare and Public Health in the US The Evolution and Reform of Healthcare in the US
Lecture c
• Review and synthesize current medical research
• Promote and generate new evidence and analytic tools
• Translate and disseminate research findings to diverse stakeholders
Benefits of CER
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Introduction to Healthcare and Public Health in the US The Evolution and Reform of Healthcare in the US
Lecture c
• CER stakeholders – spectrum of individuals who make informed decisions that will improve healthcare
• CER may provide information about benefits and harms
• CER can compare costs of different treatments based on outcomes
• CER helps patients and physicians to choose between treatments
Emphasis on CER is a part of Healthcare Reform
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Introduction to Healthcare and Public Health in the US The Evolution and Reform of Healthcare in the US
Lecture c
• The American Recovery and Reinvestment Act of 2009 created the Federal Coordinating Council for Comparative Effectiveness Research
Evolution and Reform of Healthcare in the USSummary – Lecture c
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• Defined quality indicators• Approaches to quality improvement, e.g.,
“Plan, Do, Study, Act”• Described Comparative Effectiveness
Research (CER)
Health IT Workforce Curriculum Version 3.0/Spring 2012
Introduction to Healthcare and Public Health in the US The Evolution and Reform of Healthcare in the US
Lecture c
Evolution and Reform of Healthcare in the US
References – Lecture cReferences • Committee on Quality Healthcare in America, Institute of Medicine, . (2001). Crossing the quality
chasm: a new health system for the 21st century. Washington,, DC: National Academy Press.• Comparative Effectiveness Research Funding. (n.d.). Retrieved December 6, 2011, from U.S.
Department of Health & Human Services/Recovery website: http://www.hhs.gov/recovery/programs/cer/index.html
• Initial National Priorities for Comparative Effectiveness Research. (2009). Retrieved from National Academies Press, Washington DC 20055 website: http://www.nap.edu/catalog.php?record_id=12648#toc
• Sox, H. C., Helfand, M., Grimshaw, J., Dickersin, K., & the PLoS Medicine Editors, et.al. (2010, April 29). Comparative effectiveness research: Challenges for medical journals [editorial]. The Cochrane Library, Retrieved from http://www.thecochranelibrary.com/details/editorial/687971/Comparative-Effectiveness-Research-Challenges-for-Medical-Journals.html
13Health IT Workforce Curriculum Version 3.0/Spring 2012
Introduction to Healthcare and Public Health in the US The Evolution and Reform of Healthcare in the US
Lecture c