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The Role of Stakeholders in the Diabetes Multi-Center

Research Consortium (DMCRC)

Joe V Selby MD, Director DMCRC Coordinating Center

Kaiser Permanente Northern CA

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Diabetes Multi-Center Research Consortium (DMCRC)

Coordinating Center HMO Research Network DEcIDE Center

PI Joe Selby, MD Co-PI Patrick O’Connor MD

Affiliate Center Johns Hopkins University DEcIDE Center

PI Jodi Segal, MD Co-PI Eric Bass, MD

AHRQ Project Officers Barbara Bartman, MD MPH Scott Smith, R.Ph., M.S.P.H., Ph.D.

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DMCRC – 1 Expanded Executive Committee

Also includes: Vanderbilt DEcIDE Center – Marie Griffin

MD, PI – Comparative Effectiveness of Oral Agents in Type 2 Diabetes

RTI DEcIDE Center – Suzanne West Ph.D. PI – Comparative Effectiveness of Oral Hypoglycemics on Chronic Kidney Disease and on Time to Initiation of Maintenance Insulin

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Formation and Composition of DMCRC Stakeholders’ Committee

Formation: June 2009

Composition: – Expanded DMCRC Executive Committee– Government Agencies – AHRQ, NIDDK,

CMS, FDA, CDC, VA– Clinicians – ACP,AAFP, AADE– Patients - ADA, individual patient rep.

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Purpose of the DMCRC Stakeholders’ Committee

To represent various constituencies and perspectives in a process of nominating and prioritizing topics for AHRQ-funded, empirical CER.

To review AHRQ-funded diabetes-related CER and provide input on:– Interpretation– Dissemination– Future Questions

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Timeline of DMCRC Stakeholders’ Meetings

First Face-to-FaceMeetingJune 16, 2009

Initial Topic NominationsAnd PrioritizationFocus on Treatment

2009 2010

First Tele-ConferenceFeb 17, 2010

Focus on DM Prevention

Second Face-to-faceMeetingJuly 1, 2010

Review Ongoing CER ResearchTopic Re-prioritization forBoth treatment and Prevention

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Format of DMCRC Stakeholders’ Meetings

Greetings and Update from AHRQ ~ 30 min

Presentation/Discussion of Research ~ 3 hrs – Findings from CER Work of Consortium members

– Review of recent clinical trials findings/implications

Nominations for Topics ~ 2 hrs– All participants invited to offer nominations

– Time for Brief Presentations

Voting ~ 30 min– assessing preferences of Stakeholders vs. EC

Brief Review of Results and Next Steps ~ 30 min

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Secrets of the SauceDMCRC Stakeholders’ Committee

√ Meticulous planning with facilitator

√ Clear goals and game plan

√ Leave plenty of time for discussion

√ Facilitator to keep group on track, pull quiet ones out, chair topic nomination segment

√ Acknowledge relevant work of stakeholders

√ Demonstrate consequences of prior decisions and prioritization – i.e., funded projects

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Stakeholder Prioritized Listof CER Questions on Treatment

Compare 2nd line therapies for their long-term effects (e.g., CVD endpoints) – 19 votes

Compare system approaches to coordinated care vs. usual care – 15 votes

Evaluate strategies to remove barriers to self care (including cost barriers) – 15 votes

Compare various providers and sites for providing behavior change support – 12 votes

Compare strategies for supporting insulin initiation – 9 votes

Compare system-level strategies for supporting adherence to medications – 9 votes

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Stakeholder Prioritized Listof CER Questions on Prevention

Compare strengthened linkages between primary care and community resources vs. enhancing primary care to address overweight, lifestyle change – 25 votes

What are effective strategies for counseling patients in the primary care setting for weight loss? (Including issues of coverage) – 21 votes

Compare various approaches to GDM prevention and/or prevention of T2 DM in women with GDM. – 10 votes

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Keeping Stakeholders Engaged

Emphasizing the funding by AHRQ of projects that address previously prioritized topics

Presenting and discussing findings from studies they recommended be done

Incorporating their comments and responses into ongoing analyses or taking their suggestions and designing next generation protocols

Identify effective, affordable (“Chevrolet”) programs to support individual behavior change – 10 votes

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Challenges

Addressing or managing Stakeholder priority topics not squarely in COE purview– Prevention– Systems-level approaches– Engaging with community

Staying on top and keeping Stakeholders on top of all the research that AHRQ is funding

Adding stakeholders from delivery systems, possibly from industry

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DataCommittee

ClinicalCommittee

MethodsCommittee

StakeholderCommittee

Project Manger

Executive Committee – Includes AHRQ, Coordinating, Affiliate Center Leadership

Next Steps

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Next Steps

DataCommittee

ClinicalCommittee

MethodsCommittee

StakeholderCommittee

Project Manger

Executive Committee – Includes AHRQ, Coordinating, Affiliate Center Leadership

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Next Steps

DataCommittee

ClinicalCommittee

MethodsCommittee

StakeholderCommittee

Project Manger

Executive Committee – Includes AHRQ, Coordinating, Affiliate Center Leadership