Comparative Effectiveness Approaches Comparative Effectiveness Approaches with ARRA Funding and the with ARRA Funding and the

Critical Role of Health ITCritical Role of Health IT Carolyn M. Clancy, MDCarolyn M. Clancy, MD

DirectorDirector

Agency for Healthcare Research and QualityAgency for Healthcare Research and Quality

Scottsdale Institute’s 2010 Spring ConferenceScottsdale Institute’s 2010 Spring Conference

Scottsdale – April 15, 2010Scottsdale – April 15, 2010

Comparing Evidence: Medical Comparing Evidence: Medical vs. Semiconductor Research vs. Semiconductor Research

“ “When I was doing semiconductor device research, it was When I was doing semiconductor device research, it was expected that I would compare my results with other expected that I would compare my results with other people's previously published results and that I would people's previously published results and that I would comment on any differences. But it seemed to be different comment on any differences. But it seemed to be different in medicine.in medicine.

“ “Medical practitioners primarily tended to publish their own Medical practitioners primarily tended to publish their own data; data; they often didn’t compare their data with the data of they often didn’t compare their data with the data of other practitioners, even in their own fieldother practitioners, even in their own field, let alone with the , let alone with the results of other types of treatments for the same condition.”results of other types of treatments for the same condition.”

Andy GroveAndy Grove Intel co-founder, prostate cancer patient Intel co-founder, prostate cancer patient

Forbes May 13, 1996Forbes May 13, 1996

AHRQ: New Resources, AHRQ: New Resources, Program HighlightsProgram Highlights

The Right Treatment for the The Right Treatment for the right Patient at the Right right Patient at the Right TimeTime

2121stst Century Health Care Century Health Care

Q&AQ&A

Health Care Quality and ReformHealth Care Quality and Reform

AHRQ PrioritiesAHRQ Priorities

Effective HealthEffective HealthCare ProgramCare Program

Medical ExpenditureMedical ExpenditurePanel SurveysPanel Surveys

AmbulatoryAmbulatoryPatient SafetyPatient Safety

PatientPatient Safety Safety

Health IT Patient Safety

Organizations New Patient

Safety Grants Comparative Effectiveness Reviews

Comparative Effectiveness Research

Clear Findings for Multiple Audiences

Quality & Cost-Effectiveness, e.g.Prevention and PharmaceuticalOutcomes

U.S. Preventive ServicesTask Force

MRSA/HAIs

Visit-Level Information on Medical Expenditures

Annual Quality & Disparities Reports

Safety & Quality Measures,Drug Management andPatient-Centered Care

Patient Safety ImprovementCorps

Other Research & Other Research & Dissemination ActivitiesDissemination Activities

Fiscal 2011 Budget ProposalFiscal 2011 Budget Proposal

Obama Administration proposed FY 2011 Obama Administration proposed FY 2011 budget includes $611 million for AHRQ – up budget includes $611 million for AHRQ – up from $397 million in FY 2010: from $397 million in FY 2010:

– $286 million for patient-centered health $286 million for patient-centered health research, up $261 million over the FY 2010 research, up $261 million over the FY 2010 budgetbudget

– $65 million for patient safety research, including $65 million for patient safety research, including $34 million to reduce and prevent healthcare-$34 million to reduce and prevent healthcare-associated infectionsassociated infections

– $32 million for health information technology $32 million for health information technology researchresearch

Plus ARRA Funding (More on This Later)Plus ARRA Funding (More on This Later)

AHRQ Comparative AHRQ Comparative Effectiveness ResearchEffectiveness Research

http//:effectivehealthcare.ahrq.govhttp//:effectivehealthcare.ahrq.gov

PolicymakersPolicymakers CliniciansClinicians ConsumersConsumers

AHRQ’s Priority Conditions for AHRQ’s Priority Conditions for the Effective Health Care Programthe Effective Health Care Program

Arthritis and non-Arthritis and non-traumatic joint disorderstraumatic joint disorders

CancerCancer Cardiovascular disease, Cardiovascular disease,

including stroke and including stroke and hypertensionhypertension

Dementia, including Dementia, including Alzheimer DiseaseAlzheimer Disease

Depression and other Depression and other mental health disordersmental health disorders

Developmental delays, Developmental delays, attention-deficit attention-deficit hyperactivity disorder hyperactivity disorder and autism and autism

Diabetes MellitusDiabetes Mellitus Functional limitations Functional limitations

and disabilityand disability Infectious diseases Infectious diseases

including HIV/AIDSincluding HIV/AIDS ObesityObesity Peptic ulcer disease Peptic ulcer disease

and dyspepsiaand dyspepsia Pregnancy including Pregnancy including

pre-term birthpre-term birth Pulmonary Pulmonary

disease/Asthmadisease/Asthma Substance abuseSubstance abuse

An Unprecedented InvestmentAn Unprecedented Investment

AHRQ’s Effective Health Care AHRQ’s Effective Health Care Program created by Medicare Program created by Medicare Modernization Act of 2003Modernization Act of 2003

From 2005-2009, received $129 From 2005-2009, received $129 million from Congress for CERmillion from Congress for CER

Program has published more than Program has published more than 45 products, including guides for 45 products, including guides for clinicians and consumersclinicians and consumers

The American Recovery and The American Recovery and Reinvestment Act of 2009 includes Reinvestment Act of 2009 includes $1.1 billion for comparative $1.1 billion for comparative effectiveness research, including effectiveness research, including $300 million to AHRQ$300 million to AHRQ

IOM’s 100 Priority TopicsIOM’s 100 Priority Topics

Initial National Priorities for Comparative Initial National Priorities for Comparative Effectiveness ResearchEffectiveness Research

Topics in 4 quartiles; groups of 25. Topics in 4 quartiles; groups of 25. First quartile is highest priority. Included First quartile is highest priority. Included

in first quartile:in first quartile:– Treatment strategies for atrial fibrillationTreatment strategies for atrial fibrillation

– Imaging technology for diagnosing, staging Imaging technology for diagnosing, staging and monitoring patients with cancerand monitoring patients with cancer

– Genetic and biomarker testingGenetic and biomarker testing

Report Brief Available At Report Brief Available At http://www.iom.eduhttp://www.iom.edu

Horizon Horizon ScanningScanning

EvidenceEvidence NeedNeed

IdentificationIdentification

Evidence Evidence SynthesisSynthesis

EvidenceEvidence GenerationGeneration

StrategiesStrategiesInterventionsInterventionsConditionsConditionsPopulationsPopulations

DisseminationDisseminationTranslationTranslation

ImprovementsImprovements inin

Health CareHealth Care

Research PlatformResearch PlatformInfrastructure – Methods Development – Training Infrastructure – Methods Development – Training

A Framework for CERA Framework for CER

Recovery Act CER FundingRecovery Act CER Funding Investments (Examples)Investments (Examples)

Data InfrastructureData Infrastructure– Enhance Availability and Use of Medicare Data to Support Enhance Availability and Use of Medicare Data to Support

Comparative Effectiveness ResearchComparative Effectiveness Research

– Distributed Data Research Networks, Including Linking DataDistributed Data Research Networks, Including Linking Data

Dissemination and TranslationDissemination and Translation – Dissemination of CER to Physicians, Providers, Patients and Dissemination of CER to Physicians, Providers, Patients and

Consumers Through Multiple Vehicles Consumers Through Multiple Vehicles

– Accelerating Dissemination and Adoption of CER by Delivery Accelerating Dissemination and Adoption of CER by Delivery Systems Systems

ResearchResearch– Optimizing the Impact of Comparative Effectiveness Research Optimizing the Impact of Comparative Effectiveness Research

Findings through Behavioral Economic RCT ExperimentsFindings through Behavioral Economic RCT Experiments– Comparative Effectiveness Research on Delivery Systems Comparative Effectiveness Research on Delivery Systems

Translating the Science into Translating the Science into Real-World Applications Real-World Applications

Examples of Recovery Act Evidence Generation Examples of Recovery Act Evidence Generation projects with funding available/pending:projects with funding available/pending:– Clinical and Health Outcomes Initiative in Comparative Clinical and Health Outcomes Initiative in Comparative

Effectiveness (CHOICE): First coordinated national effort Effectiveness (CHOICE): First coordinated national effort to establish a series of pragmatic clinical comparative to establish a series of pragmatic clinical comparative effectiveness studies ($100M)effectiveness studies ($100M)

– Request for Registries: Up to five awards for the creation Request for Registries: Up to five awards for the creation or enhancement of national patient registries, with a or enhancement of national patient registries, with a primary focus on the 14 priority conditions ($48M)primary focus on the 14 priority conditions ($48M)

– DEcIDE Consortium Support: Expansion of multi-center DEcIDE Consortium Support: Expansion of multi-center research system and funding for distributed data network research system and funding for distributed data network models that use clinically rich data from electronic health models that use clinically rich data from electronic health records ($24M)records ($24M)

AHRQ Patient Engagement AHRQ Patient Engagement and the Recovery Actand the Recovery Act

Citizen Forum on Effective Health Citizen Forum on Effective Health CareCare– Formally engages stakeholders in the Formally engages stakeholders in the

entire Effective Health Care enterpriseentire Effective Health Care enterprise

– A Workgroup on Comparative A Workgroup on Comparative Effectiveness will be convened to Effectiveness will be convened to provide formal advice and guidanceprovide formal advice and guidance

AHRQ Health IT AHRQ Health IT Research FundingResearch Funding

Long-term agency priorityLong-term agency priority AHRQ has invested more than AHRQ has invested more than

$300 million in contracts and $300 million in contracts and grants since 2004 grants since 2004

Focus on ambulatory safety, Focus on ambulatory safety, medication management, medication management, improved decision-making, improved decision-making, patient-centered care, health patient-centered care, health information exchangeinformation exchange

More than 200 communities, More than 200 communities, hospitals, providers and health hospitals, providers and health care systems in 48 statescare systems in 48 states

AHRQ Health IT AHRQ Health IT Investment: $300 Investment: $300

MillionMillion

http://healthit.hhs.govhttp://healthit.hhs.gov

Reach of AHRQ’s Reach of AHRQ’s Health IT ProgramHealth IT Program

CoreCore Health IT Health IT ActivitiesActivities

AHRQAHRQ

Effective Effective Health CareHealth Care

Patient Patient SafetySafety

Innovations/ Innovations/ Emerging Emerging

IssuesIssues

Priority Priority PopulationsPopulations

MEPSMEPS

ValueValue

Prevention & Prevention & Care MgmtCare Mgmt

Private Sector Private Sector CollaborationCollaboration

Office of the Office of the National National

CoordinatorCoordinator

Centers for Centers for Medicare and Medicare and Medicaid ServicesMedicaid Services

Federal Federal AgenciesAgencies

National National Quality Quality ForumForum

American American Medical Medical

Informatics Informatics AssociationAssociation

Healthcare Healthcare Information Information

& Management & Management Systems SocietySystems Society

National National Institutes of Institutes of

HealthHealth

The Leapfrog The Leapfrog GroupGroup

‘‘Two-Way’ Role for Health IT Two-Way’ Role for Health IT in Comparative in Comparative

EffectivenessEffectiveness

In: In: A pathway to clinical A pathway to clinical care for comparative care for comparative effectiveness researcheffectiveness research

Out:Out: Digitizes and Digitizes and structures health care structures health care information for use in information for use in comparative effectiveness comparative effectiveness research research

What Does It Really Mean What Does It Really Mean to Be Patient-Centric?’to Be Patient-Centric?’

Technology and ConsumersTechnology and Consumers

We create tools that make care We create tools that make care more efficient for more efficient for cliniciansclinicians

Consumers already are Consumers already are comfortable with the comfortable with the technology; they’re leading us, technology; they’re leading us, not the other way aroundnot the other way around

Consumers are demanding Consumers are demanding tools to make their care more tools to make their care more about them; let’s satisfy the about them; let’s satisfy the demand!demand!

Where to From Here?Where to From Here?

Assure that research is descriptive – not Assure that research is descriptive – not prescriptiveprescriptive

Identify synergies – methods and Identify synergies – methods and infrastructure – between CER and post-infrastructure – between CER and post-marketing surveillance: identification of marketing surveillance: identification of signals and investigations of causessignals and investigations of causes

Identify incentives for participationIdentify incentives for participation

Anticipate unanticipated consequencesAnticipate unanticipated consequences

Thank YouThank You

AHRQ Mission AHRQ Mission

To improve the quality, safety, To improve the quality, safety, efficiency, and effectiveness of efficiency, and effectiveness of health care for all Americanshealth care for all Americans

AHRQ VisionAHRQ Vision

As a result of AHRQ's efforts, As a result of AHRQ's efforts, American health care will American health care will provide services of the highest provide services of the highest quality, with the best possible quality, with the best possible outcomes, at the lowest costoutcomes, at the lowest cost

www.ahrq.govwww.ahrq.gov