Capacity Building Selected WEC Capacity Creating Sustainable
Creating the Capacity For Evidence-Based Care - Sax Institute
Transcript of Creating the Capacity For Evidence-Based Care - Sax Institute
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CreatingtheCapacityForEvidence-BasedCare
AndrewB.Bindman,MD
Professor
UniversityofCaliforniaSanFrancisco
July5,2018
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• Researchersneedtoadaptmethodstogettheirevidenceusedmorebyendusers
• Enduserscanbepolicymakersorcouldbepractitioners
• Co-creatingisthewaytogo-atleastsometimes
Yesterday
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AlsoSomethingAboutFootball
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Co-Creation
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Co-Creation
HealthServicesResearchers
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Evidence and Tools fr
Implementation• Gap from medical evidence generation to practice implementationØ Estimated at 17 yearsØ Delays health benefitsØ Contributes to disparities
MovingEvidencetotheFrontlines
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GrowingKnowledgeBackUp
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• Highly reliant upon specialty societies
• Specialty societies have competing self-interests
• Conflicting guidance within the same institution
EvidenceDisseminationChannel
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• What will it take for change?
• Different opportunities for promoting evidence-based practice rather than evidence-based policy?
BurningPlatform
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• HealthcarepracticeisrapidlyconsolidatingØ Largesystemsreplacingsmall
practices
Ø Potentialtopoolresources
• EmergenceofEHRsØ Growinginavailabilityand
powertosupporteffort
Evidence-BasedPractice:WhyNow?
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PhysiciansinHealthSystems
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EvGen:TheVision
• Digitizeddatacansupportfaster,better,andlesscostlyresearch– Speedbumpsrelatedtounformatted,nonstandardizedentry
• Lowerbarrierstostudyingownpts– Strategicdecisionsaboutsharingdataandbenchmarkingperformance
AcceleratingDatatoKnowledge
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“Alearninghealthcaresystemis[onethat]isdesignedtogenerateandapply thebestevidenceforthecollaborativehealthcarechoicesofeachpatientandprovider;todrivetheprocessofdiscoveryasanaturaloutgrowthofpatientcare;andtoensureinnovation,quality,safety,andvalueinhealthcare.”
InstituteofMedicine/NationalAcademyofMedicine.TheLearningHealthcareSystem:WorkshopSummary.OlsenL,Aisner D,McGinnisJM,eds.Washington,DC:National
AcademiesPress;2007
LearningHealthCareSystem
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BetterHealth=D2K+K2P
D2K:Datato
Knowledge
K2P:Knowledgeto
PracticeK2PD2K
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LearningfromSports
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• DataandAnalytics
• Leadership
• Budget
• Businessneedtocreatevalue
Moneyball Ingredients
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• Alternative Payment Models• ACOs, PCMH
• Providers responsible for population cost and quality
• Potential for financial rewards and some risk
• Voluntary for physicians but incentivized through higher payment rate
PayingForValue
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EvGen:TheVision
• EvidenceGenerator
• EvidenceCurator
• EvidenceAdopter
• EvidenceDisseminator
• EvidenceManager
ChangingRoleoftheOrganization
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• Integratingclinicaldata
• Enrichingdatawith“-omics”,patient-derivedinformation
• Analyzingpracticevariation
• Clinicalgovernanceforevidence
HealthSystems’EmergingCapacity
K2PD2K
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• CommonITplatformacrossalllevelsofcare
• Usingevidenceforsystem(notspecialty)guidelines
• Payingdoctorstoaddresstheirownpracticevariation
• Usingevidencetosupportvalue-basedpurchasing
• Activesurveillancefornewevidenceinliterature
LeadingEdgeHealthSystems
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Changes in how care is reimbursed has stimulatedan interest in evidence but research funding stilloriented more towards D2K than K2P
ResearchFundstoAccelerateK2P
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• Toextractvaluefrompublicinvestmentinnewknowledge
• Ensurethateveryonebenefitsfrompublicinvestmentinresearch
• Re-directingfocustowardsorganizationalcapacities
PublicInvestmentinImplementation
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• Integratingclinicaldata
• Enrichingdatawith“-omics”,patient-derivedinformation
• Analyzingpracticevariation
• Clinicalgovernanceforevidence
HealthSystemsNeeds
K2PD2K
Informationbrokers:researcherswhounderstandmanagement
Toolstoincorporateknowledgeintotheworkflow
Metricsofachievement
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• AHRQ Initiative: To construct a set of core competencies to guide the development of training programs for learning health systems researchers
• Proposal: To embed trainees at the interface of research, informatics and clinical operations within learning health systems
TrainingANewTypeofHealthServicesResearcher
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• Insider perspective• Immersion within a ‘host’
organisation• ‘Co-production’ with
practice community• Knowledge created ‘on the
ground’ • Simultaneous generation
and uptake of evidence• Enhance research capacity
of the host organisation
EmbeddedResearcher
Vindrole-Padros et al (2017) BMJ Quality & Safety
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• Investingininvestigatorteamsworkingincollaborationwithhealthsystems
• Rapidrigoroustestingratherthanlargebetonapre-specifiedapproach
• LeveraginghealthsysteminvestmentinK2P
• Publicdisseminationofresults
NewFundingModel
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KnowledgetoPracticeTools
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KnowledgetoPracticeTools
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• Learning collaborative of learning health care systems
• Organizational Level– Progress toward becoming a
learning healthcare system
ImplementationMetricsofAchievement
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• Lessaboutprovidingenduserswithaproduct
• Moreabouthelpingenduserstogrowtheirskillssotheycanimproveandsustaintheirefforts
KnowledgeTransfer
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TheClinicalandResearchDivide
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Thank you!
Your questions?