Delivery System Research: Discovering Ways to Improve Care Value*

Michael I. Harrison

Center for Delivery, Organization & Markets

AHRQ Annual Meeting

Sept. 20, 2011

*Thanks to Dina Moss, co-lead on this initiative.

Session Overview

AHRQ’s ARRA Delivery System Research Initiative Recommendations on Advancing Delivery System

Research Progress Reports/Early Findings Discussion

DELIVERY SYSTEM FOAs 6 Evaluation Grants ($12 million) – RFA 10-012

o Research on existing designs or redesigns (interventions) in payment, reporting, and organization of care delivery

o CER= compare alternative designs or redesigns; compare one redesign to status quo accepted as current policy

4 Demonstration Grants ($7 million) – RFA 10-013 --Implementation & Research on effectiveness of redesigns in o primary careo care continuumo payment and reporting

5 Spread Demonstration Grants ($18 million) -- Accelerating Implementation of CER Findings through Networks  – RFA 10-014

o Spread of CER findings by leveraging the capacities of multi-stakeholder or multi-site networks: Goal is implementation of existing evidence, not creation of new evidence.

o Evaluation to be conducted by external contractor.

ARRA Delivery System FOA Grantees: Impacted Sites of Care(1-2 sites per study)

7

3

13

0

1

2

3

4

5

6

7

8

9

10

11

12

13

14

Hospital Other Specialty Primary Care

ARRA Delivery System FOA Grantees: Primary Health Conditions

Cardiological conditions +

hypertension, 2

Pediatric Health, 1

Orthopedics, 1

Multiple Chronic Conditions, 6

Asthma, 1

Mental Health + substance abuse,

4

Chronic Kidney Disease, 1

1

National =2

5

1

1

1

1

1

32

22

1

2

1

2

1

1

2

1 1

1

1

2

ARRA Delivery System FOA Grantees: Geographic Spread

Meeting: Advancing Delivery System Research

ARRA CER Delivery System grantees, other grantees, stakeholders, experts discuss white papers:– Gaps in Research Topics & Concepts – Research Designs, Methods, & Measures – Spread Strategies

Steps for Researchers – Most need leadership by funders:– Use more mixed methods (Needed: journal, study section support)– Examine diverse contexts for improvements– Model change over longer time periods (3+ yrs)– Apply common evaluation frameworks for similar initiatives (e.g. P4P,

PCMH) – Test valuable improvements in additional, diverse contexts– Develop measures for readiness, change contexts, culture http://www.ahrq.gov/qual/deliverysys/2011mtg/mtgsumm.htm

For more information

http://www.ahrq.gov/qual/deliverysys/2011mtg/mtgsumm.htm

Michael Harrison (RFA 10-012, 10-013 and meeting)

Michael.Harrison@ahrq.hhs.gov Dina Moss (RFA 10-014)

Dina.Moss@AHRQ.hhs.gov

Reports from Delivery System Research Teams

Michael Magill, MD, University of Utah School of Medicine

Rebecca A. Malouin, PhD, Michigan State University

Wally R. Smith, MD, Virginia Commonwealth University