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Maximizing the Impact of Comparative Effectiveness Research: The Role of the DEcIDE Consortia. Scott R. Smith, PhD AHRQ Center for Outcomes & Evidence US Department of Health & Human Services. Effective Health Care (EHC) Program, 2 003 – Present.

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Maximizing the impact of comparative effectiveness research the role of the decide consortia

Maximizing the Impact of Comparative Effectiveness Research: The Role of the DEcIDE Consortia

Scott R. Smith, PhD

AHRQ Center for Outcomes & Evidence

US Department of Health & Human Services

Effective health care ehc program 2 003 present
Effective Health Care (EHC) Program, 2 003 – Present

  • Authorized in 2003 by Section 1013 of the Medicare Prescription Drug, Improvement, and Modernization Act

  • Conducts objective comparisons of the effectiveness of different health care interventions

  • Goal: To support informed health care decisions by patients, clinicians, and policymakers and improve the quality, effectiveness, and efficiency of health care to support evidence-based practice

Effective health care program
Effective Health Care Program

  • Evidence synthesis (EPC program)

    • Systematically reviewing, synthesizing, comparing existing evidence on treatment effectiveness.

    • Identifying relevant knowledge gaps.

  • Evidence generation (DEcIDE, CERTs)

    • Development of new scientific knowledge to address knowledge gaps.

    • Accelerate practical studies.

  • Evidence communication/translation (Eisenberg Center)

    • Translate evidence into improvements

    • Communication of scientific information in plain language to policymakers, patients, and providers.

Cbo comparative effectiveness definition
CBO Comparative Effectiveness Definition

Comparative Effectiveness

“…a rigorous evaluation of the impact of different options that are available for treating a given medical condition for a particular set of patients.”

Congressional Budget Office, 2007

Priority conditions for the effective health care program

Arthritis and non-traumatic joint disorders


Cardiovascular disease, including stroke and hypertension

Dementia, including Alzheimer’s Disease

Depression and other mental health disorders

Developmental delays, attention-deficit hyperactivity disorder, and autism

Diabetes Mellitus

Functional limitations and disability

Infectious diseases, including HIV/AIDS


Peptic ulcer disease and dyspepsia

Pregnancy, including pre-term birth

Pulmonary disease/Asthma

Substance abuse

Priority Conditions for the Effective Health Care Program

Evidence generation
Evidence Generation

  • DEcIDE (Developing Evidence to Inform Decisions about Effectiveness) Network.

    • Capitalizing on data

    • New methods

    • Answers for questions that don’t require multi-year, multi-million $ trials

What does decide primarily do
What Does DEcIDE Primarily Do?

  • Analyze existing health care databases to compare the effectiveness & outcomes of treatment.

  • Analyze existing disease, device, and other registries.

  • Conduct methodological studies to improve research on clinical effectiveness of treatments.

Summary unofficial decide statistics
Summary &“Unofficial” DEcIDE Statistics

  • 13 DEcIDE centers.

  • Over 60 core clinical scientists.

  • Over 500 affiliated personnel.

  • Access to >120 different health databases.

  • Health data on over 50 million Americans.

  • Nation’s largest network of researchers in therapeutic effectiveness.

Ahrq decide research centers
AHRQ DEcIDE Research Centers



Comparative effectiveness and the recovery act
Comparative Effectiveness and the Recovery Act

  • The American Recovery and Reinvestment Act of 2009 includes $1.1 billion for comparative effectiveness research:

    • AHRQ: $300 million

    • NIH: $400 million (appropriated to AHRQ and transferred to NIH)

    • Office of the Secretary: $400 million (allocated at the Secretary’s discretion)

Funding for health IT, prevention and other areas could have implications for the Agency

Today s speakers
Today’s Speakers Recovery Act

Recovery act timeline ahrq
Recovery Act Timeline: AHRQ Recovery Act

May 1: Due date for Agency wide and program-specific Recovery Act plans

July 30: AHRQ to submit FY ’09 Operations Plan

December 31, 2010: All Recovery Act funding to be obligated

February 17: The American Recovery and Reinvestment Act of 2009 is signed into law







November 1: AHRQ FY ‘10 operations plan due

March 19: Establishment of Federal Coordinating Council for Comparative Effectiveness Research

June 30: Due date for IOM submission of a list of national priority conditions*

* Stakeholder input required

Cer moving forward issues to consider
CER Moving Forward: Issues to Consider

Comparative Effectiveness is a useful tool in a much larger toolkit – it is not “the answer”

Comparative Effectiveness does not make policy or health care decisions, tell doctors how to practice medicine or make final decisions about what kind of treatments insurers will pay for

Comparative Effectiveness does weigh the evidence and present it in a way that helps consumers and their doctors make the best possible decisions about health care choices

The future
The Future Consider

  • Public-private funding and participation likely a necessity

  • More effort to get better conditional reimbursement study designs/protocols

  • Patients should be engaged as partners at the local and national levels

  • Need to tackle important issues

    • Ethical

    • When to know when the evidence is sufficient

    • Transparency

    • Setting priorities