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Jean R. Slutsky, PA, MSPH, AHRQ Howard E. Holland, AHRQ Barry Patel, PharmD , TTM, Inc. National Advisory Council Meeting November 4, 2011. AHRQ’s Patient-Centered Outcomes Research Dissemination and Implementation Activities. Presentation Topics.

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Jean R. Slutsky, PA, MSPH, AHRQ

Howard E. Holland, AHRQ

Barry Patel, PharmD, TTM, Inc.

National Advisory Council Meeting

November 4, 2011

AHRQ’s Patient-Centered Outcomes Research Dissemination and Implementation Activities

presentation topics
Presentation Topics

Overview of PCOR Framework, Dissemination Goals, and Effective Health Care Program

ARRA-Funded Dissemination, Translation, and Implementation Grants and Contracts

Academic Detailing Project

a framework for patient centered outcomes research
A Framework for Patient-Centered Outcomes Research








in Health Care











Research Platform

Infrastructure – Methods Development – Training

Stakeholder Engagement

pcor dissemination translation and implementation goals
PCOR Dissemination, Translation, and Implementation Goals

Foster awareness and use of PCOR findings, products, and tools by a wide range of audiences

Inform professional and consumer audiences about AHRQ’s Effective Health Care (EHC) Program and its processes and products

Drive toward greater degree of shared decisionmaking between clinicians and patients and caregivers

target audiences
Target Audiences

Physicians, nurses, pharmacists, and other health professionals

Consumers, patients, and their caregivers

Health care system decisionmakers and business leaders

Regional, State, and Federal policymakers

Advocates for improvements of health care systems and patient outcomes

effective health care program
Effective Health Care Program

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

From 2005-2009, AHRQ received $129 million from Congress for patient-centered outcomes research plus $300 million from ARRA

Program has published more than 100 products, including guides for clinicians and consumers, with plans for 75 more over the next two years

Emphasis on user-driven synthesis of existing evidence, creation of new evidence, and evidence translation

where the eisenberg center sits within the effective health care program components
Where the Eisenberg Center Sits Within the Effective Health Care Program Components

Secondary Research


Practice Centers

(15 Centers)





Primary Research



(11 Centers)

Outcomes Effectiveness, Safety and Methods



Eisenberg Center



Primary Research


(14 Centers)

Education Research in Therapeutics



Primary Research





what does the eisenberg center do
What Does the Eisenberg Center Do?

Translate findings into actionable guides & products


Redesign, maintain and expand the EHC Program

Web site

Disseminate findings electronically and through partnerships

Offer CME and educational resources

Create online patient decision aids

Provide Glossary

Organize and facilitate annual conference on decision, translation, dissemination science

reaching the target audience
Reaching the Target Audience

Presentation of Treatment Options Using Graphics and Plain Language

presentation topics1
Presentation Topics

Overview of PCOR Framework, Dissemination Goals, and Effective Health Care Program

ARRA-Funded Dissemination, Translation, and Implementation Grants and Contracts

Academic Detailing Project

arra dissemination translation and implementation grants
ARRA Dissemination, Translation, and Implementation Grants
  • Announced in September 2009
    • Total of $29.5M ARRA funds allocated
    • Build a portfolio of research demonstration projects
    • 3 year projects
  • Sought to:
    • Extend reach of CER Summary Guides from the EHC Program
        • Innovative adaptations
        • Customization of content presentation
        • Customization of delivery mechanism
importance of iadapt
Importance of iADAPT
  • Avoid direct translation of health information or health promotion materials
  • Audience-centered activities are most effective when using the audience’s preferred formats, channels, and contexts
intervention types
Intervention Types
  • Clinical Decision Support Systems
    • Interactive computer program to assist physicians and/or patients with decision making tasks at the point of care
      • Linked medical record to decision support
  • Culturally Tailored/Health Literacy
    • Ensure that the message is appropriate for the audience
      • Community Health Workers, Videos, Print
  • Communication/Marketing
    • Focus on delivery
      • Patient portals, Web sites
  • Academic Detailing/CME
    • Education of prescribers by trained health professionals
      • Face-to-face educational sessions
21 grants 30 3m
21 Grants ($30.3M)

Funded iADAPT Grants

arra funded community forum project
ARRA-Funded Community Forum Project
  • Expand and systematize public andstakeholderinvolvementin AHRQ’s Effective Healthcare Program
  • Part One: Public
      • Help the Program to identify more systematic and effective approaches for obtaining public views
  • Part Two: Stakeholders
      • Ensure consistent and comprehensive stakeholder involvement in all aspects of AHRQ’s expanded EHC Program
community forum support expand current activities
Community Forum: Support, Expand Current Activities
  • Tools for researchers
  • Focus on improving engagement of patients and consumers
  • Focus on innovative methods for involving stakeholders
  • Deliberative methods
  • Activities for EHC programs:
    • EPC Program: Communicating systematic review results to policy users
    • Support stakeholder involvement in Electronic Data project portfolio
  • EHC Stakeholder Group - 2010-2012
community forum tools for researchers
Community Forum: Tools for Researchers
  • Contacts Database for EHC Program staff
  • EHC Program Stakeholder Guide (to provide to stakeholders)
  • Stakeholder Engagement Training Modules
  • Organize and Improve Access to available tools and materials
community forum focus on innovative methods for involving stakeholders
Community Forum: Focus on Innovative Methods for Involving Stakeholders
  • Literature review on Innovative Methods for Engaging Stakeholders
  • Conference, Oct 21, 2011
    • Online Collaborative Platforms and Product Development Challenges
    • Online Communities
    • Grassroots Community Organizing
    • Collaborative Research
engaging the community ehc program portfolio on electronic data for cer
Engaging the Community -- EHC Program Portfolio on Electronic Data for CER
  • Projects are developing and enhancing electronic data systems to collect prospective, patient-centered outcomes data as a basis for comparative effectiveness research
  • Includes PROSPECT, Electronic Data Methods (EDM) Forum, enhanced registries, and distributed research networks (DRNs)
  • CF will work with grantees to help identify ways to engage patients and other members of the community in these projects to enhance research relevance and project sustainability
ehc stakeholder group 2010 2012 focus areas
EHC Stakeholder Group: 2010-2012 Focus Areas
  • Comparative effectiveness of delivery systems
  • Presenting uncertainty
arra dissemination contracts september 2010 september 2013
ARRA Dissemination Contracts(September 2010-September 2013)
  • National Initiative – $18M
  • Regional Offices – $8.6M
  • Online Continuing Education – $4M
  • Academic Detailing – $11.7M
  • Systematic Program Evaluation – $2.4M
national initiative for promoting evidence based health information
National Initiative for Promoting Evidence-based Health Information

Formative Research

Strategic Plan

Integrated Approach

Media & Marketing

Strategic Partnerships

Virtual Centers

Evaluation & Metrics

media and marketing
Media and Marketing
  • Multimedia Awareness Campaign
    • To promote evidence-based medical comparison information among consumers.
    • To promote PCOR among health professionals
  • Single Product Marketing
    • Efforts ongoing
  • “Bundled” Product Marketing
    • Pregnancy, Diabetes, Arthritis, Cardiovascular Conditions
national partnerships
National Partnerships
  • Goal: 100 national-level partnerships
  • Early focus on partnerships with professional and consumer groups
    • Physicians, PAs, RNs and NPs, Pharmacists, educators and community health workers, hospital associations, health associations and professional groups, clinical researchers, health plans and integrated health systems, and federal agencies
    • Patient advocacy organizations, consumer organizations, civic organizations, faith based organizations, minority organizations, disease-niche groups
virtual centers
Virtual Centers
  • Presence on highly trafficked Web sites that engage audiences and drive them to Effective Health Care Web site
  • Goal: 40 virtual centers
  • Identify target Web sites through systematic assessment and process of information gathering
regional partnership development offices
Purpose:Enhance awareness, understanding, and use of PCOR and EHC Program products in health care decisionmaking at the regional, State, and local levels

Focus:The most prevalent health disparities in each region

(diabetes  heart conditions  mental health  cancer)

Strategy: Targeted Partnerships

Create collaborative, ongoing and robust dissemination partnerships

Outreach to local and regional consumer and health care organizations, businesses, unions, consumer, and other organizations

Target audiences: clinicians, patients, and the intermediaries who reach them

Regional Partnership Development Offices
opportunities for involvement
Opportunities for Involvement
      • Obtain, disseminate and use slides, guides and other materials; make continuing education modules available to members
  • Create customized or co-branded materials based on Effective Health Care Program content
  • Feature the Effective Health Care Program and existing and new products on organization’s Web site, social media channels, or newsletters
  • Participate in the research process
  • Host webinars or exhibit materials at organization events
  • Sign up for the Effective Health Care Program e-mail list
early partnership results
Early Partnership Results
  • 107 partnerships established
  • 26 organizational meetings
  • 37 newsletter articles
  • 51 organizations have linked to the EHC site or specific products
  • 47 print publications distributed
    • 50,000 copies of publications and related ordered
online continuing education
Online Continuing Education
  • Expand on the continuing education activities already developed for physicians by the Eisenberg Center
  • 39 online continuing education modules and 6 academic detailing modules
  • Additional target audiences will include:
    • Pharmacists
    • Nurses
    • Nurse practitioners
    • Physician assistants
    • Other allied health professionals
online continuing education1
Online Continuing Education
  • As of September 30, 2011
    • 10 online modules released
    • 2 Academic Detailing modules accredited
    • Metrics
      • 64,496 page views since April 1, 2011
        • 19, 076 visits representing 12,513 unique viewers (some viewers visit 2, 3, and 4 times)
        • 4,169 certificates awarded
      • Clinicians from all 50 States and Puerto Rico
online continuing education certificates awarded by discipline
Online Continuing EducationCertificates Awarded by Discipline
  • Physician 557 13.4%
  • Physician Assistant 240 5.6%
  • Pharmacist 778 18.7%
  • Nurse Practitioner 580 13.9%
  • Nurse 840 20.2%
  • Case Manager 932 22.4%
  • Dietician 14 0.3%
  • Medical Assistant 67 1.6%
  • Health Education Specialist 44 1.0%
  • Other 106 2.5%
online continuing education evaluation
Online Continuing Education Evaluation
  • Responded “4” or “5” on 1-5 Likert Scale
    • Aspects of the Program
      • User Friendly/Very User Friendly 85%
    • Extent Program Met Learning Objectives
      • Met/Exceeded Beyond Met 84%
    • Able to Deliver Objective/Balanced Program
      • Able/Very Able 88%
    • Met Principles of Adult Learning
      • Met/Exceeded Beyond Met 86%
    • Scientific Rigor
      • Rigorous/Very Rigorous 87%
    • Faculty Knowledge and Expertise
      • Slightly/Very Knowledgeable 88%
    • Faculty Able to Convey Subject Matter Effectively
      • Able/Very Able 86%
systematic evaluation
Systematic Evaluation

Academic Detailing

National Initiative

Regional Offices

Continuing Education


Evaluate the effectiveness of the four varied, but complementary, dissemination methods to inform current and future dissemination of the Effective Health Care Program

Determine the level of awareness, understanding, behavior change/use, and benefits of patient-centered outcomes research among targeted audiences

phase 1 activities
Phase 1 Activities
  • Collect and analyze quarterly metrics from the four contracts
  • Administer surveys to clinicians, consumers, and patients
  • Follow-up focus groups with clinicians, as well as consumers and patients
  • In-depth interviews with health system decisionmakers, purchasers, and policymakers
  • Baseline and annual analysis of AHRQ Web site and Clearinghouse data
phase 2 activities
Phase 2 Activities
  • Collect and analyze quarterly metrics from dissemination contracts
  • Administrative/claims data analysis
  • Gauge awareness and use of PCOR findings and tools through surveys of clinicians and health system decisionmakers and conduct follow-up focus groups
  • Continue analysis of AHRQ-provided Web site data, including AHRQ Clearinghouse requests and Web site metrics
patient centered outcomes research dissemination framework
Patient Centered Outcomes Research Dissemination Framework
  • Example:
  • New Diabetes CER
  • Media campaign
  • Outreach to national orgs (i.e. ADA, AADE, Endocrine Society, AACE)
  • Outreach to consumers
  • Integrate message into Diabetes package
  • Promote via regional/State chapters of national orgs, local advocacy orgs, and regional health systems
  • Integrate clinical message into Diabetes AD package
  • Promote/discuss in individual practice settings
  • Create and promote CE modules based on individual findings

Prioritization and Message Development

National awareness of CER and specific findings

National Initiative

Deeper awareness of CER and findings at regional, local, or system level


Regional Offices

Individual clinician education and practice-level implementation

Academic Detailing


Online CE

presentation topics2
Presentation Topics

Overview of PCOR Framework, Dissemination, Goals, and Effective Health Care Program

ARRA-Funded Dissemination, Translation, and Implementation Grants and Contracts

Academic Detailing Project

about ttm
About TTM

Founded in 1995; have conducted over 360 quality improvement programs

Carried out over 375,000 medical chart reviews

Worked with over 50,000 physician provider offices

Provided evidence based education to physicians via academic detailing over the last 16 years

Conducted in collaboration with managed care organizations and health systems as part of quality improvement initiatives

academic detailing definition
Academic Detailing Definition

Onsite, interactive educational outreach sessions

Clinician to clinician

Dissemination of Comparative Effective Reviews


project overview
Project Overview

Dissemination of key messages from Effective Health Care Program

Face-to-face visits to 1,300 primary care providers and 200 health system directors nationwide

One visit every 6 months over 3 years (6 total visits to each provider system)

9,000 total visits over 3 years

topics for details
Topics for Details


Topic 1: Comparative Effectiveness, Safety and Indications of Pre-mixed Insulin Analogues for Adults with Type 2 Diabetes

Topic 2: Comparative Effectiveness and Safety of Oral Antidiabetic Drugs

Heart and Blood Vessel Conditions

Topic 3: Comparative Effectiveness of Angiotensin-Converting Enzyme Inhibitors (ACEIs), Angiotensin II Receptor Antagonists (ARBs), and Direct Renin Inhibitors for Treating Essential Hypertension

Muscle, Bone, and Joint Conditions

Mental Health

All content available on AHRQ Web site and developed into academic detailing material that is accredited for continuing education certification through ACCME

target audience
Target Audience

Primary care providers, physicians, PAs, nurse practitioners, nurses, and other health professionals

Large physician group practices

Small and individual physician group practices

Health system decisionmakers

Health plans

Large and small integrated delivery systems

Community hospitals

recruitment and hiring of academic detailers
Recruitment and Hiring of Academic Detailers

Process includes recruitment, screening, interviews, and checks on background and conflict of interest

Health care professionals



Nurses (RN/NP)

Physician Assistants

14 positions in 4 regions

  • Academic detailing process
  • Clinical content and collateral materials
  • Communicating key messages in a variety of settings
  • Role playing
  • Video-taped sessions
  • Field training and continuous support by clinical resource manager
  • Journal clubs
project started fall 2010
Project Started Fall 2010

Staff hired and trained as of Feb 2011

Outreach and scheduling support started Jan 2011

Collaboration with health plans/systems

Academic details

One-on-one interactive session eligible for CME if session lasts at least 30 minutes

Follow-up communication




Documentation of activities in CRM database

Scheduling of 2nd visit

status and update
Status and Update
  • 1,562 visits with 1,612 audience members conducted as of October 28th, 2011 in 35 states
  • 1,485 (92%) of the audience members reached reported that they had never used EHCP materials
  • 1,290 (80%) of the audience members reached reported that they intended to use the EHCP materials in the future
status and update1
Status and Update
  • 579 audience members reached by the detailing visits ordered/requested EHCP materials through the detailers (primarily consumer guides for patients)
  • Detailers reported high levels of receptivity to the detailing visits —83% were categorized as “Receptive” or “Very Receptive”
  • Detailers reported high levels of interest in the health condition topic (premixed insulin analogs—78% were categorized as either “Interested” or “Very Interested”
lessons learned and highlights
Lessons Learned and Highlights
  • Clinicians are hungry for unbiased and balanced information from a credible source…and are overwhelmingly welcoming detailers back for follow-up visits
  • Health plans, health systems, and large medical groups have been a valuable resource in helping to gain access to clinicians within their organizations
lessons learned and highlights1
Lessons Learned and Highlights
  • Senior Medical Director for a National Managed Care Organization has opened up opportunities to work with several clinician sites in California and Arizona
  • Medical Director State Division of Medical Assistance Programs has opened up opportunities to work with Managed Medicaid program medical directors and subsequently their clinicians within the state
  • Chief Medical Officer for a National Employer Site Based Clinic Organization has already led to 27 clinic site details all with positive responses
feedback on post ce test
Feedback on Post-CE Test
  • Before Accessing this educational activity, were you aware of the AHRQ-supported CER on premixed insulin analogues?

19%--YES 81%--NO

  • Sample Comments:
    • “I’m now aware of AHRQ, and it seems like a good program
    • “It was nice to have someone knowledgeable discuss the topic in person”
    • “I was not aware of the compilation of research available to guide therapies”
    • “Excellent opportunity for learning”
    • “First exposure to AHRQ: very good material, very good information”
data from clinicians seeking certificates following insulin ad
Data from Clinicians Seeking Certificates Following Insulin AD

Reflecting the knowledge that you have acquired about comparative effectiveness research (CER) through this educational activity, what changes do you plan to make in your future practice?

  • Using CER findings in educating patients
  • Using CER findings along with established evidence to guide decisions about which therapies should be made to individual patients
  • Using CER findings to validate my clinical knowledge and practices
  • Providing patients with AHRQ consumer guides on CER topics
  • Referring colleagues to AHRQ CER reports and guides