1 / 15

Knowing What Works in Health Care : A Roadmap for the Nation

Knowing What Works in Health Care : A Roadmap for the Nation. Alliance for Health Reform April 4, 2008 Wilhelmine Miller, MS, PhD GWU SPHHS. Charge to Committee: To Recommend…. Approach to identifying highly effective clinical services

inoke
Download Presentation

Knowing What Works in Health Care : A Roadmap for the Nation

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Knowing What Works in Health Care: A Roadmap for the Nation Alliance for Health Reform April 4, 2008 Wilhelmine Miller, MS, PhD GWU SPHHS

  2. Charge toCommittee: To Recommend… • Approach to identifying highly effective clinical services • Process to evaluate evidence about clinical effectiveness • Organizational framework for using evidence reports to make recommendations

  3. Outside Committee Scope • Considerations of cost, specifically use of cost-effectiveness analyses • Organizational locus of any new program • Recommendations regarding funding for clinical effectiveness research or program

  4. Body of evidence Systematicreview • Policy • Practice guidelines • Performance measures • Insurance coverage Evidence-Based Practice Centers Proprietary firms • USPSTF • ACP • NIH • BC • CMS • ACC/AHA

  5. Strengths of U.S. Activities and Capacity • Well-developed systematic review methods • A network of professionals skilled in systematic reviews • Pluralistic, close to the ground • Some excellent models for transparent, rigorous guideline development • Influential users of guidelines (e.g., coverage decisions, performance measures)

  6. Problems with the Status Quo • Extensive duplication of efforts by insurers and private groups • Potential conflicts of interest in assessing evidence and promulgating guidelines • Systematic reviews and guidelines often lack scientific rigor • Difficult for users to see the connection between the evidence and clinical recommendations

  7. Duplication of Efforts Of 20 services* - 14 evaluated by all 7 groups - 17 evaluated by 5 of 7 groups - 5 evaluated by AHRQ * 2006 activities

  8. Building a Foundation for Knowing What Works • Create a single entity with authority, overarching responsibility, sustained resources, and adequate capacity to ensure credible, unbiased information about clinical effectiveness is produced. • The program should: - set priorities for, fund, and manage systematic reviews of clinical effectiveness and related topics - develop a common language and standards for conducting systematic reviews of evidence and generating clinical guidelines and recommendations - provide a forum for addressing conflicting guidelines and recommendations - report to Congress annually

  9. Building a Foundation for Knowing What Works • The Secretary of HHS should appoint a Clinical Effectiveness Advisory Board to oversee the Program. • Advisory Board should be constituted to minimize bias due to conflict of interest and should represent diverse public and private sector expertise and interests. • Program should develop standards to minimize bias due to conflicts of interest for • priority setting • evidence assessment • guidelines development

  10. Setting Priorities The Program should appoint a standing Priority Setting Advisory Committee (PSAC) to identify high priority topics for systematic reviews of clinical effectiveness • Priority setting process should be open, transparent, efficient, and timely • Priorities should reflect • the potential to improve health across the life span • reduce the burden of disease and health disparities • eliminate undesirable variation • consider economic factors, such as costs of treatment and economic burden of disease • Membership of the PSAC should include a broad mix of expertise and interests and be chosen to minimize bias due to conflicts of interest

  11. Assessing Evidence • Develop evidence-based methods standards for systematic reviews, including a common language for characterizing the strength of evidence • Fund reviewers only if they commit to and consistently meet these standards • Invest in advancing the scientific methods underlying the conduct of systematic reviews and update standards for funded reviews as appropriate • Assess the capacity of the research workforce to meet the needs for systematic reviews • Expand training opportunities in systematic review and comparative effectiveness research methods as appropriate

  12. Developing Clinical Practice Guidelines • Groups developing clinical guidelines or recommendations should • adhere to the program’s standards • document their adherence • make documentation publicly available • Panels should include a balance of competing interests and diverse stakeholders, publish conflict of interest disclosures, and prohibit voting by members with material conflicts to minimize bias

  13. Using Clinical Practice Guidelines • Who should preferentially use guidelines developed according to these standards? • Clinicians and providers • Public and private insurers • Purchasers • Accrediting organizations • Performance measurement groups • Patients and consumers

More Related