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Comparative Effectiveness Approaches with ARRA Funding and the Critical Role of Health IT. Carolyn M. Clancy, MD Director Agency for Healthcare Research and Quality Scottsdale Institute’s 2010 Spring Conference Scottsdale – April 15, 2010.

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Comparative effectiveness approaches with arra funding and the critical role of health it

Comparative Effectiveness Approaches with ARRA Funding and the Critical Role of Health IT

Carolyn M. Clancy, MD


Agency for Healthcare Research and Quality

Scottsdale Institute’s 2010 Spring Conference

Scottsdale – April 15, 2010

Comparing evidence medical vs semiconductor research
Comparing Evidence: Medical vs. Semiconductor Research the Critical Role of Health IT

“When I was doing semiconductor device research, it was expected that I would compare my results with other people's previously published results and that I would comment on any differences. But it seemed to be different in medicine.

“Medical practitioners primarily tended to publish their own data; they often didn’t compare their data with the data of other practitioners, even in their own field, let alone with the results of other types of treatments for the same condition.”

Andy Grove

Intel co-founder, prostate cancer patient

Forbes May 13, 1996

Health care quality and reform
Health Care Quality and Reform the Critical Role of Health IT

  • AHRQ: New Resources, Program Highlights

  • The Right Treatment for the right Patient at the Right Time

  • 21st Century Health Care

  • Q&A

Ahrq priorities
AHRQ Priorities the Critical Role of Health IT

Patient Safety

  • Health IT

  • Patient SafetyOrganizations

  • New PatientSafety Grants

Effective HealthCare Program

AmbulatoryPatient Safety

  • Comparative Effectiveness Reviews

  • Comparative Effectiveness Research

  • Clear Findings for Multiple Audiences

  • Safety & Quality Measures,Drug Management andPatient-Centered Care

  • Patient Safety ImprovementCorps

Other Research & Dissemination Activities

Medical ExpenditurePanel Surveys

  • Visit-Level Information on Medical Expenditures

  • Annual Quality & Disparities Reports

  • Quality & Cost-Effectiveness, e.g.Prevention and PharmaceuticalOutcomes

  • U.S. Preventive ServicesTask Force


Fiscal 2011 budget proposal
Fiscal 2011 Budget Proposal the Critical Role of Health IT

  • Obama Administration proposed FY 2011 budget includes $611 million for AHRQ – up from $397 million in FY 2010:

    • $286 million for patient-centered health research, up $261 million over the FY 2010 budget

    • $65 million for patient safety research, including $34 million to reduce and prevent healthcare-associated infections

    • $32 million for health information technology research

Plus ARRA Funding (More on This Later)

Ahrq comparative effectiveness research
AHRQ Comparative Effectiveness Research the Critical Role of Health IT





Ahrq s priority conditions for the effective health care program

Arthritis and non-traumatic joint disorders the Critical Role of Health IT


Cardiovascular disease, including stroke and hypertension

Dementia, including Alzheimer 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

AHRQ’s Priority Conditions for the Effective Health Care Program

An unprecedented investment
An Unprecedented Investment the Critical Role of Health IT

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

From 2005-2009, received $129 million from Congress for CER

Program has published more than 45 products, including guides for clinicians and consumers

The American Recovery and Reinvestment Act of 2009 includes $1.1 billion for comparative effectiveness research, including $300 million to AHRQ

Iom s 100 priority topics
IOM’s 100 Priority Topics the Critical Role of Health IT

  • Initial National Priorities for Comparative Effectiveness Research

  • Topics in 4 quartiles; groups of 25.

  • First quartile is highest priority. Included in first quartile:

    • Treatment strategies for atrial fibrillation

    • Imaging technology for diagnosing, staging and monitoring patients with cancer

    • Genetic and biomarker testing

Report Brief Available At

A framework for cer
A Framework for CER the Critical Role of Health IT









Health Care










Research Platform

Infrastructure – Methods Development – Training

Recovery act cer funding investments examples
Recovery Act CER Funding the Critical Role of Health IT Investments (Examples)

  • Data Infrastructure

    • Enhance Availability and Use of Medicare Data to Support Comparative Effectiveness Research

    • Distributed Data Research Networks, Including Linking Data

  • Dissemination and Translation

    • Dissemination of CER to Physicians, Providers, Patients and Consumers Through Multiple Vehicles

    • Accelerating Dissemination and Adoption of CER by Delivery Systems

  • Research

    • Optimizing the Impact of Comparative Effectiveness Research Findings through Behavioral Economic RCT Experiments

    • Comparative Effectiveness Research on Delivery Systems

Translating the science into real world applications
Translating the Science into Real-World Applications

  • Examples of Recovery Act Evidence Generation projects with funding available/pending:

    • Clinical and Health Outcomes Initiative in Comparative Effectiveness (CHOICE): First coordinated national effort to establish a series of pragmatic clinical comparative effectiveness studies ($100M)

    • Request for Registries: Up to five awards for the creation or enhancement of national patient registries, with a primary focus on the 14 priority conditions ($48M)

    • DEcIDE Consortium Support: Expansion of multi-center research system and funding for distributed data network models that use clinically rich data from electronic health records ($24M)

Ahrq patient engagement and the recovery act
AHRQ Patient Engagement and the Recovery Act Applications

  • Citizen Forum on Effective Health Care

    • Formally engages stakeholders in the entire Effective Health Care enterprise

    • A Workgroup on Comparative Effectiveness will be convened to provide formal advice and guidance

Ahrq health it research funding
AHRQ Health IT Research Funding Applications

Long-term agency priority

AHRQ has invested more than $300 million in contracts and grants since 2004

Focus on ambulatory safety, medication management, improved decision-making, patient-centered care, health information exchange

More than 200 communities, hospitals, providers and health care systems in 48 states

AHRQ Health IT Investment: $300 Million

Reach of ahrq s health it program
Reach of AHRQ’s ApplicationsHealth IT Program

Federal Agencies

Private Sector Collaboration


Office of the National Coordinator

National Quality Forum

Prevention & Care Mgmt

Effective Health Care

Patient Safety


Health IT


Centers for Medicare and Medicaid Services

The Leapfrog Group


Innovations/ Emerging Issues


American Medical Informatics Association

National Institutes of Health

Priority Populations

Healthcare Information & Management Systems Society

Two way role for health it in comparative effectiveness
‘Two-Way’ Role for Health IT in Comparative Effectiveness

In: A pathway to clinical care for comparative effectiveness research

Out:Digitizes and structures health care information for use in comparative effectiveness research

Technology and consumers
Technology and Consumers Comparative Effectiveness

  • We create tools that make care more efficient for clinicians

  • Consumers already are comfortable with the technology; they’re leading us, not the other way around

  • Consumers are demanding tools to make their care more about them; let’s satisfy the demand!

Where to from here
Where to From Here? Comparative Effectiveness

Assure that research is descriptive – not prescriptive

Identify synergies – methods and infrastructure – between CER and post-marketing surveillance: identification of signals and investigations of causes

Identify incentives for participation

Anticipate unanticipated consequences

Thank you
Thank You Comparative Effectiveness

AHRQ Mission

To improve the quality, safety, efficiency, and effectiveness of health care for all Americans

AHRQ Vision

As a result of AHRQ's efforts, American health care will provide services of the highest quality, with the best possible outcomes, at the lowest cost