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Evidence-Based Medicine: Making Today’s Goals Tomorrow’s Reality. Carolyn M. Clancy, MD Director Agency for Healthcare Research and Quality Washington, DC Health Policy Seminar Washington, DC – April 21, 2009. Current Challenges.

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evidence based medicine making today s goals tomorrow s reality

Evidence-Based Medicine: Making Today’s Goals Tomorrow’s Reality

Carolyn M. Clancy, MD

Director

Agency for Healthcare Research and Quality

Washington, DC Health Policy Seminar

Washington, DC – April 21, 2009

current challenges
Current Challenges
  • Concerns about health spending – about $2.3 trillion per year in the U.S. and growing
  • Large variations in clinical care
  • A lot of uncertainty about best practices involving treatments and technologies
  • Pervasive problems with the quality of care that people receive
  • Translating scientific advances into actual clinical practice
  • Translating scientific advances into usable information for clinicians and patients
according to yogi berra
According to Yogi Berra
  • “If you don't know where you are going, you might wind up someplace else.”
evidence based medicine
Evidence-Based Medicine
  • Comparative Effectiveness and the American Recovery Reinvestment Act of 2009 (ARRA)
  • AHRQ’s Role in Comparative Effectiveness
  • How Can We Further Enhance Our Efforts?
  • Q&A
ahrq priorities
AHRQ Priorities

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
  • MRSA/HAIs
ahrq fy 2009 funding
AHRQ FY 2009 Funding
  • $372 million
    • $37 million more than FY 2008
    • $46 million more than the president’s request
  • FY 2009 appropriation includes:
    • $50 million for comparative effectiveness research, $20 million more than FY 2008
    • $49 million for patient safety activities
    • $45 million for health IT
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

recovery act timeline ahrq
Recovery Act Timeline: AHRQ

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

2009

January

April

July

October

2010

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

federal coordinating council
Federal Coordinating Council
  • Established by the Office of the Secretary to offer guidance and coordination to achieve maximum use of the funding
    • Members include representatives from agencies involved in comparative effectiveness research
    • The Council will consider the needs of populations served by federal programs and opportunities to build and expand on current investments and priorities
    • The Council will not recommend clinical guidelines for payment, coverage or treatment
other aspects of the recovery act
Other Aspects of the Recovery Act
  • Includes significant funding for health IT, prevention and other activities
  • HHS-wide Recovery Act Implementation Team to address all aspects of implementing bill
  • Specific subgroups for comparative effectiveness research, health IT and prevention; AHRQ and NIH co-lead comparative effectiveness workgroup
  • Detailed reporting requirements as outlined by the Office of Management and Budget and Health & Human Services
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
the future
The Future
  • 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
evidence of progress
Evidence of Progress
  • Wal-Mart
    • Plans to sell electronic medical records to doctors
  • Geisinger Health Systems
    • Building the capability to push specific types of information to select patient populations
  • Marriott
    • Launched a preventive health campaign to help address multiple languages and diverse backgrounds of employees
how can we further enhance our efforts

T1

T2

T3

How Can We Further Enhance Our Efforts?

The “3T’s” Road Map to Transforming U.S. Health Care

Improved health

care quality and

value and

population health

Basic biomedical

science

Clinical efficacy

knowledge

Clinical effectiveness

knowledge

Key T1 activity to test

what care works

Clinical efficacy research

Key T2 activities to test

who benefits from

promising care

Outcomes research

Comparative effectiveness

Research

Health services research

Key T3 activities to test

how to deliver high-quality

care reliably and in

all settings

Measurement and

accountability of health

care quality and cost

Implementation of

Interventions and health

care system redesign

Scaling and spread of

effective interventions

Research in above domains

Source: JAMA, May 21, 2008: D. Dougherty and P.H. Conway, pp. 2319-2321. The “3T’s Roadmap to Transform U.S. Health Care: The ‘How’ of High-Quality Care.”

future challenges
Future Challenges

Downstream effects of policy applications

Making sure that comparative effectiveness is “descriptive, not prescriptive”

Creating a level playing field among all stakeholders

Ensuring that information is presented to clinicians and consumers so they can actually use it

funding opportunities
Funding Opportunities
  • Opportunities for the field to become involved will be made available as soon as possible:
    • To sign up for updates, visit http://effectivehealthcare.ahrq.gov
    • To review AHRQ’s standing program and training award announcements http://www.ahrq.gov/fund/grantix.htm
2009 ahrq annual conference
2009 AHRQ Annual Conference

“Research to Reform: Achieving Health System Change”

September 13-16, 2009 Bethesda North Marriott Convention Center Bethesda, MD

  • Sessions on topics including the following:
  • Increased Funding for Comparative Effectiveness
  • AHRQ’s Rapidly Expanding Health IT Portfolio
  • Implementation of Research Findings into Changes in Practice and Policy

MARK YOUR CALENDARS!

health policy research in the 21 st century
Health Policy Research in the 21st Century
  • Comparative Effectiveness and the American Recovery Reinvestment Act of 2009 (ARRA)
  • AHRQ’s Role in Comparative Effectiveness
  • Comparative Effectiveness Research and IT: The Future?
  • Q&A