Transcript Slide 1

Comparative Effectiveness:
Moving from Research to Practice
Carolyn M. Clancy, MD
Director
Agency for Healthcare Research and Quality
The 25th Annual Rosalynn Carter
Symposium on Mental Health Policy
The Carter Center – November 6, 2009
Treatment for Mental Health
Adults with a mood, anxiety or impulse control disorder in the last
12 months who received minimally adequate treatment, 2001-2003
 Nearly 30% of
adults with mood,
anxiety or impulse
control disorders
received minimally
adequate treatment
 There were no
significant
differences by age
AHRQ 2008 National Healthcare Quality Report
By Race & Education
Adults with a mood, anxiety or impulse control disorder in the last
12 months who received minimally adequate treatment, 2001-2003
 % of adults who received
minimally adequate
treatment was lower among
Blacks and Hispanics, with
Hispanics having the lowest
% of all groups
 % was also lower among
individuals with less than a
high school education and
high school graduates,
compared with those with
some college education
AHRQ 2008 National Healthcare Disparities Report
Treatment for Depression
Adults with a major depressive episode in the last 12 months who received
treatment for depression, by race, ethnicity, income and education, 2006
 % of adults with major
depressive episode who
received treatment was
significantly lower for Blacks
than for Whites (58.9% and
71.1%) and lower for Hispanics
than for non-Hispanic Whites
(51.8% and 73.3%)
 There were no statistically
differences by income or
education level
AHRQ 2008 National Healthcare Disparities Report
Current Challenges
 Concerns about health spending – about $2.3




trillion per year in the U.S. and growing
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
A health care system that has been isolated for
people with mental health issues for far too long
CER: Moving from
Research to Practice
 AHRQ: New Resources,
Ongoing Priorities
 Comparative Effectiveness
and The American
Reinvestment and Recovery
Act of 2009
 Translating Science into
Real-World Applications
AHRQ’s Mission
Improve the quality, safety, efficiency and
effectiveness of health care for all Americans
AHRQ Priorities
Patient Safety
 Health IT
 Patient Safety
Ambulatory
Patient Safety
Organizations
 New Patient
 Safety & Quality Measures, Safety Grants
Drug Management and
Patient-Centered Care
 Patient Safety Improvement
Corps
Medical Expenditure
Panel Surveys
Effective Health
Care Program
 Comparative
Effectiveness Reviews
 Comparative Effectiveness
Research
 Clear Findings for
Multiple Audiences
Other Research &
Dissemination Activities
 Visit-Level Information on  Quality & Cost-Effectiveness, e.g.
Medical Expenditures
 Annual Quality &
Disparities Reports
Prevention and Pharmaceutical
Outcomes
 U.S. Preventive Services
Task Force
 MRSA/HAIs
New: Mental Health
Research Findings
 Compendium of recent
mental health research
projects funded by AHRQ
 Expanded funding for
improving mental health
care through health IT and
primary care delivery
 The Agency has also
developed a new focus on
the complex patient
http://www.ahrq.gov/research/mentalhth.pdf
Recent Legislation for
Parity in Mental Health
 The Paul Wellstone and Pete Domenici Mental Health
Parity and Addiction Equity Act of 2008
–
Effective January 1, 2010, designed to produce parity in
private employer-sponsored health plans for organizations
with more than 50 employees (passed as part of the
American Reinvestment and Recovery Act of 2009)
 The Medicare Improvements for Patients and
Providers Act of 2008
–
Mental health parity is gradually phased in between 2010
and 2014
 Children's Health Insurance Program Reauthorization
Act of 2009 (CHIPRA)
–
Requires mental health parity for states that offer mental
health or substance abuse services in CHIP plans
AHRQ 2009: New Resources,
Ongoing Priorities
 $372 million for AHRQ in FY ‘09 budget
– $37 million more than FY 2008
– $46 million more than Administration
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
AHRQ’s Role in
Comparative Effectiveness
Using Information to Drive Improvement:
Scientific Infrastructure to Support Reform
Lead federal funding
Aggregate best
evidence to inform
complex learning
and implementation
challenges
Engage private sector
21st Century
Health Care
Increase knowledge base
to spur high-value care
CER Outputs at AHRQ

Research reviews: Comprehensive
reports that draw on scientific studies
to make head-to-head comparisons
of treatments

Summary guides: Short, plainlanguage guides that summarize
research reviews and are tailored to
different audiences – clinicians,
consumers and policymakers

New research reports: Fastturnaround reports that draw on
health care databases, electronic
patient registries and other resources
to explore practical questions
http//:effectivehealthcare.ahrq.gov
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)
Federal Coordinating Council appointed to coordinate comparative
effectiveness research across the federal government
Definition: Federal
Coordinating Council
 CER is the conduct and synthesis of research
comparing the benefits and harms of various
interventions and strategies for preventing,
diagnosing, treating, and monitoring health
conditions in real-world settings. The purpose
of this research is to improve health outcomes
by developing and disseminating evidencebased information to patients, clinicians, and
other decision makers about which
interventions are most effective for which
patients under specific circumstances.
Definition: IOM
 Comparative effectiveness research (CER) is the
generation and synthesis of evidence that compares
the benefits and harms of alternative methods to
prevent, diagnose, treat and monitor a clinical
condition or to improve the delivery of care. The
purpose of CER is to assist consumers, clinicians,
purchasers and policy makers to make informed
decisions that will improve health care at both the
individual and population levels.
National Priorities for Comparative
Effectiveness Research
Institute of Medicine Report Brief
June 2009
Conceptual Framework
Stakeholder Input
& Involvement
Horizon
Scanning
Research Training
Evidence
Synthesis
Evidence Need
Identification
Evidence
Generation
Career Development
Dissemination
& Translation
AHRQ’s Priority Conditions for
the Effective Health Care Program
 Arthritis and non




traumatic joint disorders
Cancer
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
Obesity
Peptic ulcer disease
and dyspepsia
Pregnancy including
pre-term birth
Pulmonary
disease/Asthma
Substance abuse
IOM’s 100 Priority Topics
 Initial National Priorities for Comparative
Effectiveness Research (June 20, 2009)
 Topics in 4 quartiles; groups of 25.
 Includes several priorities for mental health,
including:
– Treatment approaches, such as integrating mental
health care and primary care
– Training of primary care physicians in primary care
mental health and co-location systems of primary care
and mental health care on outcomes including
depression, anxiety and cost
– Patient decision support tools on informing
diagnostic and treatment decisions, and including
patients with mental health problems
Report Brief Available At http://www.iom.edu
AHRQ Operating Plan for
Recovery Act’s CER Funding
 Stakeholder Input and Involvement:
To occur throughout the program
 Horizon Scanning: Identifying promising
interventions
 Evidence Synthesis: Review of current
research
 Evidence Generation: New research with a
focus on under-represented populations
 Research Training and Career
Development: Support for training, research
and careers
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)
Additional Proposed Investments
 Supporting AHRQ’s long-term commitment to
bridging the gap between research and practice:
– Dissemination and Translation
 Between 20 and 25 two-three-year grants ($29.5M)
 Eisenberg Center modifications (3 years, $5M)
– 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 ($10M)
Health IT and Comparative
Effectiveness Research
 As with comparative effectiveness
research, health IT is a useful tool in a
much larger toolkit
 AHRQ has invested more than $260
million in health IT contracts and
grants
 More then 150 communities,
hospitals, providers and
health care systems in 48
states
AHRQ Health IT Initiatives
 Examples, Ambulatory Safety and
Quality (ASQ) Program
– Pharmaceutical Safety Tracking: Children’s
Research Institute, Columbus, OH
 Monitoring medication adherence in an
urban mental health system serving a
primarily Medicaid population
– Improving Outcomes through Ambulatory
Care Coordination: Nebraska Behavioral
Health Information Network
 An HIE focused on coordination of care for
individuals with chronic mental illness
– A Personal Health Record (PHR) for Mental
Health Consumers: Emory University
 Adapts existing electronic PHR for needs of
people with a serious mental disorder and
one or more chronic conditions
CER and Innovation
 CER will enhance
the best and most
innovative strategies
 Can open up new
populations for
which something
can be useful in
 Can bring early
attention to potential
issues
Comparative Effectiveness
Challenges/Opportunities






Anticipating downstream effects of policy applications
Eliminating uncertainty about best practices involving
treatments and technologies
Making sure that comparative effectiveness is
"descriptive, not prescriptive”
Creating a level playing field among all stakeholders,
including patients and consumers
Adopting a more integrated approach to achieving
high quality health care
Using the same evidence-based information to make
different care decisions based on the characteristics,
needs, etc., of the individual
Where to From Here?
 Timing: Significant support for and interest
in comparative effectiveness research
 The mission: Address gaps in quality and
resolve conflicting or lack of evidence about
most effective treatment approaches
 Words of wisdom: “In theory, there is no
difference between theory and practice. In
practice, there is.” – Yogi Berra
Thank You
www.ahrq.gov
http//:effectivehealthcare.ahrq.gov
www.hhs.gov/recovery