AHRQ’s Role in Comparative AHRQ’s Role in Comparative EffectivenessEffectiveness

Carolyn M. Clancy, MDCarolyn M. Clancy, MD

DirectorDirector

Agency for Healthcare Research and QualityAgency for Healthcare Research and Quality

Alliance for Health Reform Briefing Alliance for Health Reform Briefing

April 4, 2008April 4, 2008

Comparative Effectiveness:Comparative Effectiveness:Effective Health Care ProgramEffective Health Care Program

To improve the quality, effectiveness, To improve the quality, effectiveness, and efficiency of health care and efficiency of health care delivered through Medicare, delivered through Medicare, Medicaid, and S-CHIP programs.Medicaid, and S-CHIP programs.– Focus is on what is known Focus is on what is known nownow: ensuring : ensuring

programs benefit from programs benefit from pastpast investments in investments in research and what research research and what research gapsgaps are are critical to fillcritical to fill

– Focus is on Focus is on clinical effectivenessclinical effectiveness

Key Program AttributesKey Program Attributes

InfrastructureInfrastructure– Connected to AHRQ Health IT investmentsConnected to AHRQ Health IT investments– Builds on AHRQ connections with providers Builds on AHRQ connections with providers

and consumers and consumers

UnbiasedUnbiased Responsive Responsive TrustedTrusted

TransparencyTransparency

Public CommentPublic Comment– Priority areasPriority areas

– Nomination of topics for researchNomination of topics for research

– Comment on draft research questionsComment on draft research questions

– Comment on draft reportsComment on draft reports

No “Black Box”No “Black Box”– Systematic Reviews include details on review methodology Systematic Reviews include details on review methodology

and topic considerations and topic considerations

AHRQ Center for AHRQ Center for Outcomes & EvidenceOutcomes & Evidence

GrantsGrantsContractsContractsIntramural ResearchIntramural Research

Program OutputsProgram Outputs

Research Research ReportsReports

Systematic Systematic ReviewsReviews

Consumer Consumer GuidesGuides

What Have We LearnedWhat Have We Learned

Often, there are no clear Often, there are no clear winners and loserswinners and losers

Need to think of questions Need to think of questions years in advance of years in advance of decision makers askingdecision makers asking

It is amazing what we don’t It is amazing what we don’t know about common and know about common and ubiquitous treatmentsubiquitous treatments

AHRQ Comparative AHRQ Comparative Effectiveness ResearchEffectiveness Research

The additional funding for comparative The additional funding for comparative effectiveness will help AHRQ generate effectiveness will help AHRQ generate a wealth of new products and tools:a wealth of new products and tools:– The number of comparative effectiveness The number of comparative effectiveness

reviews and technical briefs will doublereviews and technical briefs will double– New research initiated will include studies New research initiated will include studies

on surgery, prescription drugs, biologics on surgery, prescription drugs, biologics and vaccines for Medicare beneficiaries in and vaccines for Medicare beneficiaries in priority condition areaspriority condition areas

– A new series of technical reports will A new series of technical reports will establish a foundation for guiding the establish a foundation for guiding the evaluation of gene-based test performance evaluation of gene-based test performance

– The number of products designed to help The number of products designed to help patients and clinicians make informed patients and clinicians make informed decisions will increasedecisions will increase

Emerging Methods in Emerging Methods in Comparative Effectiveness & SafetyComparative Effectiveness & Safety

A series of 23 articles by AHRQ A series of 23 articles by AHRQ researchers on new approaches researchers on new approaches in comparative effectiveness in comparative effectiveness methods are compiled in a special methods are compiled in a special October edition of October edition of Medical CareMedical Care

A valuable new resource for A valuable new resource for scientists committed to advancing scientists committed to advancing the comparative effectiveness and the comparative effectiveness and safety researchsafety research

All articles available for free All articles available for free download on AHRQ’s website or download on AHRQ’s website or from AHRQ’s Clearinghouse from AHRQ’s Clearinghouse (Pub. No. OM07-0085)(Pub. No. OM07-0085)

http://effectivehealthcare.ahrq.gov/reports/med-care-report.cfm

From Research to High-Value From Research to High-Value Health CareHealth Care

Increased overlap between researchers / Increased overlap between researchers / product developers and health care leaders product developers and health care leaders ‘embed’ findings in clinical strategies, electronic ‘embed’ findings in clinical strategies, electronic and personal health recordsand personal health records

Distributed leadershipDistributed leadership Clear path for feedback from care delivery to Clear path for feedback from care delivery to

research enterprise at multiple pointsresearch enterprise at multiple points From ‘stand-alone’ registries to those that are From ‘stand-alone’ registries to those that are

are used both locally and regionally / nationallyare used both locally and regionally / nationally Transparency in production and Transparency in production and useuse of CE of CE

informationinformation

““Comparative Effectiveness Research typically will focus Comparative Effectiveness Research typically will focus on realistic decisions confronting patients and their on realistic decisions confronting patients and their clinicians in actual practice…. Because of this focus on clinicians in actual practice…. Because of this focus on effectiveness as opposed to efficacy, these investigations effectiveness as opposed to efficacy, these investigations will likely rely on both prospective trials and observational will likely rely on both prospective trials and observational data to determine relative value in real-world settings.data to determine relative value in real-world settings.” ” IOM Roundtable on Evidence-Based IOM Roundtable on Evidence-Based

MedicineMedicine