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