AHRQ Effective Healthcare Program

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AHRQ Effective Healthcare Program

• Karen Lohmann Siegel, PT, MA
• Health Scientist Administrator, AHRQ
• CAPT, Chief Therapist Officer, USPHS
• Institute of Federal Health Care
• March 27, 2009

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AHRQ Mission

• Improve the safety, quality, effectiveness and
  efficiency of health care for all Americans
• Better evidence for better decisions
• by providers, patients/consumers, and
  policymakers
• Narrowing the gap between what we know and what
  we do

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Translation

• It takes more than a dozen years for most
  health-related research to be translated from the
  bench to the bedside to routine clinical practice
• AHRQ Effective Health Care Program promotes
  translation of evidence into practice

Hierarchy of Research Impact
Improves Access, Outcomes,
Efficiency
Improves Delivery and Practice
Improves Processes and Policies
Improves Other Research
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Effective Healthcare Program

• Generation and translation of evidence
• EHC Core Business Areas

http//effectivehealthcare.ahrq.gov/
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Generation DEcIDE Network

• DEcIDE (Developing Evidence to Inform Decisions
  about Effectiveness) Network
• conducts accelerated practical studies of health
  care interventions for which randomized
  controlled trials would not be feasible
• projects may focus on electronic registries,
  methods for analyzing health databases, and
  prospective observational or interventional
  studies
• topic nominators include public and federal
  partners

http//effectivehealthcare.ahrq.gov/aboutUs.cfm?ab
outtypedecidecertDecide
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Generation CERTs

• Centers for Education Research on Therapeutics
  (CERTs)
• mission is to conduct research to
• increase awareness of both the uses and risks of
  therapeutics (new drugs and drug combinations,
  biological products, and devices)
• provide clinical information to stakeholders
• improve quality while reducing cost of care by
  increasing the appropriate use of therapeutics
• each research center in the network focuses on a
  broad therapeutic theme including mental health,
  HIT, adherence, musculoskeletal disorders,
  medical devices, and more

http//certs.hhs.gov/about/certsovr.htm
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Evidence Generation

• Evidence Generation examples
• Evaluate patient and prescriber decision-making
  tools
• Develop algorithms to identify inappropriate drug
  prescribing patterns
• Methods work on observational study design,
  heterogeneity, harm identification
• Handbook for establishing, maintaining and
  evaluating registries

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Effective Healthcare Program

• Generation and translation of evidence

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Evidence-based Practice Centers (EPC) Program

• Synthesize evidence on treatment effectiveness
  and comparative effectiveness
• Provide the evidence base for research agendas,
  guideline development, quality measures, and
  coverage decisions
• Identify and detail research gaps
• Advance methodology for systematic reviews

http//www.ahrq.gov/clinic/epcix.htm
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Topic Selection

• Factors considered in the selection of topics for
  AHRQ evidence reports include
• Prevalence and burden of a condition
• Controversy or uncertainty about the topic
• Availability of scientific data to support the
  systematic review
• Potential impact to reduce variation in care and
  improve outcomes
• Relevance to the needs of the Medicare, Medicaid
  and other Federal healthcare programs
• Nominating organization's plan to incorporate the
  report into its decision making

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Report Topics

• prognosis, prevention, diagnosis and/or treatment
  of particular clinical and behavioral conditions
• appropriate use of commonly provided services,
  procedures, or technologies including alternative
  or complementary therapies
• clinical and comparative effectiveness of one or
  more treatments or treatment approaches for a
  given condition
• measurement or evaluation of provider integration
  of new scientific findings regarding health care
  and delivery innovations
• no mandate to perform cost-effectiveness studies
• no mandate to recommend national standards of
  clinical practice or quality health care standards

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Evidence Synthesis

• Evidence Synthesis examples
• Comparative effectiveness reviews of surgical vs
  medical therapies
• Clinical effectiveness review of latest
  literature for professional society wanting to
  develop clinical practice guideline
• Technology assessment of an emerging technology
  to inform CMS coverage decision

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Effective Healthcare Program

• Generation and translation of evidence

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Eisenberg Clinical Decisions and Communication
Science Center
Policy Maker Guide

• From reviews, develop guides to facilitate
  informed transparent health care decisions by
• Policy makers
• Clinicians
• Consumers
• In consumer guide, key findings summarized in
  plain language. Info on risks, side effects, and
  costs are provided.

Consumer Guide
Clinician Guide
Original Report
http//effectivehealthcare.ahrq.gov/aboutUs.cfm?ab
outtypeeisenberg
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Effective Healthcare Program

• Generation and translation of evidence

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Implementation and Use

• Implementation and Use
• Partner with stakeholders to implement
  evidence-based information about treatments,
  medications, and technologies
• Electronic tools and strategies for improving
  patient participation in decision-making about
  their health care
• Examples
• Integration of comparative effectiveness review
  results into value based purchasing and benefit
  design
• Creation of continuing education units based on
  review findings
• Integration of review findings into coverage
  policies or clinical practice guidelines

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National Guideline Clearinghouse

• a public resource for evidence-based clinical
  practice guidelines
• Clinical practice guidelines are
• systematically developed statements
• to assist practitioner and patient decisions
• about appropriate health care
• for specific clinical circumstances
• Web site http//www.guideline.gov/

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Research Translation

• AHRQ EHC supports research translation
  activities
• Works with stakeholders to identify areas where
  new knowledge will enhance decision-making (topic
  nomination)
• Develops and applies sound methodology to supply
  that knowledge through generation (DEcIDE Network
  or CERTs) or synthesis (EPC Program) activities
• Generates comprehensive (EPC Program) and
  targeted reports (Eisenberg Center) so
  clinicians, consumers, and policy makers can use
  that knowledge to make informed decisions
• Serves as a repository for those decisions
  (National Guidelines Clearinghouse)
• Simultaneously builds system capacity by
  advancing methods and supporting training

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Questions?