Expanding the Capacity for Expanding the Capacity for Comparative Effectiveness ResearchComparative Effectiveness Research

Carolyn Clancy, MDCarolyn Clancy, MDDirectorDirector

U.S. Agency for Healthcare Research and QualityU.S. Agency for Healthcare Research and Quality

AcademyHealth Annual Research MeetingAcademyHealth Annual Research Meeting

Orlando – June 3, 2007Orlando – June 3, 2007

Research Needs Gaining Research Needs Gaining Increased AttentionIncreased Attention

Rationale for Rationale for Evidence-Based MedicineEvidence-Based Medicine

Maximize the likelihood Maximize the likelihood that beneficial treatments that beneficial treatments are used and that harmful are used and that harmful treatments are not used treatments are not used

Reduce costs and/or Reduce costs and/or improve cost effectivenessimprove cost effectiveness

Provide an explicit, fair Provide an explicit, fair and rational method of and rational method of resource allocationresource allocation

Why do we Need Why do we Need Effectiveness Research?Effectiveness Research?

Not all interventions that Not all interventions that sound “logical” are beneficial sound “logical” are beneficial when carefully studiedwhen carefully studied

Not all beneficial Not all beneficial interventions are equally interventions are equally beneficial, or equally safebeneficial, or equally safe

Budgets are limitedBudgets are limited Issues are complex and Issues are complex and

cannot be clarified without cannot be clarified without careful analysiscareful analysis

The Intersection of The Intersection of Effectiveness and SafetyEffectiveness and Safety

Effectiveness – Effectiveness – BenefitsBenefits

The Intersection of The Intersection of Effectiveness and SafetyEffectiveness and Safety

Safety – Safety – unintended unintended consequences, harmsconsequences, harms

The Intersection of The Intersection of Effectiveness and SafetyEffectiveness and Safety

Balance of Benefits and HarmsBalance of Benefits and Harms

Agency for Healthcare Agency for Healthcare Research and QualityResearch and Quality

Performance Performance Accountability,Accountability,

Resources & Technology Resources & Technology

CommunicationCommunication & &

Knowledge TransferKnowledge Transfer

Extramural Research,Extramural Research, Education & Education &

Priority PopulationsPriority Populations

Center for Center for Financing, AccessFinancing, Access

& Cost Trends& Cost Trends

AHRQAHRQCenter for PrimaryCenter for Primary Care, Prevention,Care, Prevention,

PartnershipsPartnerships

Center for DeliveryCenter for Delivery & Organization& Organization

& Markets& Markets

Center for QualityCenter for Quality ImprovementImprovement

& Patient Safety& Patient Safety

Center for Center for OutcomesOutcomes

& Evidence& Evidence

Effective Health CareEffective Health Care

Effective Health Care ProgramEffective Health Care Program

A.A. Evidence Synthesis (EPC program)Evidence Synthesis (EPC program)– Systematically reviewing, synthesizing, comparing existing

evidence on treatment effectiveness.– Identifying relevant knowledge gaps.

B.B. Evidence Generation (DEcIDE, CERTs)Evidence Generation (DEcIDE, CERTs)– Development of new scientific knowledge to address

knowledge gaps. – Accelerate practical studies.

C.C. Evidence Communication/Translation Evidence Communication/Translation (Eisenberg Center)(Eisenberg Center)– Translate evidence into improvements – Communication of scientific information in plain language to

policymakers, patients, and providers..

New Effective Health Care New Effective Health Care Web siteWeb site

http://effectivehealthcare.ahrq.gov/

AHRQ Comparative AHRQ Comparative Effectiveness Reviews (CERs)Effectiveness Reviews (CERs)

Comparative Effectiveness of Second-Generation Comparative Effectiveness of Second-Generation Antidepressants in the Pharmacologic Treatment of Adult Antidepressants in the Pharmacologic Treatment of Adult Depression - 1/24/2007Depression - 1/24/2007

Efficacy and Comparative Effectiveness of Off-Label Use of Efficacy and Comparative Effectiveness of Off-Label Use of Atypical Antipsychotics - 1/17/2007Atypical Antipsychotics - 1/17/2007

Comparative Effectiveness of Management Strategies for Comparative Effectiveness of Management Strategies for Renal Artery Stenosis - 10/24/2006 Renal Artery Stenosis - 10/24/2006

Comparative Effectiveness and Safety of Analgesics for Comparative Effectiveness and Safety of Analgesics for Osteoarthritis - 9/25/2006Osteoarthritis - 9/25/2006

Comparative Effectiveness of Epoetin and Darbepoetin for Comparative Effectiveness of Epoetin and Darbepoetin for Managing Anemia in Patients Undergoing Cancer Managing Anemia in Patients Undergoing Cancer Treatment - 5/23/2006 Treatment - 5/23/2006

Effectiveness of Noninvasive Diagnostic Tests for Breast Effectiveness of Noninvasive Diagnostic Tests for Breast Abnormalities - 2/9/2006 Abnormalities - 2/9/2006

Comparative Effectiveness of Management Strategies for Comparative Effectiveness of Management Strategies for Gastroesophageal Reflux Disease - 12/13/2005Gastroesophageal Reflux Disease - 12/13/2005

AHRQ Focuses on the AHRQ Focuses on the Health Care SystemHealth Care System

Assess the Assess the effectiveness, comparative effectiveness, comparative effectivenesseffectiveness and cost- effectiveness and cost- effectiveness of health of health care servicescare services

Identify ways to improve Identify ways to improve patient safetypatient safety and and qualityquality of health care systems of health care systems

Advance the appropriate use of Advance the appropriate use of health health information technologyinformation technology

Understand Understand system issuessystem issues: role of : role of organizational design, management, workflow, organizational design, management, workflow, management, and incentives on efficiency and management, and incentives on efficiency and effectivenesseffectiveness

Develop Develop datadata on the health care system for on the health care system for monitoring and decision-makingmonitoring and decision-making

Questions & Questions & Comments?Comments?