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CER and SAFTINetMarion R. Sills, MD, [email protected], SAFTINet CER Project
Overview of Comparative Effectiveness Research
(CER) Scalable Architecture for Federated
Therapeutic Inquiries Network (SAFTINet)
Overview of Comparative Effectiveness Research
(CER) Scalable Architecture for Federated
Therapeutic Inquiries Network (SAFTINet)
CER Overview: Definition 2009: The American Recovery and
Reinvestment Act allocated $1.1 billion for CER
CER Definition (Institute of Medicine, 2009)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.
CER Definition (Institute of Medicine, 2009)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.
http://www.iom.edu/Reports/2009/ComparativeEffectivenessResearchPriorities.aspx
CER Overview 2009: The American Recovery and
Reinvestment Act allocated $1.1 billion for CER
3 recipients of the funds: NIH, AHRQ 3 recipients issued requests for proposals
to develop CER infrastructure to conduct CER studies
mandated an Institute of Medicine (IOM) study to establish national priorities for CER
Overview of Comparative Effectiveness Research
(CER) Scalable Architecture for Federated
Therapeutic Inquiries Network (SAFTINet)
CER and SAFTINet 2009: The American Recovery and
Reinvestment Act allocated $1.1 billion for CER
3 recipients of the funds: NIH, AHRQ, OS-DHHS 3 recipients issued requests for proposals
to develop CER infrastructure to conduct CER studies
mandated an Institute of Medicine (IOM) study to establish national priorities for CER
SAFTINet research
infrastructure
SAFTINet research question
CER Study Question HEALTH CARE DELIVERY SYSTEM FACTORS, such as
the patient-centered medical home are important to the CONTROL of asthma (children, adults)high blood pressure hypercholesterolemia
PROCESSES OF CARE +
HEALTH CARE DELIVERY SYSTEM
FACTORS+ PATIENT FACTORS → CHRONIC DISEASE
CONTROL
CER Study QuestionHow did we get here?
PROCESSES OF CARE +
HEALTH CARE DELIVERY SYSTEM
FACTORS+ PATIENT FACTORS → CHRONIC DISEASE
CONTROL
CER Study QuestionHow did we get here?Why the SAFTINet population?Why these 4 cohorts?Why this research question?
CER Study QuestionHow did we get here?Why the SAFTINet population?Why these 4 cohorts?Why this research question?
CER Study Question
1. Low-income groups2. Minority groups3. Women4. Children5. The elderly6. Individuals with
special health-care needs (e.g., disabilities, need for chronic care or end-of-life care, or those who live in inner-city and rural areas)
1. Arthritis/joint disorders 2. Cancer 3. Cardiovascular disease4. Dementia, including Alzheimer's
Disease 5. Depression; other mental health
disorders 6. Developmental delays, ADHD and
autism 7. Diabetes Mellitus 8. Functional limitations and disability 9. Infectious diseases including HIV/AIDS 10. Obesity 11. Peptic ulcer disease and dyspepsia 12. Pregnancy including pre-term birth 13. Pulmonary disease/Asthma 14. Substance abuse
Priority Populations Priority Conditions
CER Study Question
1. Low-income groups2. Minority groups3. Women4. Children5. The elderly6. Individuals with
special health-care needs (e.g., disabilities, need for chronic care or end-of-life care, or those who live in inner-city and rural areas)
Priority Populations
Basis for defining our SAFTINet clinic population of federally qualified health centers
CER Study Question
1. Arthritis/joint disorders 2. Cancer 3. Cardiovascular disease4. Dementia, including Alzheimer's
Disease 5. Depression; other mental health
disorders 6. Developmental delays, ADHD and
autism 7. Diabetes Mellitus 8. Functional limitations and disability 9. Infectious diseases including HIV/AIDS 10. Obesity 11. Peptic ulcer disease and dyspepsia 12. Pregnancy including pre-term birth 13. Pulmonary disease/Asthma 14. Substance abuse
Priority Conditions
Basis for defining our 4 SAFTINet cohorts:
•asthma (children, adults)
•high blood pressure •hypercholesterolemia
CER Study QuestionHow did we get here?Why CER?Why the SAFTINet population?Why these 4 cohorts?Why this research question?
CER Study Question
HEALTH CARE DELIVERY SYSTEM
FACTORS→ CHRONIC DISEASE
CONTROL
First Quartile Priority:
“Compare the effectiveness of comprehensive care coordination programs, such as the medical home, and usual care in managing children and adults with severe chronic disease, especially in populations with known health disparities.”
CER Study Question
HEALTH CARE DELIVERY SYSTEM
FACTORS→ CHRONIC DISEASE
CONTROL
“Compare the effectiveness of comprehensive care coordination programs, such as the medical home, and usual care in managing children and adults with severe chronic disease.”
HEALTH CARE DELIVERY SYSTEM FACTORS, such as the patient-centered medical home are important to DISEASE CONTROL
CER Study Question HEALTH CARE DELIVERY SYSTEM FACTORS, such as
the patient-centered medical home are important to the CONTROL of asthma (children, adults)high blood pressure hypercholesterolemia
HEALTH CARE DELIVERY SYSTEM
FACTORS→ CHRONIC DISEASE
CONTROL
CER Study Question HEALTH CARE DELIVERY SYSTEM FACTORS, such as
the patient-centered medical home are important to the CONTROL of asthma (children, adults)high blood pressure hypercholesterolemia
HEALTH CARE DELIVERY SYSTEM
FACTORS→ CHRONIC DISEASE
CONTROL
Measures of Disease ControlHEALTH CARE
DELIVERY SYSTEM FACTORS
→ CHRONIC DISEASE CONTROL
Existing electronic health record data
Medicaid data, death files, etc.
Enhanced data: patient-reported outcomes (PRO)
RelevanceHEALTH CARE
DELIVERY SYSTEM FACTORS
→ CHRONIC DISEASE CONTROL
Measuring hospital utilization and cost as an outcome (includes ED): first large-scale linkage of EHR with claims data
CER methods expertise Experience with AHRQ Future directions
More pediatric cohorts Studies related to decreasing acute care
utilization, cost