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Meaningful engagement of decision makers in priority-setting Meaningful engagement of decision makers in priority-setting Presentation Transcript

  • Engaging Decision Makers in Comparative Effectiveness Research Sean Tunis MD, MSc July 11, 2008
  • Calls for a National Institute of Comparative Effectiveness Research (NICER)
    • MMA Section 1013 (2003)
    • Gail Wilenksy, Health Affairs (11/06)
    • Health Industry Forum (11/06)
    • AHIP, BCBSA proposals (early 2007)
    • MedPAC report, CBO testimony (6/07)
    • Obama, Clinton, Edwards reform plans (mid 2007)
    • CBO final report (12/07)
    • Commonwealth ‘Bending the Curve’ report (12/07)
    • House and Senate legislative proposals
  • Medicare Spending per Capita in the United States, 2003 Source: Dartmouth Atlas of Health Care. $7,000 to 11,352 (63) 6,500 to < 7,000 (53) 6,000 to < 6,500 (56) 5,500 to < 6,000 (64) 4,272 to < 5,500 (70) Not Populated Source: www.dartmouthatlas.org.
  • CER Definition
    • “Research evaluating and comparing the implications and outcomes of 2 or more health care strategies to address a particular medical condition”
    • Primary focus on drugs, devices, procedures, diagnostics
  • Methods
    • Systematic reviews / HTA
    • Retrospective studies
      • with claims and/or EMR data
    • Modeling (+/- cost data)
    • Prospective observational or experimental studies
  • How is CER Different
    • More political insulation
    • Oversight by multi-stakeholder board
    • Increased transparency
    • Improved observational methods
    • Adoption of electronic health records
    • Much more money
    • Greater determination (and panic)
  • Built By and For Decision Makers
    • Evidence enterprise designed around the needs and use of decision makers
      • Patients, clinicians, payers, policymakers
    • They must be meaningfully engaged in all aspects (priority setting, study design, etc)
    • Limited success with meaningfully engaging decision makers
      • some notable exceptions: CUE, NBCC, JDRF
      • limited effort to broadly, systematically improve
  • Center for Medical Technology Policy
    • Structure : private, non-profit
      • First 2 years: foundations, government
      • 2008+: diverse membership
    • Primary Mission : to support collaborative efforts that will improve the quality and efficiency of prospective studies of new and existing medical technologies
    • Focus: Evidence development guided by decision makers (DBEM)
      • Patients, clinicians, payers, policy makers
  • CMTP Project Categories Applied POLICY and METHODS Projects PRIORITIES for Evidence Development Trial DESIGN and IMPLEMENTATION Effectiveness GUIDANCE Documents I MPROVE THE Q UALITY AND E FFICIENCY OF R ESEARCH FOR D ECISION M AKING
  • Coronary CTA Protocol Development Workgroup Members and Observers
    • Aetna
    • Kaiser Permanente
    • UnitedHealth
    • MN Medicaid
    • BCBSA
    • GE Healthcare
    • Siemens Medical
    • Philips Medical
    • Toshiba
    • AHA
    • Patient reps
    • ACC, ACRIN
    • FDA,
    • CMS
    • AHRQ
    • Clinical researchers
    • Health economist
  • Coverage for Evidence Development Workgroup Members
    • General Electric
    • Blue Shield of California
    • Wellpoint/Anthem
    • Aircraft Gear
    • Fidelity
    • Kaiser Permanente
    • Washington State Office of TA
    • SEIU
    • University of Michigan
    • MD Anderson
    • Oklahoma Medical Authority
    • PacFed Benefits Administrators
    • Patient Advocates in Research
    • Center for Medical Consumers
    • Harvard University
    • Aetna
    • United Healthcare
    • California Association of Physician Groups
    • National Business Group on Health
    • California Pacific Medical Ctr
  • Engaging Patients - 1
    • There is a natural patient advocacy group for every topic. (Tele-ICU workgroup)
    • If there is group, members have to care about research.
      • For some patient groups, it’s all about access, all the time.
    • Technical nature of work requires belief that the results will matter
  • Engaging Patients - 2
    • Need subject-specific patient advocates as well as more general advocates – each brings a different perspective to the table
    • One of the most important characteristics of an effective and engaged advocate is “strong intellectual curiosity”
    • Smart people get energized by other smart people – bringing a variety of perspectives to the table makes the “stew” a lot spicier
  • Clinician Advisors Meeting
    • Multi-stakeholder clinician group convened to discuss how to engage clinicians in CER
    • practicing MDs (community and academic), medical group medical directors, nurses, hospital system CMO
    • Broad agreement on willingness to help
    • Time pressure, money, and unfamiliarity with research were key constraints
  • Key Take Home Messages
    • Decision makers will engage in evidence review and development if
      • they believe their perspective is valued
      • they believe that the activity will have some impact
      • Carefully selected for being smart, energetic
    • We (academics, researchers, etc) need to be more systematic learning to do this well
    • If we don’t meaningfully engage the decision makers, the enterprise will always struggle
  • Contact Info
    • [email_address]
    • www.cmptnet.org
    • 410-963-8876