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Patient-centered research at Mayo Clinic
 

Patient-centered research at Mayo Clinic

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What is patient-centered research, how it can support patient-centered care, and how it can be used to fight corruption in healthcare.

What is patient-centered research, how it can support patient-centered care, and how it can be used to fight corruption in healthcare.

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Patient-centered research at Mayo Clinic Patient-centered research at Mayo Clinic Presentation Transcript

  • Research forpatient-centered care Victor M. Montori, MD, MSc Professor of MedicineDirector, Healthcare Delivery Research HEDER Program Mayo Clinic
  • Disclosures No financial conflictsNo off-label use mentions
  • The needs of the patient come first Healthcare professionals defined what patientsneeded, how to meet those needs, and if and when needs were met.
  • Changes
  • ChangesTechnology
  • ChangesTechnologyInformation
  • ChangesTechnologyInformation Disease
  • ChangesTechnologyInformation Disease Health
  • ChangesTechnologyInformation Disease HealthEconomics
  • ChangesTechnologyInformation Disease HealthEconomics
  • ChangesTechnologyInformation Disease HealthEconomics
  • ChangesTechnology arms raceInformation Disease HealthEconomics
  • ChangesTechnology arms raceInformation Disease HealthEconomics
  • ChangesTechnology arms raceInformation without value Disease HealthEconomics
  • ChangesTechnology arms raceInformation without value Disease HealthEconomics
  • ChangesTechnology arms raceInformation without value Disease mongering HealthEconomics
  • ChangesTechnology arms raceInformation without value Disease mongering HealthEconomics
  • ChangesTechnology arms raceInformation without value Disease mongering HealthEconomics
  • ChangesTechnology arms raceInformation without value Disease mongering Health as moralityEconomics
  • Increase Patient Volume by Focusing on Prevention, Early Detection, and Wellness Increasing amount of dollars, especially super-Changes profitable self-pay dollars, are being spent on Prevention, Early Detection, and Wellness. This is profitable business immediately and very profitable downstream when risks are detected. If you market toTechnology arms race Early Detection, Prevention and Wellness you make lots of money today – while actually helping people.Information without value You make even more money downstream from the risks you detect. It is a Win – Win – Win. Disease mongering Health as moralityEconomics
  • Increase Patient Volume by Focusing on Prevention, Early Detection, and Wellness Increasing amount of dollars, especially super-Changes profitable self-pay dollars, are being spent on Prevention, Early Detection, and Wellness. This is profitable business immediately and very profitable downstream when risks are detected. If you market toTechnology arms race Early Detection, Prevention and Wellness you make lots of money today – while actually helping people.Information without value You make even more money downstream from the risks you detect. It is a Win – Win – Win. Disease mongering Health as moralityEconomics of profit
  • What are this patient’s needs?
  • What are this How would this patient’s patient want those needs? needs met?
  • The needs and wants of the informedpatient come firstWhat are this How would this patient’s patient want those needs? needs met?
  • The needs and wants of the informedpatient come firstWhat are this How would this patient’s patient want those needs? needs met?
  • Healthcare delivery research must assesshow well we meet patient needs and wants
  • Healthcare delivery research must assesshow well we meet patient needs and wants Delivered timely equitable effective efficient safe
  • Healthcare delivery research must assesshow well we meet patient needs and wants Delivered Experienced timely transparent equitable individualized effective respectful efficient dignity safe choice
  • Encounter Research
  • Evidence requirementsAddresses patient needs in useful way: Minimal error Directly Interventions promote patient goalsOutcomes reflect patient perspective
  • Answer questions with minimal error Bias Reporting bias Spin Publication bias Fraud
  • Comparative effectiveness? Karanikolas P et al. J Clin Epidemiol 2009; 62: 479-84
  • Outcomes reflect patient perspective Text 20%diabetes trials in 2003 measured patient important outcomes Montori et al. Diabetes Care 2006
  • 18% diabetes trials in future will measurepatient important outcomes as primary endpoints 8% measured QoL, pain, functional capacity Gandhi et al. JAMA 2008
  • HbA1c
  • Quality of careHbA1c
  • Quality of careClinicalinertia HbA1c
  • Quality of careClinicalinertia HbA1c Report card
  • Quality of careClinical Technicalinertia HbA1c decisions Report card
  • Live longer Feel betterLive unhindered by complications
  • Healthcare delivery research must assesshow well we meet patient needs and wants Delivered Experienced timely transparent equitable individualized effective respectful efficient dignity safe choice
  • Hess E et al. In preparation
  • 205 patients58 vs. 77% admitted for urgent stress testing 74 vs. 90% fewer stress tests 61 vs. 40% increase satisfaction with DM Hess E et al. In preparation
  • !The research we do today will determine the type of medical and surgical practice we carry on at the clinic tomorrow." - William J. Mayo, MD © 2007 Mayo Foundation for Medical Education and Research. All rights reserved.
  • Patient-centered healthcare delivery researchmust assess how well we meet patient needs and wants
  • Patient-centered healthcare delivery researchmust assess how well we meet patient needs and wants Delivered timely equitable effective efficient safe
  • Patient-centered healthcare delivery researchmust assess how well we meet patient needs and wants Delivered Experienced timely transparent equitable individualized effective respectful efficient dignity safe choice
  • Patient-centered healthcare delivery research must assess how well we meet patient needs and wants Delivered Experienced timely transparent equitable individualized effective respectful efficient dignity safe choice Practical studies with minimal bias and error, directly addressing the relative impact on patient-importantoutcomes of interventions that seek to meet the needs and wants of the informed patient.
  • Can the conduct of patient-centered research help us stop the corruption of healthcare?
  • Can the conduct of patient-centered research help us stop the corruption of healthcare?
  • montori.victor@mayo.eduhttp://kerunit.e-bm.orghttp://kercards.e-bm.infohttp://shareddecisions.mayoclinic.org@vmontorihttp://minimallydisruptivemedicine.org