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Evolution of and Trends in Health Care - Lecture C
- 1. Introduction to Health Care and Public Health in the U.S. Evolution of and Trends in Health Care in the U.S. Lecture c This material (Comp 1 Unit 9) was developed by Oregon Health & Science University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number 90WT0001. This work is licensed under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-sa/4.0/.
- 2. Evolution of and Trends in Health Care in the U.S. Learning Objectives • Describe the application of evidence- based medicine and clinical practice guidelines (Lecture a, b) • Discuss quality indicators in medicine (Lecture c) • Describe the patient-centered medical home and other models of care coordination (Lecture d) 2
- 3. Quality Indicators In Medicine • Better patient outcomes (patient health) • Better system performance (patient care) • Better professional development (clinician learning) 3
- 4. What Does Quality Mean - 1 • “The degree to which health services for individuals and populations increase the likelihood of desired health outcomes, in a manner that is consistent with current professional knowledge.” – (Institute of Medicine, 2001) 4
- 5. What Does Quality Mean - 2 • Populations want excellent health outcomes • Health outcomes need to be improved to the point of excellence • Improvement in health outcomes needs to be consistent with medical knowledge, scientific, and rational 5
- 6. Achieving Excellence Scientific Evidence + Rigorous Methodology = Conclusions applicable to health care + Measured performance improvement 6
- 7. Agency for Healthcare Research and Quality (AHRQ) • Part of Department of Health and Human Services • Mission: “To improve quality, safety, efficiency, and effectiveness of health care for all Americans” – Safety and quality: Reduce risk of harm – Effectiveness: Improve health care outcomes – Efficiency: Transform research into practice 7
- 8. Methods To Promote Quality • Quality Indicators – Process measures – Outcome measures • Role of electronic health record in improving quality – Data collection – Data analysis • Plan-Do-Study-Act (PDSA) cycle • Organizational standards 8
- 9. Comparative Effectiveness Research (CER) • 2008: Institute of Medicine noted that patient care “should be based on the conscientious, explicit, and judicious use of current best evidence” • 2009: IOM defined CER as “…evidence that compares the benefits and harms of alternative methods…” 9
- 10. Comparative Effectiveness • Generate evidence from research studies • Compare drugs, tests, health care delivery methods, etc. • Researchers may look at existing studies, or devise new studies • They may develop or use different methods and sources of data 10
- 11. Steps in Comparative Effectiveness Research (CER) • Review and synthesize current medical research • Promote and generate new evidence and analytic tools • Translate and disseminate research findings to diverse stakeholders 11
- 12. Benefits of CER • Stakeholders: Spectrum of individuals who make informed decisions that will improve health care • May provide information about benefits and harms • Can compare costs of different treatments based on outcomes • Helps patients and physicians to choose between treatments 12
- 13. Emphasis on CER is a part of Health Care Reform • The American Recovery and Reinvestment Act of 2009 created the Federal Coordinating Council for Comparative Effectiveness Research • Made recommendations on how earmarked funds were spent on CER 13
- 14. Evolution of and Trends in Health Care in the U.S. Summary – Lecture c • Defined healthcare quality and gave examples of quality indicators • Approaches to quality improvement, e.g., “Plan, Do, Study, Act” • Described Comparative Effectiveness Research (CER) 14
- 15. Evolution of and Trends in Health Care in the U.S. References – Lecture c References Committee on Quality Healthcare in America, Institute of Medicine, . (2001). Crossing the Quality Chasm: A New Health System for the 21st Century. Washington,, DC: National Academy Press. Initial National Priorities for Comparative Effectiveness Research. (2009). Retrieved from National Academies Press, Washington DC website February 1, 2017: http://www.nap.edu/catalog/12648/initial-national-priorities-for-comparative- effectiveness-research Sox, H. C., Helfand, M., Grimshaw, J., Dickersin, K., & the PLoS Medicine Editors, et.al. (2010, April 29). Comparative effectiveness research: Challenges for medical journals [editorial]. The Cochrane Library, Retrieved February 1, 2017 from http://www.cochranelibrary.com/editorial/10.1002/14651858.ED000003 15
- 16. Introduction to Health Care and Public Health in the U.S. The Evolution of and Trends in Health Care in the U.S. Lecture c This material was developed by Oregon Health & Science University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number 90WT0001. 16
Editor's Notes
- Welcome to Introduction to Health Care and Public Health in the U.S.: Evolution of and Trends in Health Care in the U.S. This is lecture c. The component, Introduction to Health Care and Public Health in the U.S., is a survey of how health care and public health are organized and how services are delivered in the U.S. It covers public policy, relevant organizations and their interrelationships, professional roles, legal and regulatory issues, and payment systems. It also addresses health reform initiatives in the U.S.
- The learning objectives for this unit, Evolution of and Trends in Health Care in the U.S., are to: Describe the application of evidence-based medicine and clinical practice guidelines; Discuss quality indicators in medicine; Describe the patient-centered medical home and other models of care coordination.
- This lecture will discuss quality indicators and comparative effectiveness research. We will begin with the definition of “quality.” When we speak of “quality” in health care, we speak of better patient outcomes or improvements in patient health. We speak of better system performance or improvements in patient care. We also think of better professional development or improvements in the way that clinicians learn and improve their knowledge.
- In 2001, the Institute of Medicine published a report called, “Crossing the Quality Chasm: A New Health System for the 21st Century” in which they defined health care quality as “The degree to which health services for individuals and populations increase the likelihood of desired health outcomes, in a manner that is consistent with current professional knowledge.”
- We know that populations and the individuals that make up these populations want excellent health outcomes. We also know that health outcomes need to be improved by health care services until the outcomes reach the point of excellence. This improvement in health outcomes needs to be consistent with the professional knowledge of medicine and practices, in a scientific and rational fashion.
- In order to achieve excellence in health care, we need a body of scientific evidence. We need a methodology that is rigorous, scientific, and able to produce conclusions which we can then distill in particular contexts. We need to be able to take these conclusions and apply them to the practice of health care. And not only just apply them, in terms of improving patient health, but also try to measure an improvement in performance of the system itself. We can also measure if the professional development by clinicians has improved and we can use the data that has been collected on patient outcomes to bolster and improve the scientific literature - to indeed, demonstrate if quality of care has been improved.
- An important organization that is improving the quality of health care in the United States is the Agency for Healthcare Research and Quality, also known as "arc". AHRQ is a part of the Department of Health and Human Services. Its mission is to improve quality, safety, efficiency, and effectiveness of health care for all Americans. It attempts to improve health care outcomes by emphasizing the use of evidence to reduce risk of harm and to improve health care outcomes. AHRQ attempts to transform health research into practice in order to facilitate wider access to effective health care services; there is also a mission to reduce unnecessary costs
- In order to demonstrate that quality has improved, we need to define a set of measurements, or quality indicators, that quantify results. Quality indicators may describe processes– for example, percent of patients prescribed aspirin at hospital discharge after myocardial infarction--or outcomes, for example, in-hospital mortality rate for patients admitted for myocardial infarction. The electronic health record is important in improving quality, not just acting as a vehicle for data collection, but also providing the data required for analysis in a sophisticated fashion. Quality analysis is often conducted as a single or series of PDSA cycles. The “PDSA” stands for “Plan,” “Do,” “Study,” and “Act”, which are the elements of the quality improvement process. Many organizations also specify standards, for example, an absolute reduction in the number of hospital acquired infections.
- Let us now turn our attention to Comparative Effectiveness Research, or “CER.” In 2008, the Institute of Medicine noted that patient care should be based on the conscientious, explicit, and judicious use of current best evidence. A year later, the Institute of Medicine defined “Comparative Effectiveness Research” as “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.”
- In order to study comparative effectiveness, researchers may gather evidence that is generated from research studies and compare drugs, tests, health care delivery methods, or other factors. Researchers may look at existing studies or devise and conduct new studies and may use or develop different methods and sources of data in order to compare the elements under testing.
- Comparative Effectiveness Research is particularly useful when new and emerging clinical interventions are identified. Researchers can review the current medical research and synthesize information that helps to identify gaps that exist between medical research, as it exists, and the needs of clinical medicine. Comparative Effectiveness Research can help to promote and generate new scientific evidence and analytic tools. It can also help to translate and disseminate research findings to multiple stakeholders both in the research and in the clinical patient care spectrum of health care.
- Who are the stakeholders that benefit from Comparative Effectiveness Research? They may be patient-consumers, clinicians, policymakers, or purchasers. All of these groups can use CER to make informed decisions that will improve health care and quality based on reliable science. Comparative Effectiveness Research also provides information about benefits and harms and can also compare costs of treatments based on outcomes. CER also helps patients and physicians to choose between treatments, especially when more than one treatment option is available to the patient. It is a partnership tool that physicians can use to help their patients choose the best options.
- Comparative Effectiveness Research is an essential part of the health care reform plan. The American Recovery and Reinvestment Act of 2009, or ARRA, created the Federal Coordinating Council for Comparative Effectiveness Research that coordinated CER across the federal government and was responsible for making recommendations on how earmarked funds were spent.
- This concludes lecture c of Evolution of and Trends in Health Care in the U.S. In summary, this lecture defined health care quality and discussed the use of quality indicators and quality improvement methodologies in improving health care quality. It also introduced Comparative Effectiveness Research.
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