Working together or working apart: Cross group cooperation in priority setting Jean Slutsky Director, Center for Outcomes ...
Underlying construct of a collaborative/cooperative relationship Clear understanding of organizational goals and the needs...
Miles’ Law and Setting Priorities <ul><li>Where you stand depends on where you sit </li></ul><ul><ul><ul><ul><li>Rufus E. ...
2003 Legislative Mandate for Comparative Effectiveness <ul><li>Process.--In carrying out subparagraph (A), the Secretary– ...
2003 Legislative Mandate for Comparative Effectiveness <ul><li>3) Evaluation and synthesis of scientific evidence.–  </li>...
Main criteria for establishing priorities <ul><li>Prevalence of a condition  </li></ul><ul><li>Burden of a condition  </li...
Transparency <ul><li>Legislation mandates a transparent and participatory process </li></ul><ul><ul><li>Getting input from...
Current Priority List <ul><li>Arthritis and non-traumatic joint disorders </li></ul><ul><li>Cancer </li></ul><ul><li>Cardi...
AHRQ and Systematic Review <ul><li>AHRQ rarely (really rarely!) commissions a systematic review without a request from a “...
AHRQ and Systematic Review <ul><li>Long-term funding support for the Rocky Mountain Evidence-Based Health Care Workshop </...
Intersections and opportunities for collaboration <ul><li>Establish common priorities </li></ul><ul><li>Perform joint meth...
Intersections and opportunities for collaboration <ul><li>Training/career awards </li></ul><ul><li>Identify research gaps ...
Things to keep in mind <ul><li>The Cochrane Collaboration is an international treasure </li></ul><ul><li>Different countri...
Questions/Discussion <ul><li>[email_address] </li></ul><ul><li>www.effectivehealthcare.ahrq.gov </li></ul><ul><li>Home of ...
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Open Discussion: Working together or working apart: Cross-group cooperation in priority setting

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Open Discussion: Working together or working apart: Cross-group cooperation in priority setting

  1. 1. Working together or working apart: Cross group cooperation in priority setting Jean Slutsky Director, Center for Outcomes and Evidence Baltimore 11 July 2008
  2. 2. Underlying construct of a collaborative/cooperative relationship Clear understanding of organizational goals and the needs of stakeholders More collaboration for Priority setting Transparency Transfer Trust Trust between organizations and their members Sharing information, methods and work
  3. 3. Miles’ Law and Setting Priorities <ul><li>Where you stand depends on where you sit </li></ul><ul><ul><ul><ul><li>Rufus E. Miles, Jr. (1910-1996) </li></ul></ul></ul></ul>
  4. 4. 2003 Legislative Mandate for Comparative Effectiveness <ul><li>Process.--In carrying out subparagraph (A), the Secretary– </li></ul><ul><ul><li>(i) shall ensure that there is broad and ongoing consultation with relevant stakeholders in identifying the highest priorities for research, demonstrations, and evaluations to support and improve the programs established under titles XVIII, XIX, and XXI of the Social Security Act; </li></ul></ul><ul><ul><li>iii) shall ensure that the research and activities undertaken pursuant to this section are responsive to the specified priorities and are conducted in a timely manner. </li></ul></ul>
  5. 5. 2003 Legislative Mandate for Comparative Effectiveness <ul><li>3) Evaluation and synthesis of scientific evidence.– </li></ul><ul><li>(A) In general.--The Secretary shall– </li></ul><ul><ul><li>(i) evaluate and synthesize available scientific evidence related to health care items and services (including prescription drugs) identified as priorities in accordance with paragraph (2) with respect to the comparative clinical effectiveness, outcomes, appropriateness, and provision of such items and services (including prescription drugs); </li></ul></ul>
  6. 6. Main criteria for establishing priorities <ul><li>Prevalence of a condition </li></ul><ul><li>Burden of a condition </li></ul><ul><li>Cost of care of a condition </li></ul><ul><li>Disproportionate representation of the condition in the Medicare, Medicaid, S-CHIP spopulation </li></ul><ul><li>Potential for impact </li></ul><ul><li>Note : First four criteria used specifically for identifying priority conditions. Since potential for improvement is heavily dependent on the specific clinical strategy, this is used to consider the clinical intervention strategies for a particular condition. </li></ul>
  7. 7. Transparency <ul><li>Legislation mandates a transparent and participatory process </li></ul><ul><ul><li>Getting input from and meeting the needs of consumer and other stakeholders including CMS, other payers, and providers </li></ul></ul><ul><ul><li>Public comment and meetings on priorities, research questions, and draft reports </li></ul></ul><ul><ul><li>Updating </li></ul></ul><ul><ul><li>Translation of findings for different audiences </li></ul></ul>
  8. 8. Current Priority List <ul><li>Arthritis and non-traumatic joint disorders </li></ul><ul><li>Cancer </li></ul><ul><li>Cardiovascular disease, including stroke and hypertension </li></ul><ul><li>Dementia, including Alzheimer Disease </li></ul><ul><li>Depression and other mental health disorders </li></ul><ul><li>Developmental delays, attention-deficit hyperactivity disorder and autism </li></ul><ul><li>Diabetes Mellitus </li></ul><ul><li>Functional limitations and disability </li></ul><ul><li>Infectious diseases including HIV/AIDS </li></ul><ul><li>Obesity </li></ul><ul><li>Peptic ulcer disease and dyspepsia </li></ul><ul><li>Pregnancy including pre-term birth </li></ul><ul><li>Pulmonary disease/Asthma </li></ul><ul><li>Substance abuse </li></ul>
  9. 9. AHRQ and Systematic Review <ul><li>AHRQ rarely (really rarely!) commissions a systematic review without a request from a “user” </li></ul><ul><ul><li>Guarantees a receptor site </li></ul></ul><ul><ul><li>Keeps the work relevant to those in the trenches </li></ul></ul><ul><li>Does occasionally fund investigator initiated reviews but not unless a stakeholder or user is identified </li></ul><ul><li>Funds the U.S. Cochrane Center directly for training and dissemination </li></ul>
  10. 10. AHRQ and Systematic Review <ul><li>Long-term funding support for the Rocky Mountain Evidence-Based Health Care Workshop </li></ul><ul><li>Open competition funding cycles for organizations to perform systematic reviews under the Evidence-based Practice Center Program </li></ul><ul><li>Funding for methods research in systematic review </li></ul><ul><li>Training grants (currently mid-career and dissertation) </li></ul><ul><ul><li>Includes comparative effectiveness </li></ul></ul>
  11. 11. Intersections and opportunities for collaboration <ul><li>Establish common priorities </li></ul><ul><li>Perform joint methods research </li></ul><ul><li>Collaboration on commissioned reviews </li></ul><ul><li>Compete for dedicated funding </li></ul><ul><li>Interpretation and translation of reviews </li></ul>
  12. 12. Intersections and opportunities for collaboration <ul><li>Training/career awards </li></ul><ul><li>Identify research gaps for new research agendas for funding agencies </li></ul><ul><li>Fund more investigator initiated work relevant to each groups priorities </li></ul><ul><li>Develop a robust registry of protocols and completed reviews </li></ul>
  13. 13. Things to keep in mind <ul><li>The Cochrane Collaboration is an international treasure </li></ul><ul><li>Different countries have different challenges </li></ul><ul><li>Decision makers are fundamental to making sure our work is relevant and used </li></ul><ul><li>Systematic review must not only drive practice change but funding priorities for new research </li></ul>
  14. 14. Questions/Discussion <ul><li>[email_address] </li></ul><ul><li>www.effectivehealthcare.ahrq.gov </li></ul><ul><li>Home of the comparative effectiveness work and work in progress, public comment and topic nomination </li></ul><ul><li>http://www.ahrq.gov/clinic/epcix.htm </li></ul><ul><li>EPC topics done and in progress </li></ul><ul><li>http://www.ahrq.gov/fund/ </li></ul><ul><li>Notices of funding opportunities and training grants </li></ul>

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