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.

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  • Patient-centered research at Mayo Clinic

    1. 1. Research forpatient-centered care Victor M. Montori, MD, MSc Professor of MedicineDirector, Healthcare Delivery Research HEDER Program Mayo Clinic
    2. 2. Disclosures No financial conflictsNo off-label use mentions
    3. 3. The needs of the patient come first Healthcare professionals defined what patientsneeded, how to meet those needs, and if and when needs were met.
    4. 4. Changes
    5. 5. ChangesTechnology
    6. 6. ChangesTechnologyInformation
    7. 7. ChangesTechnologyInformation Disease
    8. 8. ChangesTechnologyInformation Disease Health
    9. 9. ChangesTechnologyInformation Disease HealthEconomics
    10. 10. ChangesTechnologyInformation Disease HealthEconomics
    11. 11. ChangesTechnologyInformation Disease HealthEconomics
    12. 12. ChangesTechnology arms raceInformation Disease HealthEconomics
    13. 13. ChangesTechnology arms raceInformation Disease HealthEconomics
    14. 14. ChangesTechnology arms raceInformation without value Disease HealthEconomics
    15. 15. ChangesTechnology arms raceInformation without value Disease HealthEconomics
    16. 16. ChangesTechnology arms raceInformation without value Disease mongering HealthEconomics
    17. 17. ChangesTechnology arms raceInformation without value Disease mongering HealthEconomics
    18. 18. ChangesTechnology arms raceInformation without value Disease mongering HealthEconomics
    19. 19. ChangesTechnology arms raceInformation without value Disease mongering Health as moralityEconomics
    20. 20. 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
    21. 21. 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
    22. 22. What are this patient’s needs?
    23. 23. What are this How would this patient’s patient want those needs? needs met?
    24. 24. The needs and wants of the informedpatient come firstWhat are this How would this patient’s patient want those needs? needs met?
    25. 25. The needs and wants of the informedpatient come firstWhat are this How would this patient’s patient want those needs? needs met?
    26. 26. Healthcare delivery research must assesshow well we meet patient needs and wants
    27. 27. Healthcare delivery research must assesshow well we meet patient needs and wants Delivered timely equitable effective efficient safe
    28. 28. Healthcare delivery research must assesshow well we meet patient needs and wants Delivered Experienced timely transparent equitable individualized effective respectful efficient dignity safe choice
    29. 29. Encounter Research
    30. 30. Evidence requirementsAddresses patient needs in useful way: Minimal error Directly Interventions promote patient goalsOutcomes reflect patient perspective
    31. 31. Answer questions with minimal error Bias Reporting bias Spin Publication bias Fraud
    32. 32. Comparative effectiveness? Karanikolas P et al. J Clin Epidemiol 2009; 62: 479-84
    33. 33. Outcomes reflect patient perspective Text 20%diabetes trials in 2003 measured patient important outcomes Montori et al. Diabetes Care 2006
    34. 34. 18% diabetes trials in future will measurepatient important outcomes as primary endpoints 8% measured QoL, pain, functional capacity Gandhi et al. JAMA 2008
    35. 35. HbA1c
    36. 36. Quality of careHbA1c
    37. 37. Quality of careClinicalinertia HbA1c
    38. 38. Quality of careClinicalinertia HbA1c Report card
    39. 39. Quality of careClinical Technicalinertia HbA1c decisions Report card
    40. 40. Live longer Feel betterLive unhindered by complications
    41. 41. Healthcare delivery research must assesshow well we meet patient needs and wants Delivered Experienced timely transparent equitable individualized effective respectful efficient dignity safe choice
    42. 42. Hess E et al. In preparation
    43. 43. 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
    44. 44. !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.
    45. 45. Patient-centered healthcare delivery researchmust assess how well we meet patient needs and wants
    46. 46. Patient-centered healthcare delivery researchmust assess how well we meet patient needs and wants Delivered timely equitable effective efficient safe
    47. 47. 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
    48. 48. 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.
    49. 49. Can the conduct of patient-centered research help us stop the corruption of healthcare?
    50. 50. Can the conduct of patient-centered research help us stop the corruption of healthcare?
    51. 51. montori.victor@mayo.eduhttp://kerunit.e-bm.orghttp://kercards.e-bm.infohttp://shareddecisions.mayoclinic.org@vmontorihttp://minimallydisruptivemedicine.org

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