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Patient-centered research at Mayo Clinic

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Victor Montori
Victor Montori

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

Health & Medicine
1 of 57
Research for patient-centered care Victor M. Montori, MD, MSc Professor of Medicine Director, Healthcare Delivery Research HEDER Program Mayo Clinic
Disclosures No financial conflicts No off-label use mentions
The needs of the patient come first Healthcare professionals defined what patients needed, how to meet those needs, and if and when needs were met.
Changes
Changes Technology
Changes Technology Information
Changes Technology Information Disease
Changes Technology Information Disease Health
Changes Technology Information Disease Health Economics
Changes Technology Information Disease Health Economics
Changes Technology Information Disease Health Economics
Changes Technology arms race Information Disease Health Economics
Changes Technology arms race Information Disease Health Economics
Changes Technology arms race Information without value Disease Health Economics
Changes Technology arms race Information without value Disease Health Economics
Changes Technology arms race Information without value Disease mongering Health Economics
Changes Technology arms race Information without value Disease mongering Health Economics
Changes Technology arms race Information without value Disease mongering Health Economics
Changes Technology arms race Information without value Disease mongering Health as morality Economics
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 to Technology 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 morality Economics
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 to Technology 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 morality Economics 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 informed patient come first What are this How would this patient’s patient want those needs? needs met?
The needs and wants of the informed patient come first What are this How would this patient’s patient want those needs? needs met?
Healthcare delivery research must assess how well we meet patient needs and wants
Healthcare delivery research must assess how well we meet patient needs and wants Delivered timely equitable effective efficient safe
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
Encounter Research
Evidence requirements Addresses patient needs in useful way: Minimal error Directly Interventions promote patient goals Outcomes 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 measure patient important outcomes as primary endpoints 8% measured QoL, pain, functional capacity Gandhi et al. JAMA 2008
HbA1c
Quality of care HbA1c
Quality of care Clinical inertia HbA1c
Quality of care Clinical inertia HbA1c Report card
Quality of care Clinical Technical inertia HbA1c decisions Report card
Live longer Feel better Live unhindered by complications
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
Hess E et al. In preparation
205 patients 58 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 research must assess how well we meet patient needs and wants
Patient-centered healthcare delivery research must assess how well we meet patient needs and wants Delivered timely equitable effective efficient safe
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
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-important outcomes 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.edu http://kerunit.e-bm.org http://kercards.e-bm.info http://shareddecisions.mayoclinic.org @vmontori http://minimallydisruptivemedicine.org

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Patient-centered research at Mayo Clinic

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