Sills MR, Kwan BM. SAFTINet Research Aims and Approach Overview for Stakeholders. Teleconference. 19 January 2011.

1. SAFTINet Research Project Overview
… and how does this relate to the PEC?
Bethany M. Kwan, PhD, MSPH Marion R. Sills, MD, MPH
bethany.kwan@ucdenver.edu sills.marion@tchden.org
SAFTINet Project Manager Lead, SAFTINet CER Project
SAFTINet

2. CER Study Question
 HEALTH CARE DELIVERY SYSTEM FACTORS, such as
the patient-centered medical home are important
to the CONTROL of
asthma (children, adults)
high blood pressure
hypercholesterolemia
PROCESSES OF
CARE
+
HEALTH CARE
DELIVERY SYSTEM
FACTORS
+ PATIENT FACTORS →
CHRONIC DISEASE
CONTROL

3. CER Study Question
How did we get here?
PROCESSES OF
CARE
+
HEALTH CARE
DELIVERY SYSTEM
FACTORS
+ PATIENT FACTORS →
CHRONIC DISEASE
CONTROL

4. CER Study Question
How did we get here?
Why CER?
Why the SAFTINet population?
Why these 4 cohorts?
Why this research question?

5. CER Study Question
How did we get here?
Why CER?
Why the SAFTINet population?
Why these 4 cohorts?
Why this research question?

6. Why CER
 2009: The American Recovery and
Reinvestment Act
 allocated $1.1 billion for CER

7. Why CER
 2009: The American Recovery and
Reinvestment Act
 allocated $1.1 billion for CER

8. What is CER? (Institute of Medicine, 2009)
Comparative Effectiveness Research (CER)
is 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.
The purpose of CER is to assist consumers,
clinicians, purchasers, and policy makers to
make informed decisions that will improve
health care at both the individual and
population levels.
http://www.iom.edu/Reports/2009/ComparativeEffectivenessResearchPriorities.aspx

9. IOM Priorities for Comparative Effectiveness Research (2009)
What is CER? (Institute of Medicine,
2009)

10. Why CER
 2009: The American Recovery and
Reinvestment Act
 allocated $1.1 billion for CER
 3 recipients of the funds: NIH, AHRQ, OS-DHHS
 3 recipients issued requests for proposals
 to develop CER infrastructure
 to conduct CER studies
 mandated an Institute of Medicine (IOM) study to
establish national priorities for CER

11. Why CER
 2009: The American Recovery and
Reinvestment Act
 allocated $1.1 billion for CER
 3 recipients of the funds: NIH, AHRQ, OS-DHHS
 3 recipients issued requests for proposals
 to develop CER infrastructure
 to conduct CER studies
 mandated an Institute of Medicine (IOM) study to
establish national priorities for CER
SAFTINet
research
infrastructure
SAFTINet
research
question

12. CER Study Question
 Research question was chosen to best
align with national priorities

13. CER Study Question
How did we get here?
Why CER?
Why the SAFTINet population?
Why these 4 cohorts?
Why this research question?

14. CER Study Question
Priority Populations Priority Conditions

15. CER Study Question
1. Low-income groups
2. Minority groups
3. Women
4. Children
5. The elderly
6. Individuals with special
health-care needs (e.g.,
disabilities, need for
chronic care or end-of-
life care, or those who
live in inner-city and
rural areas)
1. Arthritis/joint disorders
2. Cancer
3. Cardiovascular disease
4. Dementia, including Alzheimer's
Disease
5. Depression; other mental health
disorders
6. Developmental delays, ADHD and
autism
7. Diabetes Mellitus
8. Functional limitations and disability
9. Infectious diseases including HIV/AIDS
10. Obesity
11. Peptic ulcer disease and dyspepsia
12. Pregnancy including pre-term birth
13. Pulmonary disease/Asthma
14. Substance abuse
Priority Populations Priority Conditions

16. CER Study Question
1. Low-income groups
2. Minority groups
3. Women
4. Children
5. The elderly
6. Individuals with special
health-care needs (e.g.,
disabilities, need for
chronic care or end-of-
life care, or those who
live in inner-city and
rural areas)
Priority Populations
Basis for defining
our SAFTINet
clinic population

17. CER Study Question
1. Arthritis/joint disorders
2. Cancer
3. Cardiovascular disease
4. Dementia, including Alzheimer's
Disease
5. Depression; other mental health
disorders
6. Developmental delays, ADHD and
autism
7. Diabetes Mellitus
8. Functional limitations and disability
9. Infectious diseases including HIV/AIDS
10. Obesity
11. Peptic ulcer disease and dyspepsia
12. Pregnancy including pre-term birth
13. Pulmonary disease/Asthma
14. Substance abuse
Priority Conditions
Basis for defining
our 4 SAFTINet
cohorts:
•asthma (children,
adults)
•high blood pressure
•hypercholesterolemia

18. CER Study Question
How did we get here?
Why CER?
Why the SAFTINet population?
Why these 4 cohorts?
Why this research question?

19. Institutes of Medicine Top 100 Priority Areas
Igelhart al, NEJM(2009)

20. CER Study Question
HEALTH CARE
DELIVERY SYSTEM
FACTORS
→
CHRONIC DISEASE
CONTROL
First Quartile Priority:
“Compare the effectiveness of
comprehensive care coordination
programs, such as the medical
home, and usual care in managing
children and adults with severe
chronic disease, especially in
populations with known health
disparities.”

21. CER Study Question
HEALTH CARE
DELIVERY SYSTEM
FACTORS
→
CHRONIC DISEASE
CONTROL
“Compare the effectiveness of comprehensive
care coordination programs, such as the
medical home, and usual care in managing
children and adults with severe chronic
disease.”
HEALTH CARE DELIVERY SYSTEM
FACTORS, such as the patient-
centered medical home are
important to DISEASE CONTROL

22. CER Study Question
 HEALTH CARE DELIVERY SYSTEM FACTORS, such as
the patient-centered medical home are important
to the CONTROL of
asthma (children, adults)
high blood pressure
hypercholesterolemia
HEALTH CARE
DELIVERY SYSTEM
FACTORS
→
CHRONIC DISEASE
CONTROL

23. Measures of Delivery Factors
HEALTH CARE
DELIVERY SYSTEM
FACTORS
→
CHRONIC DISEASE
CONTROL
 Patient-centered medical
home (PCMH)
 Integrated mental health care
(IMHC)
 Others

24. Measures of Disease Control
HEALTH CARE
DELIVERY SYSTEM
FACTORS
→
CHRONIC DISEASE
CONTROL
 Existing electronic health record data
 Medicaid data, death files, etc.
 Enhanced data

25. Involving the PEC
HEALTH CARE
DELIVERY SYSTEM
FACTORS
CHRONIC DISEASE
CONTROL
 What do you already measure?
 What is important to measure?
 What is feasible to measure?
 How can SAFTINet and PEC partners help
measure these in your practice?

26. Schedule for future PEC-Research
meetings
Date Topic
2/16 Initial discussion of enhanced data collection
measures such as health-related quality of life and
disease control measures
3/16 Initial discussion of health systems delivery
characteristics measures
4/6 Asthma outcomes
4/20 Cardiovascular disease outcomes
5/18 Patient-Centered Medical Home measures