cer safti net overview edrc 1 feb 2011

CER and SAFTINetMarion R. Sills, MD, [email protected], SAFTINet CER Project

mailto:[email protected]

Overview of Comparative Effectiveness Research

(CER) Scalable Architecture for Federated

Therapeutic Inquiries Network (SAFTINet)

CER Overview 2009: The American Recovery and

Reinvestment Act allocated $1.1 billion for CER

CER Overview: Definition 2009: The American Recovery and


CER Definition (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.

CER Definition (Institute of Medicine, 2009)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

http://www.iom.edu/Reports/2009/ComparativeEffectivenessResearchPriorities.aspx

CER Overview 2009: The American Recovery and


3 recipients of the funds: NIH, AHRQ 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

CER Overview IOM report established national priorities

Overview of Comparative Effectiveness Research

(CER) Scalable Architecture for Federated

Therapeutic Inquiries Network (SAFTINet)

CER and SAFTINet 2009: The American Recovery and


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

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

CER Study QuestionHow did we get here?

PROCESSES OF CARE +


FACTORS+ PATIENT FACTORS → CHRONIC DISEASE

CONTROL

CER Study QuestionHow did we get here?Why the SAFTINet population?Why these 4 cohorts?Why this research question?

CER Study QuestionPriority Populations Priority Conditions

CER Study Question

1. Low-income groups2. Minority groups3. Women4. Children5. The elderly6. 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 disease4. 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

CER Study Question

1. Low-income groups2. Minority groups3. Women4. Children5. The elderly6. 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 of federally qualified health centers

CER Study Question

1. Arthritis/joint disorders 2. Cancer 3. Cardiovascular disease4. 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

CER Study QuestionHow did we get here?Why CER?Why the SAFTINet population?Why these 4 cohorts?Why this research question?

Institutes of Medicine Top 100 Priority Areas

Igelhart al, NEJM(2009)

CER Study Question


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.”

CER Study Question



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

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



CONTROL

Measures of Disease ControlHEALTH CARE

DELIVERY SYSTEM FACTORS

→ CHRONIC DISEASE CONTROL

Existing electronic health record data

Medicaid data, death files, etc.

Enhanced data: patient-reported outcomes (PRO)

RelevanceHEALTH CARE

DELIVERY SYSTEM FACTORS

→ CHRONIC DISEASE CONTROL

Measuring hospital utilization and cost as an outcome (includes ED): first large-scale linkage of EHR with claims data

CER methods expertise Experience with AHRQ Future directions

More pediatric cohorts Studies related to decreasing acute care

utilization, cost

cer safti net overview edrc 1 feb 2011

Healthcare