creating the capacity for evidence-based care - sax institute
TRANSCRIPT
CreatingtheCapacityForEvidence-BasedCare
AndrewB.Bindman,MD
Professor
UniversityofCaliforniaSanFrancisco
July5,2018
• Researchersneedtoadaptmethodstogettheirevidenceusedmorebyendusers
• Enduserscanbepolicymakersorcouldbepractitioners
• Co-creatingisthewaytogo-atleastsometimes
Yesterday
AlsoSomethingAboutFootball
Co-Creation
Co-Creation
HealthServicesResearchers
Evidence and Tools fr
Implementation• Gap from medical evidence generation to practice implementationØ Estimated at 17 yearsØ Delays health benefitsØ Contributes to disparities
MovingEvidencetotheFrontlines
GrowingKnowledgeBackUp
• Highly reliant upon specialty societies
• Specialty societies have competing self-interests
• Conflicting guidance within the same institution
EvidenceDisseminationChannel
• What will it take for change?
• Different opportunities for promoting evidence-based practice rather than evidence-based policy?
BurningPlatform
• HealthcarepracticeisrapidlyconsolidatingØ Largesystemsreplacingsmall
practices
Ø Potentialtopoolresources
• EmergenceofEHRsØ Growinginavailabilityand
powertosupporteffort
Evidence-BasedPractice:WhyNow?
PhysiciansinHealthSystems
EvGen:TheVision
• Digitizeddatacansupportfaster,better,andlesscostlyresearch– Speedbumpsrelatedtounformatted,nonstandardizedentry
• Lowerbarrierstostudyingownpts– Strategicdecisionsaboutsharingdataandbenchmarkingperformance
AcceleratingDatatoKnowledge
“Alearninghealthcaresystemis[onethat]isdesignedtogenerateandapply thebestevidenceforthecollaborativehealthcarechoicesofeachpatientandprovider;todrivetheprocessofdiscoveryasanaturaloutgrowthofpatientcare;andtoensureinnovation,quality,safety,andvalueinhealthcare.”
InstituteofMedicine/NationalAcademyofMedicine.TheLearningHealthcareSystem:WorkshopSummary.OlsenL,Aisner D,McGinnisJM,eds.Washington,DC:National
AcademiesPress;2007
LearningHealthCareSystem
BetterHealth=D2K+K2P
D2K:Datato
Knowledge
K2P:Knowledgeto
PracticeK2PD2K
LearningfromSports
• DataandAnalytics
• Leadership
• Budget
• Businessneedtocreatevalue
Moneyball Ingredients
• Alternative Payment Models• ACOs, PCMH
• Providers responsible for population cost and quality
• Potential for financial rewards and some risk
• Voluntary for physicians but incentivized through higher payment rate
PayingForValue
EvGen:TheVision
• EvidenceGenerator
• EvidenceCurator
• EvidenceAdopter
• EvidenceDisseminator
• EvidenceManager
ChangingRoleoftheOrganization
• Integratingclinicaldata
• Enrichingdatawith“-omics”,patient-derivedinformation
• Analyzingpracticevariation
• Clinicalgovernanceforevidence
HealthSystems’EmergingCapacity
K2PD2K
• CommonITplatformacrossalllevelsofcare
• Usingevidenceforsystem(notspecialty)guidelines
• Payingdoctorstoaddresstheirownpracticevariation
• Usingevidencetosupportvalue-basedpurchasing
• Activesurveillancefornewevidenceinliterature
LeadingEdgeHealthSystems
Changes in how care is reimbursed has stimulatedan interest in evidence but research funding stilloriented more towards D2K than K2P
ResearchFundstoAccelerateK2P
• Toextractvaluefrompublicinvestmentinnewknowledge
• Ensurethateveryonebenefitsfrompublicinvestmentinresearch
• Re-directingfocustowardsorganizationalcapacities
PublicInvestmentinImplementation
• Integratingclinicaldata
• Enrichingdatawith“-omics”,patient-derivedinformation
• Analyzingpracticevariation
• Clinicalgovernanceforevidence
HealthSystemsNeeds
K2PD2K
Informationbrokers:researcherswhounderstandmanagement
Toolstoincorporateknowledgeintotheworkflow
Metricsofachievement
• AHRQ Initiative: To construct a set of core competencies to guide the development of training programs for learning health systems researchers
• Proposal: To embed trainees at the interface of research, informatics and clinical operations within learning health systems
TrainingANewTypeofHealthServicesResearcher
• Insider perspective• Immersion within a ‘host’
organisation• ‘Co-production’ with
practice community• Knowledge created ‘on the
ground’ • Simultaneous generation
and uptake of evidence• Enhance research capacity
of the host organisation
EmbeddedResearcher
Vindrole-Padros et al (2017) BMJ Quality & Safety
• Investingininvestigatorteamsworkingincollaborationwithhealthsystems
• Rapidrigoroustestingratherthanlargebetonapre-specifiedapproach
• LeveraginghealthsysteminvestmentinK2P
• Publicdisseminationofresults
NewFundingModel
KnowledgetoPracticeTools
KnowledgetoPracticeTools
• Learning collaborative of learning health care systems
• Organizational Level– Progress toward becoming a
learning healthcare system
ImplementationMetricsofAchievement
• Lessaboutprovidingenduserswithaproduct
• Moreabouthelpingenduserstogrowtheirskillssotheycanimproveandsustaintheirefforts
KnowledgeTransfer
TheClinicalandResearchDivide
Thank you!
Your questions?