NEHI maps out future of comparative effectiveness
Filed under: Government, Health care reform, Health policy, Studies, Tools
NEHI, a nonprofit research group that was known as the New England Heathcare Institute, has released a white paper mapping out a potential near future for comparative effectiveness research in the United States. We first noticed the report on the Kaiser Family Foundation’s Health Reform Source site.
The white paper’s authors, Tom Hubbard, Shin Daimyo and Karan Desai, make a strong case that proper dissemination will be the real key to the success of CER. Their argument hinges on the observation that, even today, good medical research rarely makes it into clinical practice without a hefty nudge. 
When it comes to delivering this nudge to all that stimulus-funded comparative effectiveness research, the paper’s authors have singled out the newly created Patient-Centered Outcomes Research Institute. PCORI’s stated role is to help all stakeholders make informed health care decisions. It’s also, the authors write, uniquely positioned to become a key force in CER dissemination alongside the AHRQ’s Office of Communications and Knowledge Transfer. Unlike AHRQ, PCORI is an independent organization that’s free to form relationships and build consensus across the spectrum.
All in all, the report’s a quick and handy read. There are only 9 pages of text, and you’ll come out with a better understanding of the practical problems facing those who seek to apply comparative effectiveness research. If you’re looking for examples of successful implementation programs, head to pages 8 through 10.
Video, presentations from comparative effectiveness conference available online
Filed under: Government, Health care reform, Health data, Public health, Studies, Tools
Earlier this month, ECRI’s 17th annual conference tackled the thorniest detail of comparative effectiveness research, namely that it’s rarely a simple matter of A > B. Groups and individuals respond differently.
With a theme of “Comparative Effectiveness and Personalized Medicine,” the nonprofit and its partners at NIH and Health Affairs, among others, sought to better understand how big research ideas will interface with the person-by-person decisions through which such work will ultimately be implemented.
The conference has a detailed postmortem online, including two days of video (Fair warning: Together, they’re a good 700+ minutes of conference) and slides from a number of the presentations. I strongly recommend using the conference schedule listed on the slides page as a rough guide to finding the most relevant bits of video.
In case you’re looking for a place to start, here are two of the most relevant presentations:
- Keeping the comparative effectiveness debate rational
- Comparative effectiveness research in the Veterans Health Administration (and in Kaiser Permanente, which references patient preference and participation)
The online Q and A is also interesting, though there are only a handful of answers up at present. The most relevant one so far comes from Vivian Coates (Vice President, Information Services and Health Technology Assessment, ECRI Institute), in response to a query about a central listing of comparative effectiveness projects.
The CER inventory contract was awarded to the Lewin Group Center for Comparative Effectiveness Research (CER) in June, 2010. Over the 27 month period of the contract, Lewin will design, build and launch a web-based inventory that catalogs CER outputs and activity, including research studies, relevant research methods, training of researchers, data infrastructure and approaches for dissemination and translation of comparative effectiveness research to health care providers and patients.
Days numbered for UK’s arbiter of comparative effectiveness
Filed under: Europe, Health care reform, Health data, Health policy, Hot Health Headline
While comparative effectiveness research in the United States is booming thanks to the stimulus, a United Kingdom bastion of the discipline may be on the way out. Over at the NPR health blog, Joanne Silberner reports that the National Institute for Health and Clinical Excellence (NICE), which publishes guidelines on treatments and medical devices based on their cost and effectiveness, could be gone by 2013.
At a drug industry trade group meeting in London earlier this week, Health Minister Lord Howe, Under Secretary of State for Quality, said NICE has become “redundant,” and that it should focus on setting quality standards rather than evaluating individual drugs.
Meanwhile, the Cameron administration has disregarded NICE advice on several cancer drugs, and Howe reports that the government is working on a new “value-based pricing system.”
Related
For more European health news, see AHCJ’s Covering Europe initiative.
Article looks at evidence behind back surgery
Filed under: Conflicts of interest, Health care reform, Hot Health Headline
In the Star Tribune, Janet Moore seeks to counter aggressive spinal surgery with equally aggressive journalism. It’s a comprehensive take on a subject which journalists have been hammering away at piecemeal for some time now. Her anecdotes are strong, and her numbers doubly so. For example:
Photo by planetc1 via Flickr
Four out of five Americans will suffer from disabling back pain during their lifetimes, according to the National Institutes of Health. Spending on back care soared between 1997 and 2005, reaching $86 billion — just shy of what Americans spent battling cancer.
As those numbers have multiplied, so have questions about the more aggressive forms of back treatment. A 2008 study in the Journal of the American Medical Association, for example, noted that the increase in back-care spending occurred “without evidence of corresponding improvement” in patients’ health.
As Moore points out, this is a debate that will continue as health reform is implemented because the new legislation will “require doctors and hospitals to demonstrate that their services are cost-effective. In that vein, the New England HealthCare Institute estimates the United States could save roughly $1 billion a year by eliminating unnecessary back surgeries.”
Minnesota is home to Medtronic, a leading maker of devices used in spinal surgery. Medtronic has consultation arrangements with a number of doctors and some experts question whether that relationship has an effect on how many spinal surgeries are done. The head of the Association for Ethics in Spine Surgery, says these financial incentives create demand for certain brands of product.
It’s a lengthy piece, and the numbers are just one component. The whole package is definitely worth a read.
Related
Boulton explains comparative effectiveness
Filed under: Government, Health data, Health policy, Hot Health Headline
Next time somebody asks why the stimulus plan included $1.1 billion for comparative effectiveness research (and where all that money’s going), point them to Guy Boulton’s latest explanatory piece in the Milwaukee Journal Sentinel.
In this first installment, Boulton lays a strong foundation for the rest of his “occasional series” on comparative effectiveness by thoroughly answering the “how” and “why” of the massive research effort with carefully selected examples, experts and statistics. No word yet on where the series will go from here, but it’s a promising start.
Tip sheet for AHCJ members
Tracking health-related stimulus money: By Michael Grabell, ProPublica
WSJ looks at effects of Penn. outcomes database
Filed under: Health care reform, Health data, Health policy, Hospitals, Hot Health Headline
The Wall Street Journal’s Thomas Burton has taken a look at the effects of one state’s commitment to publishing hospital data. Since 1989 Pennsylvania has compiled and published data on hospital outcomes and, to a lesser extent, costs. Collecting the data isn’t cheap, estimates of the cost to the state’s 172 acute-care hospitals range from $7 million to $10 million, but Burton’s story makes it clear that the investment has paid off. Burton reinforces that impression with statistics (”An August 2008 study in the American Journal of Medical Quality reported that Pennsylvania in-hospital odds of death were 21% to 41% lower than those in other states.”) and convincing examples (by basing their health plans on outcomes data, companies were able to save millions). His profile of a now-defunct Hershey company plan is particularly interesting.
“High-quality care costs less — always,” says David B. Nash, a medical-quality expert and dean at Thomas Jefferson University’s School of Population Health in Philadelphia. “If the federal government could behave like a savvy shopper, that would change the health-cost game overnight. But the government is a bill payer, not a savvy shopper.”
Burton also reports that some stakeholders, given the success of Pennsylvania’s example, are pushing for hospital outcomes research to be part of the $1 billion stimulus investment into comparative effectiveness.
The White House is looking at publishing information possibly including medical outcomes as part of overhaul efforts, officials say. Quality data could also be used in existing programs. “There is a clear understanding from the Obama administration that both Medicare and Medicaid need to move in the direction of what’s happening in Pennsylvania,” says Jonathan Blum, director of the government’s Center for Medicare Management.
Bloomberg explains all five House, Senate plans
Filed under: Government, Health care reform, Health policy, Hot Health Headline
Bloomberg’s Kristin Jensen and Nicole Gaouette have perused all five proposed health care reform plans, each originating from a different committee in either the U.S. Senate or House of Representatives, and were kind enough to explain exactly what they have in common and what they don’t.
In case you’re wondering, they all come with an individual mandate, expanded coverage, comparative effectiveness, increased regulation of insurers and cost-cutting measures. They differ in terms of budget, funding, a public option and an employer mandate.
Reporters miss crucial detail about Lewin Group
Filed under: Conflicts of interest, Health care reform, Health data, Health policy
The Lewin Group, which refers to itself as “a leading health care policy and management consulting firm,” has launched a Center for Comparative Effectiveness Research that is expected to offer research “for use by policy makers, researchers, health care providers and others to improve patient care and optimize resources.”
Some reporters writing about this development, and other issues, are still referring to the Lewin Group as a nonpartisan organization, yet AHCJ president Trudy Lieberman pointed out in April that the group is ultimately part of United Healthcare Group, a major insurance company. Lieberman turned up evidence indicating that there may be no formal protections in place for Lewin Group’s editorial independence.
However, in recent stories, ABC News, The Washington Post, Investor’s Business Daily, KPCC, a southern California public radio station, and other news outlets continue to describe the Lewin Group as “nonpartisan.” And, while the Lewin Group does refer to itself as “objective,” it’s probably not a good idea to overlook their corporate ties entirely.
Let the comparison shopping begin
The august Institute of Medicine is out with academic medicine’s answer to the Billboard Hot 100. A panel of experts has come up with a list of the top 100 health topics that deserve a rigorous comparison of options to determine which are best.
The recommendations, part of a larger report that lays out a blueprint for research, are organized by quartile, and the top 25 would be the ones with a bullet, to stretch the pop music analogy.
Some of the high priorities:
- What are the best strategies to reduce infections spread in health-care settings?
- What’s the best way to use expensive biotech drugs – like Remicade, Enbrel and Humira – to treat inflammatory diseases, such as rheumatoid arthritis?
- How should dental care be delivered to children to most effectively prevent cavities?
Comparing effectiveness is suddenly an idea whose time has come. “Health care decisions too often are a matter of guesswork, because we lack good evidence to inform them,” said Harold C. Sox, editor of The Annals of Internal Medicine, and panel co-chairman, according to The New York Times.
In legislation to boost the economy, Congress set aside more than $1 billion to fund comparisons that would pick health winners and losers. It was the IOM’s job to come up with recommendations on where to start.
For a little peek into how the priorities were chosen, Consumer Reports‘ Health Blog has a Q&A with Consumer Union President Jim Guest, who was a member of the Federal Coordinating Council for Comparative Effectiveness Research that came up with the recommendations.
The New England Journal of Medicine weighed in with a “Perspective” piece on implications of the report. For more about comparative effectiveness, see this piece from AHCJ board member Andrew Holtz, M.P.H.
Dartmouth Atlas: Powerful when used right
Filed under: Health care reform, Health data, Health journalism, Health policy, Hot Health Headline, Pharmaceuticals
The Dartmouth Atlas contains detailed information on regional variations in health care spending and use and therefore has the potential to play a key role in the debate over health care cost and efficiency.
Nonetheless, it has come under fire in a few prominent publications lately. Writing for the Health Affairs blog, Amitabh Chandra defends the utility of the Atlas, pointing out that in many cases quibbles with the Atlas arise due to a lack of broad perspective or understanding of the health care system as a whole and an inability to properly interpret Dartmouth’s findings.
In addition to refuting certain attacks on the Atlas, Chandra expands his defense to include an outline of just why it can be a useful resource when trying to evaluate health care spending and effectiveness.
To learn more about the Dartmouth Atlas and how to use it to determine how medical resources are distributed and used in the United States, read AHCJ’s Covering Hospitals, a slim guide that focuses on how journalists can best use Dartmouth Atlas and Hospital Compare.
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