Comparative Effectiveness Research Impact on Quality and Access - - PowerPoint PPT Presentation

▶

Feb 08, 2024 357 likes •590 views

Comparative Effectiveness Research Impact on Quality and Access John Santa MD MPH Director, Health Ratings Center Consumers Union March 21, 2011 Disclosures General internist, most recent practice at the VA in 2008. Employed by

SLIDE 1

Comparative Effectiveness Research Impact on Quality and Access

John Santa MD MPH Director, Health Ratings Center Consumers Union March 21, 2011

SLIDE 2

Disclosures

General internist, most recent practice at the VA

in 2008.

Employed by Consumers Union, publisher of:

– Consumer Reports – Consumer Reports – ConsumerReportsHealth.org

20 million readers a month, older, affluent, well

educated, not diverse. Trying to diversify.

Independent of industry
Non profit, non partisan

SLIDE 3

12. Consumer

Reports employee

R A T E R T

SLIDE 4

Health Alerts via Text

SLIDE 5

Comparative Effectiveness

Current context
Key consumer principles
Early successes
Important events on horizon
Comments about cancer

SLIDE 6

Systems are perfectly designed to get the results they achieve.

SLIDE 7

Current CE Playing Field Not Level

Industry dominates information to

consumers

Pharma most prominent but all sectors effective
Billions in direct to consumer
Billions in direct to consumer
Words regulated but visuals, tone and context may

be more important

Billions in physician marketing
Detailing, sampling, financial relationships
Billions in a biased research enterprise
Methodology, positive finding bias, ghostwriters

SLIDE 8

Recent Examples

ProPublica analysis and release of physician

financial relationship info

Fugh Berman analysis of estrogen literature
Rothman—Health Advocacy Organizations and
Rothman—Health Advocacy Organizations and

the Pharmaceutical Industry

Avandia studies
St Jude Medical and US DOJ agreement

– DOJ alleges kickbacks to physicians for post marketing trials and registries

SLIDE 9

SLIDE 10

Key Consumer Principles

Consumers should be involved “from the

start….at the top”….for appropriate CE tasks including research.

Careful selection…..of consumers and
Careful selection…..of consumers and

researchers

Training, orientation, support, feedback is

needed…..for both consumers and researchers.

Independence is crucial……for consumers and

for researchers.

SLIDE 11

Consumers Are Interested in Comparisons

Multiple successful health information

releases—hospitals, drugs, treatments

Strong readership scores for all health

articles—competes well with other content articles—competes well with other content

Strong media interest
Surveys show consumers use

comparative data in decision making

SLIDE 12

SLIDE 13

Successes

Academic detailing---Avorn and others
ClinicalTrials.gov
Drug Effectiveness Review Project

– BestBuyDrugs

Hospital infections---Pronovost and others
Surgical Checklist---Gawande and others
Decision Guides---FIMDM and others

SLIDE 14

Heart/Vascular Prevention Test Ratings Men, 45-54, Asymptomatic

SLIDE 15

Cardiovascular Screening Tests in Healthy 40-60 year olds

11% had a MD conversation about FU if

test abnormal

9% discussed accuracy of test
4% knew about potential complications
1% discussed with MD whether test saved

lives

2010 Survey of Consumer Reports Subscribers

SLIDE 16

On the Horizon

Medicare physician performance data
National reporting system for hospital

infections

Patient Centered Outcome Research
Patient Centered Outcome Research

Institute

Required reporting on physician financial

relationships with industry

Insurance Exchanges

SLIDE 17

Important Activities

IOM reports on CER, Systematic Reviews,

Trustworthy Clinical Guidelines

AHRQ’s efforts to engage consumers—

past, present and future past, present and future

NIH’s efforts to engage consumers

– www.gem-beta.org/Public/EHRInitiative.aspx?cat=4

PCORI—how will consumers be engaged?
Delivery system reform

SLIDE 18

Cancer CE Opportunities

If you want to say yes, you must be willing

to say no.

Context of comparisons
Poor delivery of what we know works
Poor delivery of what we know works
Overuse of what we know does not work
Prevention, diagnostic testing, “elective”

treatments good starters.

“Free the data” and use it for comparisons

for all---community cancer centers

SLIDE 19

CONSUMER REPORTS

MARCH 2011

SLIDE 20

Zeno’s Paradox

“To get there, you first have to make it

halfway. Then you have to make it

halfway from there. And then halfway halfway from there. And then halfway

again. You will never arrive, but

always getting closer.”

SLIDE 21

“When you’re through learning, you’re through.”

John Wooden

Former UCLA basketball coach

SLIDE 22