Effective healthcare program initiatives in future CER/PCOR in mental health September 19, 2011 AHRQ...
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Effective healthcare program initiatives in future CER/PCOR in mental health September 19, 2011 AHRQ Annual Conference Sonia Tyutyulkova, MD, PhD Center
Effective healthcare program initiatives in future CER/PCOR in
mental health September 19, 2011 AHRQ Annual Conference Sonia
Tyutyulkova, MD, PhD Center for Outcomes and Evidence, AHRQ
Slide 2
Stakeholder Engagement Group Scientific Resource Center RTI
International-University of North Carolina Evidence-based Practice
Center Shannon Brode, MPH Daniel E. Jonas, MD, MPH Alyssa J.
Mansfield, MPH, PhD Brian B. Sheitman, MD Elizabeth Tant Meera
Viswanathan, PhD Lea C. Watson, MD, MPH DEcIDE Mental Health
Consortium Coordinating Center Stephen Crystal Tobias Gerhardt
Sheree Nessee-Todd Mark Olfson Harold Pincus Teresa Viggiano
Slide 3
Comparative Effectiveness Research CER is the conduct and
synthesis of research comparing the benefits and harms of different
interventions and strategies to prevent, diagnose, treat and
monitor health conditions in real world settings. The purpose of
this research is to improve health outcomes by developing and
disseminating evidence-based information to patients, clinicians
and other decision makers responding to their needs.
Slide 4
Patient-Centered Outcomes Research Assesses the benefits and
harms of preventive, diagnostic, therapeutic, or health delivery
system interventions to inform decision making, highlighting
comparisons and outcomes that matter to people; Is inclusive of an
individual's preferences, autonomy and needs, focusing on outcomes
that people notice and care about such as survival, function,
symptoms, and health-related quality of life; Incorporates a wide
variety of settings and diversity of participants to address
individual differences and barriers to implementation and
dissemination; Investigates (or may investigate) optimizing
outcomes while addressing burden to individuals, resources, and
other stakeholder perspectives.
Slide 5
Effective Health Care Program Created in 2005, authorized by
Section 1013 of the Medicare Prescription Drug, Improvement, and
Modernization Act (MMA) of 2003 To improve the quality,
effectiveness, and efficiency of health care delivered through
Medicare, Medicaid, and S-CHIP programs Focus on Clinical
effectiveness Comparative Effectiveness
Slide 6
Effective Healthcare Program Structure
Slide 7
Raphael, 1509-1511, The School of Athens, Fresco, Apostolic
Palace, Rome, Vatican City Stakeholder Driven Research
Slide 8
Series of Stakeholder Meetings 2010 - 2011
Slide 9
ProcessProcess
Slide 10
Rene Magritte (1898-1967), Ceci nest pas une pipe (1926) Need
to Fundamentally Change Our Approach to Clinical Research for
Serious Mental Illness
Slide 11
Measurements and outcomes need consensus definitions.
Measurements and outcomes need consensus definitions. Develop
measurements and outcome assessment tools that are based on a
chronic care model rather than the inadequate metrics that exist
today that are based on an acute-care model. Development of
infrastructure that supports longitudinal studies Development of
infrastructure that supports longitudinal studies and facilitate
development of comparable datasets (detailed registries).
Development of CER methodology. Stakeholder Identified Priorities
in SMI
Slide 12
Service delivery, treatment settings, and structuring the
delivery of care Make treatment settings and service delivery
systems into experiments for studies such as: (a) comparing the
effectiveness of different systems for structuring the delivery of
care, such as psychiatric medical homes vs. usual care; (b)
comparing how variation across settings, systems, and states
impacts disparities for specific groups; (c) state-to-state or
smaller area comparisons; (d) public systems vs. various models of
private insurance; (e) systems that deliver care in teams vs. those
settings that deliver care in solohealthpractitioner or split-care
arrangements; (f) delivery tools, such as prior authorization, and
their impact; and (g) ethnic specific provider supports.
Slide 13
Identify disparities and reasons for disparities and reevaluate
the framework for researching disparities. Role of the therapeutic
relationship. Strategies to personalize/individualize treatment.
Treatment approaches to avoid early mortality and morbidity. Role
of the psychiatric hospital, lengths of stay, and transition
support services after discharge. Retooling Universities and
Education. Strategies to increase adherence to evidence-based
guidelines and treatment regimens. Correctional programs and
interventions for people involved with the criminal justice system.
Interventions for people with comorbid medical illness or substance
abuse. Prevention, early identification, trajectories, and
developmental perspective. Dissemination and implementation.
Reducing barriers and improving access. Mental health policy.
Modifiable factors: tobacco, exercise, and nutrition. Alternatives
to force or involuntary approaches. Providing housing or social
support. Strategies to reduce stigma, prejudice, and
discrimination. Stakeholder Identified Priorities in SMI
Slide 14
System and Care Delivery Interventions
Slide 15
Slide 16
Systematic Reviews and Clinical Practice Guidelines
Slide 17
Effective Health Care Program Guides
PolicymakersCliniciansConsumers
Slide 18
Evidence-based Practice Centers (EPC) Evidence Reports
Antipsychotics Efficacy and Comparative Effectiveness of Off-Label
Use of Atypical Antipsychotics Antipsychotics Comparative
Effectiveness of First- and Second-Generation Antipsychotics for
Children and Young Adults Antipsychotics Antipsychotics in Adults:
Comparative Effectiveness of First-Generation versus
Second-Generation Medications Antidepressants Comparative
Effectiveness of Second-Generation Antidepressants in the
Pharmacologic Treatment of Adult Depression Non-Pharmacologic
Interventions Non-Pharmacologic Interventions for
Treatment-resistant Depression in Adults
Slide 19
Evidence-based Practice Centers (EPC) Evidence Reports
Effectiveness of Practice-based Interventions Addressing
Concomitant Mental Health and Chronic Medical Conditions in the
Primary Care Setting Comparison of Characteristics of Nursing Homes
and Other Residential Long- Term Care Settings for Persons with
Dementia Treatment Approaches to Avoid Early Morbidity and
Mortality in Serious Mental Illness
Slide 20
The Evidence Landscape
Slide 21
Slide 22
Patient-Centered Outcomes Research How can the health care
system improve my chances of achieving the outcomes I prefer?
Slide 23
http://effectivehealthcare.ahrq.gov/
Slide 24
Stakeholder Identified Priorities DEcIDE Network Application
and Effectiveness of Quality Measurement and Improvement Strategies
to Enhance Care Processes and Outcomes for Individuals with Mental
Illnessevidence-concordant measurement processes and measures
Application and Effectiveness of Quality Measurement and
Improvement Strategies to Enhance Care Processes and Outcomes for
Individuals with Mental Illness. What evidence-concordant
measurement processes and measures are most appropriate and
effective in assessing mental health care and its quality in
various settings and plan arrangements? Integration of General
Medical and Behavioral Health Care for Adults with Severe Mental
Illness Improving Mental Health Care Continuity and Transitions for
Adults with Severe Mental Illness traditional versus
technologically enhanced methods What is the comparative
effectiveness traditional versus technologically enhanced methods
(e.g., tele-medicine, computer programs, web-based systems, smart
phones, etc.) in delivering evidence-based treatments ? Structuring
Care Delivery at the Provider Level. T Structuring Care Delivery at
the Provider Level. To what extent will functional outcomes differ
for patients seen by clinicians: with varying frequencies of
visits, for varying lengths of office visits, and varying ease of
access to clinicians? In relation to characteristics of the
provider and other individual and relationship factors. identifying
individuals who are at high risk suicidereduce the risk of
completed suicide What approaches are most effective in identifying
individuals with SMI or SED who are at high risk of suicide and of
intervening to reduce the risk of completed suicide?
