Advisory Panel on Improving Healthcare Systems March 31, 2017 8:30 a.m. – 4:00 p.m. EST
Housekeeping • Webinar is available to the public • Members of the public are invited to listen to this teleconference and view the webinar • Anyone may submit a comment through the webinar chat function, although no public comment period is scheduled • Visit www.pcori.org/events for more information • Chair Statement on COI and Confidentiality 2
Welcome & Introductions Steve Clauser, PhD, MPA Director, Healthcare Delivery and Disparities Research
IHS Advisory Panel Leadership • Michael Dueñas, OD • IHS Advisory Panel Chair • Timothy Daaleman, DO, MPH • IHS Advisory Panel Co-Chair 4
IHS Advisory Panel Members • • John Galdo, PharmD, BCPS* Rebecca Aslakson, MD, PhD Associate Professor, Johns Hopkins School of Medicine Clinical Pharmacy Educator, Barney’s Pharmacy • • Leah Backhus, MD, MPH Ravi Govila, MD* Associate Professor, Veterans Affairs and Stanford Vice President, Medical Management and PPO, Blue University Cross Blue Shield of Michigan • • Ignatius Bau, JD Joan Leon, BA • Jim Bellows, PhD, MPH Retired Health Consultant • Senior Director, Care Management Institute, Kaiser James Perrin, MD Permanente Professor of Pediatrics, Harvard Medical School and • David Bruhn, PharmD, MBA Pediatrician, Massachusetts General Hospital Physician Health Outcomes Liaison, National Accounts, Organization GlaxoSmithKline • Carolyn Petersen, MS, MBI • Bonnie Clipper, DNP, RN, MA, MBA, FACHE, CENP Senior Editor, MayoClinic.org Chief Clinical Officer, Cornerstone Hospital of Austin • Alexis Snyder, BA • Timothy Daaleman, DO, MPH Independent Contractor, Patient Family Advisor Professor of Family Medicine, University of North • Jamie Sullivan, MPH Carolina at Chapel Hill School of Medicine Director of Public Policy, COPD Foundation • Michael Dueñas, OD • Craig Umscheid, MD, MS* Chief Public Health Officer, American Optometric Associate Professor of Medicine and Epidemiology, Association University of Pennsylvania Perelman School of Medicine • Lisa Freeman, BA • Mitzi Wasik, PharmD Independent Patient Safety Advocate and Consultant Medical Stars Business Lead, Aetna • Nancy Yedlin, MPH Vice President, Donaghue Foundation 5
Guests • Cheryl Pegus, MD, MPH* • Addressing Disparities Advisory Panel Chair • Elizabeth Jacobs, MD, MAPP, FACP • Addressing Disparities Advisory Panel Co-Chair • Ray Dorsey, MD, MBA University of Rochester • PCORI Funded Investigator 6
Improving Healthcare Systems Program Staff Penny Mohr, MA Carly Parry, PhD, MSW Steven Clauser, PhD, MPA Els Houtsmuller, PhD Neeraj Arora, PhD Sr. Program Officer Sr. Program Officer Associate Director Director Associate Director Beth Kosiak, PhD Gyasi Moscou-Jackson, PhD Jeanne Murphy, PhD, CNM Andrea Brandau, MPP Stephanie Parver, MPH Anum Lakhia, MPH Program Officer Program Officer Program Officer Program Officer Program Associate Program Associate Jamie Trotter Sindhura Gummi, MPH Hannah Kampmeyer Aaron Shifreen Allie Olender Anushka Sindkar Program Associate Program Associate Senior Admin Assistant Program Assistant Program Assistant Intern
Addressing Disparities Program Staff Cathy Gurgol, MS Mira Grieser, MHS Steven Clauser, PhD, MPA Parag Aggarwal, PhD Ayodola Anise, MHS Associate Director Director Sr. Program Officer Program Officer Program Officer Julia Anderson, MPH, MEM Soknorntha Prum, MPH Marisa Torres, MPH Kaitlynn Robinson-Ector, MPH Alyzza Dill, MPH Program Associate Program Associate Program Associate Program Associate Program Associate Dionna Attinson Tomica Singleton Program Assistant Senior Admin Assistant 8
Agenda and Logistics for this Meeting Steve Clauser, PhD, MPA Director, Healthcare Delivery and Disparities Research
Program Updates Steve Clauser, PhD, MPA Director, Healthcare Delivery and Disparities Research
Overview of PCORI PCORI’s MISSION PCORI helps people make informed health care decisions, and improves health care delivery and outcomes, by producing and promoting high integrity, evidence-based information that comes from research guided by patients, caregivers and the broader health care community. Assessment of Improving Communication & Prevention, Diagnosis, Healthcare Dissemination and Treatment Options Research Systems Accelerating PCOR Addressing and Methodological Disparities Research Addressing Disparities Goal Statement IHS Goal Statement To support comparative effectiveness research that will identify best options for reducing and eliminating To support studies of the comparative effectiveness of alternative features of healthcare systems that will provide information of value to patients, their caregivers and clinicians, as well as to healthcare disparities. leaders, regarding which features of systems lead to better patient-centered outcomes .
Healthcare Delivery and Disparities Research (HDDR) Healthcare Delivery and Disparities Research Number of projects : 164 Amount awarded : $568 million Number of states represented: 28 (plus DC) ) Improving Healthcare Systems (IHS) Number of Projects: 92 Amount Awarded: $371 million Addressing Disparities (AD) Number of Projects: 72 Amount Awarded: $197 million 13
HDDR: Defined Disparities Medicare reimbursement, Community-based National Health resources, local Federal health reform, Policy Environment Accreditations, etc. hospital services, local professional State Health Policy norms, churches etc. Medicaid Environment reimbursement, Hospital performance Organizational Local Community data, etc. leadership, Delivery Environment system design, Clinical decision Caregivers, friends, Organization support, etc. network support, and/or Practice social media, etc. Setting Communication Provider/Team barriers, cultural Socio-demographics, Family & competency, staffing insurance coverage, Social mix, team culture, role comorbidities, patient Supports definition, care preferences, bias/prejudice, etc. behavioral factors, Individual cultural perspectives, Patient etc. Figure adapted from: Taplin, SH; Clasuer, S., et al. (2012). Introduction: Understanding and Influencing Multilevel Factors across the Cancer Care Continuum. Journal of the National Cancer Institute, 44, 2-10.
IHS Studies Comparing Interventions by System Level System Level Examples of Comparisons in the IHS Portfolio Compares the use of an electronic asthma medication tracker to standard Individual Patient primary care (no tracker) for children with asthma and their parents and caregivers to improve quality of life, among other patient-centered outcomes. Compares the use of advance planning tools for access to community-based Family and Social and in-home services for the frail elderly and their caregivers to an electronic Supports educational intervention of available services and programs. Measures understanding and knowledge outcomes. Compares nursing home staff team-based training and palliative care delivery using an adapted NQF protocol to a standard nursing home palliative care Provider/Team protocol to improve EOL outcomes, such as pain, shortness of breath, in- hospital deaths, hospitalizations, and presence of advance directive Compares elements of patient-centered medical home (e.g., addition of a PCP in the context of regularly scheduled dialysis sessions and health promoters to Organization and/or help support patients and their caregivers) to traditional team-based specialty Practice Setting care for end-stage renal disease patients to improve utilization, quality of life and caregiver burden outcomes. Compares an ED-to-home community health worker that links patients with Local Community community-based social-support (e.g., home-delivered meals) and medical Environment follow-up, to care transition programs using written and verbal discharge instructions alone to improve utilization and quality of life outcomes. 15
Addressing Disparities Framework Barriers Mediators Outcomes Use of Services *Modified from Lisa A. Cooper: Barriers to and mediators of equitable health care for racial and ethnic groups 16
AD Driver Model 17
HDDR: Strategic Framework Patient and Stakeholder Engagement Throughout Intervention Targets: • Technology (e.g., inter- operative EHR, telemedicine, Improve Practice: Improve Outcomes social media) that Matter to • Novel deployment of Patients: • Quality personnel (e.g., nurse • Coordination navigators, community health • Efficiency workers, home-care physicians, • Clinical Outcomes health care teams) • Patient and • Functional Status • Creative uses of incentives Caregiver • Health-Related (e.g., free or subsidized Involvement Quality of Life • Access preventive care, cost-sharing, • Symptoms • Equity patient incentives) • Survival • Organizational Policies : (e.g. standing orders, policies) • Cultural tailoring: (family involvement, language) 18
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