By Richard Kronick, Ph.D.
On June 15, 2015, while attending AcademyHealth’s Annual Research Meeting in Minneapolis, I was excited to announce AHRQ’s plans to fund three Centers of Excellence to study how health care systems promote evidence-based practices in delivering care. The centers will identify the characteristics of health systems that successfully disseminate and apply evidence from patient-centered outcomes research (PCOR) and analyze the connections between successful dissemination of PCOR, patient health outcomes, and effective use of resources.
AHRQ has enjoyed a groundbreaking role in support of evidence-based medicine and the dissemination of PCOR into clinical practice. Increasingly, health care is being delivered by providers who are part of health systems. As we work to disseminate PCOR more broadly to patients and clinicians, we want to capitalize on the lessons learned by systems that have figured out how to successfully disseminate evidenced-based medicine. There is much to learn, particularly about how large delivery systems with new types of complex and virtual arrangements, incentives, and ownership structures, use evidence to improve care. To transform health care in the U.S., we must develop methods and data to identify and compare these large, diverse systems that are emerging nationwide.
Understanding how health systems disseminate information on what works—and what doesn’t—will further fuel the momentum toward evidence-based practice. Grants for the three Centers of Excellence—funded by the Patient Centered Outcomes Research Trust Fund, created by the Affordable Care Act—will provide approximately $52 million over 5 years to identify, classify, track, and compare health care delivery systems to understand the organizational and environmental factors affecting the use of evidence-based medicine. Supporting the Agency’s effort to accelerate the dissemination and implementation of PCOR aligns with the wider Department of Health and Human Services (HHS) Delivery System Reform Initiative to encourage better care, smarter spending, and healthier people.
The three Centers of Excellence that will carry out this work, their principal investigators, and their area of focus include:
- Dartmouth College (Principal Investigator: Elliott Fisher, M.D., M.P.H.), in collaboration with the University of California at Berkeley, Harvard University, and the High Value Healthcare Collaborative (18 systems). This center will use mixed methods involving existing and ongoing claims-based data, conduct a national survey of health care organizations and systems to understand the inner workings of systems, and, in particular, explore how market and organizational factors influence the implementation of biomedical, delivery system, and patient engagement innovations.
- National Bureau of Economic Research (NBER) (Principal Investigator: David Cutler, Ph.D., Harvard University and NBER), in collaboration with the Health Research & Educational Trust and the Network of Regional Healthcare Initiatives. This center will create a large national database to identify health systems in the United States and their characteristics and outcomes, as well as the evolving consolidation and integration of systems over time, and use that data to study health systems nationally as well as cancer care, pediatric health care delivery, and dialysis and post-acute care.
- RAND Corporation (Principal Investigator: Cheryl Damberg, Ph.D.), in collaboration with Pennsylvania State University. This center will examine health systems in five regions with the goal of understanding the role of incentives, use of health IT, and organizational integration within systems and their impact on performance and evidence dissemination.
AHRQ also will fund a coordinating center to help facilitate collaboration between the three centers in the development of a national compendium of the performance of health care systems across the U.S.
AHRQ’s efforts to understand more about health systems are an essential complement to our recently launched EvidenceNow initiative. This work focuses on helping small- and medium-sized primary care practices in 12 States improve the heart health of their nearly 8 million patients. I’m confident that these efforts, taken together, will provide crucial understanding about the most effective strategies for disseminating evidence in diverse clinical practice settings.
About the Author: Richard Kronick, Ph.D., is Director of the Agency for Healthcare Research and Quality. This article was originally published on AHRQ Views Blog and is republished here with permission.