Post on 27-Mar-2015
AHCPR1
Using the Electronic Age to Improve Health Outcomes
J. Michael Fitzmaurice, Ph.D.
Agency for Health Care Policy and Research
April 28, 1999
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Overview
Much health information is available – Quality is a concern
How do you judge web site quality– Mitretek/HITI -- Others
Issues AHCPR’s Quality Tools Evaluation
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Where do people get health information?
Recent Rondale Press survey of American of all ages– Television--39 percent– Physicians--37 percent– Newspapers--28 percent– Family or friends--24 percent– Magazines--23 percent– Books--23 percent– The Internet came in lower at 13 percent
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How do people use health information?
To make choices in the market– Health plans– Physician– Nursing homes
To assist choices for treatment to improve quality of care and outcomes – Self-care decisions– Physician-patient decisions
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Desirable characteristics
Accessible, with search capability Seniors like large type--preferrably Arial
rather than Times Roman Health topic interest increases with
age--Healthfinder--Mary Jo Deering, HHS/ODPHP
Low readability levels
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Information Quality
“Good and bad information light up just as brightly”--
C. Everett Koop, MD
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Quality of Information
Coulter, et al., in British Medical Journal (Jan. 1999), evaluated patient materials.– Brochures -- Videos -- Phone helplines
One-third of materials evaluated did not have a publication date
Few materials admitted to any scientific uncertainty
Few were specifically designed to inform treatment choice.
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Criteria for Assessing Quality of Internet Health Information
Developed by Mitretek/Health Information Technology Institute--Helga Rippen, MD, Ph.D., MPH, Director
Convened over 20 experts from national organizations
To develop criteria and test them Targets: public, developers, policymakers WWW.MITRETEK.ORG/HITI
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Criteria
Credibility Content Disclosure Links Design Interactivity Caveats
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Credibility
Source– Credentials, Conflict of interest, Bias
Context Currency Relevance/Utility (validity) Editorial Review Process
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Content
Accuracy Hierarchy of evidence Original source stated Disclaimer Omissions noted
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Disclosure
Purpose of the site Profiling of users
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Links
Selection of forward links Architecture of site Content (accurate, current, credible,
relevant) Back linkages: number & quality
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Design
Accessibility Logical organization Internal search engine
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Interactivity
Mechanism for feedback Chat rooms and bulletin boards Tailoring--based on user characteristics
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Caveats
Alerts to users– Sound-alike names– Impressive sounding names– Puffery in claims--”miracles,” “secret cures,” “amazing
results”
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Top Ten Criteria
Straw test as an example: n=28– Source -- Disclosure– Accuracy -- Currency– Original source stated– Hierarchy of evidence– Relevance/Utility -- Disclaimer– Link-content -- Review process
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Other Site Evaluations
Mary Jo Deering and colleagues (Kim, et al. British Medical Journal, 1999)– Looks at published rating criteria for evaluating
the quality of health sites on the Web.– Found consensus of criteria, including
– Disclosure of authors and sponsors– Currency of information
Health Improvement Institute awards good ratings of sites.
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Issues
Privacy, confidentiality, security– Will people get personal health information
(PHI) about me that I do not release?– Will PHI I release, with conditions, not be
redisclosed without my approval?– By what means will disclosure and redisclosure
of PHI be prevented?– State laws– Federal law: Privacy Act, FOIA– International laws: EU Directive
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Issues
Oversight– FDA--Drugs and medical devices
– Clinical software is a device Competent human intervention
– FTC--misleading advertising and business practices
– False and deceptive claims and practices
Liability– Flawed medical advice– System failure
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Issues
Accreditation and Certification– Ability and capability to deliver– Quality and effectiveness of product– Examples:
– JCAHO– NCQA– State licensing boards
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Issues
Role of government– Investment: time, risk, B>C, access– Regulation– Education– Ensure competition
Payment for web health services– Private pricing– Government activity in payment
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Issues
Health system design and incentives– Web-based information may
– Increase the time physicians take to educate patient
– Reduce the patient seen/physician in 8 hours
– Improve healthiness and reduce the demand for future office visits , evidence of improved health system efficiency
– Physicians do not get paid for this extra time today
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Issues
Access for all– Many are disadvantaged--no access to a
computer or the Net.– African Americans, Hispanics,– Low income and rural families
– Universal Access--at any price? Public Health
– Externalities -- Efficiency– Equity
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Strategies
Strengthen EV and Q of Applications Improve Basic Knowledge Strengthen Capacity of Stakeholders
– Clearinghouses -- Collaborations Ensure Equitable Access Source: Wired for Health and Well-Being
– Science Panel on Interactive Communications and Health, April 1999
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AHCPR Snapshot
AHCPR-- a research agency that studies the U.S. health care system– Outcomes research
– Quality of care measurement
– Cost, Access, and Utilization What works to improve patient health
outcomes in the community?– And what does it cost?
Funds peer-reviewed research grants
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AHCPR’s Health Tools
Medical Expenditures Panel Survey– $30 million/year– 10,000 households/24,000 people– Also surveys employers, physicians, hospitals,
LTC facilities CONQUEST--a data base
– 1200+ clinical performance measures– Validity, availability– HEDIS, FACCT, scientific studies
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AHCPR’s Health Tools Consumer Assessment of Health Plans Survey
(CAHPS)– Will be used by 100 million people in 1999– Medicare, Medicaid, NCQA, OPM, Kaiser
National Guidelines Clearinghouse– www.guidelines.gov -- www.ahcpr.gov– AHCPR, AMA, AAHP partnership
Evidence-based Practice Centers– Compile science findings about specific health
conditions and procedures
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AHCPR’s Health Tools
Scientific Research Findings– Published findings
from AHCPR-funded grants
AHCPR staff expertise and collaboration
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What if we connected!
Personal web-based medical record Provider medical record Health plan enrollment and service
utilization record AHCPR tools
– CONQUEST--aggreg. cpms--provider/plan– CAHPS--patient evaluation in MR– NGC--providers guideline variation
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Evaluating Web Effectiveness
Number of hits is not sufficient for improved outcomes
Should make a difference in health outcomes and improving our lives
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Evaluating the Impact
Does improving access via web sites to critical health information lead to a greater number of– Hits? – Information
retrievals?
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Evaluating the Impact
Does a larger number of hits cause a change in – Provider choice of
treatment?– Patient behavior?
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Evaluating the Impact
Does the change in treatment choice and patient behavior lead to – Improved health
status?– Lower costs?– Both?
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Bottom Line
We need to design and provide information with outcomes in mind--
Dr. John Eisenberg AHCPR Administrator
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Bottom Line
Hits are not enough. We need to show their effects on patient and provider satisfaction and behavior change.
Most important, we need to learn their effects on improving peoples’ health and quality of life.
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Using the Electronic Age to Improve Health Outcomes
J. Michael Fitzmaurice, Ph.D.
Agency for Health Care Policy and Research
April 28, 1999