Creating the Capacity For Evidence-Based Care - Sax Institute

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Creating the Capacity For Evidence-Based Care Andrew B. Bindman, MD Professor University of California San Francisco July 5, 2018

Transcript of Creating the Capacity For Evidence-Based Care - Sax Institute

Page 1: Creating the Capacity For Evidence-Based Care - Sax Institute

CreatingtheCapacityForEvidence-BasedCare

AndrewB.Bindman,MD

Professor

UniversityofCaliforniaSanFrancisco

July5,2018

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• Researchersneedtoadaptmethodstogettheirevidenceusedmorebyendusers

• Enduserscanbepolicymakersorcouldbepractitioners

• Co-creatingisthewaytogo-atleastsometimes

Yesterday

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AlsoSomethingAboutFootball

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Co-Creation

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Co-Creation

HealthServicesResearchers

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Evidence and Tools fr

Implementation• Gap from medical evidence generation to practice implementationØ Estimated at 17 yearsØ Delays health benefitsØ Contributes to disparities

MovingEvidencetotheFrontlines

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GrowingKnowledgeBackUp

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• Highly reliant upon specialty societies

• Specialty societies have competing self-interests

• Conflicting guidance within the same institution

EvidenceDisseminationChannel

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• What will it take for change?

• Different opportunities for promoting evidence-based practice rather than evidence-based policy?

BurningPlatform

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• HealthcarepracticeisrapidlyconsolidatingØ Largesystemsreplacingsmall

practices

Ø Potentialtopoolresources

• EmergenceofEHRsØ Growinginavailabilityand

powertosupporteffort

Evidence-BasedPractice:WhyNow?

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PhysiciansinHealthSystems

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EvGen:TheVision

• Digitizeddatacansupportfaster,better,andlesscostlyresearch– Speedbumpsrelatedtounformatted,nonstandardizedentry

• Lowerbarrierstostudyingownpts– Strategicdecisionsaboutsharingdataandbenchmarkingperformance

AcceleratingDatatoKnowledge

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“Alearninghealthcaresystemis[onethat]isdesignedtogenerateandapply thebestevidenceforthecollaborativehealthcarechoicesofeachpatientandprovider;todrivetheprocessofdiscoveryasanaturaloutgrowthofpatientcare;andtoensureinnovation,quality,safety,andvalueinhealthcare.”

InstituteofMedicine/NationalAcademyofMedicine.TheLearningHealthcareSystem:WorkshopSummary.OlsenL,Aisner D,McGinnisJM,eds.Washington,DC:National

AcademiesPress;2007

LearningHealthCareSystem

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BetterHealth=D2K+K2P

D2K:Datato

Knowledge

K2P:Knowledgeto

PracticeK2PD2K

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LearningfromSports

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• DataandAnalytics

• Leadership

• Budget

• Businessneedtocreatevalue

Moneyball Ingredients

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• Alternative Payment Models• ACOs, PCMH

• Providers responsible for population cost and quality

• Potential for financial rewards and some risk

• Voluntary for physicians but incentivized through higher payment rate

PayingForValue

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EvGen:TheVision

• EvidenceGenerator

• EvidenceCurator

• EvidenceAdopter

• EvidenceDisseminator

• EvidenceManager

ChangingRoleoftheOrganization

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• Integratingclinicaldata

• Enrichingdatawith“-omics”,patient-derivedinformation

• Analyzingpracticevariation

• Clinicalgovernanceforevidence

HealthSystems’EmergingCapacity

K2PD2K

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• CommonITplatformacrossalllevelsofcare

• Usingevidenceforsystem(notspecialty)guidelines

• Payingdoctorstoaddresstheirownpracticevariation

• Usingevidencetosupportvalue-basedpurchasing

• Activesurveillancefornewevidenceinliterature

LeadingEdgeHealthSystems

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Changes in how care is reimbursed has stimulatedan interest in evidence but research funding stilloriented more towards D2K than K2P

ResearchFundstoAccelerateK2P

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• Toextractvaluefrompublicinvestmentinnewknowledge

• Ensurethateveryonebenefitsfrompublicinvestmentinresearch

• Re-directingfocustowardsorganizationalcapacities

PublicInvestmentinImplementation

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• Integratingclinicaldata

• Enrichingdatawith“-omics”,patient-derivedinformation

• Analyzingpracticevariation

• Clinicalgovernanceforevidence

HealthSystemsNeeds

K2PD2K

Informationbrokers:researcherswhounderstandmanagement

Toolstoincorporateknowledgeintotheworkflow

Metricsofachievement

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• AHRQ Initiative: To construct a set of core competencies to guide the development of training programs for learning health systems researchers

• Proposal: To embed trainees at the interface of research, informatics and clinical operations within learning health systems

TrainingANewTypeofHealthServicesResearcher

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• Insider perspective• Immersion within a ‘host’

organisation• ‘Co-production’ with

practice community• Knowledge created ‘on the

ground’ • Simultaneous generation

and uptake of evidence• Enhance research capacity

of the host organisation

EmbeddedResearcher

Vindrole-Padros et al (2017) BMJ Quality & Safety

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• Investingininvestigatorteamsworkingincollaborationwithhealthsystems

• Rapidrigoroustestingratherthanlargebetonapre-specifiedapproach

• LeveraginghealthsysteminvestmentinK2P

• Publicdisseminationofresults

NewFundingModel

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KnowledgetoPracticeTools

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KnowledgetoPracticeTools

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• Learning collaborative of learning health care systems

• Organizational Level– Progress toward becoming a

learning healthcare system

ImplementationMetricsofAchievement

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• Lessaboutprovidingenduserswithaproduct

• Moreabouthelpingenduserstogrowtheirskillssotheycanimproveandsustaintheirefforts

KnowledgeTransfer

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TheClinicalandResearchDivide

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Thank you!

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