1. Research Evaluation and Evidence Generation in Population Health
Welcome to Research Evaluation and Evidence Generation in Population Health. This is Lecture c.
Lecture c
This material (Comp 21 Unit 10) was developed by Johns Hopkins University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number 90WT0005.
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2. Research Evaluation and Evidence Generation in Population Health Learning Objectives — Lecture c
Discuss health information technology (HIT) needs for proposed interventions.
Extend current trends in population health research into the future given new capabilities that are emerging.
The objectives for this lecture are:
Discuss HIT needs for proposed interventions, and
Extend current trends in population health research into the future given new capabilities that are emerging.
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3. What Is HIT?
HIT consists of an enormously diverse set of technologies for transmitting and managing health information for use by:
Consumers.
Providers.
Payers.
Insurers
All the other groups with an interest in health and health care.
Let’s review: what is HIT? Well, it's an enormously diverse amount of technologies, in fact, health information technology.
Many consumers will be aware using wearable devices such as Fitbits and FuelBands. They'll have health IT on their phones. They'll be looking for health information on the Internet.
We often think about health information technology being important to providers. But payers and insurers also use health information technology to facilitate the collection of insurance and other benefits.
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4. What Are the Various Components of HIT? — 1
Applications.
Patient registries.
Accounting and practice management systems (PMS).
Computerized physician order entry with clinical decision support (CPOE/CDS).
E-prescribing.
Electronic medical record (EMR) and electronic health record (EHR).
Patient health records (PHRs).
A few applications that may be relevant to those engaged in population health endeavors are patient registries. These are often disease-specific or treatment-specific. For example, for disease-specific registries, there are diabetes and cancer registries. For intervention-specific, we have documents of vaccines.
Accounting and practice management systems: these overlay many hospital or medical groups. These practice management systems, to name a few functions, staff the nurses, make sure that they're there on time, perform payroll tasks, and schedule patients. Practice management systems can vary widely in their own right.
Physicians will often use something called computerized physician order entry (CPOE). Here is where the physician will put in the instructions to other clinicians on how to tend to patients. E-prescribing is how you get your medications. Again, a lot of this takes place in something called an electronic medical record, or EMR. The consumer will access the EMR through something called the patient portal, or patient health record.
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5. What Are the Various Components of HIT? — 2
Applications.
Results reporting.
Electronic documentation.
Appointment scheduling.
Patient kiosks.
Telemedicine.
Interface engines.
What are some more components of health information technology? As outputs, you will see results reporting. You may get a lab result back. You may go to someplace like LabCorp and have a blood draw. You may get an that will tell you things such as your cholesterol level or some other lab report in which you’re interested. That may also go directly to your physician and be entered into your electronic medical record as a form of electronic documentation. More HIT includes appointment scheduling and patient kiosks. Telemedicine has been with us for many years now, but it’s growing rapidly. The day will come when we can simply turn on our smart phone and consult face to face with our physician. That'll be wonderful.
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6. What Are the Various Components of HIT? — 3
Process.
HIE (health information exchanges).
RHIOs (regional health information organizations).
MPI (message passing interface).
HIPAA security.
A larger part of the various HIT components occurs at the regional or state level. These are health information exchanges, or regional health information organizations. The hope is that whatever provider you see will have access to your medical record. This will save money on the creation of new information. In other words, you don't want every doctor you see to order unnecessary lab tests. With health information exchanges, you can share information and also keep it secure.
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7. Why Is HIT Useful/Necessary?
Health care delivery is inherently fragmented.
Multiple providers/services and multiple payers.
More than 360,000 care delivery sites in the U.S.
Inefficient or absent communication.
Increased provider.
HIT is necessary because health care is fragmented. There are many providers operating in many types of sites, whether it is a hospital, medical group, something we call the “doc in a box,” which may be a physician site located in a strip mall or some other unusual setting. We even see doctors' offices in commercial outlets such as Walmart and Sears. So, it’s really quite fragmented. That's why HIT is important: we hope to connect those various parts in a unified way so that you, the customer, gets a holistic treatment.
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8. Ultimate Goal of Using HIT: Triple Aim
Improve the quality of health services and outcomes for all patients.
Reduce the cost of health overall.
Make sure health care is more integrated.
Not only to collect data.
Data used to track, alert, and manage:
Individual patient outcomes.
Population health outcomes.
Improve overall care of all patients.
And what is the ultimate goal? It is the Triple Aim: improving the quality of health; reducing the cost of health overall; and ensuring that health care is more integrated. It's not only collecting data; hopefully it’s used to manage your care.
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9. Current Population Health Priority Questions
What works?
For whom? Under which circumstance? At what cost? Compared to what?
How do you implement, sustain, and spread effective interventions?
What is the impact of the Affordable Care Act?
On services? On health? On disparities?
There are many priorities that are being framed more and more frequently in population terms. It’s important to distinguish between population and public. Public is usually a large swath of our community—and it may not differentiate those people in a meaningful way. For example, looking at African American communities, which occasionally have different issues than other communities for a variety of reasons. Another example, looking at women only, because of a particular health issue. Looking at a population of students. Looking at a population in a workplace. And that’s why the population question is becoming more and more important. The Affordable Care Act is actually influencing what types of services are delivered in what setting. Are disparities really being reduced?
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10. Research Implications
Comparative effectiveness research (CER).
Experimental designs.
Population health services and systems research.
Dissemination and implementation research.
Both health care and population health services need to be functioning properly in order for our community to get a holistic set of care. What are the research implications of this? The Affordable Care Act has had a significant influence on this when it was legislated quite explicitly that more comparative effectiveness research (CER) is needed. In research design, these would be your classic multiple intervention studies.
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11. Affordable Care Act Definition: Comparative Effectiveness Research (CER)
“Research evaluating and comparing health outcomes and the clinical effectiveness, risks, and benefits of 2 or more medical treatments, services, and items.”
So how does the Affordable Care Act actually define comparative effectiveness research? “Research evaluating and comparing health outcomes and the clinical effectiveness, risks, and benefits of two or more medical treatments, services, and items.”
In other words, this is where we really want to see that if you're trying to improve the diet of a particular population (in this specific case, we said medical treatments), that multiple interventions are actually being examined.
Source: Garber, A. M., & Sox, H. C., 2010.
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12. Affordable Care Act Definition: Medical Treatments, Services & Items
Defined as “health care interventions, protocols for treatment, care management, and delivery, procedures, medical devices, diagnostic tools, pharmaceuticals (including drugs and biologicals), integrative health practices, and any other strategies or items being used in the treatment, management, and diagnosis of, or prevention of illness or injury in, individuals.”
The medical treatments, services, and items of CER are much broader than just pure treatments. We can define them as health care interventions, protocols, treatment care management, delivery procedures, diagnostics, devices, and on and on. You can see their full description on this slide.
Source: Dreyer, N. A., et al, 2010.
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13. CER Defining Characteristics
Objective of directly informing clinical or health policy decision.
Compares at least two alternatives.
Results at population and subgroup level.
Measures outcomes important to patients.
Methods and data sources appropriate for the decision of interest.
Conducted in real-world settings (population health).
A defining characteristic of comparativeness effectiveness research is that it should also have population-based objectives that can be expressed in policy terms. This should be important to the consumers. You’ll see many of these programs explicitly include consumer audiences as part of their management boards.
The methods and data sources should match the research question. If you think you need a research designer or a statistician, you probably do. If you’re asking the question, the answer is yes, and it's better to get them on board sooner rather than later. Lastly, people really want these conducted in real-world settings.
Source: Garber, A. M., & Tunis, S. R., 2009.
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14. Definition of Patient-Centered Outcomes Research (PCOR)
PCOR helps people make informed health care decisions and allows their voices to be heard in assessing the value of health care options.
More and more, the patient and the population is becoming the center of outcomes research. This actually goes by a very specific name: PCOR, patient-centered outcomes research.
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15. PCOR Answers Patient-Focused Questions:
“Given my personal characteristics, conditions and preferences, what should I expect will happen to me?”
“What are my options and what are the benefits and harms of those options?”
“What can I do to improve the outcomes that are most important to me?”
“How can the health care system improve my chances of achieving the outcomes I prefer?”
Here, you can see some of the characteristics around PCOR and how the patient-focused questions might be framed. Examples include given my personal characteristics, conditions and preferences, what should I expect will happen to me? And what are my options and what are the benefits and harms of those options? These questions are written in a similar format of a quality goal.
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16. PCORI Research Priorities
Assessment of prevention, diagnosis, and treatment options.
Improving health care systems.
Communication and dissemination research.
Addressing disparities.
Accelerating patient-centered outcomes research and methodological research.
The Affordable Care Act, and later legislation, actually created an institute for PCOR. The Patient-Centered Outcomes Research Institute (or PCORI) has research priorities. This institute is leading this trend in many ways, and it’s worth going to their website if you have the opportunity. They also have very good resources for those of us engaged in population health interventions. Here are a few of the topics that interest PCORI including assessment of prevention, diagnosis, and treatment options; improving health care systems; and accelerating patient-centered outcomes and methodological research.
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17. The ultimate goal of HIT is the Triple Aim.
Research Evaluation and Evidence Generation in Population Health Summary — Lecture c
HIT is necessary because health care is fragmented and HIT aims to unify the various parts of health care.
The ultimate goal of HIT is the Triple Aim.
Current trends in population health research will continue toward the future.
CER.
PCOR and PCORI.
Let's review what we've learned in this lecture. We've defined HIT and its components including applications and process, discussing the necessity of HIT to unify the various parts of health care. We've learned about some of the goals of HIT, specifically the Triple Aim. And we've also discussed population health priorities and some of the research implications that will extend current trends toward the future. Specifically, we learned more about comparative effectiveness research and patient-centered outcomes research.
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18. Population Health Research Evaluation and Evidence Generation in Population Health Unit Summary
Community engagement, effective research design and evaluation are important factors in population-based interventions.
Purpose-driven and focused literature reviews support proposed interventions.
Current trends in HIT and population health research, including CER and PCOR, support the Triple AIM.
This concludes our unit on research evaluation and evidence generation in population health. In summary, we've discussed the processes of research and evaluation in population health in order to assess the value and effects that specific population-based interventions create. We've discussed the importance of community engagement, effective research design, and evaluation. We spent some time discussing literature reviews including search strategies and focus. And lastly, we discussed the necessity and goals of health information technology and population health research.
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19. Research Evaluation and Evidence Generation in Population Health References — Lecture c
Dreyer, N. A., Tunis, S. R., Berger, M., Ollendorf, D., Mattox, P., & Gliklich, R. (2010). Why observational studies should be among the tools used in comparative effectiveness research. Health Affairs, 29(10),
Garber, A. M., & Sox, H. C. (2010). The role of costs in comparative effectiveness research. Health Affairs, 29(10),
Garber, A. M., & Tunis, S. R. (2009). Does comparative-effectiveness research threaten personalized medicine?. New England Journal of Medicine, 360(19),
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20. Population Health Research Evaluation and Evidence Generation in Population Health Lecture c
This material (Comp 21 Unit 10) was developed by Johns Hopkins University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number 90WT0005.
No audio.
Health IT Workforce Curriculum Version 4.0