01-09c - introduction to healthcare and public health in the us - unit 09 - healthcare reform -...

Introduction to Healthcare and Public Health in the USThe Evolution and Reform of

Healthcare in the USLecture c

This material (Comp1_Unit9c) was developed by Oregon Health & Science University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number IU24OC000015.

The Evolution and Reform of Healthcare in the USLearning Objectives

2

• Describe evidence-based medicine, clinical practice guidelines, and quality indicators in medicine (Lecture a, b, c)

• Describe the patient-centered medical home model (Lecture d)

• Discuss the key issues driving healthcare reform in the US (Lecture e)

Health IT Workforce Curriculum Version 3.0/Spring 2012

Introduction to Healthcare and Public Health in the US The Evolution and Reform of Healthcare in the US

Lecture c

Quality Indicators In Medicine

3Health IT Workforce Curriculum Version 3.0/Spring 2012


Lecture c

• What is quality?• "the degree to which health services for

individuals and populations increase the likelihood of desired health outcomes, in a manner that is consistent with current professional knowledge.“ (Institute of Medicine, 2001)

What Does Quality Mean?

• Better patient outcomes (patient health)• Better system performance (patient care)• Better professional development (clinician

learning)• Scientific evidence + particular context =

measured performance improvement



Lecture c

Agency for Healthcare Research and Quality (AHRQ)



Lecture c

• Part of Department of Health and Human Services

• Mission: “to improve quality, safety, efficiency, and effectiveness of healthcare for all Americans”– Safety and quality: Reduce risk of harm– Effectiveness: Improve healthcare outcomes– Efficiency: Transform research into practice

Methods To Promote Quality



Lecture c

• Metrics for measuring quality– Process measures– Outcome measures

• Role of EHR in improving quality– Data collection– Data analysis

• Plan-Do-Study-Act (PDSA) cycle• Organizational standards

Comparative Effectiveness Research (CER)



Lecture c

• In 2008 the Institute of Medicine noted that patient care “should be based on the conscientious, explicit, and judicious use of current best evidence”

• In 2009 the IOM defined CER as “…evidence that compares the benefits and harms of alternative methods…”

Comparative Effectiveness



Lecture c

• Generate evidence from research studies • Compare drugs, tests, healthcare delivery

methods, etc.• Researchers may look at existing studies,

or devise new studies• They may develop or use different

methods and sources of data

Steps in Comparative Effectiveness Research (CER)



Lecture c

• Review and synthesize current medical research

• Promote and generate new evidence and analytic tools

• Translate and disseminate research findings to diverse stakeholders

Benefits of CER



Lecture c

• CER stakeholders – spectrum of individuals who make informed decisions that will improve healthcare

• CER may provide information about benefits and harms

• CER can compare costs of different treatments based on outcomes

• CER helps patients and physicians to choose between treatments

Emphasis on CER is a part of Healthcare Reform



Lecture c

• The American Recovery and Reinvestment Act of 2009 created the Federal Coordinating Council for Comparative Effectiveness Research

Evolution and Reform of Healthcare in the USSummary – Lecture c

12

• Defined quality indicators• Approaches to quality improvement, e.g.,

“Plan, Do, Study, Act”• Described Comparative Effectiveness

Research (CER)

Health IT Workforce Curriculum Version 3.0/Spring 2012


Lecture c

Evolution and Reform of Healthcare in the US

References – Lecture cReferences • Committee on Quality Healthcare in America, Institute of Medicine, . (2001). Crossing the quality

chasm: a new health system for the 21st century. Washington,, DC: National Academy Press.• Comparative Effectiveness Research Funding. (n.d.). Retrieved December 6, 2011, from U.S.

Department of Health & Human Services/Recovery website: http://www.hhs.gov/recovery/programs/cer/index.html

• Initial National Priorities for Comparative Effectiveness Research. (2009). Retrieved from National Academies Press, Washington DC 20055 website: http://www.nap.edu/catalog.php?record_id=12648#toc

• Sox, H. C., Helfand, M., Grimshaw, J., Dickersin, K., & the PLoS Medicine Editors, et.al. (2010, April 29). Comparative effectiveness research: Challenges for medical journals [editorial]. The Cochrane Library, Retrieved from http://www.thecochranelibrary.com/details/editorial/687971/Comparative-Effectiveness-Research-Challenges-for-Medical-Journals.html



Lecture c

http://www.hhs.gov/recovery/programs/cer/index.html

http://www.nap.edu/catalog.php?record_id=12648#toc

http://www.thecochranelibrary.com/details/editorial/687971/Comparative-Effectiveness-Research-Challenges-for-Medical-Journals.html

http://www.thecochranelibrary.com/details/editorial/687971/Comparative-Effectiveness-Research-Challenges-for-Medical-Journals.html

01-09c - introduction to healthcare and public health in the us - unit 09 - healthcare reform -...

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