1、Technology and Caregiving: Research Priorities,Carolyn Clancy, MD Director October 3, 2003,Overview,About AHRQ: The Evidence Agency Health-information technology: essential to improving health and health care Research opportunities,AHRQ Customers and Goals,Outcomes,Quality,Cost, Use and Access,Clini
2、cal Decision-makers,Health System Decision- makers,Public Policy Decision- makers,AHRQ RESEARCH FOCUS: HOW IT DIFFERS,Patient-centered, not disease-specific Dual Focus - Services + Delivery Systems (including home) Effectiveness research focuses on actual daily practice, not ideal situations (“effic
3、acy”) AHRQ mission includes production and use of evidence-based information,Overview,About AHRQ: The Evidence Agency Health-information technology: essential to improving health and health care Research opportunities,New York Times, December 18, 2002,RAND Study: Quality of Health Care Often Not Opt
4、imal,Medical Care Often Not Optimal Failure to Treat Patients Fully Spans Range of What Is Expected of Physicians and Nurses,Study: U.S. Doctors are not following the guidelines for ordinary illnesses,.,The American healthcare system, often touted as a cutting-edge leader in the world, suddenly find
5、s itself mired in serious questions about the ability of its hospitals and doctors to deliver quality care to millions.,Medical errors corrode quality of healthcare system,RAND Study: Quality of Health Care Often Not Optimal,Doctors provide appropriate health care only about half the time,Percentage
6、 of time,E. McGlynn, S. Asch, J. Adams, et al., The Quality of Health Care Delivered to Adults in the United States, N Engl J Med, 2003,Potential of IT for Assessing Quality,IT can enhance the precision and decrease the cost of measurement i.e., getting to the “right” measures IT can also enhance tr
7、anslation of strategies to improve quality (e.g., decision support) IT can greatly enhance the timeliness of data collection,“Potential is what you have when you havent done it yet” Darrel RoyallUniversity of TexasFootball coach,Percent of Americans Saying “I Have A Chronic Condition”,Chronic Illnes
8、s and Caregiving Survey, Harris 2000,Patient-Centered Care,Information technology can support: Communication Clinical knowledge Online support groups Decreased hospitalizations and shorter lengths of stay Improve health care outcomes Improved quality of lifeGustafson et al. Am J Prev Med. 1999,Resea
9、rch in Progress - 1,Clinical decision support to reduce medication errors and adverse events in nursing homes Use of HIT to identify patients at high risk of adverse outcomes in long term care settings Use of HIT to improve pain management for patients at home Impact of shared medical records on qua
10、lity, safety and patient-MD communication,Research in Progress - 2,Computerized tool to help individuals choose which Medicare plan is best for them CHESS: on-line information and support to improve patient outcomes (HIV; other conditions) Decision support: should I be screened for prostate cancer?,
11、Overview,About AHRQ: The Evidence Agency Health-information technology: essential to improving health and health care Research opportunities,IT and Research,Identify and prioritize critical questions: e.g., clinical variations as a reflection of inadequate knowledge Accelerate collection of relevant
12、 data Facilitate consistent measurement of key outcomes Enhance participation of communities and stakeholders “Reinvent” dissemination and translation,Shared Decisionmaking: Decisions and Outcomes,Alternative 1,Alternative 2,Patient,IT and Population Health,Enhance healthy behaviors e.g., exercise,
13、diet Facilitate data sharing within and across communities regarding potential threats to public health Facilitate registries (e.g., immunizations) and exchange of information across systems Linking data sources: target improvement efforts,Admissions per 100,000 Population - County of Patient Reside
14、nce,Diabetes Long-Term Complications,Dallas-Fort Worth Hospital Council - Data Initiative - 2000 Hospital Discharge Data,September 26, 2002,Texas,Example,“Dorothy,” a very obese 32 year old woman, is seen for a suspected UTI and found to have diabetes Her physician provides information about diet an
15、d exercise but is only cautiously optimistic One month later, Dorothy returns, having lost 30 lbs and shows Dr. C how she is using a customized application for her Palm Pilot to track her progress with diet and exercise,IT Challenges,Put IT that we know works into practice Support the development an
16、d implementation of IT innovations Develop IT and other health care innovations that put the patient at the center of care Translate these new IT innovations into practice Researchers, health care professionals, engineers, and others need to work together to ensure that clinical care design and infr
17、astructure support the full potential of IT,Critical Challenges,Common data elements and definitions; build capacity to make improvements Clear rules of the road: Who owns the data? Who decides what is in a record? Who can make changes? IRBs Transparency of purpose of data collection and use Making
18、it easy,Secretary Thompson March 21, 2003,In the modern era, every century has had its major advance that has brought medical science another giant step forward. . What will the major advance of the 21st century be?I am convinced that the medical revolution of our childrens lifetimes will be the application of information technology to health care.,
