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Maximizing the Impact of Comparative Effectiveness Research: The Role of the DEcIDE Consortia

Slide presentation from the AHRQ 2009 conference.

On September 14, 2009, Scott Smith made this presentation at the 2009 Annual Conference. Select to access the PowerPoint® presentation (3 MB).

Slide 1

Maximizing the Impact of Comparative Effectiveness Research: The Role of the DEcIDE Consortia

Scott R. Smith, PhD
AHRQ Center for Outcomes & Evidence
US Department of Health & Human Services


Slide 2

Effective Health Care (EHC) Program, 2003 - Present

  • Authorized in 2003 by Section 1013 of the Medicare Prescription Drug, Improvement, and Modernization Act
  • Conducts objective comparisons of the effectiveness of different health care interventions
  • Goal: To support informed health care decisions by patients, clinicians, and policymakers and improve the quality, effectiveness, and efficiency of health care to support evidence-based practice


Slide 3

Effective Health Care Program

  • Evidence synthesis (EPC program)
    • Systematically reviewing, synthesizing, comparing existing evidence on treatment effectiveness.
    • Identifying relevant knowledge gaps.
  • Evidence generation (DEcIDE, CERTs)
    • Development of new scientific knowledge to address knowledge gaps.
    • Accelerate practical studies.
  • Evidence communication/translation (Eisenberg Center)
    • Translate evidence into improvements
    • Communication of scientific information in plain language to policymakers, patients, and providers.


Slide 4

CBO Comparative Effectiveness Definition

Comparative Effectiveness
".a rigorous evaluation of the impact of different options that are available for treating a given medical condition for a particular set of patients."
Congressional Budget Office, 2007


Slide 5

Priority Conditions for the Effective Health Care Program

  • Arthritis and non-traumatic joint disorders
  • Cancer
  • Cardiovascular disease, including stroke and hypertension
  • Dementia, including Alzheimer's Disease
  • Depression and other mental health disorders
  • Developmental delays, attention-deficit hyperactivity disorder, and autism
  • Diabetes Mellitus
  • Functional limitations and disability
  • Infectious diseases, including HIV/AIDS
  • Obesity
  • Peptic ulcer disease and dyspepsia
  • Pregnancy, including pre-term birth
  • Pulmonary disease/Asthma
  • Substance abuse


Slide 6

Available EHC Products

  • Research Reviews
  • New Research Reports
  • Technical Briefs
  • Summary Guides


Slide 7

Evidence Generation

  • DEcIDE (Developing Evidence to Inform Decisions about Effectiveness) Network.
    • Capitalizing on data
    • New methods
    • Answers for questions that don't require multi-year, multi-million $ trials


Slide 8

What Does DEcIDE Primarily Do?

  • Analyze existing health care databases to compare the effectiveness & outcomes of treatment.
  • Analyze existing disease, device, and other registries.
  • Conduct methodological studies to improve research on clinical effectiveness of treatments.


Slide 9

Summary &"Unofficial" DEcIDE Statistics

  • 13 DEcIDE centers.
  • Over 60 core clinical scientists.
  • Over 500 affiliated personnel.
  • Access to >120 different health databases.
  • Health data on over 50 million Americans.
  • Nation's largest network of researchers in therapeutic effectiveness.


Slide 10

AHRQ DEcIDE Research Centers

Image: A map of the United States is shown with the 13 research centers.

  1. Acumen, LLC - Palo Alto, CA
  2. U of Colorado - Aurora, CO
  3. U of Pennsylvania - Philadelphia, PA
  4. U of Illinois - Chicago, IL
  5. Vanderbilt U - Nashville, TN
  6. Outcome Science - Cambridge, MA
  7. Harvard Pilgrim - Boston, MA
  8. U of Maryland - Baltimore, MD
  9. U of North Carolina - Chapel Hill, NC
  10. Brigham & Women's Hospital - Boston, MA
  11. Johns Hopkins - Baltimore, MD
  12. Duke University - Durham, NC
  13. RTI International - RTP, NC


Slide 11

DEcIDE Focus Areas in Comparative Effectiveness

An image of a three tiered circle is shown

First Tier

  • Cancer
  • Diabetes
  • Cardiovascular
  • ADHD
  • TBD

Second Tier

  • Distributed Networks
  • Methods
  • Data Analytics
  • Stakeholders

Third Tier

  • Comparative Effectiveness


Slide 12

Comparative Effectiveness and the Recovery Act

  • The American Recovery and Reinvestment Act of 2009 includes $1.1 billion for comparative effectiveness research:
    • AHRQ: $300 million
    • NIH: $400 million (appropriated to AHRQ and transferred to NIH)
    • Office of the Secretary: $400 million (allocated at the Secretary's discretion)

Funding for health IT, prevention and other areas could have implications for the Agency


Slide 13

Today's Speakers

  • 3:15-3:35
    • Cardiovascular Consortium
      Eric D. Peterson, MD, MPH, FAHA, FACC
      Professor of Medicine, Division of Cardiology
      Duke University Medical Center
  • 3:35-3:55
    • Diabetes Consortium
      Joe Selby, MD, MPH &
      Director, Division of Research
      Kaiser Permanente, North California
  • 3:55-3:10
    • Cancer Consortium
      Deborah Schrag, MD & Caprice Greenberg, MD,MP
      Dana-Farber Cancer Institute
      Department of Medicine, Harvard Medical School
  • 3:10-3:25
    • Audience Questions to Panel



Slide 14

Recovery Act Timeline: AHRQ

February 17: The American Recovery and Reinvestment Act of 2009 is signed into law

March 19: Establishment of Federal Coordinating Council for Comparative Effectiveness Research

May 1: Due date for Agency wide and program-specific Recovery Act plans

June 30: Due date for IOM submission of a list of national priority conditions*

July 30: AHRQ to submit FY '09 Operations Plan

November 1: AHRQ FY '10 operations plan due

December 31, 2010: All Recovery Act funding to be obligated

* Stakeholder input required


Slide 15

CER Moving Forward: Issues to Consider

  • Comparative Effectiveness is a useful tool in a much larger toolkit - it is not "the answer"
  • Comparative Effectiveness does not make policy or health care decisions, tell doctors how to practice medicine or make final decisions about what kind of treatments insurers will pay for
  • Comparative Effectiveness does weigh the evidence and present it in a way that helps consumers and their doctors make the best possible decisions about health care choices


Slide 16

The Future

  • Public-private funding and participation likely a necessity
  • More effort to get better conditional reimbursement study designs/protocols
  • Patients should be engaged as partners at the local and national levels
  • Need to tackle important issues
    • Ethical
    • When to know when the evidence is sufficient
    • Transparency
    • Setting priorities
Current as of December 2009
Internet Citation: Maximizing the Impact of Comparative Effectiveness Research: The Role of the DEcIDE Consortia. December 2009. Agency for Healthcare Research and Quality, Rockville, MD.


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