Provision of Preventive Services in the Complex Patient (Text Version)

Slide Presentation from the AHRQ 2008 Annual Conference

On September 9, 2008, Laura Castro, Maureen Smith, made this presentation at the 2008 Annual Conference. Select to access the PowerPoint® presentation (144 KB).

Slide 1

Provision of Preventive Services in the Complex Patient

AHRQ Annual Meeting
September 9, 2008.

Slide 2

The Issue

• Aging American population.
• Rising prevalence and burden of chronic illnesses.
• Most quality metrics designed for the uncomplicated case.

Slide 3

Goals of the Funding Opportunity

• Inform prioritization of guidelines, whether for prevention or disease management, in order to:
  • Maximize effective care.
  • Avoid inappropriate incentives for clinicians.
  • Respect patient autonomy and choice in the setting of a limited life span.

Slide 4

Three Study Types Envisioned

1. Descriptive Epidemiology.
2. Analytic Epidemiology.
3. Modeling.

Slide 5

Descriptive Epidemiology

• Large data set analyses (population surveys, medical databases, electronic health record (EHR), insurance claims).
• Chronic illnesses needing:
  • Natural history.
  • Impact on quality of life over time.
  • Life expectancy.
• Cumulative burden of therapies over time:
  • Number and types of medications.
  • Other recommended treatments.
  • Services for tertiary prevention.

Slide 6

Analytic Epidemiology

• Retrospective cohort designs.
• Assess benefits and harms of preventive or therapeutic interventions.
• In "real world" settings for patients who have multiple chronic co-morbid conditions.
• Require sufficient clinical data and innovative statistical techniques to determine the relative positive and negative impacts of prevention/therapy in a populations with co-morbid illness.

Slide 7

Modeling studies

• Decision models and cost-effectiveness analysis.
• Project impact of recommended therapies and preventive services on patients with two or more co-morbid chronic conditions.
• Models sufficiently comprehensive to model the impact of the co-morbid illness on.
  • Issues of competing morbidity and/or mortality.
  • Benefits and harms of the intervention.

Slide 8

R21 Grant Program

• 2008 funds $3.7 million.
• 18 awards.
• R21 : exploratory research.
• Second phase planned for 2010 to build on results.

Slide 9

Today's Presenters

• 'Complex Patient' R21 grantees:
  • Laura M. De Castro MD; Duke U.
    • "Relationship of Depression to Sickle Cell Disease Severity, Health Care Utilization and Quality of Life."
  • Maureen Smith MD; U. Wisconsin
    • "Guideline Adherence and Health Outcomes in Medicare FFS Patients with Diabetes."
• Expert commentary:
  • Barbara J. Turner MD, MSED, MA.
    Professor of Medicine
    Division of General Internal Medicine
    University of Pennsylvania School of Medicine.