Collaborative Networks for Conducting Comparative Effectiveness Research

Slide Presentation from the AHRQ 2008 Annual Conference

On September 9, 2008, George Neyarapally, Wilson Pace, David West, Rich Platt, and David Magid, made this presentation at the 2008 Annual Conference. Select to access the PowerPoint® presentation (1.3 MB).

Slide 1

Collaborative Networks for Conducting Comparative Effectiveness Research

Tuesday September 9, 2008
8:00-9:30 a.m.

Slide 2

Session Outline

• 8:00—8:15 AHRQ introduction—George Neyarapally.
• 8:15—8:50 CO Distributed Research Network (DRN) project—Wilson Pace, David West.
• 8:50—9:25 HMO Research Network (HMORN) Distributed Research Network (DRN) project—Rich Platt, David Magid.
• 9:25—9:30 Questions.

Slide 3

Introduction: AHRQ's Distributed Research Network Initiative in DEcIDE

• George Neyarapally
  PharmD, MPH, RPh
  AHRQ, Center for Outcomes and Evidence

Slide 4

• Background.
• Rationale for Distributed Research Network Initiative.
• Goals of the Task Order.
• Benchmarks of Success.

Slide 5

• Established as part of Medicare Modernization Act (MMA) in 2005 and incorporated in the Effective Health Care program.
• 13-center research network that is designed to be a data and scientific resource to external public & private health organizations (particularly Centers for Medicare & Medicaid Services [CMS]) to provide unbiased, actionable information to inform decision makers.
• Main goal of DEcIDE is to develop new knowledge about the clinical and comparative effectiveness and safety of treatments and technologies in a valid, transparent, and scientifically rigorous manner.

Slide 6

Distributed Research Network Prototypes for Population-based Studies

• Two pilot project models of distributed research networks will be created & evaluated.
• The aim is to develop a distributed network prototype that supports secure analyses of electronic information across multiple organizations to study risks, effects, and outcomes of various medical therapies.
• The long-term goal is a coordinated partnership of multiple research networks that provide information that can be quickly queried and analyzed.

Slide 7

Unique Aspects of Effective Health Care Program

• User-driven research & systematic reviews.
• Transparent methods, with process for reviewing COI with every project.
• Research for public health:
  • Focused on improving quality of Medicaid, Medicare, SCHIP.
  • Programs with rising costs.
• Partnership with stakeholders & public nomination.

Slide 8

Rationale for Task Order (RFTO)

Current Research Paradigm?

• Silo investigators and databases. Lack of coordination of research across multiple institutions.
• Researchers and decision-makers are disconnected, often working independent of each other.
• Small studies often with limited external validity / generalizability which constrains good decisionmaking.
• Vast collections of data that are infrequently shared.
• Length to study completion does not meet the needs of policymakers, providers or patients.
• Perceived inability of government to respond quickly to emerging clinical questions & public health problems that face regulators, payers, providers, & individual patients.

Slide 9

Rationale for AHRQ's Distributed Research Network Initiative

• Leverage existing resources including intellectual (scientists) and data resources.
• Create a pipeline for conducting rapid cycle research related to clinical effectiveness and comparative effectiveness.
• Reduce the timeline for providing valid evidence that can inform clinical decisions and public health problems.
• Prepare for the future needs of federal government to address questions of public policy in real time.

Slide 10

Examples

• Simple:
  • How many patients receive carotid stents as compared to medical management?
• More complex:
  • Are patients who take dual therapy with ACE inhibitors and angiotensin receptor blockers at increased risk for adverse outcomes?
  • What is the balance of risks and benefits of combination therapy?

Slide 11

Major Components of AHRQ's DRNI

• Two pilot projects:
  • HMORN.
  • University of Colorado & American Academy of Family Physicians (AAFP).
• Internal working group including Health Information Technology (Health IT) staff and coordination with Food and Drug Administration (FDA) and other federal health agencies.

Slide 12

General Goals of RFTO

• Develop a scalable, evolvable, model that initially differentiates itself from other distributed networks by its capability to support user-driven research on the safety, clinical effectiveness, and comparative effectiveness of treatments.
• Develop a research cooperative and governance structure that advances the traditional model to assist decision makers.
  • This advancement is essential for the continuation of public trust and funding from public and private payers.

Slide 13

General Goals of RFTO

• Understand the extent to which the distributed research paradigm can be applied to problems facing policymakers, clinicians, & patients.
  • Where does the model exist in the continuum of research?
• Establish program governance.
  • Not only address the technical aspects but the "sociologic" aspects of a research cooperative.
  • Minimize barriers to collaboration and close coordination with scientific staff at AHRQ.
  • Relationship building.

Slide 14

Four Phases of Projects

• Technical Specifications—Spring to Fall 2008.
• Pilot testing—Spring 2008 to Winter 2008.
• Research Study—Summer 2008 to early 2009.
• Blueprint Prospectus—Spring 2009.

Slide 15

Elements of the Ideal System

• Create an open architecture that is technically and socially scalable to extend participation and collaboration with other AHRQ programs to meet the MMA mandates.
• Develop a system which allows timely access to real time information and ensure a rapid response to questions facing clinicians, patients, and policymakers.
• Make technical and procedural burdens as light as possible without sacrificing scientific integrity.
• Closer connection between researchers and decision makers.
• Low-cost, lightweight system that requires modest infrastructure, easy maintenance, and a coordinated research agenda.

Slide 16

Short-term Benchmarks

• Provide new information that helps advance a distributed model in health care research.
• Enrich AHRQ's current capacity to conduct observational research on CE, specifically in DEcIDE & Centers for Education and Research on Therapeutics (CERTs).
• Form a close partnership with AHRQ and stakeholders so that useful information is derived from this large investment of resources.

Slide 17

DRN Projects 2.0

• Future DRN projects—how will we build upon these pilot projects?