Methods and Early Results from AHRQ's Healthcare Horizon Scanning System

Select to access the PowerPoint® presentation (1.8 MB).

Slide 1

Methods and Early Results from AHRQ's Healthcare Horizon Scanning System

Karen Schoelles MD, SM
Project Director, AHRQ Healthcare Horizon Scanning System
ECRI Institute
AHRQ Annual Meeting
September 10, 2012

Slide 2

AHRQ Healthcare Horizon Scanning System

• Purpose:
  • To inform and guide the planning and prioritization of patient-centered outcomes research investments through the Effective Health Care Program.

Slide 3

AHRQ Healthcare Horizon Scanning System

• Description: A process:
  • To identify and monitor health care innovations.
  • To create an inventory of innovations that address an unmet need and have the highest potential for impact on clinical care, the health care system, patient outcomes and costs.

Slide 4

Image: A cartoon shows a man consulting a fortune-teller, who is gazing into a crystal ball. The caption reads "A Starbucks will open on your block."

Slide 5

Why Scan the Horizon?

"Horizon scanning aims to help break the element of surprise—shifting our focus earlier along the stages of change to allow proactive planning and decision making.

Without horizon scanning, things seem to 'come out of nowhere' but really they are just entering our consciousness at a late point in the stages of change."

—Jennifer DeLurio, Horizon Scanning Leads Manager

Slide 6

Effective Health Care Web site page for Horizon Scanning Overview

https://effectivehealthcare.ahrq.gov/topics/horizon-scan/overview

Slide 7

AHRQ Healthcare Horizon Scanning System

• Range of interventions:
  • Drugs, biologics, medical devices.
  • Procedures.
  • Screening and diagnostic tests, including imaging.
  • Behavioral health interventions.
  • Care delivery innovations.
  .
• Includes new uses of existing/diffused interventions.

Slide 8

Arthritis and nontraumatic joint disease

1. Cancer.
2. Cardiovascular disease.
3. Dementia (including Alzheimer's).
4. Depression and other mental health disorders.
5. Developmental delays, attention-deficit hyperactivity disorder & autism.
6. Diabetes mellitus.

Slide 9

AHRQ Priority Conditions, continued

8. Functional limitations and disability.
9. Infectious disease, including HIV/AIDS.
10. Obesity.
11. Peptic ulcer disease and dyspepsia.
12. Pregnancy, including preterm birth.
13. Pulmonary disease/asthma.
14. Substance abuse.
15. (Cross-cutting topics).

Slide 10

Stages of Horizon Scanning

• Identify the users.
• Determine the timeframe.
• Conduct horizon scanning and identify emerging technologies.
• Filter the identified technologies.
• Prioritize the technologies.

Slide 11

Stages of Horizon Scanning, continued

• Assess technologies of high priority.
• Use peer review to check for quality.
• Disseminate the information.
• Update the information.

Slide 12

AHRQ Healthcare Horizon Scanning System: Identified Users

• Primarily AHRQ.
• Other CER/PCOR [comparative effectiveness and patient-centered outcomes research] funders.
• Researchers.
• Consumers/patients.

Slide 13

AHRQ Horizon Scanning Timeframe

Image: A yellow arrow pointing from left to right depicts the following timeline: Initial evaluation in humans → 7 years → Approval, clearance, initial dissemination → 2 years → Diffusion into Medical Practice.

Slide 14

AHRQ Healthcare Horizon Scanning and Identification of Interventions

• Broad scanning and lead selection:
  • About 100 selected sources plus meeting abstracts.
  • 12 medical librarians scan these sources regularly for leads.
  • Leads are selected if they relate to one or more Priority Conditions.
  • Leads coalesce into specific topics.

Slide 15

AHRQ Horizon Scanning: Filtering and Prioritization

• Protocol defines criteria.
• Primary question: Does it address an unmet need?
  • Gap in effective ways to:
    • Screen.
    • Diagnose.
    • Treat.
    • Monitor.
    • Manage.
    • Provide or deliver care.

Slide 16

Assessing High Priority Topics

• Analysts nominate topics based on protocol-defined criteria.
• Selected topics investigated with specific searches for information.
• Experts are asked to comment on reports.

Slide 17

Horizon Scanning: Assessing Potential for Impact

Image: A photograph of a woman dressed as a fortune-teller and holding a crystal ball is shown.

Slide 18

Image: A cartoon shows a woman consulting a fortune-teller; a flat object sits on the table instead of a crystal ball. The fortune-teller says, "I got the new flat screen HDCB."

Slide 19

AHRQ Healthcare Horizon Scanning System—Outputs

Image: A screenshot of AHRQ's Effective Health Care Program Web site shows PDF links for Horizon Scan updates. The most recent update is August 2012.

Slide 20

AHRQ Horizon Scanning Status Reports

Inventory of:

• Topics followed as of prior report.
• New topics added since prior report.
• Topics archived since prior report.

Slide 21

AHRQ Horizon Scanning Status Reports

Slide 22

Image: The AHRQ banner is shown.

Slide 23

Horizon Scanning: Assessing Potential for Impact

• Seven parameters:
  • Potential importance of the unmet need.
  • Potential to improve patient health.
  • Potential to affect health disparities.
  • Potential to disrupt the health care delivery system.
  • Potential for adoption by clinicians and/or patients.
  • Potential impact on cost.
  • Overall potential to meet the unmet need.

Slide 24

Input on Potential for Impact

• Approximately 350 experts nationwide.
• Experts with a variety of perspectives:
  • Clinical practice.
  • Clinical research.
  • Health care delivery.
  • Health business.
  • Health technology assessment.
  • Health facility administration.

Slide 25

Input on Potential for Impact

• Each expert asked to disclose any potential intellectual or financial conflicts of interest (COI).
• Perspectives of an expert with a COI are balanced by perspectives of experts without COIs.
• No more than two experts with a possible COI are considered out of a total of the seven or eight experts who are sought to provide comment for each topic.

Slide 26

Horizon Scanning: Assessing Potential for Impact

• Eligible topics:
  • Within 0-4 years of potential diffusion (e.g., in phase III trials or preliminary efficacy data in the target population) in the United States.
  • Or in very early diffusion.
• Comments received from at least 6-8 experts.

Slide 27

Sample Potential High Impact Report: Priority Condition 9—Infectious Diseases
June 2012

• 107 Infectious Disease topics tracked in the system as of May 2012.
• 11 topics eligible for Potential High Impact assessment and comments received from 6-8 experts.
• 9 of 11 selected as having potential for high impact based on comments received:
  • 6 at higher end of "high."
  • 2 in moderately high range.
  • 1 at lower end of "high."

Slide 28

Sample Topics Selected for Potential High Impact Report

• Hepatitis C Virus Infection Interventions:
  • NS3/4A Protease Inhibitors (Boceprevir and Telaprevir) for Treatment of Chronic Hepatitis C Infection—HIGH.
• HIV/AIDS Interventions:
  • Collaborative Care Model for Treatment of HIV and Comorbid Depression—LOWER END OF HIGH.
  • Emtricitabine/Tenofovir (Truvada) for Prevention of HIV Infection—HIGH.
  • Routine Anal Pap Smear Screening at HIV Clinics to Prevent Anal Cancer—MODERATATLEY HIGH.

Slide 29

Sample Topics Selected for Potential High Impact Report, continued

• Healthcare-Acquired and Bacterial Infection Interventions:
  • Antimicrobial Copper Surfaces in the ICU for Prevention of Healthcare-Acquired Infections—HIGH.
  • Fecal Microbiota Transplantation for Recurrent Clostridium difficile Infection—HIGH.
  • Fidaxomicin (Dificid) for Treatment of Clostridium difficile Infection—HIGH.
  • Xpert MTB/RIF Test for Simultaneous Detection and Drug Sensitivity Testing of Mycobacterium Tuberculosis—MODERATELY HIGH.

Slide 30

Potential High Impact Report: Obesity

Topics Eligible for Assessment:

• Controlled release phentermine/topiramate (Qnexa®) for treatment of obesity.
• EndoBarrier Endoluminal Sleeve for treatment of obesity.
• Full Sense Bariatric Device for treatment of morbid obesity.
• Liraglutide (Victoza®) for treatment of obesity.
• Lorcaserin (Lorgess®) for treatment of obesity.
• Maestro vagus nerve block system for treatment of morbid obesity.
• Methionine aminopeptidase 2 inhibitor (ZGN-433) for treatment of obesity.
• Naltrexone and bupropion HCL (Contrave®) for treatment of obesity.
• Tesofensine for treatment of obesity.

Slide 31

Obesity—Potential High Impact

• 19 topics were in the system.
• 9 topics met eligibility criteria for high impact assessment and 6-8 sets of expert comments were provided.
• Experts thought 7 of the 9 had no potential for high impact at this time.
• Phentermine/topiramate (Qnexa®): HIGH end of the high impact range.
• EndoBarrier endoluminal sleeve for excess weight loss—LOW end of high impact range.

Slide 32

Image: At the center of the figure is a square captioned "Topics already in the system." Around the square is a circle of yellow with arrows pointing from it to a number of ovals in a circle; the ovals are labeled "Trials fail to meet endpoints," "Developer cannot procure funding," "FDA issues a negative decision," "Intervention doesn't diffuse," "Safety issues appear," and "Better alternative developed." Outside the circle of ovals are four quadrilateral shapes labeled "Leads for new topics," "New trial results become available," "Formulations, delivery routes and combinations change," and "Intervention reappears with new developer." Red arrows point from these quadrilateral shapes toward the center of the figure. Smaller red arrows are superimposed over the yellow circle, pointing in a clockwise direction.

Slide 33

Reasons for Archiving by Priority Area
(as % of Archived Topics)

Image: A bar graph shows the following reasons for archiving, by percentage of archived topics:

Cross-Cutting:

• Expert Comments - 67%.
• Diffused Past 2 Years - 33%.

Substance Abuse:

• Development Stopped - 30%.
• Expert Comments - 60%.
• Not Meeting HS Criteria - 10%.

Pulmonary:

• Diffused Past 2 Years - 67%.
• Not Meeting HS Criteria - 33%.

Obesity:

• Development Stopped - 75%.
• Expert Comments - 25%.

Infectious Diseases:

• Development Stopped - 62%.
• Expert Comments - 15%.
• Diffused Past 2 Years - 8%.
• Not Meeting HS Criteria - 15%.

Functional Limitations:

• Development Stopped - 76%.
• Negative FDA Decision - 6%.
• Not Meeting HS Criteria - 18%.

Diabetes:

• Development Stopped - 83%.
• Not Meeting HS Criteria - 17%.

Developmental Delay:

• Development Stopped - 17%.
• Expert Comments - 67%.
• Diffused Past 2 Years - 17%.

Depression:

• Development Stopped - 57%.
• Expert Comments - 43%.

Dementia:

• Development Stopped - 80%.
• Expert Comments - 20%.

Cardiovascular:

• Development Stopped - 28%.
• Expert Comments - 69%.
• Diffused Past 2 Years - 3%.

Cancer:

• Development Stopped - 84%.
• Negative FDA Decision - 8%.
• Little Uptake - 3%.
• Diffused Past 2 Years - 3%.
• Not Meeting HS Criteria - 3%.

Arthritis:

• Development Stopped - 50%.
• Negative FDA Decision - 10%.
• Little Uptake - 20%.
• Diffused Past 2 Years - 10%.
• Not Meeting HS Criteria - 10%.

Slide 34

Reasons for Archiving by Priority Condition as Percentage of Topics in that Priority Condition

Image: A bar graph shows the following reasons for archiving, by percentage of priority area:

Arthritis:

• Development Stopped - 14%.
• Negative FDA Decision - 3%.
• Little Uptake - 5%.
• Diffused Past 2 Years - 3%.
• Not Meeting HS Criteria - 3%.

Cancer:

• Development Stopped - 10%.
• Negative FDA Decision - 1%.
• Diffused Past 2 Years - 2%.

Cardiovascular:

• Development Stopped -7%.
• Expert Comments - 16%.
• Diffused Past 2 Years - 1%.

Dementia:

• Development Stopped - 15%.
• Expert Comments - 4%.

Depression:

• Development Stopped - 9%.
• Expert Comments - 7%.

Developmental Delay:

• Development Stopped - 5%.
• Expert Comments - 21%.
• Diffused Past 2 Years - 5%.

Diabetes:

• Development Stopped - 9%.
• Not Meeting HS Criteria - 2%.

Functional Limitations:

• Development Stopped - 7%.
• Negative FDA Decision - 1%.
• Not Meeting HS Criteria - 2%.

Infectious Diseases:

• Development Stopped - 6%.
• Expert Comments - 2%.
• Diffused Past 2 Years - 1%.
• Not Meeting HS Criteria -2%.

Obesity:

• Development Stopped - 17%.
• Expert Comments - 6%.

Pulmonary:

• Diffused Past 2 Years - 5%.
• Not Meeting HS Criteria - 3%.

Substance Abuse:

• Development Stopped - 14%.
• Expert Comments - 29%.
• Not Meeting HS Criteria - 10%.

Cross-Cutting:

• Expert Comments - 12%.
• Diffused Past 2 Years - 6%.

Slide 35

Horizon Scanning Challenges

• Drinking from the fire hose.
  • Large volume of leads and topics.
• Tracking developments on 1000 topics already in the system and updating across all outputs.
• Fast pace of change.
• Difficulty finding innovations in care delivery.
• Difficulty getting broader input, including from patients and clinicians, given PWRA requirements.

Slide 36

Horizon Scanning Team

• AHRQ: Elise Berliner, COTR.
• ECRI:
  • Diane Robertson, Project Manager.
  • Randy Hulshizer, Content Team Leader.
  • Eileen Erinoff, Director, Information Center.
  • Jennifer DeLurio, Leads Manager.
  • Marna Sanders, and 11 more fabulous medical librarians, a.k.a. lead finders.
  • Brian Wilkinson, and Abigail Dean—Senior Horizon Scanning Analysts.
  • Vladimir Cadet, Mike Leshinski, Marcus Lynch—Horizon Scanning Analysts.
  • And many more helping hands!

Slide 37

"Everything that can be invented has been invented."

   —Charles H. Duell, Commissioner, U.S. Office of Patents, 1899.