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Wednesday, January 5, 2011

Top Medical Centers Join Forces on Comparative Effectiveness Research

From Medscape News

December 17, 2010 — In a major boost to comparative effectiveness research, 6 of the nation's top healthcare organizations announced this week that they will share clinical data in an effort to improve quality of care and reduce expenses for several common but costly conditions and treatments.

The Cleveland Clinic, Dartmouth-Hitchcock Medical Center, Denver Health, Geisinger Health System, Intermountain Healthcare, and the Mayo Clinic have a combined 10 million patients. They will work with the Dartmouth Institute for Health Policy and Clinical Practice to determine best practices and disseminate actionable recommendations throughout the medical community. Results should start being available within a year or 2.

The goal of the collaborative is to improve the efficiency of standard clinical care delivery to reduce the per capita cost in these conditions and to keep costs in line with the Consumer Price Index, Marc Harrison, MD, chief medical operations officer of the Cleveland Clinic, told Medscape Medical News.

The collaborative will focus on 8 conditions and treatments "for which costs have been increasing rapidly in recent years and for which there are wide variations in quality and outcomes across the country," according to a news release. The 8 conditions and treatments are knee replacement, diabetes, heart failure, asthma, weight loss surgery, labor and delivery, spine surgery, and depression.

"What makes this collaboration so unique is that we have 6 systems, each already distinguished as providing high quality in a cost-conscious way, seeking to share best practices with each other and the entire medical community," Dr. Harrison said. "This project is for real-time rapid cycle improvement among competitors.

"Share What We Learn"

"We plan on writing papers in mainstream medical journals," he said. "We want to be completely transparent about what we identify as best practices. We understand that the least expensive option isn't always the best value option. We'll function on the premise that there's no 'secret sauce' that only we possess. Our responsibility is to share what we learn so that optimal care models can be replicated across the country."

Other medical leaders of the 6 organizations echoed Harrison's sentiments. "By collaborating to gather data and identify the most effective care models, we can address variation in treatment, cost, and outcomes to give patients the quality care they need and bend the cost curve down in a meaningful way," Brent James, MD, chief quality officer at Intermountain Healthcare, said in a statement.

"If we know that the treatment path for diabetes at one institution results in better clinical outcomes, higher patient satisfaction, and lower overall costs, then there is knowledge to be shared and replicated in other institutions," noted Robert Nesse, MD, chief executive officer of the Mayo Clinic Health System, in a statement. "We need to learn from each other and put systems in place that ensure that every patient gets the very best, most appropriate care, every time."

Last year's federal stimulus legislation allocated $1.1 billion to comparative effectiveness research, and a new tax in this year's healthcare reform law could transfer an estimated $500 million per year to comparative effectiveness research.

The $1.1 billion authorized by the stimulus legislation was split among the Agency for Healthcare Research and Quality, the National Institutes of Health, and the Department of Health and Human Services.

Not a "Horse Race"

The collaborative is completely self-funded and receives no government stimulus funding. In some ways, its efforts are a privatized version of the government research, but as Dr. Harrison noted, "We don't look at this as a horse race. We don't worry about beating the government in coming out with new guidelines. If we can learn something from the government research, fantastic, and vice versa."

Leah Binder, chief executive officer of the Leapfrog Group, a coalition of employers that promotes patient safety and cost-effective care, applauds the new initiative. "These are superb hospitals with proven track records. I think we'll see some very innovative pioneering approaches. Sometimes research can sit on the shelf for years. If this collaborative finds something good, it can be put into practice immediately.

"It's impressive that these medical centers are willing to learn from each other," she added. "In medicine, we sometimes reinvent the wheel over and over, hospital by hospital. This cross-cultivation of ideas is very promising. I don't see this as being competitive with government efforts at comparative effectiveness research but as supplemental." Total knee replacement, performed more than 300,000 times a year in the United States with a cost that ranges from $16,000 to $24,000, will be the first treatment analyzed by the collaborative. Work to define best practices in diabetes and heart failure care will begin early in 2011.

"In my view, the most critical piece of this initiative is the transfer of knowledge to other health systems," Glenn Steele, MD, president and chief executive officer of the Geisinger Health System, said in the release. "We need to aggressively implement a rapid learning network to disseminate our work and assist other systems in implementing these best practices, especially the highest cost systems."

Comparative effectiveness research is controversial among physicians. Although most believe that it can improve the quality of care, they also think it will limit their clinical freedom. In a survey published in the October 19 issue of the Annals of Internal Medicine and reported at the time by Medscape Medical News, 56.5% of physicians agreed that national guidelines should be developed to influence clinical practice, and 55.2% said they believed that comparative effectiveness research would improve the quality of care. However, almost two thirds agreed with the statement: "Comparative effectiveness data will be used to restrict my freedom to choose treatments for my patients."