THE LEARNING HEALTH SYSTEM SERIES
ACCELERATING
Medical Evidence
Generation
AND USE
Joe Selby, Eric Larson, Rainu Kaushal, Maryan Zirkle,
Marianne Hamilton Lopez, and Danielle Whicher, Editors
WASHINGTON, DC
NAM.EDU
NATIONAL ACADEMY OF MEDICINE • 500 FIFTH STREET, NW • WASHINGTON, DC 20001
NOTICE: This publication has undergone peer review according to procedures established by the National Academy of Medicine (NAM). Publication by the NAM signifies that it is the product of a carefully considered process and is a useful contribution worthy of public attention, but does not represent formal endorsement of conclusions and recommendations by the NAM. The views presented in this publication are those of individual authors and do not represent formal consensus positions of the NAM; the National Academies of Sciences, Engineering, and Medicine; or the authors’ organizations.
Support for this activity was provided by the Patient-Centered Outcomes Research Institute.
Digital Object Identifier: https://doi.org/10.17226/27123
Library of Congress Cataloguing-in-Publication Data:
Names: Selby, Joe, editor. | Larson, Eric B., editor. | Kaushal, Rainu, editor. | Zirkle, Maryan, editor. | Lopez, Marianne Hamilton, editor. | National Academy of Medicine (U.S.), publisher. | Accelerating Medical Evidence
Generation and Use (Conference) (2016 : Washington, D.C.)
Title: Accelerating medical evidence generation and use : summary of a meeting series / Joe Selby, Eric Larson, Rainu Kaushal, Maryan Zirkle, Marianne Hamilton Lopez, and Danielle Whicher, editors.
Description: Washington, DC : National Academy of Medicine, [2017] | Summary of 2 meetings hosted by the National Academy of Medicine on January 21 and September 8, 2016. The meetings were sponsored by PCORI and held under the auspices of the NAM Executive Leadership Network (ELN) for Continuously Learning Health Care, an executive-level initiative of the Leadership Consortium for a Value & Science-Driven Health System. | Includes bibliographical references.
Identifiers: LCCN 2017042175 (print) | LCCN 2017041416 (ebook) | ISBN 9781947103047 (pbk.) | ISBN 9781947103054 (Ebook)
Subjects: | MESH: Biomedical Research--methods | Evidence-Based Medicine | Data Collection | Information Dissemination | Health Information Management | Delivery of Health Care--organization & administration | United States | Congresses
Classification: LCC R850 (ebook) | LCC R850 (print) | NLM W 20.5 | DDC 610.72/4--dc23
LC record available at https://lccn.loc.gov/2017041416
Copyright 2017 by the National Academy of Sciences. All rights reserved.
Printed in the United States of America.
Suggested citation: Selby, J., E. Larson, R. Kaushal, M. Zirkle, M. Hamilton Lopez, and D. Whicher, editors. 2017. Accelerating medical evidence generation and use: Summary of a meeting series. Washington, DC: National Academy of Medicine.
“Knowing is not enough; we must apply.
Willing is not enough; we must do.”
—Goethe
ABOUT THE NATIONAL ACADEMY OF MEDICINE
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Learn more about the National Academy of Medicine at NAM.edu.
PLANNING COMMITTEE
ERIC B. LARSON, MD, MPH, MACP (Chair), Kaiser Permanente Washington Health Research Institute
AMY ABERNETHY, MD, PhD, Flatiron
JONATHAN FINKELSTEIN, MD, MPH, Harvard Medical School
BRENT JAMES, MD, MStat, Intermountain Healthcare
RAINU KAUSHAL, MD, MPH, Weill Cornell Medical College & New York-Presbyterian Hospital
KATHERINE M. NEWTON, PhD, Kaiser Permanente Washington Health Research Institute
JONATHAN B. PERLIN, MD, PhD, MSHA, Hospital Corporation of America
JOE V. SELBY, MD, MPH, Patient-Centered Outcomes Research Institute
NIRAV R. SHAH, MD, MPH, Kaiser Permanente
NAM Staff
Development of this publication was facilitated by contributions of the following NAM staff, under the guidance of Michael McGinnis, MD, MPP, NAM Leonard D. Schaeffer Executive Officer and Executive Director of the Leadership Consortium for a Value & Science-Driven Health System:
MARIANNE HAMILTON LOPEZ, PhD, MPA, Senior Program Officer and Project Director
DANIELLE WHICHER, PhD, MHS, Senior Program Officer
GWEN HUGHES, Senior Program Assistant
MICHELLE JOHNSTON-FLEECE, MPH, Senior Program Officer
VANANH VO, Senior Program Assistant (after November 2016)
ROSHEEN BIRDIE, Senior Program Assistant (until September 2016)
LAURA HARBOLD DeSTEFANO, Director of Communications
KYRA E. CAPPELUCCI, Communications Specialist
MOLLY DOYLE, Communications Specialist
REBECCA MORGAN, MLIS, Senior Research Librarian, National Academies of Sciences, Engineering, and Medicine
Consultant
TERESA WISEMAN, Rapporteur
REVIEWERS
This special publication was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with review procedures established by the National Academy of Medicine. We wish to thank the following individuals for their review of this publication:
TOM W. CARTON, PhD, MS, Louisiana Public Health Institute; Research Action for Health Network
NIRAV R. SHAH, MD, MPH, Kaiser Permanente
JOHN WARNER, MD, MBA, University of Texas, Southwestern University Hospitals
Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the content of the publication, nor did they see the final draft before it was published. Review of this publication was overseen by Marianne Hamilton Lopez, PhD, MPA, Senior Program Officer, NAM; and Michael McGinnis, MD, MPP, Leonard D. Schaeffer Executive Officer, NAM. Responsibility for the final content of this publication rests entirely with the editors and the NAM.
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CONTENTS
Scope and Objectives of the Meetings
Organization of the Meeting Series
2 Executive Decision Needs and Data Priorities
A Health Executive’s Perspective
Generating Evidence in Health Systems
Data Transforming Practice: Childhood Osteomyelitis Example
3 Evidence Generation Returns-On-Investment
The Value of the Research and Data Infrastructure
The CMS Transforming Clinical Practice Initiative (TCPI)
Scale and Spread: A Network of Continuous Learning
Applying Lessons to Broadly Eliminate Harms
The PCORnet Health Systems Demonstration Project
Identifying Research Needs on the Ground
Synergy Among Networks and Data Systems
Increasing the Focus on Population Health
4 Needs, Opportunities, and Strategies for Accelerating Progress
Pressing Data and Analytic Needs of Executive-Level Decision Makers
PCORnet’s Impact on Health Care Delivery Locally and Nationally
Important Next Steps in Building and Improving PCORnet
Health Care System Research Questions
Identifying and Managing High Health Care Utilizers
New Health Care Delivery Models
Novel Analytic Tools and Methods
Prioritization of Themes and Questions
Open Discussion of Needs, Opportunities, and Strategies
Linking Care Delivery Data to Health Plan Data
Training and Workforce Development
Dissemination and Implementation
High-Value Care: Prices, Costs, Access, Incentives, and Outcomes
5 Harmonized Performance Measurement for Continuous Learning
Infrastructures for Data Collection
Tapping New Data Sources to Improve Health Quality
Accelerating Medical Evidence Generation and Use
Data Collection: Maximizing the Uses of Clinical and Claims Data
Engaging Providers in Implementing Change
6 Follow-On, Themes, and Strategic Expansion
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ACRONYMS AND ABBREVIATIONS
| ACA | Patient Protection and Affordable Care Act |
| ACO | accountable care organization |
| AHRQ | Agency for Healthcare Research and Quality |
| CDRN | Clinical Data Research Network (funded by PCORI) |
| CEO | chief executive officer |
| CHAB | community health advisory board |
| CHOP | Children’s Hospital of Philadelphia |
| CLABSI | central line–associated bloodstream infection |
| CMS | Centers for Medicare & Medicaid Services |
| CT | computed tomography |
| ED | emergency department |
| EHR | electronic health record |
| ELN | NAM Executive Leadership Network |
| FDA | US Food and Drug Administration |
| IHI | Institute for Healthcare Improvement |
| IOM | Institute of Medicine (now National Academy of Medicine) |
| MRI | magnetic resonance imaging |
| MRSA | methicillin-resistant Staphylococcus aureus |
| NAM | National Academy of Medicine |
| NIH | National Institutes of Health |
| NQF | National Quality Forum |
| ONC | Office of the National Coordinator for Health Information Technology |
| PCMH | patient-centered medical home (or primary care medical home) |
| PCORI | Patient-Centered Outcomes Research Institute |
| PCORnet | National Patient-Centered Clinical Research Network |
| PICC | peripherally inserted central catheter |
| PPRN | Patient-Powered Research Network |
| REACHnet | Research Action for Health Network |
| ROI | return on investment |
| TCPI | Transforming Clinical Practice Initiative |
