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Relevant Thought Pieces – Defining Population Health

Relevant Thought Pieces – Defining Population Health

In an effort to share relevant news regarding population health, research methods, transparency and other topics related to our core mission, PHII is encouraging members to share interesting articles as part of a new “Relevant Thought Pieces” blog segment. The first of these relevant thought pieces, recommended by Dr. Tom Wilson, is a recent blog post from Health Affairs entitled, ‘What Are We Talking About When We Talk About Population Health?’.

The term “population health” has received a boost in recent years due to initiatives such as the Triple Aim, which includes improving the individual experience of care, reducing per capita cost of care, and improving the health of populations. However, this ubiquitous usage has led to a definition that is sometimes too broad and ambiguous. The article discusses definitions and determinants of population health, the impact of social inequalities, and suggests employing two separate definitions to provide clarity: using population health management or population medicine when referring to patient populations, and reserving the traditional population health definition for geographic populations, which are the concern of public health officials, community organizations, and business leaders.

Do you agree?

 

Comparative Effectiveness Research Ramps Up

 

One of the cornerstones of the Patient Protection and Affordable Care Act (PPACA) is the establishment of the Patient Centered Outcomes Research Institute (PCORI).  PCORI is an independent, non-profit organization charged with “evaluating and comparing health outcomes and the clinical effectiveness, risks, and benefits of medical treatments, services, procedures, drugs, and other strategies or items that treat, manage, diagnose, or prevent illness or injury.”

This is very similar to the Population Health Impact Institute’s (PHII) mission to promote transparency and accountability for organizations and individuals through its array of accreditation, certification and educational programs.  PHII also is independent, non-profit organization and was founded over 10 years ago. 

In mid-May, PCORI announced it was accepting applications for its second year of research funding initiatives for $81 million. PCORI also indicated in a press statement that it aims to commit at least $355 million in support for patient-centered clinical effectiveness research in 2013.

PCORI’s Executive Director Joe Selby, MD, MPH, said, “We are committed to facilitating a new approach to conducting health and healthcare research, one that focuses on the research questions of most importance to patients and that actively involves patients, clinicians, and other end-users of the research in the way it is conducted.”  

Last year, Dr. Selby spoke at the Case Management Society of America’s annual Public Policy Summit where he provided an overview of PCORI, including the topics and methodology the organization is pursuing. Here is a recap.

Overview

The mission of PCORI is to “fund research that will provide patients, their caregivers and clinicians with evidence-based information needed to make better-informed health care decisions.”  In line with its patient-centered approach, Dr. Selby emphasized the importance of researchers being able to disseminate the results of PCORI research back to patients. Patients should be at the heart of the research “from planning to publication,” he said, and encouraged patients and other stakeholders to participate as panel reviewers. And with their broad view of the health care system, Brokers also could participate as panel reviewers.   

Research Methodologies

According to Dr. Selby, PCORI is looking to fund research that examines the prognosis or predictions of different types of care, the treatment options available to patients including the benefits and harms of those options, and any behavioral impacts on patients and/or  on health care systems.  He outlined nine criteria used to evaluate research projects:

·   The impact of the research

·   Whether the research will lead to improvements

·   Whether the research is inclusive of different populations

·   Whether the research addresses current gaps in the provision of healthcare

·   The research’s impact on system performance

·   The research’s potential to influence decision making

·   Whether the research is patient-centered

·   Whether the research utilizes rigorous research methods

·   The resources used in performing the research

After evaluating research based on the above criteria, Dr. Selby laid out the research agenda and priorities of PCORI:

·   The assessment of prevention, screening, and treatment options

·   The improvement of health care systems

·   The communication and dissemination of research to patients

·   The fairness and attention to disparities within the health care system

·   Accelerating patient-centered research

With a large budget, Dr. Selby’s task of funding patient-centered research is an extraordinary one.  The research funded by PCORI may lead to significant strides in the delivery and effectiveness of health care.

To learn more about PCORI, click here. 

Garry Carneal, JD MA, PHII Board Member

 

PHII in the news: Interview on Transparency and Transitions of Care in Case-In-Point

See  this week's  Case-in-Point Newsletter. Click here.

Nice Write-Up On 3/11 Webinar by Dr. Siderov

Click here.

 

 

We launched the H-TAP! (The "Health Care Transparency Program")

Click here for entire news release.  Nice quotes from Nurtur & Universal American are included 

Nurtur: "Nurtur is proud to be the first health management organization to have five of our chronic condition management programs accredited pursuant to the H-TAP Standards," comments Bryan Mullen, Nurtur Chief Information Officer. "Historically the area of evaluation and measurement has been the subject of much debate and contention in the disease management industry.  By participating in the extremely rigorous PHII review process, and successfully completing the H-TAP accreditation for our programs, we continue to provide the confidence of transparency in demonstrating program impact to our clients."

Universal American:
 Patricia Salber, MD MBA, Chief Medical Officer of Universal American Corp, states "H-TAP is essential for our business.  On a going forward basis, it will allow us to apply a uniform set of peer-reviewed transparency standards to different population programs--all requiring different attribution methods and metrics. One-size-fits-all does not works with shoes, or program evaluation.  H-TAP standards also provide a framework and lingo for more efficient and effective internal and external communication regarding our value."

Your comments on this unique accreditation program are appreciated! 

PHI Institute selected to present 3 minute comment to the Federal Coordinating Committee on Comparative Effectiveness Research on behalf of ABQAURP, AHIMA Foundation, CMSA, IHPM, & PHI Institute: 5/13/09

To the Federal Coordinating Council for Comparative Effectiveness Research:

On behalf of the American Board of Quality Assurance and Utilization Review Physicians, Inc., the American Health Information Management Association Foundation, the Case Management Society of America, the Institute of Health and Productivity Management, and the Population Health Impact Institute, we thank the Federal Coordinating Council for Comparative Effectiveness Research, the Department of Health and Human Services (HHS), the Department of Veterans Affairs, the Department of Defense, the Office of Management and Budget and the Agency for Healthcare Research and Quality for today’s opportunity to comment on Comparative Effectiveness Research (CER).

To make Comparative Effectiveness Research (CER) useful and understandable to health care consumers and providers, tax payers, business purchasers and the government, we wish to stress the central role of transparency of methods in reducing bias and rebuilding trust. 

The disclosure of possible bias because of a researcher’s potential conflict of interest, common in peer-reviewed journals, is obviously important. But a more serious form of bias is related to the admonition of the 17th century founders of the Royal Society of London, which became its slogan:   Nullius in Verba. -  "Don’t take anyone’s word for it!"

It is essential that the public understands that biased results can result from the methods employed in the research.  Confirmation and reproducibility are the keys to ascertaining the truth.

The methods that can lead to bias include the evaluation design chosen, assumptions behind statistical tests, imperfect comparability of populations being compared, data integrity, choice of cut-off points, mathematical errors, and other internal and external validity issues.   The tried-and-true way to resolve this problem is to provide detailed, timely, and clearly written disclosures of the methods used, which will enable the user of CER findings to "trust, but verify."

Our concern is that the traditional reliance on expert and anonymous peer review to ferret out these problems is not working.  The peer-reviewed literature itself has revealed that results in more than one-third of articles in major peer-reviewed journals were later overturned or mitigated [1].   Only eight percent of scientists --one-in twelve -- said it "works well as it is." [2]   While this self-criticism shows the eventual positive role of peer-review, we need to take action now to enable the public to trust the system. This newly expanded CER endeavor must signal the start of a new system that should include the following six points:

1)      Leaders should state that most, if not all, of science will have strengths as well as weaknesses, biases and shortcomings.  We recommend that CER researchers should pledge to reduce bias--it will rarely if ever be totally eliminated --and to prominently state in clear language the usefulness as well limitations of their findings.

2)      Researchers should show results prior to "adjustments," as well as "adjusted" results.  If the journal refuses to publish details, then the researchers should make these results easily available to readers on-line.

3)      Research papers should disclose, in detail, the methods and metrics used, the assumptions behind statistical tests, the extent to which assumptions are met (or not met), and the comparability of populations compared, as well as the strengths and weaknesses of their results.

4)      Funders should allow for an open --even anonymous (and moderated) -- peer-review process, in a timely and on-going fashion at the beginning, middle, and end of a research study.

5)      The Department of Health and Human Services should consider compensating official, conflict-free peer reviewers at a rate that is competitive with the rates paid to those conducting the CER.  

6)      A structured approach to method disclosures, such as that developed by the Population Health Impact Institute (www.PHIinstitute.org), should be considered.

We thank the Federal Coordinating Council for Comparative Effectiveness Research for this opportunity to comment.

Respectfully yours,

Dr. Arthur I. Broder, MD, CHCQM
Chairman of the Board, American Board of Quality Assurance and Utilization Review Physicians, Inc (www.abqaurp.org)

Mary Madison, MPA
Executive Director, American Health Information Management Association Foundation (www.ahimafoundation.org)<!--{12428660063813}--><!--{12428660063814}-->

Jeff Frater, RN, BSN
President, Case Management Society of America (www.cmsa.org)

Sean Sullivan, JD
President and CEO, Institute for Health and Productivity Management (www.ihpm.org)

Thomas W. Wilson, PhD, DrPH [presenter]
Board Chair, Population Health Impact Institute (www.PHIinstitute.org)

End notes:

[1] Ioannidis JP. Contradicted and initially stronger effects in highly cited clinical research.  JAMA. 2005 Jul 13;294(2):218-28.

[2]
ChubinDE, Hackett EJ.  Peerless Science: Peer Review and U.S. Science Policy (S U N Y Series in Science, Technology, and Society, 1990: pg. 192

Uncle Sam Wants You (Please consider us too)!

 

Our posting in response to a Disease Care Management Blog. Click here.

Comparative Effectiveness Discussed in the NYT: Some love it, some hate it, some are in-between

Check out the discussion of comparative effectiveness, cost-effectiveness, and the like following Professor Uwe Reinhardt's posting in the NYT's Economix blog

Welcome to the Population Health Blog: First Posting

We've launched!

You are reading the new "PopulationHealthBlog." It is sponsored by the Population Health Impact Institute, a non-profit 501c3 entity. 

This blog is geared for anyone with an interest in population health interventions, especially the methods used to support claims of their impact. These include:

  • Companies that have achieved METHODS EVALUATION PROCESS (MEP) accreditation or are applying for accreditation
  • Individuals who are MEP certified or are in the process of being certified.
  • Individuals who have attended our workshops.
  • Anyone with an interest in learning more about the evaluation of wellness, disease management, patient centered medical home, payment for performance, and other initiatives designed to improve the health of populations.

The blog is especially aimed at the dozens of volunteers and committee members that have helped craft our message and advance our mission and goals: 

Here is our goal in a nutshell.   The goal of the PopulationHealthBlog is to use the written word from fellow members of our community to improve the delivery of population health management services. 

The method used to achieve this goal – and this approach represents the unique niche of the Population Health Impact Institute – is to promote

  • The use of transparent methods employed to attribute the population health intervention to outcomes
  • The accurate use of evidence from these methods to infer impact – including objective levels of certainty – of these interventions.

We look forward to your contributions.

We invite you to view or comment on www.populationhealthblog.org.  
 

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