Bringing Evidence from Research to the Bedside

by U.S. Medicine

January 25, 2012

Carolyn M. Clancy, MD - AHRQ Director
Carolyn M. Clancy, MD – AHRQ Director

Scientific evidence is the foundation of an advanced healthcare system. While the U.S. medical research enterprise might be the envy of the world, we face a significant challenge in rapidly and reliably bringing the fruits of our research to actual patients. The AHRQ champions the national effort to develop a base of evidence that fosters high-quality healthcare, as well as works to ensure that that research reaches and benefits everyone soon after it emerges.

As one of 12 agencies within the HHS, AHRQ’s mission is to improve the quality, safety, efficiency and effectiveness of healthcare for all Americans. Supporting and disseminating scientific evidence to bolster American medicine is central to this mission. AHRQ, which funds and engages in health-services research that seeks to improve healthcare, is proud to partner with and support other agencies, as well as the private sector in order to improve the quality of care delivered in the U.S. 

Accelerating Patient-Centered Outcomes Research

In recent years, AHRQ’s name commonly has been associated with patient-centered outcomes research. This is due, in part, to the American Recovery and Reinvestment Act of 2009 (Recovery Act), but AHRQ’s commitment to patient-centered outcomes research significantly predates that Act.

AHRQ’s Effective Health Care Program is the nation’s longest-standing commitment to patient-centered outcomes research, sometimes known as comparative effectiveness research.  This research looks at existing studies to compare what works and what doesn’t and for what kind of patient and conducts new studies. Its goal: to help clinicians and patients make more informed decisions about what to do about a medical problem. Since the Effective Health Care Program was established, as a result of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, it has produced reports on more than 100 products, including comparative-effectiveness reviews, technical briefs, new research and summary publications that disseminate the results of this important research to clinicians, consumers and others.

In the years since the Effective Health Care Program was established, we have learned many things about patient-centered outcomes research.

First, we have come to understand that healthcare as it is practiced in the real world can be very different from medical science as proposed in a laboratory. While randomized, controlled trials remain the gold standard for testing new drugs, procedures and interventions, we have come to understand that patient-centered outcomes research reflects very real questions (e.g., patient adherence) that healthcare confronts every day. We have, therefore,  tried diligently to ensure that our research reflects this. For instance, a comparative-effectiveness review published recently on diagnosis and treatment of attention deficit hyperactivity disorder found that parent behavior training was backed by strong evidence of effectiveness to treat ADHD in children under age 6. However, the researchers also acknowledged that a major barrier is parents dropping out of these rigorous training regimens.

Second, we have learned a great deal about how clinicians absorb information. The traditional method has been to learn of scientific advancements episodically, one study at a time. Many clinicians came to these studies without knowing of some studies that had been conducted previously, thus were learning without benefit of context. This is why it can take years for innovations in healthcare to become actual practice. The Effective Health Care Program has, therefore, made it a significant priority to translate its research into usable information for clinicians by summarizing the state of the science today.

“The AHRQ champions the national effort to develop a base of evidence that fosters high-quality healthcare and works to ensure that that research reaches and benefits everyone quickly after it emerges.”

Third, the importance of dissemination to consumers has become clear. The work of the Effective Health Care Program always was intended to reach a broad audience. As the program has grown, the need to translate this research to multiple communities, including consumers, has only increased. Thus, AHRQ has recommitted to bringing this research to patients by working with the John M. Eisenberg Center for Clinical Decisions and Communications Science in Houston at Baylor College of Medicine to create products for consumers. Recent publications of great consumer interest include summaries on treating sleep apnea, treatments for acid-reflux disease and choosing medicines to treat high blood pressure.

The Recovery Act gave patient-centered outcomes research an unquestioned and unprecedented boost: a $1.1 billion investment to accelerate the effort to compare the evidence of treatments and interventions. AHRQ received a substantial portion of this investment, making patient-centered outcomes research a top priority for the agency. More recently, a new area of focus is the establishment of the Patient-Centered Outcomes Research Institute (PCORI), which was mandated by the 2010 Patient Protection and Affordable Care Act. PCORI, by law an independent, non-profit organization, will further advance patient-centered outcomes research by commissioning studies that are guided by patients, caregivers and the broader health-care community. PCORI will support the development and dissemination of high integrity, evidence-based information that patients can use to make real-world decisions. I am honored to join my colleague Francis S. Collins, MD, PhD, director of the National Institutes of Health, in serving on PCORI’s Board of Governors, along with 19 other highly qualified individuals appointed by the U.S. Government Accountability Office.

Bringing Evidence from Research to the Bedside Cont.

Finding Best Practices, Faster

The essential goal of patient-centered outcomes research is to ensure that groundbreaking clinical research leads to rapid dissemination of best practices, so that the best care possible is delivered to patients more quickly at the bedside. It is a tenet of AHRQ’s mission and extends throughout all the areas of research the agency supports.

The Comprehensive Unit-based Safety Program (CUSP) is one area of research that has borne fruit. Its implementation also is an example of a program that was developed with AHRQ funding, implemented on a small scale to test its effectiveness and — once it was shown to work — before widely being extended.

CUSP is a proven method to prevent and reduce healthcare-associated infections (HAIs), especially central line-associated bloodstream infections (CLABSI), catheter-associated urinary tract infections (CAUTI), surgical site infections (SSI) and ventilator-associated pneumonia (VAP), which confound the American healthcare system. They are costly, deadly and largely preventable. Since 2008, AHRQ has been promoting the nationwide adoption of CUSP to reduce CLABSI.

CUSP is a multipronged program that promotes a culture of patient safety through improved communication and teamwork among unit staff members, the use of tools such as checklists to support implementation of evidence-based practices for HAI prevention, such as hand-washing and removing unnecessary catheters. A recent report from the ongoing AHRQ-funded project that implements CUSP to reduce CLABSI found these infections were reduced by an average of 33% after one year. 

Its success having been demonstrated, CUSP is being rolled out broadly. Nationwide expansion of CUSP, with its $10 million in fiscal year 2011 funding, has allowed AHRQ to spread the CUSP program to hospitals nationwide, extend it to other settings beyond ICUs and focus on reducing other types of HAIs, such as CAUTI, SSI and VAP. It is taking place through an alliance that consists of AHRQ; the Health Research and Educational Trust, an affiliate of the American Hospital Association; the Johns Hopkins University Quality and Safety Research Group, which developed the CUSP approach; and the Michigan Health and Hospital Association’s Keystone Center for Patient Safety and Quality. To aid its implementation, AHRQ is developing a CUSP toolkit, which will be available in 2012.

Conclusion: Delivering Research Where It’s Needed

AHRQ’s activities are varied, comprising projects in patient safety, patient-centered outcomes research, health information technology, prevention and value. These projects range from small conference grants to large, multistate research projects, yet they all bear a common, unifying theme: the quest to accelerate healthcare quality improvement by putting research into the hands of those who need it.

AHRQ remains committed to its mission of improving healthcare for all Americans. This is broad goal must be achieved one patient at a time. While AHRQ is heavily interested in improving the health of populations, we recognize that healthcare is delivered to individuals. Each patient is different, with his or her own history, circumstances, values, needs and desires. AHRQ remains committed to giving patients and clinicians tools — not rules — to achieve the safest, highest-quality healthcare possible.

Back to Outlook 2012

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