In the eye of the beholder The impact
In the eye of the beholder – The impact of perspective on the value of an Innovation July 18, 2011 Paul Wallace MD SVP and Director, Center for Comparative Effectiveness Research The Lewin Group Falls Church, VA Paul. Wallace@lewin. com 1
Focus: Patient centered or personalized? 2
The effect of perspective on “focus” 3
Effective learning and spread… Policy; National States; Systems; Health Plans Hospitals; Practices Patients, Providers What works? How can we make it work here? The average patient, seen by the average doctor, in the average health system, with average coverage How does this impact me, here and now?
Logic Models • What the Health Care System does to patients (e. g. cancer screening) • What the Health Care System does with patients and their families (e. g. care management) • What patients best do by themselves, with support of the health care system (e. g. behavior change – weight management) 5
Balancing rigor with flexibility and speed… Policy; National P < 0. 05 States; Systems; Health Plans Hospitals; Practices Patients, Providers 6
“Gray Areas”. . . 115 new technologies examined: Medically appropriate 38 ? 7 Insufficient evidence because the evidence is: Generally not medically appropriate A. Of insufficient quantity 66 and/or quality B. Conflicting or inconsistent 3 C. There is no evidence 1 7
“Gray Areas”. . . 115 new technologies examined: Medically appropriate 7 38 Insufficient evidence because the evidence is: Generally not medically appropriate A. Of insufficient quantity 66 and/or quality B. Conflicting or inconsistent 3 C. There is no evidence 1 8
Comparative Population Effectiveness: The Kaiser Permanente National Joint Replacement Registry [Evaluation] feedback changed practice with respect to: implant selection, minimally invasive procedures, uncemented knees, and surgical indications and preoperative care. Paxton, EW et al; The Permanente Journal 15: 1216, 2008
ce lan Ba Opportunities to balance rigor and reality eo us • Largest scale - What works? en im er xp fe – Find boundaries of appropriate variation – Effectiveness studies (whole population) l ta • Middle Scale - How can we make it work here? an do – Test widely and often (“parallel processing”) – Serial observation (e. g. rapid cycle) va er bs la na tio • Personal Scale - How does this impact me, here and now? s he ac ro pp – Registries – Patient generated data – Social Media 10
Design with the end users in mind 11
Thanks… Center for Information Therapy (Ix)® 12
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