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THE JOHNS HOPKINS PRIMARY CARE POLICY CENTER –INTEGRATING POLICY RESEARCH WITH POLICY MAKING 约翰霍普金斯大学基本医疗政策研究中心 —整合政策研究与政策制定 Leiyu Shi, Dr. PH, MBA, MPA Professor, Johns Hopkins Bloomberg School of Pubic Health Director, Johns Hopkins Primary Care Policy Center 约翰霍普金斯大学公共卫生学院教授约翰霍普金斯大学基本医疗政策研究中心主任 (e-mail: lshi 2@jhu. edu; Tel: 410 -614 -6507) September 6, 2014 Beijing, China © 2008, Johns Hopkins University. All rights reserved.

Presentation Outline 内容概要 1. Johns Hopkins Primary Care Policy Center 约翰霍普金斯大学基本医疗政策研究中心 2. Lessons Learned from Policy Research and Policy Making 政策研究与制定经验 3. Implications for HTA 对卫生技术评估的启示 © 2008, Johns Hopkins University. All rights reserved.

Mission of Johns Hopkins PCPC 中心使命 • Established in 1997 with funding from the federal Bureau of Primary Health Care, Health Resources and Services Administration, Department of Health and Human Services. 成立于1997年，获得美国卫生部资金支持。 • Conducts short-term policy analyses and longer-term applied policy research that can help inform public policy making in healthcare. 通过开展短期政策分析和长期的政策实践研究，协助卫生服务领域的公共政策制定。 • As the Contractor, PCPC supports HRSA/BPHC’s tradition of providing evidence -based policy that advances HRSA/BPHC’s mission of serving the nation’s underserved populations. 作为与卫生部合同的承约方，长期协助其制定以证据为基础的卫生政策，重点服务于弱势人群。 • In close partnership with HRSA/BPHC, PCPC provides analytic and consultation support on research and evaluation projects that advance primary care and community health centers. 与卫生部紧密合作，向其提供研究与项目评估的咨询建议，以提升基本医疗与社区医疗中心。 © 2008, Johns Hopkins University. All rights reserved.

Impact of Patient Protection and Affordable Care Act �医改法案的影响 The ACA provides $11 billion over a 5 -year period to strengthen community health centers. Of these funds, $9. 5 billion are allocated to support ongoing health center operations, create new sites in medically underserved areas, and expand preventive and primary care services at existing sites. The remaining $1. 5 billion will support major construction and renovation projects nationwide. 医改法案将在五年期间提供 110亿美元以加强社区医疗中心建设。其中 95亿美元将用于支持社区医疗中心的运作、在医疗欠发达地区建立社区医疗中心、以及在现有机构扩展预防与基本医疗服务。另外 15亿美元将用于支持全国范围内的建设和改造程。 U. S. Department of Health and Human Services. 2011. Community health centers and the Affordable Care Act in 2011: Increasing access to affordable, cost effective, high quality care. http: //www. healthcare. gov/news/factsheets/2011/08/communityhealthcenters 08092011 a. html. Accessed January 2013. © 2008, Johns Hopkins University. All rights reserved.

Lesson 1. Having a conceptual framework that guides applied policy research/evaluations ��一：运用概念框架指�政策研究和�估 Figure 1 displays a conceptual model of PCPC’s health center research foci which consist of four major areas. 图示 1的概念模型展示了中心对于社区医疗中心研究聚焦的四个主要领域 • Expanding health centers by increasing the number of primary care access points, people served, and services provided within the primary health care network; 通过提升可及性、扩充人员和服务扩展社区医疗中心 • Strengthening the health center safety net by increasing clinical, managerial, and financial efficiency of the primary health care network; 通过提升医疗、管理和财务效率强化社区医疗中心安全网 • Improving quality of care for patients and families in the primary health care network; 患者和服务家庭提升医疗质量 • Mobilizing the workforce by monitoring state strategic planning efforts relating to the primary health care networkforce. 通过监测国家战略计划调动基本医疗服务劳动力 © 2008, Johns Hopkins University. All rights reserved.

Figure 1. A Conceptual Model of Primary Care Policy Center Research Foci �示 1. 中心研究重点的概念模型 STRUCTURE �构 • Vulnerable populations served by community health centers 社区医� 中心服� 的脆弱人群 • Determinants/predictors of services to vulnerable populations 面向脆弱人群医� 服� 的决定因素/ �� 因素 • Sustainability of community health centers 社区医� 中心的可持� 性 • Financial performance �� 效 • Recruitment and retention of primary care providers 基本医� 人� 的招聘与留用 • Multi-disciplinary primary care team 多学科基本医�� EXPAND STRENGTHEN COMMUNITY HEALTH CENTERS � 展与强化社区医� 中心 OUTCOME �果 PROCESS �程 • Access to preventive and primary care � 防与基本医� 的可及性 • Continuity of care 持� 性 • Comprehensiveness of services 全面性 • Coordination of care �� 性 • Cost efficiency 成本效率 • Clinical and service quality 服�� 量 • Manage risks 管理�� • Enhance perinatal, chronic disease, and preventive care 提高�� 期、慢性病和� 防医� • Culturally competent, familyoriented, and community-focused 文化� 任、家庭� 向和关注社区 IMPROVE QUALITY AND PERFORMANCE 提高� 量和� 效 • Clinical indicators � 床指� ACS hospitalization Emergency room use Preventive care measures Chronic care measures Perinatal care measures Primary care achievements • Service indicators 服� 指� Patient satisfaction Provider satisfaction Services integration Financial efficiency, productivity Community development • Health indicators 健康指� o. Individual level o. Community level (infant mortality, low birthweight, total mortality, quality of life, disability) • Reducing disparities 减少差异 o. SES o. Race/ethnicity o. Insurance ENHANCE HEALTH STATUS AND REDUCE HEALTH DISPARITIES 提升健康水平，减少� 生差异 © 2008, Johns Hopkins University. All rights reserved.

Lesson 2. Seeking direct, timely, and ongoing inputs from the policy community and other stakeholders 经验二：从政策制定者和相关利益方寻求直接、及时和持续的意见和建议 Successful projects depend on effective communication both between the researchers, policymakers, and professionals. 成功的项目得益于研究者、政策制定者，及专业人员间有效的交流。 Communication will include initial meeting, regular trips, conference calls, progress reports, ad hoc telephone calls, and e-mail exchanges. 交流包括举办会议、定期差旅、电话会议、进展报告、专设通话以及邮件沟通等。 © 2008, Johns Hopkins University. All rights reserved.

Lesson 3. Having a unique set of database that facilitates policy relevant research and analyses 经验三：运用一系列独特的数据库辅助政策研究和分析 PCPC has a unique set of community health center related datasets. 中心拥有一系列数据库用于社区医疗中心研究 The core datasets include: the Uniform Data System (annually since 1996), the CHC User and Visit Survey (1995, 2002, 2009), the SCN Primary Care Surveillance System (annually since 2002), and the Area Resource File (annually since 1990). Other health center related datasets include the Health Collaboratives Registries, the Healthy School Healthy Community User/Visit Survey, Homeless User/Visit Survey, and the Health Center Financial Audit Reports. In addition, for the sake of comparisons, we have access to major national surveys including Hospital Discharge Survey, Medical Expenditure Panel Survey, National Health Interview Survey, National Health Care Survey, National Ambulatory Medical Care Survey, National Hospital Ambulatory Care Survey, SLAITS, vital statistics, Behavioral Risk Factor Surveillance System, Robert Wood Johnson Foundation's Community Tracking Study, and Kaiser's National Surveys of American Families. © 2008, Johns Hopkins University. All rights reserved.

Lesson 4. Maintaining a multidiscipline of expertise and content areas 经验四：保持专业能力和知识领域的多学科性 PCPC brings significant levels of expertise in virtually all key domains of health care content and methods likely to be relevant to applied policy research. 在几乎所有与卫生政策研究相关的关键领域，中心都具备十分突出的专业实力。 See Figure 2 for list of policy relevant expertise and content areas. 图示 2 列举了与政策研究相关的专业能力和知识领域 © 2008, Johns Hopkins University. All rights reserved.

FIGURE 2. HEALTH POLICY RELEVANT EXPERTISE AND CONTENT AREAS �示 2. �生政策相关��能力和知��域 POLICY-RELEVANT EXPERTISE: ��能力 - Program evaluation �目�估 - Design of demonstration studies 研究�� - Health services research methods �生服�研究方法 - Survey research �卷�� - Technology assessment �生技��估 - Economic analysis/ CBA-CEA ��学分析 - Management sciences/ operations research 管理科学 - Behavioral sciences 行�科学 - Information technology 信息系� - Case studies and qualitative assessment 案例研究和定性�估 - Clinical/quality analysis �床/�量分析 - Social science methods 社会科学研究方法 - Biostatistics/ epidemiology 生物��/流行病学 - Medical, nursing and pharmacy sciences 医学、�理学、�学 POLICY-RELEVANT CONTENT AREAS: 知��域 - Managed care and health insurance 管理式医�与医�保� - Disease management and population health 疾病管理与人群健康 - Primary / ambulatory care 基本/急�医� - Inpatient and Intensive care 住院与重症医� - Mental health / behavioral health services 精神健康/行�健康服� - Risk adjustment and case-mix ��与病例�合 - Cost of care (effectiveness/ efficiency/ outcomes) 医�服�花� - Quality / performance improvement/ TQM �量/�效提升/全面�量管理 - Patient safety and medical errors 病人安全与医�差� - Health promotion/prevention 健康促�/�防 - Vulnerable populations/ access/ disparities 脆弱人群/可及性/差异 - Special age/gender groups (children, adolescents, elderly, women, men) 特殊年�/性�群体（儿童、青少年、老年人…） - Public health insurance programs (Medicare/Medicaid/ S-CHIP) 公共医�保��目 - Long term care / home care �期�理/ 家庭�理 - Pharmacy programs �物�目 - Consumer involvement / outreach �客参与/�展 - Provider incentives and behaviors 医�人�激励与行� © 2008, Johns Hopkins University. All rights reserved.

Lesson 5. Handling challenges typical of applied policy research 经验五：处理典型的政策实践研究的挑战 We strive to collaborate with all interested constituencies and serve the role as facilitators of these collaborative activities. 与所有利益团体合作，担当调和者角色。 – Many of the projects are of interest to many constituencies including the BPHC, other HRSA divisions, other Federal agencies, community health centers, the various primary care related organizations and associations, and research organizations and individuals who study vulnerable populations. How to channel their interests and expertise into positive forces for the projects is critical for the ultimate success of the projects. 很多项目涉及众多利益团，如何疏通各方利益并发挥其能力是促使项目获得最终成功的关键。 – Our goal is to seek and incorporate the ideas and concerns of the constituencies. At the same time, we closely monitor the progress of the overall project goals and requirements and make sure that the collaborative approach does not significantly slow down the projects. Special attention is paid to resolving the following apparent conflicts: funding level versus volume of work, scientific rigor versus expeditiousness, input seeker versus input provider, and collaboration versus quick turnaround. 我们的目标是汇聚各方想法。与此同时，密切关注项目进展、确保进度，并特别关注和解决以下矛盾：资金水平与作量、科学的严谨性与高效完成、寻求方案与提供方案、合作与迅速周转。 © 2008, Johns Hopkins University. All rights reserved.

Lesson 6. Disseminating work timely and in a variety of ways 经验六：及时、多样化的传播研究成果 In addition to scholarly presentation in academic conferences and publications in SCI journals, we communicate study findings through more policy relevant channels. These include: 除了学术报告和发表论文，我们通过以下与政策相关的渠道发布研究成果： – issue briefs, newsletters, congressional hearings, policy briefings, professional meetings, international speeches, and chartbooks 发布摘要、通讯、国会听证会、政策简报、专业会议、国际讲演及图册 © 2008, Johns Hopkins University. All rights reserved.

Policy and Research: Ingredients to Success 政策与研究：成功的要素 Importance of the problem (e. g. , health, quality of life, cost, access, equity, social stability) 问题的重要性（如：健康、生活质量、花费、可及性、公平性、社会稳定） Solution to the problem (e. g. , strong evidence and science) 问题的解决方法（如：充分的证据和科学） Political feasibility (e. g. , decisionmakers’ agenda) 政策的可行性（如：决策制定者的日程） Stakeholders’ interests 利益相关者的利益 Financial feasibility (e. g. , funding demand) 财务的可行性（如：资金需求） Administrative feasibility (e. g. , change in administrative structure) 管理的可行性（如：管理结构的改变） © 2008, Johns Hopkins University. All rights reserved.

Facilitators to HTA Adoption卫生技术评估实施的促进因素 Continue dialogue to promote understanding and interaction 持续对话以促进理解和互动 Provide strong evidence and science regarding efficacy 提供充分的与效率相关的证据和科学 Access to policymakers’ agenda 获得政策制定者的日程 Mobilize and align stakeholders’ interests 调动和调整利益相关者的利益 Make economic sense or identify source(s) of funding for new technology 为新技术创造经济效益或识别资金渠道 Work within current administrative structure 在现有管理结构中运作 © 2008, Johns Hopkins University. All rights reserved.