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USMI Dialogue: AHRQ Examines Interventions' Effectiveness

USMI asked Carolyn M. Clancy, MD, director of HHS' Agency for Healthcare Research and Quality, about AHRQ's Effective Health Care Program. Her reply:

The program was created by Section 1013 of the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003 to conduct research regarding "the outcomes, comparative clinical effectiveness, and appropriateness of health items and services." Launched by AHRQ in September 2005 with a budget of $15 million, the program initially focuses on services of special importance to Medicare, but will eventually be expanded to address Medicaid and the State Children's Health Insurance Program (SCHIP). There are three principal components of the program: Comparative Effectiveness Reviews: AHRQ's existing network of 13 evidence-based practice centers (EPCs) has been given the expanded role of conducting comparative effectiveness reviews for treating selected medical conditions. In the course of performing these reviews, the EPCs will identify gaps in the existing evidence base. Network of New Research Centers: A new network of 13 DEcIDE (Developing Evidence to Inform Decisions about Effectiveness) research centers is tasked with filling research gaps with accelerated studies using a database of 50 million patients. The DEcIDE network will perform prospective observational studies by evaluating patient-level data stripped of identifying information. Understandable Communication of Research Findings: The mission of the new John M. Eisenberg Clinical Decisions and Communications Science Center, based at Oregon Health and Science University, is to ensure that the findings of the Effective Health Care Program are usable by stakeholders, including clinicians and consumers. The Center will also assure that reports are presented in formats that make them useful and actionable to a range of audiences and will develop tools to facilitate consumer decision-making.

"AHRQ's Effective Health Care Program provides current, objective evidence about the relative effectiveness of different medical interventions. Its goal is to assist consumers, clinicians, and others in making informed choices among treatment alternatives, including drugs. A cardinal objective of the program is assuring that stakeholders have ready access to the best available evidence to guide major health care decisions. It is important for this program to hear from those in the field who can help steer our reviews toward the most important and strategic treatment questions that need to be addressed."

The first step in the program was completed in December 2004 with the selection of 10 priority conditions for initial attention, following a public comment period. These are: Arthritis and nontraumatic joint disorders. Cancer. Chronic obstructive pulmonary disease/asthma. Dementia, including Alzheimer's disease. Depression and other mood disorders. Diabetes mellitus. Ischemic heart disease. Peptic ulcer/dyspepsia. Pneumonia. Stroke, including control of hypertension. Obviously, this initial set of conditions is of primary importance to older and more chronically ill Medicare patients; future lists will include conditions of particular relevance to younger and more acutely ill Medicaid and SCHIP populations. The first three reviews addressed management of gastroesophageal reflux disease (GERD), noninvasive tests for breast abnormalities, and the effectiveness of epoetin/darbepoetin for managing anemia in patients undergoing cancer treatments. These reports are posted on the Effective Health Care Web site (www.effectivehealthcare.ahrq.gov). The Effective Health Care Program provides additional opportunities for public input into what is designed to be a transparent process. Each of the Comparative Effectiveness Reviews issued by the program is posted on the Effective Health Care Website in draft form for public comment before being finalized Everyone is invited to suggest topics for Comparative Effectiveness Reviews by visiting the Effective Health Care Web site and going to "Suggest topics for future research!" To ensure that our program is focusing on those areas where the most significant treatment questions exist, we need input from all those who are confronting decisions in areas where the evidence needs to be improved and comparative effectiveness needs to be better assessed.