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Agency for Healthcare Research Quality

Second China–U.S. Health Summit

Keynote Address by Carolyn M. Clancy, M.D., Director, Agency for Healthcare Research and Quality (AHRQ)

Beijing, China (Via Videoconference), October 31, 2012

Hello and thank you for inviting me to speak at the Second China–U.S. Health Summit.

My name is Dr. Carolyn Clancy. I am director of the U.S. Agency for Healthcare Research and Quality, also known as AHRQ.

I would have loved nothing better than to join you there at the China National Convention Center in Beijing—to participate in the discussions about the common challenges that we face in improving the quality, safety, efficiency, and effectiveness of health care for everyone in China and the United States. Unfortunately, that was not possible, so I'm very grateful for the opportunity to speak with you by videorecording.

At the Department of Health and Human Services, we're extremely proud of the very productive relationships that we have developed with our counterparts in China. We very much look forward to continuing these relationships as we work together to learn more about issues such as professionalism, public health, and patient-centered care.

The China Initiative at the Harvard School of Public Health has been instrumental in generating high-level policy dialogues between China and the United States over the last several years. The Summit is positioned to play a significant role in these dialogues moving forward, and on behalf of Secretary Sebelius, I want to congratulate you on establishing it as an annual event.

AHRQ is one of the 12 agencies within the Department of Health and Human Services. Working with the public and private sectors, AHRQ builds the knowledge base for what works—and what does not work—in health and health care. We then translate this knowledge into everyday practice and policymaking.

Here are some trends involving health system transformation in China that have been written about over the last several months:

  • Clinical experts are demanding more data on comparative effectiveness studies and patient-reported outcomes studies.
  • National and commercial health insurance organizations are increasingly demanding evidence of medical pathways in the process of reimbursement.
  • Most health professionals in China have accepted the concept of evidence-based medicine and are demanding more data on the effectiveness and safety of medical products used by Chinese patients.

These trends are the same or similar to those we're seeing in the United States. For example:

  • There is not enough credible, empirically based patient-centered outcomes research available to help patients, providers, payers, and policymakers make informed treatment decisions.
  • The Federal Government has provided us with the resources to initiate the process of building a health care system in which the lag between data acquisition and exploration can be measured in weeks or days, and not months or years, as is currently often the case.
  • And health professionals want more data that can help them make better decisions.

In 2009, both China and the United States dedicated extremely substantial resources to health system transformation. And we've now reached the phase where a lot of changes—unprecedented changes—are underway.

Of course, those changes absolutely pale in comparison to all of the work that is still ahead of us. But we're clearly making progress—just not as fast as we'd like, right?

I'm the oldest of seven children. When we were growing up, and my brothers would come up with a clever plan for something, they would call it, "Management Thinking." Actually they would say "MT" because that was their short-hand for management thinking.

It's the same way we think today about systems intervention. We've acted as if it's something that's really easy. We put out all kinds of scientific findings and then expect them to magically trickle down to the point of care perfectly and seamlessly. Of course, we have a great deal of evidence that it doesn't quite happen that way.

Also contributing to this phenomenon is the fact that health care traditionally has been disease-centered, with physicians making almost all treatment decisions based largely on clinical experience and data from various medical tests.

In the patient-centered model that we're both working to build, patients are more active participants in their own care, and interactions between diseases are important. They receive services designed to focus on their individual needs and preferences, in addition to advice and counsel from health professionals.

In her speech at last year's Summit, my former HHS colleague Sherry Glied talked about the historic investment our health care reform law made in tools to help transform our health care delivery system. These are tools that are helping to reduce preventable injuries to patients, reward quality and innovation, and spur adoption of technology that improves care while better aligning payment incentives to reward providers who work to improve care.

Among the programs and strategies that Sherry mentioned were patent-centered outcomes research, the Partnership for Patients, and the Million Hearts campaign.

Patient-centered outcomes research is a key element in my Agency's safety and quality improvement efforts. I was given the opportunity to talk about this at a very significant meeting that was held in Shanghai back in March.

Our mandate for conducting this type of research was put forward in the form of our Effective Health Care Program that was created as part of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, which expanded medication insurance coverage for the elderly and disabled.

The program became operational in 2005 and from then until 2009, we received $129 million from the Congress. The focus on patient-centered outcomes research at HHS changed dramatically with passage of the American Recovery and Reinvestment Act of 2009 and the Patient Protection and Affordable Care Act in 2010.

Using our work at AHRQ to provide some context; from 2005 to 2009, we developed about 50 products. With increased resources provided by the two laws, we have completed about 100 more products, and plans call for that type of accelerated development to continue.

We've also funded several initiatives, including one to advance the national dialogue on using electronic clinical data for patient-centered outcomes research and quality improvement. It's called the Electronic Data Methods Forum, and it brings together 11 grants in three basic areas:

  • Developing new clinical infrastructure and improving the methodology for collecting prospective data from electronic clinical data to generate new evidence on the comparative effectiveness of health care interventions.
  • Two enhanced registries that are focused on further developing an existing patient registry to track health outcomes, and measure quality and performance.
  • Three research networks that are linking data by expanding the existing electronic health data infrastructure with an emphasis on developing the capability of near- and real-time data extraction and analysis, along with new data collection at the point of care.

The networks include between 12,000 and 7.5 million patients each, with a potential reach of up to 50 million patients. The work also includes 38 patient-centered outcomes research studies that address all of our priority populations and almost all of our priority conditions.

A month before last year's Summit, HHS launched the Partnership for Patients, bringing together leaders of major hospitals, employers, physicians, nurses, and patient advocates, along with State and Federal Governments in a shared effort to make hospital care safer, more reliable, and less costly.

Today, more than 7,700 partners, including more than 3,300 hospitals, as well as physicians and nurses groups, consumer groups, and employers, have pledged their commitment to the effort.

One goal of the initiative is to reduce hospital-acquired conditions by 40 percent by 2012. Achievement of this goal centers around 26 Hospital Engagement Networks that are working to improve patient safety, reduce complications and preventable hospital readmissions, and save lives.

These Networks are also working to develop learning collaboratives for hospitals and provide a variety of activities to improve patient safety. And, they are required to establish and implement a system to track and monitor hospital progress in meeting quality improvement goals.

At the time of this meeting last year, Secretary Sebelius had just launched the Million Hearts, a public-private partnership to prevent one million heart attacks and strokes over the next 5 years. Million Hearts is now promoting innovations to identify people at cardiac risk, ensure they receive appropriate treatment, reduce the need for blood pressure and cholesterol treatment, promote healthy diet and physical activity, and support smoke-free environments.

In many ways, what we're working to do is all about getting beyond our own experiences, to expand our horizons beyond each transaction, and opening avenues to learn much more about what happens to patients over time.

And while decisions and policies must be implemented locally, evidence should be shared globally. Collaboration must be a global endeavor.

When we share, we become energized. We come up with lots of new ideas about how we can help our patients, and together, we help to turn local successes into strategies that can improve care everywhere.

In a speech announcing the Department's new Global Health Strategy in January, Secretary Sebelius said, "Health is an issue which aligns the interests of the countries around the world."

Health leaders everywhere are trying to solve the same problems: obesity, chronic disease, rising health care costs, a shortage of primary care providers, and so forth.

Of course, each nation has its own unique characteristics, so what works in one may not work quite as seamlessly in another. But we can—and we must—learn from each other.

Summits like this one are critical to ensuring that we continue our collaboration—pooling our work and resources to make sure that we're exploring all avenues on the path to patient-centered care. And I hope there will be many, many more China-U.S. Health Summits.

Thank you very much.

Current as of November 2012

Internet Citation:

Second China–U.S. Health Summit. Keynote Address by Carolyn Clancy, October 31, 2012. Agency for Healthcare Research and Quality, Rockville, MD.


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