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. http://www.ahrq.gov/news/sp103112.htm
540 Gaither Road Rockville, MD 20850 