Thanks to Congress keeping the federal government open, I had a chance to attend the AHRQ Research Conference on October 4, 2015. I thought I would share a few observations.
The Plenary and literature on display vividly illustrated the richness of activities underway at AHRQ. Lisa Simpson, President and CEO of AcademyHealth, opened the session by reflecting on the importance of AHRQ-supported activities. Mary Wakefield, Acting Deputy Secretary of the Department of Health and Human Services (HHS), gave an overview of how AHRQ activities fit within the broader context of HHS. The highlight of the plenary was Rick Kronick, Director of AHRQ, quantifying the impact of their work. He focused on safety and quality as particular success stories. An estimated 1.3 million medical errors, 50,000 deaths, and $12 billion in spending were avoided because of AHRQ research and tools. That’s a lot for just a few years! And there is no arguing the societal good of these reductions. Dr. Kronick’s October 2ndblog parallels much of the information he presented.
The Plenary also included a panel discussion between Alice Rivlin (Brookings Institute), Bruce Siegel (America’s Essential Hospitals), and Beverley Johnson (Institute for Patient- and Family-Centered Care). It was a notably entertaining exchange given they were talking about some serious problems in medical care. My favorite line was Dr. Siegel’s observation that hospitals are under a lot of pressure in the unfamiliar territory of doing “less with less.” Much of the session was spent talking about challenges to genuine patient engagement. Dr. Rivlin spoke about her recent experience at a major DC area hospital, during which she was asked to check a box and sign a form indicating she had been engaged in her care. Ms. Johnson spoke of challenges in providing supportive care for an aging parent that arose from her being refused access to the parent’s medical record. Clearly there is much to be done in this area, and our Outcomes Research Branch is a focal point for this activity at NCI.
The common theme of the other sessions I attended was the tension between scientific rigor and the need to make decisions. Whereas an economist might spend years developing an elaborate and exceedingly high quality cost-effectiveness analysis, health insurers need an answer in a few months. Program evaluations face tremendous challenges, such as post hoc data collection and the lack of appropriate comparison groups. Secondary data analyses can be informative but are open to endless criticism of data quality, assumptions, analytic methods, etc. While the question of “what is good enough” was not a surprise to me, it was a reminder that our NIH application and grant award cycles may be out of step with the timelines decision-makers face.