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Institute of Medicine (US) Roundtable on Value & Science-Driven Health Care. Learning What Works: Infrastructure Required for Comparative Effectiveness Research: Workshop Summary. Washington (DC): National Academies Press (US); 2011.

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Learning What Works: Infrastructure Required for Comparative Effectiveness Research: Workshop Summary.

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Appendix FWorkshop Agenda


Infrastructure Required to Learn Which Care Is Best

A Learning Healthcare System Workshop IOM Roundtable on Evidence-Based Medicine

July 30–31, 2008

Lecture Room, The National Academy of Sciences Washington, DC 20001

Issues motivating the discussion

  1. Substantial demand for greater insights into the comparative clinical effectiveness of clinical interventions and care processes to improve the effectiveness and value of health care.
  2. Expanded interest and activity in the work needed—e.g., comparative effectiveness research, systematic reviews, innovative research strategies, clinical registries, coverage with evidence development.
  3. Currently fragmented and largely uncoordinated selection of studies, study design and conduct, evidence synthesis, methods validation and improvement, and development and dissemination of guidelines.
  4. Expanding gap in workforce with skills to develop data sources and systems, design and conduct innovative studies, translate results, and guide application.
  5. Opportunities presented by the attention of recent initiatives and the increasing possibility for development of an entity and resources for expanded work on the comparative effectiveness of clinical interventions.
  6. Growing appreciation of the importance of assessing the infrastructure needed for this work—e.g., workforce needs, data linkage and improvement, new methodologies, research networks, technical assistance.
  7. Desirability of a common venue to identify and characterize the need categories, begin to estimate the shortfalls, consider approaches to addressing the shortfalls, and identify priority next steps.

Discussion assumptions: (1) Resources will be available to expand work on the comparative effectiveness of medical interventions, and (2) a designated entity will exist with a formal charge to coordinate the expanded work.

Goal: Clarify the elements and nature of the needed capacity, solicit quantitative and qualitative assessments of the needs, and characterize in a fashion that will facilitate engagement of the issues by policy makers.


8:00Welcome and Introductions
John W. Rowe, Columbia University & IOM Roundtable on Evidence-Based Medicine
8:15Keynote: A Vision for the Capacity to Learn What Care Works Best
What are the core elements of a robust and sustainable capacity for comparative effectiveness research? How do they relate to each other as a real infrastructure? What are the priorities and how might we build upon, link, and improve existing public and private system elements?
Mark B. McClellan, Brookings Institution & IOM Roundtable on Evidence-Based Medicine
8:45Session 1: The Work Required
Each presenter will describe the nature of the activity and what is known about the current capacity, suggest an approach to determining the necessary capacity, give an “opening bid” estimate of what that need might be, and offer initial suggestions on policies or activities for progress.
Chair: Mark B. McClellan, Brookings Institution & IOM Roundtable on Evidence-Based Medicine

The Cost and Volume of Current Comparative Effectiveness Research

  • Erin Holve, AcademyHealth

Intervention Studies That Need to Be Conducted

  • Douglas B. Kamerow, RTI International

Clinical Data Sets That Need to Be Mined

  • Jesse A. Berlin, Johnson & Johnson

Knowledge Synthesis and Translation That Need to Be Applied

  • Richard A. Justman, UnitedHealthcare
[9:45 – 10:00 BREAK]

Methods That Need to Be Developed

  • Eugene H. Blackstone, Cleveland Clinic

Coordination and Technical Assistance That Need to Be Supported

  • Jean R. Slutsky, Agency for Healthcare Research and Quality
OPEN DISCUSSION (60 minutes)
11:30Lunch Presentation: The Potential Returns from Evidence-Driven Health Care
Gail R. Wilensky, Project HOPE
1:00Session 2: The Information Networks Required
Each presenter will describe the nature of the systems required to capture and use data for insights on clinical effectiveness and to ensure effective and efficient review and dissemination of those insights. Presenters will also describe what is known about the current capacity, give a rough estimate of the necessary capacity, and offer initial suggestions on policies or activities for progress.
Chair: Kathleen A. Buto, Johnson &Johnson

Information Technology Requirements

  • Robert H. Miller, University of California at San Francisco

Data and Information Hub Requirements

  • Carol C. Diamond, The Markle Foundation

Integrative Vehicles Required for Evidence Review and Dissemination

  • Lorne A. Becker, Cochrane Collaboration
OPEN DISCUSSION (45 minutes)
2:30Session 3: The Talent Required
Session Three will review the competencies and workforce necessary to carry out comparative effectiveness work, including the presentation of initial estimates of the workforce needed in key areas, comments on the estimates from end users of such research, and insights on the implications for training programs.
Chair: Donald M. Steinwachs, Johns Hopkins University Bloomberg School of Public Health & IOM Roundtable on Evidence-Based Medicine

Comparative Effectiveness Workforce—Framework and Assessment

  • William R. Hersh, Oregon Health and Science University
  • Reactor Panel
    Jean Paul Gagnon, sanofi-aventis
    Bruce H. Hamory, Geisinger Health System
    Steve E. Phurrough, Centers for Medicare & Medicaid Services
    Robert J. Temple, Food and Drug Administration
OPEN DISCUSSION (30 minutes)

Panel Discussion: Training and Education Needs

  • Clinical Epidemiology and Research—Eric B. Bass, Johns Hopkins University
  • Health Services Research— Timothy S. Carey, University of North Carolina at Chapel Hill
  • Informatics—Don E. Detmer, American Medical Informatics Association
  • Guideline Development— Richard N. Shiffman, Yale University
  • Knowledge Translation—David H. Hickam, Eisenberg Center
OPEN DISCUSSION (30 minutes)

Toward an Integrated Enterprise—An International Case Study

  • Sean R. Tunis, Center for Medical Technology and Policy
OPEN DISCUSSION (20 minutes)
5:15Highlightsof Day's Discussion
John W. Rowe, Columbia University & Roundtable on Evidence-Based Medicine


8:00Welcomeand Recap of The First Day
J. Michael McGinnis, Institute of Medicine
8:15Session 4: Next Steps—Priorities for Implementation
In this discussion of priorities, strategies, staging, and policies, each participant will offer comments that reflect on the nature (quantitative and qualitative) of the need in the relevant area, how to clarify the understanding on that count, and the possible approaches to ramping up. Specific consideration of how to take best advantage of existing manufacturer and related private sector capacity will also be discussed. Ten minutes of comments on each of the following areas, followed by open discussion.
Chair: Nancy H. Nielsen, American Medical Association & IOM Roundtable on Evidence-Based Medicine

Information Technology Platform Requirements

  • Mark E. Frisse, Vanderbilt University

Data Resource Development and Analysis Improvement

  • T. Bruce Ferguson, East Carolina Heart Institute

Research Infrastructure Improvement

  • Daniel E. Ford, Johns Hopkins University

Transforming Health Professions Education

  • Benjamin K. Chu, Kaiser Foundation Health Plan and Hospitals

Building the Training Capacity

  • Steven A. Wartman, Association of Academic Health Centers
[10:00 – 10:15 BREAK]
10:15Session 5: Public–Private Partnerships
Session panelists will address the following questions: How might better advantage be taken of capacity in the private sector? What existing or planned efforts might best inform the development of needed infrastructure for comparative analyses and research (e.g., biomarkers consortium, data aggregation efforts, Food and Drug Administration Sentinel Network)?
Chair: W. David Helms, AcademyHealth

Carmella A. Bocchino, America's Health Insurance Plans


Rachel E. Behrman, Food and Drug Association


William Z. Potter, Merck Research Laboratories

11:15Session 6: Getting Started
This final session will be a facilitated open discussion of the priorities and strategies for building the needed infrastructure. There will be 30-45 minutes each on the following.
Chair: John W. Rowe, Columbia University & Roundtable on Evidence-Based Medicine

The Roadmap—Policies, Priorities, Strategies, and Sequencing

  • Stuart Guterman, The Commonwealth Fund

Quick Hits—Things That Can Be Done Now

  • W. David Helms, AcademyHealth

Building Support

  • Mary Woolley, Research!America
12:45Concluding Summary Remarks and Adjournment
J. Michael McGinnis, Institute of Medicine

Planning Committee:

  • John W. Rowe (Chair), Mailman School of Public Health,
  • Columbia University
  • Stuart H. Altman, Brandeis University
  • Kathleen A. Buto, Johnson & Johnson
  • Carolyn M. Clancy, Agency for Healthcare Research and Quality
  • W. David Helms, AcademyHealth
  • Mark B. McClellan, Brookings Institution
  • Peter R. Orszag, Congressional Budget Office
Copyright © 2011, National Academy of Sciences.
Bookshelf ID: NBK64775
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