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Comparative Effectiveness and Healthcare Quality

The Institute of Medicine (IOM) defines comparative effectiveness research (CER) as generation and synthesis of evidence that compares the benefits and harms of alternative methods to prevent, diagnose, treat, and monitor a clinical condition or to improve the delivery of care. The purpose is to assist consumers, clinicians, purchasers, and policy makers to make informed decisions that will improve health care at both the individual and population levels.

The federal Agency for Healthcare Research and Quality (AHRQ) notes that healthcare quality problems are reflected today in the wide variation in the use of health care services, the underuse and overuse of some services and the misuse of others. Disparities in healthcare quality have been associated with race and ethnicity and with socioeconomic status.

Dr. Morrato is leading the Comparative Effectiveness and Healthcare Quality research program at ACCORDS. She has received funding through the Agency for Health Care Research and Quality to develop interventions for accelerating the diffusion of new comparative effectiveness evidence in the medical community.  Dr. Morrato also serves as a member of the Food and Drug Administration’s Drug Safety and Risk Management Advisory Committee, which advises the FDA on pharmaceutical safety evidence and risk mitigation strategies.

Telephone and Internet Triage: ACCORDS researchers (Drs. Bunik and Kempe) published the first papers examining outcomes associated with algorithm-guided nurse triage phone services for after-hours acute care.  Previous work examined parental attitudes and level of satisfaction with such services, patient outcomes, including rehospitalizations and deaths, and health care system outcomes such as compliance with recommendations and number of visits generated.  Currently we are collaborating with Kaiser Permanente to assess the effectiveness of a web-based self-triage program developed to function in tandem with telephone management protocols.

Surgical Quality Improvement and Outcomes Research: ACCORDS researchers (Drs. Morrato and Kempe and Juliana Barnard) have conducted several qualitative evaluations of a clinical program in Musculoskeletal Surgery for patients undergoing scoliosis surgery who have complex medical problems, the "high risk pathway." In addition, ACCORDS Child Program researchers and analysts have examined national variability in the use of surgical procedures by hospital type and by region. Currently, COR is hiring two PhDs in conjunction with the Department of Surgery to aid in expanding surgical outcomes research.

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