Promoting Comparative Effectiveness in Case Management


Pat Stricker, RN, M EdPat Stricker, RN, M Ed
Senior Vice President
TCS Healthcare Technologies

I’m still reflecting on "take-aways" from the 21st Annual CMSA Conference. Each year there are some sessions that really stay with me. This year it was one by Dr. Tom Wilson, PhD, entitled "Health Care Effectiveness Review – Measurement and Performance". It sounded like a good outcomes session, so I decided to attend. But it was much more than that!

What Dr. Wilson described is a new, exciting way to transform the overwhelming, intimidating process of developing a research study and publishing its results into a simple method that any of us can feel comfortable doing. We have probably all had some successful program, project, new initiative, or maybe a study that showed lowered costs or increased productivity that we felt others would be interested in learning about. However, we didn’t publish it because it didn’t seem like it was "formal" enough. Likewise, we are interested in knowing what successes (or failures) others are having, but they aren’t published, so that information doesn’t get shared. So what can we do about this?

Those of us working in case management have an obligation to demonstrate the clinical and financial efficacy of how we intervene with patients and their providers and to share this information with others. One challenge we must address is that our choice of services is broad and dynamic, so any "return on investment" (ROI) analysis or report might not adequately document how case managers are positively impacting the targeted population.

Similar challenges and problems have confronted other areas of medicine as well. In fact, much has been written in recent years about some of the "poor" evidence that is used to support studies that are published in peer reviewed journals, including even the New England Journal of Medicine.

This has given rise to the "comparative effectiveness" movement. The U.S. Agency of Healthcare Research and Quality (AHRQ) has taken a leadership role in promoting research and medical interventions that are more transparent and accountable. AHRQ notes:
Comparative effectiveness research is designed to inform health-care decisions by providing evidence on the effectiveness, benefits, and harms of different treatment options. The evidence is generated from research studies that compare drugs, medical devices, tests, surgeries, or ways to deliver health care.1
Even the Congressional Budget Office touts the benefits of comparative effectiveness research in a 2007 report.2 CBO defined the concept as: "As applied in the health care sector, an analysis of comparative effectiveness is simply a rigorous evaluation of the impact of different options that are available for treating a given medical condition for a particular set of patients."3 A primary motivation for CBO’s support is the ability to save costs in the Medicare and Medicaid programs.

Dr. Wilson, founder of the Population Health Impact Institute – PHI Institute (www.phiinstitute.org), has worked closely with CMSA to operationalize the principles of comparative effectiveness criteria in the case management environment, including presenting at several CMSA conferences, providing an online individual certification course, and an accreditation program for organizations.

And now Dr. Wilson and the PHI Institute aims to provide a new kind of "peer" reviewed publication targeted to real-world workers and designed to enhance measurement and performance of care management programs.

As noted in Dr. Wilson’s description of the conference session, the "peer-reviewed learnings" will focus on the easy-to-understand "Method Evaluation Process" (MEP) developed by PHI Institute. Articles selected for publication can be either new submissions or articles that have been published previously, but may need some re-formulation. All articles submitted will be reviewed by true "peers"--individuals who have been granted MEP certification and wish to help the real world writers and readers advance the cause of care coordination learning.

As Dr. Wilson notes, "the goal is to provide a number of educational forums and opportunities to support research at the design, study, analysis and publication phases. Credible research can add important insights on how case managers and others can better manage individuals, especially those with a number of co-morbidities".

If you want to consider a 1st step, take a look at PHI Institute’s transparency pledge at http://phiinstitute.org/transparency-pledge. Your 2nd step should be to listen to Dr. Wilson’s session as soon as it becomes available with all the course offerings from the conference on the CMSA website. And if you want to take a "really big" 3rd step, why not submit an article for publication? Come on. It may be easier than you think!

Documenting case management outcomes is an ongoing journey. By using resources made available by AHRQ, PHI Institute, CMSA and others, the journey can be made more educational, focused, effective, and FUN!
References:
  1. See http://www.effectivehealthcare.ahrq.gov/index.cfm/what-is-comparative-effectiveness-research1/.
  2. See "Research of the Comparative Effectiveness of Medical Treatments" COB (December 2007, 48 pages) at http://www.cbo.gov/ftpdocs/88xx/doc8891/12-18-ComparativeEffectiveness.pdf.
  3. Ibid at page 11.