1. Delivery System Research: Discovering Ways to Improve Care Value* Michael I. Harrison Center for Delivery, Organization & Markets AHRQ Annual Meeting Sept. 20, 2011 * Thanks to Dina Moss, co-lead on this initiative.

2. Session Overview AHRQ’s ARRA Delivery System Research Initiative AHRQ’s ARRA Delivery System Research Initiative Recommendations on Advancing Delivery System Research Recommendations on Advancing Delivery System Research Progress Reports/Early Findings Progress Reports/Early Findings Discussion Discussion

3. DELIVERY SYSTEM FOAs 6 Evaluation Grants ($12 million) – RFA 10-012 6 Evaluation Grants ($12 million) – RFA 10-012 o Research on existing designs or redesigns (interventions) in payment, reporting, and organization of care delivery o CER= compare alternative designs or redesigns; compare one redesign to status quo accepted as current policy 4 Demonstration Grants ($7 million) – RFA 10-013 --Implementation & Research on effectiveness of redesigns in 4 Demonstration Grants ($7 million) – RFA 10-013 --Implementation & Research on effectiveness of redesigns in o primary care o care continuum o payment and reporting 5 Spread Demonstration Grants ($18 million) -- Accelerating Implementation of CER Findings through Networks – RFA 10-014 5 Spread Demonstration Grants ($18 million) -- Accelerating Implementation of CER Findings through Networks – RFA 10-014 o Spread of CER findings by leveraging the capacities of multi-stakeholder or multi-site networks: Goal is implementation of existing evidence, not creation of new evidence. o Evaluation to be conducted by external contractor.

6. 1 National =2 5 1 1 1 1 1 3 2 2 2 1 2 1 2 1 1 2 1 1 1 1 2 ARRA Delivery System FOA Grantees: Geographic Spread

7. Meeting: Advancing Delivery System Research ARRA CER Delivery System grantees, other grantees, stakeholders, experts discuss white papers: ARRA CER Delivery System grantees, other grantees, stakeholders, experts discuss white papers: – Gaps in Research Topics & Concepts – Research Designs, Methods, & Measures – Spread Strategies Steps for Researchers – Most need leadership by funders: Steps for Researchers – Most need leadership by funders: – Use more mixed methods (Needed: journal, study section support) – Examine diverse contexts for improvements – Model change over longer time periods (3+ yrs) – Apply common evaluation frameworks for similar initiatives (e.g. P4P, PCMH) – Test valuable improvements in additional, diverse contexts – Develop measures for readiness, change contexts, culture http://www.ahrq.gov/qual/deliverysys/2011mtg/mtgsumm.htm

8. For more information http://www.ahrq.gov/qual/deliverysys/2011mtg/ mtgsumm.htm http://www.ahrq.gov/qual/deliverysys/2011mtg/ mtgsumm.htm http://www.ahrq.gov/qual/deliverysys/2011mtg/ mtgsumm.htm http://www.ahrq.gov/qual/deliverysys/2011mtg/ mtgsumm.htm Michael Harrison (RFA 10-012, 10-013 and meeting) Michael Harrison (RFA 10-012, 10-013 and meeting) Michael.Harrison@ahrq.hhs.gov Michael.Harrison@ahrq.hhs.govMichael.Harrison@ahrq.hhs.gov Dina Moss (RFA 10-014) Dina Moss (RFA 10-014) Dina.Moss@AHRQ.hhs.gov

9. Reports from Delivery System Research Teams Michael Magill, MD, University of Utah School of Medicine Michael Magill, MD, University of Utah School of Medicine Rebecca A. Malouin, PhD, Michigan State University Rebecca A. Malouin, PhD, Michigan State University Wally R. Smith, MD, Virginia Commonwealth University Wally R. Smith, MD, Virginia Commonwealth University