1. Center for Evidence-based Policy Globalizing Evidence, Localizing Decisions Make it Purpose Driven, Ethical, Equitable, and Sustainable. Quality of Care and Outcomes Research in Cardiovascular Disease and Stroke 2010 Scientific Sessions Mark Gibson, Director Center for Evidence-based Policy Oregon Health and Science University May 20, 2010 Washington, D.C. 1

2. Center for Evidence-based Policy Globalizing Evidence, Localizing Decisions 2 Presenter Disclosure Information Mark Gibson Make it Purpose Driven, Ethical, Equitable, and Sustainable. FINANCIAL DISCLOSURE: Receives funding from state Medicaid programs, NIMH, and the Milbank Memorial Fund. No business conflicts. UNLABELED/UNAPPROVED USES DISCLOSURE: None

3. Center for Evidence-based Policy Globalizing Evidence, Localizing Decisions Defining the Purpose of Health Care Economic Commodity –Business development –Employment –Benefits of employment Health as Sole Purpose of Healthcare 3

4. Center for Evidence-based Policy Globalizing Evidence, Localizing Decisions Values Problem 4 Pursuit of Happiness (Health) –Personal assets –Community assets Pursuit of Profit –Ethics of health care business –Legal compliance insufficient

5. Center for Evidence-based Policy Globalizing Evidence, Localizing Decisions Oregon Health Plan Goal is improving population health Limits are real Priorities must be established Some services won’t be provided Population treated equitably 5

6. Center for Evidence-based Policy Globalizing Evidence, Localizing Decisions Priority Setting Based on Benefit, Harm, and Cost (Eddy) –Better for population than nothing –Outweighs harms in improving health –Comparatively better –Empirical evidence trumps subjective –Burden of proof lies with advocates of service Outcomes Reflect Patient Preferences 6

7. Center for Evidence-based Policy Globalizing Evidence, Localizing Decisions Issue of Connectivity Used There, Lost Here (Conservation International) Era of Behavior (Seidman) –Ethical connectivity –Situational ethics –Sustainable ethics Generational Challenge 7

8. Center for Evidence-based Policy Globalizing Evidence, Localizing Decisions Contact Information Mark Gibson, Director Center for Evidence-based Policy Oregon Health and Science University 3455 SW US Veterans Hospital Road Portland, OR 97239-2941 gibsomar@ohsu.edu 503-494-2679 www.ohsu.edu/policycenter 8