Category Archives: Health outcomes

Video Highlights the Importance of Stakeholder Advisory Boards

Clinical trials, Health outcomes, Patient engagement, , ,

The PATIENTS program at the University of Maryland has produced a brief video on the role of Stakeholder Advisory Boards. Stakeholders are anyone who cares about the outcomes of a clinical study to inform healthcare decisions. The board’s purpose is to advise the study team during the course of a trial to help ensure the results are relevant and important to all stakeholders.

A Stakeholder Advisory Board comprises a diverse and balanced collection of individuals and organizations from the following groups:

  • Patients, caregivers, and advocacy organizations
  • Clinicians, nursing staff, specialists, and healthcare system administrators
  • Academic investigators and other researchers
  • Public and private healthcare payers
  • Policy and guideline organizations
  • Industry sponsors and therapeutic product developers

The 4-minute video features Ellen Tambor, MA, Senior Research Manager at the Center for Medical Technology Policy and a member of the Collaboratory’s Stakeholder Engagement Core working group.

Watch the YouTube video here.

Task Force Releases Recommendations for National Medical Device Evaluation System

Data sharing, Electronic health records, Health outcomes, , , , ,

A new report (PDF) containing recommendations for the creation of a national registry system for evaluating and monitoring medical devices has been released for public comment today. The report, a joint project of the Medical Device Registry Task Force and cover_19aug2015 the Medical Device Epidemiology Network (MDEpiNet), is available on boh the US Food and Drug Administration (FDA) website and on  the MDEpiNet website.

The report reflects the results of a year-long effort, prompted by the FDA’s Center for Devices and Radiological Health (CDER), that  is focused on fostering a national system for monitoring the use of medical devices in the “real-world” setting of patient care, once the devices have been approved for the market (known as “postmarket surveillance”).

The term “medical devices” encompasses a wide range of technologies, including implantable pacemakers, cardiovascular stents, robotic surgical devices, and artificial joint replacements, among many others. At present, information about the use of these devices in routine care settings, including safety issues reported by doctors and patients, is collected in a variety of registries and health record systems. A  networked national system, such as the one described in the task force report, would be able to unite and build upon both existing and novel data resources, thereby improving safety monitoring and accelerating the development of new devices:

“Task Force recommendations for [Coordinated Registry Network] CRN architecture, and thus for the National System, center on leveraging existing, self sustaining electronic resources, such as device registries, electronic health records, administrative data and even social media and personal mobile device sources.”

The Task Force Report offers recommendation in several key areas, including:

  • Establishing a national dialog about medical device evaluation that includes all stakeholders;
  • Leveraging existing efforts in the arena of device registries and electronic data systems;
  • Describing the desired characteristics of a national Coordinated Registry Network (CRN) for medical devices;
  • Outlining priorities for developing and refining medical devices in multiple therapeutic areas;
  • Identifying and improving methods for analyzing data on medical devices; and
  • Addressing network governance and issues related to patient privacy and informed consent.

Each of these key areas also features suggested pilot projects designed to inform ongoing efforts.

A related perspective article summarizing the National Registry System project has also been published online in the Journal of the American Medical Association.

Related Links

In the News: Increase in Use of Personal Health Data

Data privacy, Electronic health records, Health outcomes, Patient-Centered Outcomes Research, Pragmatic clinical trials, , , , ,

An explosion in the collection of personal data is fostering concerns about the extent to which health information is accessed—and about the privacy and confidentiality of this information. Two recent National Public Radio stories highlight a few of the burgeoning uses of these abundant data.

In the first, an insurer uses personal data to predict who will get sick so it can identify patients at highest risk for hospital admission, or readmission, and then provide them with personal health coaches. The coordinated care given to patients by the coaches (for example, arranging a visiting nurse or streamlining appointments) has been shown to improve hospitalization rates. The insurer says it follows federal health privacy guidelines for anonymity and uses the information to better serve its members.

The second story explains that results of online health searches aren’t always confidential, and data brokers are tracking information and selling it to interested parties. The author notes that data gathered on the Web are, for the most part, unregulated. Both stories raise questions about privacy and confidentiality of health information and how to best protect it.

Pragmatic clinical trials also seek to use personal health data to answer important questions on the risks, benefits, and burdens of therapeutic interventions. In a blog post in Health Affairs, Joe Selby, executive director of the Patient-Centered Outcomes Research Institute (PCORI), underscores the need for trust, support, and active engagement of patients when involving them in health data research, even with privacy protections in place. PCORI has launched the National Patient-Centered Clinical Research Network (PCORnet) as a means of harnessing large clinical data sets to study the comparative effectiveness of treatments, and a central tenet of the network is that patients, clinicians, and healthcare systems should be actively involved in the governance of the use of health information.

Read the full articles

From NPR: Insurer Uses Personal Data To Predict Who Will Get Sick
From NPR: Online Health Searches Aren't Always Confidential
From Health Affairs: Advancing the Use of Health Data in Research With PCORnet

 

Surprises in a Randomized Trial: The Oregon Health Study

Health outcomes, Randomized controlled trials,

A recent article appearing on the New York Times blog The Upshot describes some unexpected findings from a randomized controlled experiment that evaluated the costs and benefits of an expansion of public health insurance. In 2008, the state of Oregon began a limited expansion of Medicaid benefits for uninsured, low-income adults. By way of a lottery and waiting list, the state chose some low-income residents to apply for Medicaid while others remained uninsured. The Oregon Health Insurance Experiment made use of this random assignment to study the effects of Medicaid on health care use, health outcomes, financial strain, and well-being among low-income adults. For 2 years, the researchers used an in-person data-collection protocol to assess a wide variety of outcomes. Among the unexpected findings:

Patients who got insurance used the emergency room more often than their uninsured peers, undermining a common argument in favor of expanded insurance coverage.

People who got Medicaid also had a much easier time finding doctors, countering views held by the programs’ critics that Medicaid can be worse than no insurance.

According to the study authors’ conclusions published in the New England Journal of Medicine, “Medicaid coverage yielded no significant improvements in measured physical health outcomes in the first 2 years, but it did increase use of health care services, raise rates of diabetes detection and management, lower rates of depression, and reduce financial strain.” Other study analyses are published in Science, among other journals.