Introduction to Healthcare in the US: The Evolution and Reform of Healthcare in
the US
Audio Transcript
Slide 1
Welcome to Introduction to Healthcare in the US: The Evolution and Reform of
Healthcare in the US. This is Lecture c.
The component, Introduction to Healthcare in the US, is a survey of how healthcare
and public health are organized and services are delivered in the US.
Slide 2
By the end of this unit, The Evolution and Reform of Healthcare in the US, students
will be able to:



describe evidence-based medicine, clinical practice guidelines, and quality
indicators in medicine;
describe the patient-centered medical home model; and
discuss the key issues driving healthcare reform in the US.
Slide 3
This lecture will discuss quality indicators and comparative effectiveness.
We will begin with the definition of “quality.” In 2001, the Institute of Medicine published
a report called, “Crossing the Quality Chasm [kaz-uh m]: A New Health System for the
21st Century.” We know that populations and the individuals that make up these
populations want excellent health outcomes. We also know that outcomes need to be
improved by healthcare services until they reach the point of excellence.
This improvement in health outcomes needs to be consistent with the professional
knowledge of medicine and practices, as it exists in a scientific and rational fashion.
Quality, then, is the degree to which health services for individuals and populations
increase the likelihood of desired health outcomes, in a manner that is consistent with
current professional knowledge.
Slide 4
So, what does “quality” mean? When we speak of “quality” we speak of better patient
outcomes or improvements in patient health. We speak of better system performance
or improvement in patient care. We also think of better professional development or
improvements in the way that clinicians learn and improve their knowledge.
In order to achieve this, we need a body of scientific evidence. We need a methodology
that is rigorous, scientific, and able to produce conclusions which we can then distill in
particular contexts. We need to be able to take these recommendations, or these
inferences, and apply them to the practice of healthcare. And not only just apply them,
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Introduction to Healthcare and Public Health in the US
The Evolution and Reform of Healthcare in the US
Lecture c
1
This material was developed by Oregon Health & Science University, funded by the Department of Health and Human Services,
Office of the National Coordinator for Health Information Technology under Award Number IU24OC000015.
in terms of improving patient health, but also try to measure an improvement in
performance of the system itself.
We can also measure if the professional development by clinicians has improved and
we can use the data that has been collected on patient outcomes, to bolster and
improve the scientific literature - to indeed, demonstrate if quality of care has been
improved.
Slide 5
An important organization that is improving the quality of healthcare in the United States
is the Agency for Healthcare Research and Quality, also known as AHRQ [A-H-R-Q] or
"arc" [ark]. AHRQ [ark] is a part of the Department of Health and Human Services and
its mission is to improve quality, safety, efficiency, and effectiveness of healthcare for all
Americans. It attempts to improve healthcare outcomes by emphasizing the use of
evidence to reduce risk of harm and to improve healthcare outcomes.
AHRQ [ark] attempts to transform health research into practice in order to facilitate a
wider access to effective healthcare services; there is also a mission to reduce
unnecessary costs.
Slide 6
In order to demonstrate that quality has been improved, we need to define a set of
measurements that quantify results. These metrics for measuring quality may look at
processes or outcomes. The electronic health record is important in improving quality,
not just acting as a vehicle for data collection, but also providing the data required for
analysis in a sophisticated fashion.
Quality analysis is often conducted as a single or series of PDSA cycles. The “PDSA”
stands for “Plan,” “Do,” “Study,” and “Act”, which are the elements of the quality
improvement process. Many organizations also specify standards, for example, an
absolute reduction in the number of hospital acquired infections.
Slide 7
Let us now turn our attention to Comparative Effectiveness Research, or “CER [C-E-R].”
In 2008, the Institute of Medicine noted that patient care should be based on the
conscientious, explicit, and judicious use of current best evidence.
A year later, the Institute of Medicine defined “Comparative Effectiveness Research” as
“the 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.”
Slide 8
In order to study comparative effectiveness, researchers may gather evidence that is
generated from research studies and compare drugs, tests, healthcare delivery
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Introduction to Healthcare and Public Health in the US
The Evolution and Reform of Healthcare in the US
Lecture c
2
This material was developed by Oregon Health & Science University, funded by the Department of Health and Human Services,
Office of the National Coordinator for Health Information Technology under Award Number IU24OC000015.
methods, or other factors. Researchers may look at existing studies or devise and
conduct new studies and may use or develop different methods and sources of data in
order to compare the elements under testing.
Slide 9
Comparative Effectiveness Research is particularly useful when new and emerging
clinical interventions are identified. Researchers can review the current medical
research and synthesize information that helps to identify gaps that exist between
medical research, as it exists, and the needs of clinical medicine.
Comparative Effectiveness Research can help to promote and generate new scientific
evidence and analytic tools. It can also help to translate and disseminate research
findings to multiple stakeholders both in the research and in the clinical patient care
spectrum of healthcare.
Slide 10
Who are the stakeholders that benefit from Comparative Effectiveness Research? They
may be patient-consumers, clinicians, policymakers, or purchasers. All of these groups
can use CER [C-E-R] to make informed decisions that will improve healthcare and
quality based on reliable science.
Comparative Effectiveness Research also provides information about benefits and
harms and can also compare costs of treatments based on outcomes. CER [C-E-R]
also helps patients and physicians to choose between treatments, especially when
more than one treatment option is available to the patient.
It is a partnership tool that physicians can use in order to help their patients choose the
best options.
Slide 11
Comparative Effectiveness Research is an essential part of the healthcare reform plan.
The American Recovery and Reinvestment Act of 2009, or ARRA [air-uh], created the
Federal Coordinating Council for Comparative Effectiveness Research that will
coordinate CER [C-E-R] across the federal government and is responsible for making
recommendations on how earmarked funds will be spent.
Slide 12
This concludes Lecture c of Evolution and Reform of Healthcare in the US. In
summary, this lecture defined quality indicators and described approaches to quality
improvement. It also presented Comparative Effectiveness Research or C-E-R.
Slide 13
(Reference slide)
No audio
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Introduction to Healthcare and Public Health in the US
The Evolution and Reform of Healthcare in the US
Lecture c
3
This material was developed by Oregon Health & Science University, funded by the Department of Health and Human Services,
Office of the National Coordinator for Health Information Technology under Award Number IU24OC000015.
end
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Introduction to Healthcare and Public Health in the US
The Evolution and Reform of Healthcare in the US
Lecture c
4
This material was developed by Oregon Health & Science University, funded by the Department of Health and Human Services,
Office of the National Coordinator for Health Information Technology under Award Number IU24OC000015.