There are two days down and a half day to go at AcademyHealth's 2014 Annual Research Meeting. As was the case with day one, the meeting was packed full of timely and relevant content that presenters hope will aid in the advancement of health and health care. Monday's sessions included the Best of ARM: Part One, the Article-of-the-Year Award presentation, and addressed topics ranging from the primary care shortage to electronic health records to public health.

Below, please find a recap of day two's sessions from various members of the AcademyHealth staff:

Thomas Goetz: Flipping the Clinic

Delivering the keynote presentation, Thomas Goetz, co-founder of Iodine and author of the bestselling book The Decision Tree, implored ARM attendees to move beyond thinking about care in a traditional sense. His talk was aimed at providing tips and techniques for taking “what you do” and getting it out there, to the people who can make it matter most. Goetz framed the mission for health services researchers in three central questions: How do we learn faster? How do we share more? How do we connect?

Doing this—learning faster, sharing more, and connecting—will entail not just better funding for translational medicine, but will require a fundamental shift in how we think about delivering research. The point of impact in the health care system comes to a head during the clinical hour (the hour or so patients actually spend with their provider), but that encounter is miniscule compared to the daily lives outside of that meeting. Thinking in these terms, one realizes we’re trying to do a lot in that one hour; we’re not trying to leverage everything we know about what happens outside the clinic and apply it. “Engage with people not in the one hour of the year when they call themselves ‘patients,’ but when they’re consumers…making decisions about what they’re going to do with their time and how they’re going to spend their money.” Too much emphasis is currently placed on one visit.

The idea to fix this is to “flip the clinic,” or use some strategies and resources from other industries to change how we think about this hour and optimize time. The notion of flipping the clinic is to spread ideas, foster a community, and give permission to try (yes, it's OK to try to change the way you administer care).

At the end of the plenary, Goetz said there are three ways we can get closer to people: live in their world, not ours; speak their language, not ours; and don't measure outcomes, measure experiences.

Learn more about Geotz's work at fliptheclinic.org.

Best of ARM: Part One

This morning's inaugural Best of ARM session highlighted some of the top abstracts presented at the 2014 meeting. Paul Wallace, Stephen Parente, and Jack Needleman reviewed abstracts and put the research findings into context. Abstract topics included coverage and unexpected outcomes. Most abstract authors were present for the session, which produced a rich dialogue between the discussants, authors, and audience.

Abstracts included:

  • Does Medicaid Crowd Out Other Public Health Spending? Projecting ACA's Effects on Public Health Financing, Delivery, and Outcomes

  • The Effect of Continuous Medicaid Enrollment on Surgical Cancer Outcomes

  • The Effect of the Affordable Care Act's Young Adult Insurance Expansions on Hospital-Based Behavioral Health Care

  • Insurance Cancellations in Contest: Stability of Coverage in the Non-Group Health Insurance Prior to Health Reform

  • Innovative Payment Mechanisms in Maryland Hospitals

  • Interprofessional Care and Intensive Care Unit Outcomes: A Multicenter Cohort Study

Best of ARM: Part Two will take place on Tuesday at 9:00 a.m. in room 33 A-C.

Article-of-the-Year Award Session: Shipping Out Instead of Shaping Up: Rehospitalization from Nursing Homes as an Unintended Effect of Public Reporting

AcademyHealth’s 2014 Article-of-the-Year Award recognizes the best scientific work that the fields of health services research and health policy have produced and published in 2013. This year, 27 submissions competed for the award, but taking the top spot was “Shipping Out Instead of Shaping Up: Rehospitalization from Nursing Homes as an Unintended Effect of Public Reporting” by R. Tamara Konetzka, Daniel Polsky, and Rachel M. Werner, which was published in the Journal of Health Economics.

During this session, Dr. Konetzka explained to attendees that there are two areas where this work could make broad contributions: public reporting literature and post-acute care. Currently, the health care system is suffering from a market failure; there’s asymmetric information. This creates problems because if consumers can’t judge the quality of care, there is little incentive for providers to compete on quality. The second area, post-acute care, has become more costly over time and is one of the main factors contributing to the high cost of medical care in general as well as to the variation in spending.

Using observational design, Drs. Konetzka, Polsky, and Werner found evidence that the Nursing Home Compare (NHC) system is being gamed, so we need to think about putting hospitalization measures in NHC. Next, and more broadly, their work found that providers are indeed responding to the incentives that they’re given, so researchers should think about that context when implementing policies.

Late-Breaking Abstract Session: Adoption Challenges

The second session coming out of the special late-breaking call for abstracts, “Adoption Challenges” discussed the researchers’ encounters with adoption of various practices and technology, such as electronic health records.

Papers, panelists, and findings included:

  • A Survey of Physician Perceptions on Improving Health Care Value

    • John Caloyeras, RAND

    This survey found that about 70 percent of physicians spend time on “direct patient care” on tasks that aligned with training. “Physicians reported that 14 percent, 12 percent and 4 percent of the time they spend on direct patient care activities could be done instead by physicians with fewer years of clinical training, non-physicians, or automated or computerized systems, respectively.”

  • CommunityHealth Works: A Review of Evidence

    • Pamela Kulbok, University of Virginia

    This is a systematic review of the existing evidence on the role of including community health workers relative to the triple aim.

  • Electronic Health Records Survey: Ohio Electronic Update Rates and Barriers to EHR Adoption

    • Lorin Ranbom, Ohio Colleges of Medicine Government Resource Center

    Limited to Ohio, this survey’s results indicate that approximately 70 percent (16,634) of eligible providers have adopted HER systems; 30 percent (4,852) of eligible providers indicated not having adopting an EHR system of which 2,046 reported a desire to adopt an EHR system within five years.

An additional author, Jungyeon Kim, Texas A&M Health Science Center, presented data that is not yet available for release, Are Hospitals Ready to Stage 2 Meaningful Use?

Navigating the Health Insurance Exchanges: Consumer Choice and the Use of Available Information

Health Insurance Exchanges have become an important source of coverage for millions of Americans. However, in order to successfully choose a plan that best fits their needs through Exchanges, consumers must be able to understand their plan options, analyze premium and out-of-pocket costs, and apply this information to their own situation. This session, moderated by Robin Weinick, explored the issues that impact consumers’ ability to choose the best value plans, as well as potential strategies and tools that Exchanges can employ to better support consumers.

The panelists, Judith Hibbard, Keith Marzilli Ericson, Pamela Nadash, and Anna Sinaiko, discussed the evidence showing that consumers have difficulty choosing from wide menus of options, or making decisions when presented with too much information. Given the complex information processing involved in plan selection through Exchanges, consumers have had difficulty shopping in exchanges, and have also had negative experiences with the plans they do choose. One potential mitigation strategy emerged through plan standardization, which, after being introduced in Massachusetts’s Exchange, led to consumers choosing higher value plans. The panelists identified additional strategies for enabling consumers to more successfully choose plans, including providing tools to project costs; interpreting the plan information for the consumers; and using stories or narratives to get closer to the consumers' actual experiences. All panelists were in agreement that decision support tools also have tremendous value-add in informing consumers’ plan selections in Exchanges.

Fostering and Assessing Patient and Stakeholder Engagement in PCORI Pilot Projects

Designed to illustrate the Patient-Centered Outcomes Research Institute's approach to fostering and assessing engagement in the PCORI pilot projects, this panel was made more compelling by the inclusion of two case studies, one from Clifton Bingham on stakeholder input related to arthritis clinical care and the other a presentation by community partner Zachary Rowe, from Friends of Parkside.

After AcademyHealth's own Alison Rein set up the session by outlining the goals and structure of the PCOR learning network, Lauren Ellis, of PCORI, outlined early findings from an assessment of the pilot project's work to engage patients and consumers. A key point was that identifying and including stakeholders should be done "with the totality of the whole work" beginning with the research question. Bingham's work illustrated that the outcomes that mattered to patients were significantly different than those typically collected, and he demonstrated how that impacted not only what they measured, but how. Rowe explained how the use of a gaming system called "CHat" to engage community members in a discussion about health funding decisions and priorities. Rowe's focus was on understanding incentives and barriers, from the basics of how institutions might work together to how community organizations were paid and from establishing trust to using language participants could understand.

The lessons from this learning network will be important as more research teams tackle studies and interventions where patients and other stakeholders are "more than just research subjects."

Improving Patient-Centered Care

Dominick Esposito of Mathetmatica Policy Research moderated a panel that examined the relationship between patients and providers and potential methods to improve patient-centered care. Panelists focused specifically on measuring the care quality of veterans, cancer survivors, and patients suffering from chronic illnesses.

Each panelist identified different areas in which patient-centered care could significantly improve. Sharon LaVela concluded that the VA could improve their efforts to improve holistic care and include family members in key care decisions. Holly Mead found that post-cancer care is different than the cancer treatment phase of care and needs to be treated as such, and Kathryn Martinez identified the current quality of cancer care as problematic due to poor provider communication.

Building Successful Careers in Settings Beyond Universities

This morning’s career development panel featured advice for graduate students, post-doctoral fellows, and others about career trajectory in non-university settings. A quick survey at the beginning of the session showed that most attendees were doctoral students.

Providing insights into their own career choices, panelists Steven Clauser, Michael Gluck, Peter Hussey, Paula Lozano, and Pierre Young offered advice to young researchers. Attendees provided questions at the beginning of the session, which were answered throughout, tailoring the discussion to the interests of the attendees.

Panelists shared the following tips:

  • Be Flexible – Organization’s interests will come before personal interests so be a generalist. You most likely will not determine your research topics so flexibility is important.

  • Stay Grounded – Being in a real-world setting means real-world pressures plus more responsibility requires more time, a healthy work/life balance is important. Organizational support of that balance helps.

  • Build Your Reputation – To move from private sector or government back to academia, you need to develop a solid research reputation.

  • Stay Connected to Academia – If you are in a non-academic based role, consider maintaining an adjunct academic appointment.

  • Be a Team Player – Outside of academia, there is more of a culture of teamwork and collaboration.

  • Seek Out Mentors – Mentors are vital. Seek out mentors in and outside of your network. Meetings like the ARM help facilitate networking and mentoring.

  • Stay Well-Rounded – Understand the big picture and work in different settings beyond traditional research projects.

  • Diversify Your Skill Set – Outside academia, strong writing, analytic, leadership, and management skills are important.

Session Chair, Tracy Lieu, also led the group in a 30-second stretch break.

New Concerns Regarding Disparities

This session primarily shared methods and findings from studies on various disparity populations, with one presentation from Arlene Chung from the Translational Clinical Science Institute who discussed health information technology (HIT) and how it can be a double-edged sword when it comes to disparities; it can improve the quality of care, but actually enhance disparities. She went on to describe three HIT models, citing their benefits, which include identification of different populations and assistance with care coordination, as well as their challenges and the gaps that remain. Among the challenges are accessibility and usability.

Innovations in Integrating Behavioral Health and Primary Care

This session focused on recent findings related to integrating behavioral health with general medical care. Issues raised during the panel related to optimal payment mechanisms, patient preferences for treatment location, and advantages of a personal health record.

Session Chair Susan Busch observed that each study is in the process of implementing evidence-based solutions. The difference, she noted, lies in the stage of implementation. Panelists Colleen Barry, Benjamin Druss, and Catherine Fullerton each provided an update on his/her next step in the implementation process. The Q&A discussion of the session resulted in an observation that another common theme of the studies was health literacy.

 

We hope you've enjoyed your ARM experience thus far and that you enjoy your final day of the conference (if you're not attending any of the Interest Group or adjunct meetings to follow). We will continue to update this blog post with links to presentations as they become available. On this final day of ARM, please be sure to continue contributing to the rich discussions that have been taking place both offline and online, and follow along at @AcademyHealth, @phsr_ah, and @edm_ah.

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