Meeting Minutes, March 2020
National Advisory Council
Contents
Summary
Call to Order and Approval of March 26, 2020, Meeting Summary
大象视频Budget Update and Recent Accomplishments
大象视频and COVID-19 Discussion
21st Century Care Initiative
Public Comment
Wrap-Up and NAC Input
Adjournment
Summary
NAC Members Present
Tina M. Hernandez-Boussard, Ph.D., M.P.H., M.S., Stanford University School of Medicine (NAC Chair)
Gregory L. Alexander, Ph.D., R.N., FAAN, FACMI, University of Missouri
Karen S. Amstutz, M.D., M.B.A., FAAP, Indiana University Health
Asaf Bitton, M.D., M.P.H., Ariadne Labs, Brigham and Women鈥檚 Hospital
Cathy J. Bradley, Ph.D., M.P.A., Colorado School of Public Health
Gretchen M. Dahlen, M.H.S.A., FACHE, Consumer Health Ratings
Susan Edgman-Levitan, P.A., Massachusetts General Hospital
Peter J. Embi, M.D., M.S., FACP, FACMI, Regenstrief Institute
Christine A. Goeschel, Sc.D., M.P.A., M.P.S., R.N., FAAN, MedStar Health
Rahul Gupta, M.D., M.P.H., M.B.A., FACP, March of Dimes
Andrew L. Masica, M.D., M.S.C.I., Baylor Scott & White Health
Hoangmai Huu Pham, M.D., M.P.H., Anthem, Inc.
Ramanathan Raju, M.D., M.B.A., CPE, FRCS, FACS, FACHE, Northwell Health
Edmondo J. Robinson, M.D., M.B.A., M.S., Christiana Care-Wilmington
Patrick S. Romano, M.D., M.P.H., University of California, Davis
Yanling Yu, Ph.D., Washington Advocates for Patient Safety
Ex Officio Members and Alternates Present
Naomi Tomoyasu, Ph.D., Veterans Health Administration (for David Atkins)
Michael Lauer, M.D., National Institutes of Health
Paul Rosen, M.D., M.P.H., Centers for Medicare & Medicaid Services (for Shari Ling)
Robin M. Wagner, Ph.D., Centers for Disease Control and Prevention (for Chesley Richards)
大象视频Staff Members Present
Gopal Khanna, M.B.A., Director
David Meyers, M.D., FAAFP, Deputy Director and Chief Physician
Lucie M. Levine, Chief Financial Officer
Bob McNellis, M.P.H., P.A., Senior Advisor for Primary Care
Jaime Zimmerman, M.P.H., PMP, Designated Management Official
Karen Brooks, CMP, NAC Coordinator
Call to Order and Approval of March 26, 2020, Meeting Summary
Gopal Khanna, M.B.A., Director of the 大象视频 (AHRQ), welcomed the meeting participants and listeners. He pointed to the current COVID-19 crisis and the need for the country to address health and safety during trying times. He thanked the National Advisory Council (NAC) members for joining the meeting and introduced the new Chair of the NAC, Tina M. Hernandez-Boussard, Ph.D., M.P.H., M.S.
Dr. Hernandez-Boussard called the meeting to order at 12:30 p.m. She also welcomed the NAC members, other participants, and WebEx listeners. She noted, in addition to her new role as NAC Chair, the following changes in the professional positions of NAC members:
- Shari Ling, M.D., ex officio NAC member, was made Acting Chief Medical Officer at the Centers for Medicare & Medicaid Services (CMS).
- Gregory L. Alexander, Ph.D., R.N., FAAN, FACMI, was appointed Professor at Columbia University.
- Karen S. Amstutz, M.D., M.B.A., FAAP, became Vice President of Community Health at Indiana University Health.
- Andrew L. Masica, M.D., M.S.C.I., SFHM, became Senior Vice President and Chief Medical Officer at Texas Health Resources.
- Edmondo J. Robinson, M.D., M.B.A., M.S., became a Senior Vice President and Chief Digital Innovation Officer at Moffit Cancer Center.
Dr. Hernandez-Boussard announced the appointments of the following new NAC members:
- Asaf Bitton, M.D., M.P.H.
- Gretchen Dahlen, M.H.S.A., FACHE
- Susan Edgman-Levitan, P.A.
- Omar Lateef, D.O.
- Hoangmai Huu Pham, M.D., M.P.H.
- Ramanathan Raju, M.D., M.B.A., CPE, FRCS, FACS, FACHE
- Patrick Romano, M.D., M.P.H.
- Yanling Yu, Ph.D.
She asked the attending NAC members to introduce themselves.
Dr. Hernandez-Boussard referred to the draft minutes of the previous NAC meeting (November 21, 2019) and asked for changes and approval. The NAC members voted unanimously to approve the November meeting minutes with no changes.
大象视频Director Khanna presented the meeting鈥檚 agenda, which featured sessions on AHRQ鈥檚 budget and efforts in research, practice improvement, and data/analytics. The meeting also included sessions/discussions on AHRQ鈥檚 efforts related to COVID-19 and AHRQ鈥檚 future vision (the 21st Century Care Initiative). Director Khanna encouraged the NAC members to bring their distinct perspectives and insights to the discussions and to consider their potential roles in supporting AHRQ鈥檚 work. He noted that David Meyers, M.D., FAAFP, recently assumed the position of 大象视频Deputy Director.
大象视频Budget Update and Recent Accomplishments
Lucie M. Levine, Chief Financial Officer, AHRQ, and David Meyers, M.D., FAAFP, Deputy Director and Chief Physician, 大象视频
Budget
Ms. Levine reported that AHRQ鈥檚 current enacted budget (FY 2020) is $338 million, which is identical to the previous year鈥檚 budget. The FY 2020 budget includes:
- $72.3 million for patient safety.
- $96.3 million for health services research, data, and dissemination.
- $16.5 million for digital healthcare research and technology.
- $11.6 million for the U.S. Preventive Services Task Force.
- $70 million for the Medical Expenditure Panel Survey (MEPS).
- $71.3 million for program support.
Congress reauthorized the Patient-Centered Outcomes Research Trust Fund for the next 10 years. 大象视频will receive about $100 million in each of those years. Those funds will be used to disseminate and implement patient-centered outcomes research (PCOR) findings, incorporate PCOR findings into practice, assist in digital healthcare research and technology, and provide training and career development.
President Trump鈥檚 FY 2021 budget request calls for transitioning the highest priority 大象视频activities to a new entity within the National Institutes of Health. The new entity would be named the National Institute for Research on Safety and Quality, and its proposed FY 2021 budget request is $256 million.
大象视频Accomplishments
Dr. Meyers described recent accomplishments of the agency in five areas.
Health systems research
- 大象视频awarded four grants to measure the incidence of diagnostic errors and to enhance understanding of their contributing factors, impacts, and costs.
- 大象视频will support a midyear summit to develop a national agenda for patient safety research.
- 大象视频is offering two grants for researchers to address multiple chronic conditions. One is titled 鈥淯sing Data Analytics to Support Primary Care,鈥 and the other is titled 鈥淚mproving Quality of Care and Patient Outcomes During Care Transitions.鈥
Practice improvement
- 大象视频produced a self-service how-to guide, which augments the Agency鈥檚 鈥淪ix Building Blocks鈥 opioid treatment program.
- AHRQ鈥檚 Comprehensive Unit-Based Safety Program (CUSP) was used in a safety implementation program for improving antibiotic use and resulted in reduced antibiotic use in 400 hospitals.
- New funding will support primary care to advance cardiovascular health in States with a high prevalence of preventable cardiovascular events ($18 million in total).
Data and analytics
- AHRQ鈥檚 Healthcare Cost and Utilization Project (HCUP) produced a statistical brief on influenza care in recent years. The MEPS program produced a brief on population trends regarding influenza in 2016-2017.
- 大象视频launched a website on the Network of Patient Safety Databases, which includes data visualization tools and a chartbook of national analysis.
- 大象视频updated its Compendium of U.S. Health Systems, incorporating data from 2018. In particular, the data showed a continuing consolidation of providers and hospitals into systems.
Integrated initiatives
- 大象视频supported a study that showed increasing U.S. opioid-related hospitalizations and emergency department visits by patients age 65 years and over in the years 2010-2015. The Agency is supporting ongoing strategies to improve opioid management.
Operational excellence
- 大象视频created a new division, Digital Healthcare Research, to examine the evolving digital healthcare ecosystem and support efforts. The Agency is developing a strategic plan to guide investments in digital healthcare technologies. It will identify problem and pain-point areas, with an eye to the Agency鈥檚 priorities.
- 大象视频created the role of Chief Data Officer, supported a challenge for visualization resources of community-level social determinants of health, and supported an insight summit to explore data innovations. The Agency is supporting initiatives on synthetic healthcare data and social determinants of health data.
- 大象视频has been expanding its digital footprint, increasing the volume and frequency of messaging on social media sites, adding graphics and videos to the 大象视频website, adding real-time analytics, and adding a library of social media content.
大象视频and COVID-19 Discussion
Robert McNellis, M.P.H., Senior Advisor for Primary Care, AHRQ, and NAC Members
Director Khanna began a session on 大象视频and the COVID-19 crisis by noting the Agency鈥檚 efforts to maintain safety and counter the virus (teleworking, virtual meetings).
Mr. McNellis further described 大象视频efforts to address the challenge, noting that 大象视频is part of the all-government response. This response includes short-, intermediate-, and long-term approaches to fight the pandemic. 大象视频is engaging with sister agencies to identify gaps and opportunities in the fight and to contribute the Agency鈥檚 competencies and resources. The following are four primary areas of effort:
- Drafting proposals for possible intermediate and longer term projects, given funds.
- Considering options for generating grantee work related to COVID-19.
- Supporting, with data, modeling work in HHS to address, as examples, hospital bed capacity, ICU capacity, and ventilators.
- Working within an interagency group to identify agency assets, harness data, and develop new ideas.
Mr. McNellis asked the NAC members to consider the following questions:
- What do you see, from your delivery system perspective, as pain points?
- How can 大象视频help in 6 to 12 months and in 1 to 2 years?
Discussion
- Dr. Embi proposed that supplemental funding be used to advance capabilities in information exchange and data sharing. 大象视频could advance efforts to develop learning health systems. The pandemic is creating learning opportunities.
- Dr. Bitton suggested 大象视频consider ways to address financially the need for protective equipment and ventilators. The Agency could fund research on preparedness. Its research will be important as primary care practices shift to the use of virtual experience, especially for ambulatory care. 大象视频could work to obtain data.
- Ms. Edgman-Levitan agreed that 大象视频should support research in the evaluation of virtual care activities and their potential effectiveness. 大象视频could join the related new collaborative created by the Institute for Healthcare Improvement.
- Dr. Yu encouraged 大象视频to work with other agencies (NIH, CDC) on long-term projects, which might include development of a national surveillance system and use of digital resources.
- Dr. Pham suggested that, in the years to come, some independent medical practices will not survive. Telehealth will not be sufficient to sustain them. 大象视频could study issues of access and infrastructure. The marketplace will experience large changes.
- Dr. Alexander stressed the impact on the long-term-care community. 大象视频could support research to study effects of isolation and use of telemedicine.
- Dr. Romano agreed with the need to examine the use of telemedicine/telehealth. 大象视频could study issues of quality and safety, as in diagnostic error. There will be changes and issues regarding the workforce鈥攖eamwork, burnout, retraining.
- Dr. Masica encouraged 大象视频to study impacts on chronic health issues, especially within populations with disparities.
- Dr. Amstutz suggested that 大象视频consider natural experiments, as in the results of public health delivery. 大象视频could study community health organizations.
- Dr. Hernandez-Boussard noted the different State strategies in addressing COVID-19. 大象视频could work to collect and evaluate the evidence/effects.
21st Century Care Initiative
Gopal Khanna, M.B.A., David Meyers, M.D., FAAFP, and NAC Members
Director Khanna introduced a session on AHRQ鈥檚 21st Century Care Initiative. This new effort builds on the Nation鈥檚 21st Century Cures Act, with 大象视频realizing its particular role in advancing care (reforming the financing of care, deriving better value, and attacking specific challenges).
Dr. Meyers noted that the 21st Century Cures Act of 5 years ago is being updated in new legislation, 鈥淐ures 2.0,鈥 and features new aspects, such as digital healthcare and a focus on caregivers. AHRQ鈥檚 efforts will be directed toward digital health and data, health economics, real-world evidence for care, whole-person care, safe care, and primary care.
Dr. Meyers asked NAC members to consider and discuss the following questions:
- What are the likeliest areas for impact with new investment in improving care delivery?
- Where can 大象视频specifically have the greatest impact?
- What are the greatest challenges facing your organizations and members in the next 10 years related to the delivery of care?
- Are there other initiatives 大象视频should be aware of as it thinks about 21st century care?
Discussion
- Dr. Pham stressed the importance of machine learning and the broad issues and enterprise surrounding that.
- Dr. Raju encouraged 大象视频to study the area of profitable health services, strategies for increasing hospital capacity, and ways to extend care as the number of providers decreases.
- Dr. Bradley stressed the opportunity to advance the data science infrastructure, with 大象视频supporting its development and integration. 大象视频should continue to disseminate tools for studying health economics.
- Dr. Alexander welcomed the six research areas that were listed and added a need to examine where the various parts of the healthcare system reside today (capabilities, disparities). He agreed on the importance of studying the use of artificial intelligence in each of those various parts of the system.
- Dr. Embi encouraged 大象视频to continue to support progress in learning health systems.
- Dr. Goeschel stressed the importance of community care and the need to maintain the human touch in healthcare.
- Dr. Amstutz stressed the area of digital healthcare and the importance of scaling care. Human factors are key in patient management, which features teamwork and communication.
- Ms. Dahlen stressed the importance of behavioral health, which is a cross-cutting issue. The consumer lens is important and should be considered. Ms. Dahlen encouraged 大象视频to study issues of affordability and access to care.
- Dr. Robinson also stressed the patient perspective and cautioned about the potential digital divide across patients and the need to consider social determinants of health. Interactions must be designed carefully. Dr. Embi agreed, calling for research in the area of knowledge management.
- Dr. Yu encouraged 大象视频to help advance the area of patient-reported outcomes. Ms. Edgman-Levitan suggested that the CAHPS databases be used to advance patient engagement (they offer data on communications). 大象视频could engage in the international 鈥淲hat Matters to You鈥 initiative (Institute for Healthcare Improvement).
- Dr. Bitton encouraged 大象视频to support research that is systemic and takes risks, as in a focus on implementation.
- Dr. Bradley cited the problem of a lack of use of the large amounts of data that are collected today. 大象视频could study strategies for better use and for fitting data systems into delivery systems.
Public Comment
Shanina C. Knighton, Ph.D., R.N., of Case Western Reserve University recalled her past experience as a nurse and investigator. Working in an emergency department, she observed that patients are often unaware of their potential for causing healthcare-associated infections. Patients usually are not familiar with the situations in the healthcare environment and perhaps could benefit from tailored education.
Dr. Knighton encouraged 大象视频to support work to increase information and discussion about such problems. She wondered about potential 鈥渕oments of care鈥 that can be missed. For example, old opioid medications should be collected from patients when they obtain new prescriptions. We need data and infrastructure to address such potential problems.
A member of the International Association of Plumbing and Mechanical Officials, which has a role in developing codes, referred to her research work on Legionella (Legionnaires鈥 disease) and wondered whether COVID-19 might exist in hospital patients in cross-contamination with Legionella, which can exist in hospital cooling towers. Perhaps 大象视频could support research into that possibility.
Lucy A. Savitz, Ph.D., M.B.A., of Kaiser Permanente Northwest and a former NAC member suggested that 大象视频use task orders and its ACTION Network research mechanism to support work on learning healthcare systems and the spread of tools to address the COVID-19 pandemic. The mechanisms could support research to understand health outcomes in general.
Announcement
Dr. Meyers announced that 大象视频has published two new notices of intent to fund (1) research on health system responsiveness to COVID-19 (for grantees already working in the field) and (2) research on novel high-impact studies evaluating health system personnel responses to COVID-19 (focus on telehealth, primary care, and system-level changes).
Chairman's Wrap-Up and NAC Input
Dr. Hernandez-Boussard asked NAC members to offer final suggestions about 大象视频priorities and ways AHRQ鈥檚 work and messages might be disseminated.
- Dr. Alexander stated that he can share results of AHRQ-supported research with his and other organizations.
- Dr. Bitton encouraged 大象视频to support research on the science of scale, moving research results beyond the pilot level.
- Dr. Bradley urged 大象视频to partner with other Federal agencies to disseminate messages.
- Ms. Dahlen encouraged 大象视频to use mass media with messages that connect directly to the consumer.
- Dr. Goeschel stated that she can disseminate 大象视频messages at universities and MedStar Health鈥檚 research institute. She can promote 大象视频research opportunities and findings to groups such as the American Physical Therapy Association.
- Dr. Gupta encouraged 大象视频to produce more webinars and to record them for further dissemination by institutions on their websites.
- Dr. Pham suggested that 大象视频seek a balance in approaching both end-users (clinics) and researchers. The Agency might form new partnerships with practice organizations and associations of hospital executives.
- Dr. Embi encouraged 大象视频to be in contact with professional societies, such as the American Medical Informatics Association. 大象视频could cosponsor webinars and leverage infrastructures, including those of private enterprises.
- Dr. Amstutz encouraged the use of public-private partnerships for some grants. 大象视频could fund innovation health systems (sandboxes) that include such partnerships.
- Dr. Raju suggested that NAC members disseminate 大象视频messages at local and national medical meetings and through social media.
- Dr. Robinson encouraged 大象视频to partner with organizations such as the Digital Medicine Society. 大象视频potentially could be a major driver in that area.
- Dr. Yu stated that 大象视频could advertise its resources as it helps educate the public about the COVID-19 pandemic.
- Dr. Masica encouraged 大象视频to push forward its dissemination and implementation activities during the pandemic.
- Dr. Wagner suggested that 大象视频use its current partnerships to a greater extent, for example, identifying new opportunities to reach the public.
Adjournment
Director Khanna and Dr. Hernandez-Boussard thanked the NAC members and presenters for their input. Dr. Hernandez-Boussard noted that the next NAC meeting will take place on July 14, 2020. She adjourned the meeting at 3:30 p.m.
Respectfully submitted,
Tina M. Hernandez-Boussard, Ph.D., M.P.H., M.S., Chair
National Advisory Council
大象视频
