Colorado Health Outcomes (COHO)

1. Colorado Health Outcomes (COHO) OUR HEALTH SERVICES RESEARCH ENTERPRISE June 9, 2010

2. WHAT IS HEALTH SERVICES RESEARCH? Health services research . . . examines how people get access to health care, how much care costs, and what happens to patients as a result of this care. The main goals of health services research are to identify the most effective ways to organize, manage, finance, and deliver high quality care; reduce medical errors; and improve patient safety. (Agency for Healthcare Research and Quality, 2002 )

3. A BRIEF HISTORY COHO was formed 11 years ago by Dean Krugman as a Center within the School of Medicine to house health outcomes research. John Steiner was the first and only Director of COHO until his departure in November 2008 COHO has a partner organization that is dedicated to health services research related to children – the Children’s Outcomes Research Program or COR – led by Dr. A. Kempe

4. A Place For Collaboration Primary Care Research Unit: HRSA Grant to facilitate primary care research (Family Medicine, General Internal Medicine, Pediatrics) Brings together faculty from multiple departments and schools (School of Medicine, School of Public Health, School of Pharmacy, School of Nursing, Business School, and others) Goal: To be a central resource where health services researchers may collaborate and find the resources required for their research to succeed.

5. OTHER HIGH PROFILE EXAMPLES Colorado Regional Health Information Organization (CORHIO- Dr. Art Davidson): CORHIO eliminates some of the inefficiencies and duplicated efforts in the health care system by streamlining the availability and use of clinical data for higher quality, more efficient and less costly care. Latinos Using Cardio Health Actions to Reduce Risk (LUCHAR – Dr. S. Bull): A partnership with the University and Denver Health for CBPR to reduce CVD risk factors

6. A Service to the Institution: Education and Training • Primary Care Research Fellowship – Dr. Kempe • Support for the Clinical Faculty Scholars Program - Dr. Libby – CCTSI • Mentoring Junior Faculty (DFM, GIM, Pediatrics, GI, SPH, SOP, Others) • Mentoring Students via MSA • A myriad of regular conferences and training sessions • SAS • Qualitative Methods • Primary Care • Many more!

7. HOW AND WHY IS THE DFM VC FOR RESEARCH INVOLVED? • When John Steiner moved to his new venue – a number of other things moved as well. • LUCHAR moved with Sheana Bull to the School of Public Health • CORHIO was winding down as a research project and starting a life in the community • COHO’s Associate Director (Dr. Debbi Main) moved downtown and now leads the HBS Department • A Talent and a Financial Loss

8. A Search for a Leader The current leadership structure was not the first choice – for good reason When things didn’t fall into place - the Dean went to Frank for help Frank identified an opportunity to both assist our institution and to further DFM’s research goals. Bob Anderson in the Department of Medicine shared this vision Pediatrics was already committed to the vision

9. So What Was the Vision An opportunity to take COHO to the next level An entrepreneurial approach to building a health services research Center Achieving economies of scope and scale Facilitating better science Achieving financial viability – including institutional support Building a sustainable platform for HSR Gaining strength by joining with others rather than operating in a silo (possible only because of our Chair’s vision)

10. What Are We Doing With This Opportunity? • Capitalizing upon a stellar biostatics and analysis core (Diane, Miriam, Brenda, and Caroline) • Building a qualitative analysis core to house and grow our talented researchers (Karen) • Enjoying the benefits of the best business unit around • Kyle, Sherry, Renee, Tracy • Integration of operations while maintaining identities • Sharing resources, work, projects • Possible only because of the shared vision at the Department level and commitment where the rubber hits the road

11. Assuring Funding Streams for Research That Matters • Academic Enrichment Funds: Approximately $1 million over three years – to include half of West’s salary • Indirect Cost Recovery: An ongoing concern for the future • Securing funding streams for lines of research to improve health – a major focus over the past year. How can we do that?

12. Strategic Efforts • Comparative Effectiveness Research: A term that is already dated - now called “Patient-Centered Health Outcomes and Effectiveness Research” How is this different from what we have been doing for years and calling it health services research? Ally Kempe, 2008, 2009, 2010 Comparative effectiveness research is designed to inform health-care decisions by providing evidence on the effectiveness, benefits, and harms of different treatment options. The evidence is generated from research studies that compare drugs, medical devices, tests, surgeries, or ways to deliver health care.

13. CER: A National Priority $1.1 Billion in the ARRA Ongoing AHRQ funding at over $650 million/year A central theme for AHRQ, and now NIH A “pony to ride” for health services researchers with interest in improving health outcomes for individuals and populations An umbrella to house observational analyses using secondary data sets, pragmatic trials, CBPR, systems redesign, and advanced clinical informatics

14. CER Funding Has made Some New Things Possible For Us! • DARTNet: • Diabetes Study: $1.3 million • Depression Study: $1.6 million • MRSA Study: $ 500,000 • Antibiotics Study: $ 400,000 • Cardiovascular Outcomes Study: $ 1 million • Pharmacy School’s Educational Initiative for CER (Dr. Anne Libby)

15. OTHER CRITICALLY IMPORTANT TOPICS • Immunization Research (right immunizations at the right place at the right time) • Practice Redesign • Quality Improvement • Value of the PCMH • Collaborative Models of Care • Improving Care Safety and Efficiency • Developing Patient Curricula • Evaluating Program Effectiveness • Improving Community Health • Many Others!

16. Laying the Foundation Have Secured the PBRN Master Contract from AHRQ through 2012 Have applied to continue the DEcIDE Master Contract from AHRQ through 2013 Have two major R01’s pending (nearly $10 million each) to buttress DARTNet, and to further Quality Improvement activities in primary care and in underserved populations Succession Planning Not forgetting the Education and Training Mission

17. Expectations Growth and stability in funding Adding Talent Making the best of the opportunities before us Assuring that we responsibly teach others and pass the baton

18. Value of: Violence Interventions Criminal Justice Interventions Maternal Care Interventions

19. Questions?