# Presentation: 155439

## Promoting Healthy Behaviors in Clinical Practice:  Lessons Learned From Practice Based Research and Education 

- Helen Burstin, MD, MPH
- Director, Center for Primary Care, Prevention and
- Clinical Partnerships
*Secretary’s Prevention Summit  *
*October 23, 2005*

## Mission Statement:  AHRQ

*        *

- The mission of the Agency for Healthcare Research and Quality is to improve the quality, safety, efficiency, and effectiveness of health care for all Americans.

## Research at HHS:Where Does AHRQ Fit In?

- NIH -- basic biomedical, lab bench research and “efficacy” clinical trials
- CDC -- the public health system, community-based interventions
**AHRQ** -- “effectiveness” of health care services and the health care delivery system (What works in real world settings?)

**Notes:**
To further help differentiate AHRQ’s research from CDC’s and  NIH’s research, I’ll use an example related to diabetes--a condition that occurs with great frequency within the African American population.. NIH research identifies what can work to improve patient health.  NIH’s primary orientation is laboratory bench science, which seeks to broaden our understanding of basic biology and the biological mechanisms of disease, and clinical trials, designed to establish the potential usefulness of new interventions under ideal conditions (“efficacy”).  For example, how does type A and B diabetes differ and what treatments might be instituted to cure the disease. CDC evaluates health behaviors and tests community interventions that might be used to reverse unhealthy behaviors or reinforce healthy ones.  For example, programs to increase exercise or improve diet.
By contrast, AHRQ develops evidence to help clinicians and patients select the best interventions for that individual.  For example, do multiple medications control the patient’s diabetes or does it work better to combine medication therapy with support from team made up of doctors, nurses, and exercise coaches?  AHRQ research then helps providers develop measures to evaluate what works best.  This research relates to quality improvement efforts.
In its clinical research, AHRQ assesses the effectiveness in daily practice of promising new interventions, compares their benefits, costs, and side-effects with existing approaches, and when effective interventions are not being used, identifies options for overcoming barriers to their widespread use.   AHRQ’s clinical research is unique in two other ways: its focus on the interaction between patients and their care-givers and patient-centered research (rather than treating each disease in isolation), recognizing that the number of individuals with multiple chronic conditions is growing and the care for their different conditions must be coordinated.
AHRQ’s research on the health care delivery system reflects the belief that health care services are not delivered in a vacuum.  The outcomes, effectiveness, and quality of health care interventions are influenced by who delivers the service, the extent to which the systems in which clinicians work support or frustrate their efforts, and the financial incentives or barriers to provide the right service at the right time in the right way.  For example, research related to the development of effective disease management strategies and improved coordination of care draws upon both clinical and health systems research.  

##  2004 National Reports on Quality and Disparities

** ****2004 National Reports on Quality and Disparities**

- Second annual reports focus on quality of and disparities in health care in America

**www.qualitytools.ahrq.gov**

**Notes:**
Quality Report finds that quality is improving and identifies areas which are in need of major improvements

## Diffusion of knowledge

- *Balas EA, Boren SA., Managing Clinical Knowledge for Health Care Improvement. Yearbook of Medical Informatics 2000.

## AHRQ Prevention Continuum

**Knowledge**
**Generation**

-  **Effective preventive services      **
-     ** ****USPSTF**
- Effective delivery
**    **PBRNs

**Provide **
**User-driven **
**Knowledge**

**Facilitate**
**Dissemination &**
**Implementation**

**Targeted partnerships**
-  Federal  & Private
**User-driven tools**
- Health Information Technology (PDA,EHR), Cancer Planet, Data sets (PQI)
**Integrate evidence with outreach **
-   Steps to a Healthier US,
- HRSA Prevention Pilots

**Engaging stakeholders**
- clinicians, consumers,payers
-  purchasers, policy makers
**Publications/products**
- journals, fact sheets,
- web-based resources

## Slide 7

## PBRN 1st Interdisciplinary Meeting

**PBRN 1****st**** Interdisciplinary Meeting**
**July 21-22, 2005**
**185 participants**

## AHRQ Support of PBRNs:Resource Center

- Contract awarded in 2002 to Indiana University/NORC
- Directors:  	Bill Tierney, MD  (Indiana)			Dan Gaylin, MPA (NORC)
- Support has been extended to any primary care network based in U.S. that registers with the Resource Center
- Learning collaboratives, Extranet, National Conference

##  RWJ-AHRQ Initiative

- PBRNs to develop creative, practical strategies for promoting healthy behaviors that can be easily adopted by other primary care practices.
- 4 health risk behaviors: smoking, risky drinking, sedentary lifestyle; and unhealthy diet

## PDA: Preventive Services Selector Program 

- PDA Program for Clinicians:
- USPSTF recommendations searchable by age and sex
- Available to download PDA application at _[www.ahrq.gov](http://www.ahrq.gov/)__ _
- Updated regularly

## AHRQ Prevention Continuum

**Knowledge**
**Generation**

-  **Effective preventive services      **
-      USPSTF,EPC
**Effective delivery**
-     PBRN’s

**Provide **
**User-driven **
**Knowledge**

**Facilitate**
**Dissemination &**
**Implementation**

**Targeted partnerships**
-  Federal  & Private
**User-driven tools**
- Health Information Technology (PDA,EHR), Cancer Planet, Data sets (PQI)
**Integrate evidence with outreach **
-   Steps to a Healthier US,
- HRSA Prevention Pilots

**Engaging stakeholders**
- clinicians, consumers,payers
-  purchasers, policy makers
**Publications/products**
- journals, fact sheets,
- web-based resources

## Slide 13

**Notes:**
The search form allows the user to view an index of all recommendations in the database or search for recommendations based on age, sex, or pregnancy.  In addition, the user can filter the results by the grade level of evidence (A, B, D) and the type of recommendation (Screening, Counseling, Preventive Medications).
How to use the search form:
To see all USPSTF recommendations select the View Topic Index button at the bottom of the screen.

## New annual user-driven resource                        

- New annual user-driven resource
- Remarkable response to date
- (in your packets)

## Presenters

**Kurt Stange, M.D., Ph.D. **Prescription for Health: Promoting Healthy Behaviors in Primary Care Practice**Steven H. Woolf, M.D., M.P.H.**A Multi-Component Systems Approach for Promoting Healthy Behaviors in Primary Care**Richard Riegelman, M.D., Ph.D., M.P.H. **Educating for Practicing Prevention: The Clinical Prevention and Population Health Curriculum Framework

- _For additional questions, please contact:_
- Dr. Helen Burstin  _hburstin__[@ahrq.gov](mailto:cclancy@ahrq.gov)_