Meeting Minutes, March 2020
National Advisory Council
Contents
Summary
Call to Order and Approval of March 26, 2020, Meeting Summary
ƵBudget Update and Recent Accomplishments
Ƶand 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’s 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)
ƵStaff 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 Agency for Healthcare Research and Quality (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.
ƵDirector Khanna presented the meeting’s agenda, which featured sessions on AHRQ’s budget and efforts in research, practice improvement, and data/analytics. The meeting also included sessions/discussions on AHRQ’s efforts related to COVID-19 and AHRQ’s 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’s work. He noted that David Meyers, M.D., FAAFP, recently assumed the position of ƵDeputy Director.
ƵBudget Update and Recent Accomplishments
Lucie M. Levine, Chief Financial Officer, AHRQ, and David Meyers, M.D., FAAFP, Deputy Director and Chief Physician, Ƶ
Budget
Ms. Levine reported that AHRQ’s current enacted budget (FY 2020) is $338 million, which is identical to the previous year’s 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. Ƶwill 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’s FY 2021 budget request calls for transitioning the highest priority Ƶactivities 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.
ƵAccomplishments
Dr. Meyers described recent accomplishments of the agency in five areas.
Health systems research
- Ƶawarded four grants to measure the incidence of diagnostic errors and to enhance understanding of their contributing factors, impacts, and costs.
- Ƶwill support a midyear summit to develop a national agenda for patient safety research.
- Ƶis offering two grants for researchers to address multiple chronic conditions. One is titled “Using Data Analytics to Support Primary Care,” and the other is titled “Improving Quality of Care and Patient Outcomes During Care Transitions.”
Practice improvement
- Ƶproduced a self-service how-to guide, which augments the Agency’s “Six Building Blocks” opioid treatment program.
- AHRQ’s 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’s 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.
- Ƶlaunched a website on the Network of Patient Safety Databases, which includes data visualization tools and a chartbook of national analysis.
- Ƶupdated 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
- Ƶsupported 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
- Ƶcreated 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’s priorities.
- Ƶcreated 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.
- Ƶhas been expanding its digital footprint, increasing the volume and frequency of messaging on social media sites, adding graphics and videos to the Ƶwebsite, adding real-time analytics, and adding a library of social media content.
Ƶand COVID-19 Discussion
Robert McNellis, M.P.H., Senior Advisor for Primary Care, AHRQ, and NAC Members
Director Khanna began a session on Ƶand the COVID-19 crisis by noting the Agency’s efforts to maintain safety and counter the virus (teleworking, virtual meetings).
Mr. McNellis further described Ƶefforts to address the challenge, noting that Ƶis part of the all-government response. This response includes short-, intermediate-, and long-term approaches to fight the pandemic. Ƶis engaging with sister agencies to identify gaps and opportunities in the fight and to contribute the Agency’s 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 Ƶhelp 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. Ƶcould advance efforts to develop learning health systems. The pandemic is creating learning opportunities.
- Dr. Bitton suggested Ƶconsider 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. Ƶcould work to obtain data.
- Ms. Edgman-Levitan agreed that Ƶshould support research in the evaluation of virtual care activities and their potential effectiveness. Ƶcould join the related new collaborative created by the Institute for Healthcare Improvement.
- Dr. Yu encouraged Ƶto 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. Ƶcould study issues of access and infrastructure. The marketplace will experience large changes.
- Dr. Alexander stressed the impact on the long-term-care community. Ƶcould support research to study effects of isolation and use of telemedicine.
- Dr. Romano agreed with the need to examine the use of telemedicine/telehealth. Ƶcould study issues of quality and safety, as in diagnostic error. There will be changes and issues regarding the workforce—teamwork, burnout, retraining.
- Dr. Masica encouraged Ƶto study impacts on chronic health issues, especially within populations with disparities.
- Dr. Amstutz suggested that Ƶconsider natural experiments, as in the results of public health delivery. Ƶcould study community health organizations.
- Dr. Hernandez-Boussard noted the different State strategies in addressing COVID-19. Ƶcould 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’s 21st Century Care Initiative. This new effort builds on the Nation’s 21st Century Cures Act, with Ƶrealizing 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, “Cures 2.0,” and features new aspects, such as digital healthcare and a focus on caregivers. AHRQ’s 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 Ƶspecifically 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 Ƶshould 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 Ƶto 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 Ƶsupporting its development and integration. Ƶshould 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 Ƶto 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 Ƶto 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 Ƶto 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). Ƶcould engage in the international “What Matters to You” initiative (Institute for Healthcare Improvement).
- Dr. Bitton encouraged Ƶto 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. Ƶcould 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 Ƶto support work to increase information and discussion about such problems. She wondered about potential “moments of care” 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’ disease) and wondered whether COVID-19 might exist in hospital patients in cross-contamination with Legionella, which can exist in hospital cooling towers. Perhaps Ƶcould support research into that possibility.
Lucy A. Savitz, Ph.D., M.B.A., of Kaiser Permanente Northwest and a former NAC member suggested that Ƶuse 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 Ƶhas 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 Ƶpriorities and ways AHRQ’s 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 Ƶto support research on the science of scale, moving research results beyond the pilot level.
- Dr. Bradley urged Ƶto partner with other Federal agencies to disseminate messages.
- Ms. Dahlen encouraged Ƶto use mass media with messages that connect directly to the consumer.
- Dr. Goeschel stated that she can disseminate Ƶmessages at universities and MedStar Health’s research institute. She can promote Ƶresearch opportunities and findings to groups such as the American Physical Therapy Association.
- Dr. Gupta encouraged Ƶto produce more webinars and to record them for further dissemination by institutions on their websites.
- Dr. Pham suggested that Ƶseek 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 Ƶto be in contact with professional societies, such as the American Medical Informatics Association. Ƶcould cosponsor webinars and leverage infrastructures, including those of private enterprises.
- Dr. Amstutz encouraged the use of public-private partnerships for some grants. Ƶcould fund innovation health systems (sandboxes) that include such partnerships.
- Dr. Raju suggested that NAC members disseminate Ƶmessages at local and national medical meetings and through social media.
- Dr. Robinson encouraged Ƶto partner with organizations such as the Digital Medicine Society. Ƶpotentially could be a major driver in that area.
- Dr. Yu stated that Ƶcould advertise its resources as it helps educate the public about the COVID-19 pandemic.
- Dr. Masica encouraged Ƶto push forward its dissemination and implementation activities during the pandemic.
- Dr. Wagner suggested that Ƶuse 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
Agency for Healthcare Research and Quality
