First Annual Centers of Excellence Workshop
The first annual meeting of the Centers of Excellence under the Comparative Health System Performance (CHSP) Initiative was held in September 2016 and was attended by AHRQ, the Centers of Excellence, and the Coordinating Center. The purpose of these meetings is to (1) promote learning, networking, and collaboration across the three Centers of Excellence, AHRQ, and the Coordinating Center; (2) identify opportunities to harmonize data sources, measures, and analytic methods; and (3) solicit input on dissemination opportunities.
At this first meeting, the group agreed on the objective of creating a list of health systems for the health services research community and other interested stakeholders, and in turn, discussed the definition of a health system and progress to date on using secondary data sources to identify systems. In addition, researchers from the Centers of Excellence shared their thoughts on the questions they intend to study and continued discussions started earlier in the year on harmonizing a subset of measures that they and the Coordinating Center will use to measure health system performance.
The discussion reflected consensus on the importance of understanding health systems and their role in patient-centered outcomes research (PCOR) adoption and performance improvement. Andy Bindman, director of AHRQ, noted that the primary objective of the initiative is to promote broad dissemination of information on the characteristics and practices of high-performing health systems, particularly those practices focused on the use of PCOR, and to synthesize findings on the association between health system performance and use of PCOR.
- Download Agenda (PDF, 169 KB).
- Download Workshop Slides (PDF, 2.02 MB).
- Summary of the First Annual Workshop.
Developing a List of Health Systems
In support of the goals of the CHSP Initiative, the Coordinating Center, the Centers of Excellence, and AHRQ discussed working together to develop a "compendium" that will enable users to access health system data and information about practices aimed at improving patients’ outcomes through the use of PCOR evidence. The compendium is expected to take the form of an interactive Web site that will house information in a variety of formats, including a research linkage file.
The group agreed that as a starting point, they will work together to create a list of health systems and their affiliated practices and hospitals to share publicly. This list will be updated over time and will be the basis for a broader data resource that will include additional information, such as attributes of these systems. It is intended to be a much needed resource for researchers studying health system change and the key factors contributing to improved quality and efficiency in care delivery.
Defining a Health System
Foundational to the effort to develop a list of systems is the ability to define a health system. The group agreed that for the purposes of creating a public, national list of health systems, the definition must be “operationalized” using available secondary data. Because of the limitations in the range of information collected through secondary data, the initiative initially will use a narrow definition based largely on organizational structure, such as ownership arrangements among providers and the composition of systems. The expectation is that the criteria used to define a system will broaden as the Centers of Excellence’s research informs the collective effort. AHRQ also encourages the Centers of Excellence to study a variety of health systems beyond those that meet this narrow definition.
Working With Data To Identify Health Systems
The Centers of Excellence and AHRQ shared their experiences in working with secondary data to identify health systems and discussed:
- Strategies to clean the data.
- Use of multiple sources to gain the most complete information.
- The value of identifying practices by tax identification number (TIN) and assigning TINs to systems where appropriate.
- Differences in lists of systems derived from different data sources and using different methodological approaches.
- The potential need to validate the findings from secondary data (e.g., through health system leader review).
Key Research Topics
The Centers of Excellence discussed specific aspects of the focus of their research. Among the topics noted were:
- The importance of external factors, including market factors, in influencing performance.
- The importance of understanding internal/organizational culture, structures, and mechanisms that can influence care delivery and PCOR adoption.
- The likelihood that systems and patient experience vary by patient population as defined by condition (e.g., oncology, pediatrics).
- The importance of considering patient experience in identifying health "systems" (e.g., providers that function in a coordinated manner may be a system), defining their attributes (e.g., characteristics that patients think are important in a well-coordinated system), and measuring their performance (e.g., using patient experience measures such as CAHPS).
- The variation in adoption of PCOR findings by type of innovation (e.g., biomedical, care delivery, patient engagement).
The group shared lessons they have learned about measuring health system performance and attributes in order to promote harmonization across the Centers of Excellence. Harmonization of measures is important to help the research community synthesize the findings of the CHSP Initiative.