Identifying Key Areas for Delivery System Research

Initial National Priorities for Comparative Effectiveness Research report that fit the definition of delivery system research suggested in this paper

The IOM listed 100 priority topics, with the first quartile having highest priority within this list of 100, and the fourth quartile lowest priority. The order of listing within a quartile does not indicate priority within the quartile.

Of the 31 topics in the list below, 27 focus on processes for improving care to individuals or to populations of patients; that is, they focus on the process category of the conceptual model presented in this paper. Only four topics (in italics below) focus on other categories included in the conceptual model.

Note: The text of the topics has been taken from the IOM document verbatim and has not been edited. The report is available at http://www.nap.edu/catalog.php?record_id=12648, accessed January 8, 2014.

First Quartile

1. Compare the effectiveness of comprehensive care coordination programs, such as the medical home, and usual care in managing children and adults with severe chronic disease, especially in populations with known health disparities.
2. Compare the effectiveness of interventions (e.g., community-based multi-level interventions, simple health education, usual care) to reduce health disparities in cardiovascular disease, diabetes, cancer, musculoskeletal diseases, and birth outcomes.
3. Compare the effectiveness of literacy-sensitive disease management programs and usual care in reducing disparities in children and adults with low literacy and chronic disease (e.g., heart disease).

Second Quartile

1. Compare the effectiveness of the co-location model (psychological and primary care practitioners practicing together) and usual care (identification by primary care practitioner and referral to community-based mental health services) in identifying and treating social-emotional and developmental disorders in children ages 0-3.
2. Compare the effectiveness of diverse models of comprehensive support services for infants and their families following discharge from a neonatal intensive care unit.
3. Compare the effectiveness of shared decision making and usual care on decision outcomes (treatment choice, knowledge, treatment-preference concordance, and decisional conflict) in children and adults with chronic disease such as stable angina and asthma.
4. Compare the effectiveness of strategies for enhancing patients’ adherence to medication regimens.
5. Compare the effectiveness of patient decision support tools on informing diagnostic and treatment decisions (e.g., treatment choice, knowledge acquisition, treatment-preference concordance, decisional conflict) for elective surgical and nonsurgical procedures—especially in patients with limited English-language proficiency, limited education, hearing or visual impairments, or mental health problems.
6. Compare the effectiveness (including resource utilization, workforce needs, net health care expenditures, and requirements for large-scale deployment) of new remote patient monitoring and management technologies (e.g., telemedicine, Internet, remote sensing) and usual care in managing chronic disease, especially in rural settings.
7. Compare the effectiveness of diverse models of transition support services for adults with complex health care needs (e.g., the elderly, homeless, mentally challenged) after hospital discharge.
8. Compare the effectiveness of accountable care systems and usual care on costs, processes of care, and outcomes for geographically defined populations of patients with one or more chronic diseases.
9. Compare the effectiveness of coordinated care (supported by reimbursement innovations) and usual care in long-term and end-of-life care of the elderly.
10. Compare the effectiveness of pharmacologic treatment and behavioral interventions in managing major depressive disorders in adolescents and adults in diverse treatment settings.
11. Compare the effectiveness of an integrated approach (combining counseling, environmental mitigation, chronic disease management, and legal assistance) with a non-integrated episodic care model in managing asthma in children.
12. Compare the effectiveness of birthing care in freestanding birth centers and usual care of childbearing women at low and moderate risk.

Third Quartile

1. Compare the effectiveness and cost-effectiveness of conventional medical management of type 2 diabetes in adolescents and adults, versus conventional therapy plus intensive educational programs or programs incorporating support groups and educational resources.
2. Compare the effectiveness of alternative redesign strategies—using decision support capabilities, electronic health records, and personal health records—for increasing health professionals’ compliance with evidence-based guidelines and patients’ adherence to guideline-based regimens for chronic disease care.
3. Compare the effectiveness of different quality improvement strategies in disease prevention, acute care, chronic disease care, and rehabilitation services for diverse populations of children and adults.
4. Compare the effectiveness of formulary management practices and usual practices in controlling hospital expenditures for products other than drugs including medical devices (surgical hemostatic products, radiocontrast, interventional cardiology devices, and others).
5. Compare the effectiveness of comprehensive, coordinated care and usual care on objective measures of clinical status, patient-reported outcomes, and costs of care for people with multiple sclerosis.
6. Compare the effectiveness of different strategies to engage and retain patients in care and to delineate barriers to care, especially for members of populations that experience health disparities.

Fourth Quartile

1. Compare the effectiveness of different disease management strategies in improving the adherence to and value of pharmacologic treatments for the elderly.
2. Compare the effectiveness of care coordination with and without clinical decision supports (e.g., electronic health records) in producing good health outcomes in chronically ill patients, including children with special health care needs.
3. Compare the effectiveness of coordinated, physician-led, interdisciplinary care provided in the patient’s residence and usual care in managing advanced chronic disease in community-dwelling patients with significant functional impairments.
4. Compare the effectiveness of diagnostic imaging performed by non-radiologists and radiologists.
5. Compare the effectiveness of different disease management strategies for activating patients with chronic disease.
6. Compare the effectiveness of different delivery models (e.g., home blood pressure monitors, utilization of pharmacists or other allied health providers) for controlling hypertension, especially in racial minorities.
7. Compare the effectiveness of hospital-based palliative care and usual care on patient-reported outcomes and cost.
8. Compare the effectiveness of different treatment approaches (e.g., integrating mental health care and primary care, improving consumer self-care, a combination of integration and self-care) in avoiding early mortality and comorbidity among people with serious and persistent mental illness.
9. Compare the effectiveness of traditional training of primary care physicians in primary care mental health and co-location systems of primary care and mental health care on outcomes including depression, anxiety, physical symptoms, physical disability, prescription substance use, mental and physical function, satisfaction with the provider, and cost.
10. Compare the effectiveness of different treatment strategies (e.g., psychotherapy, antidepressants, combination treatment with case management) for depression after myocardial infarction on medication adherence, cardiovascular events, hospitalization, and death.