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Biomedical subjects

Carolyn M Clancy

Publications and source records attributed to Carolyn M Clancy.

At least 19 recordsLinked to original sources
PubMed2003

Practical clinical trials: increasing the value of clinical research for decision making in clinical and health policy.

Decision makers in health care are increasingly interested in using high-quality scientific evidence to support clinical and health policy choices; however, the quality of available scientific evidence is often found to be inadequate. Reliable evidence is essential to improve health care quality and to support efficient use of limited resources. The widespread gaps in evidence-based knowledge suggest that systematic flaws exist in the production of scientific evidence, in part because there is no consistent effort to conduct clinical trials designed to meet the needs of decision makers. Clinical trials for which the hypothesis and study design are developed specifically to answer the questions faced by decision makers are called pragmatic or practical clinical trials (PCTs). The characteristic features of PCTs are that they (1) select clinically relevant alternative interventions to compare, (2) include a diverse population of study participants, (3) recruit participants from heterogeneous practice settings, and (4) collect data on a broad range of health outcomes. The supply of PCTs is limited primarily because the major funders of clinical research, the National Institutes of Health and the medical products industry, do not focus on supporting such trials. Increasing the supply of PCTs will depend on the development of a mechanism to establish priorities for these studies, significant expansion of an infrastructure to conduct clinical research within the health care delivery system, more reliance on high-quality evidence by health care decision makers, and a substantial increase in public and private funding for these studies. For these changes to occur, clinical and health policy decision makers will need to become more involved in all aspects of clinical research, including priority setting, infrastructure development, and funding.

Clinical Trials as Topic↗
PubMed2002

When is "good enough"? The role and responsibility of physicians to improve patient safety.

In September 2001, the Agency for Healthcare Research and Quality (AHRQ) and the ABIM Foundation jointly sponsored an invitational conference entitled "The Role and Responsibility of Physicians to Improve Patient Safety." The goal of the conference was to begin a national conversation focusing on the individual clinician's role and strategies physicians might employ to advance patient safety. The authors summarize the main themes and issues that emerged at the conference. The authors draw from work by the Institute of Medicine (IOM) to support the need for greater emphasis on quality improvement. To date, most of the work in this area has involved a systems-level approach, and physicians are often viewed as obstacles to improvement programs. By contrast, physicians may view population- or systems-based approaches to health care as interfering with the delivery of care to specific patients. The authors argue that physicians, individually and collectively, have a key role in quality improvement efforts, albeit a role that is yet fully defined. After reviewing successful examples involving physicians, the authors explore the major levers to achieve change-removing barriers, creating incentives, emphasizing collaboration, increasing education, and promulgating regulation-and summarize ten recurring themes, including both current and near-term opportunities, for physicians to exercise leadership in quality improvement and patient safety. Finally, they assert that even modest change can lead to substantial improvements, particularly if medical societies and the profession's standard-setting bodies work together.

Education, Medical↗
PubMed2002

Is outcomes research on cancer ready for prime time?

Contemporary treatment of patients with cancer has been challenged by the same influences that have stimulated broad interest among stakeholders in assessing the outcomes or "results" of medical care. These interrelated external forces include growing awareness of practice variations, increased recognition of the patient's central role in decision making, acknowledgment that treatment decisions for situations where cure is not possible require explicit metrics to assess trade-offs between length and quality of life, strong interest in cost containment, and broad public concern that efforts to rationalize spending may have led to decreases in quality of care. Clinical and health services researchers interested in cancer diagnosis and treatment have striven to address these issues and have been in the forefront of efforts to develop and use valid measures of health-related quality of life. However, the current challenges to the field of outcomes research are equally applicable to those applying its tools and methods to the study of cancer: lack of standardization of outcomes measures, limited evidence that assessing outcomes of care is followed by improved outcomes in practice, and development of a research infrastructure that links the products of outcomes research with informed, shared decision making in routine practice. The purpose of this article is to provide a brief overview of lessons learned from the first decade of outcomes research sponsored by the Agency for Healthcare Research and Quality that will inform suggested directions for future directions for cancer outcomes research.

Decision Making↗
PubMed2002

Meeting the health care needs of persons with disabilities.

The Agency for Healthcare Research and Quality (AHRQ) has established the Office of Priority Populations Research and is currently developing a research agenda to improve health care for persons with disability (PWDs). This article describes the background of and potential for the AHRQ disability agenda and some of the challenges ahead and considers future directions for disability-related health services research. Strategies for this agenda might include ensuring the inclusion of PWDs in current and future health care research studies and database development; support for studies and data focusing exclusively on PWDs; and support for studies of the challenges common to all or most of the priority populations.

Civil Rights↗
PubMedDate not supplied

The importance of outcomes research in pediatric emergency medicine.

Applying the methods and tools of outcomes research, "evaluation of the impact of health care on the health outcomes or 'end results' of patients and populations," to the clinical domain of emergency services for children offers an important strategic opportunity for addressing the questions that confront all health care services: What works? For which patients? At what cost? From whose perspective? Although the important questions to address are extensive, much of the intersection between emergency services and outcomes research remains unexplored. Important challenges for researchers intrigued by the opportunities at this intersection of fields include: 1) clear definition of the scope of emergency services; 2) consideration of the appropriate end-point of emergency services-the entire episode of illness and/or services provided within the emergency setting; 3) selection and development of measures that incorporate children's and families' perspectives; and 4) a clear focus on linking research findings with strategies for improving outcomes and informed decision making. This essay will provide an overview of accomplishments and challenges from the field of outcomes research, suggest important opportunities for applying existing methods to emergency medical services for children, and identify potential career paths for current and future investigators.

Child↗
PubMedDate not supplied

A call to excellence.

Health care improvement affects us all and is not optional. For change to occur, consumers must demand excellence from their providers and clinicians. Patient safety is part of a broader set of health care quality issues. Championing this view will not be easy, for it means fundamental change to the myriad interrelated systems that make up U.S. health care. HHS is taking the lead on patient safety through a number of initiatives and activities.

Centers for Medicare and Medicaid Services, U.S.↗