Article type
Year
Abstract
Background: While using evidence to inform decision making processes, policymakers often draw rely on evidence coming from other jurisdictions while planning high-level health system transformations. In these contexts, decision makers often want to know what interventions are effective to achieve the quadruple aim. This presentation aims to show how contextualizing findings from a systematic review can address pressing issues to inform health system transformations in other contexts.
Accountable care organizations were implemented in the U.S. in 2012, building on the successful elements of health maintenance organizations and managed care innovations. However, since their inception there has been a lot written in academic literature either touting their benefits or pointing out their flaws. Other jurisdictions have begun adopting this model with little synthesized information on its benefits and risks, including most recently significant health system reforms in Ontario, Canada
Objectives: To present how contextualizing the findings from systematic reviews can be used to inform health system transformation, showing an application on accountable care organizations.
Methods: We conducted a systematic review on accountable care organizations. We selected this topic because of the paucity of synthesized evidence addressing this reform and its relevance to ongoing reforms in Ontario and abroad. We searched three databases from 2010 to February 2020: Medline, EMBASE and EconLit. To find gray literature, the electronic database search was supplemented by a hand search of relevant websites. We extracted data related to the type of ACO, time period study, study design, relevance to the quadruple aim, and the key findings. We use Cochrane EPOC Risk of Bias tool and the Maryland Scientific Methods Scale to assess the quality of the included studies. We then map the findings from the systematic review on the components of the health system reform in Ontario to determine where lessons can be used to inform its design and implementation.
Results: We found 10,630 non-duplicate potentially eligible articles from our search. Of these, 11 have been included for data extraction and ten of which apply a difference in difference methodology. Initial findings from the 11 studies focus on two of the four quadruple aims. In particular on improving patient health outcomes and reducing per capita costs. In general, the findings indicate modest improvements in patient health and a reduction in per capita costs, most of which can be attributed to a reduction in discretionary services.
Conclusions: A key component of rapid-learning and improvement is ensuring that research evidence can be easily used by decision makers to inform the design of a solution. The contextualization of findings from a systematic review can be used to support the rapid-learning cycle and to ensure that lessons learned can be applied to ongoing design of reforms elsewhere.
Accountable care organizations were implemented in the U.S. in 2012, building on the successful elements of health maintenance organizations and managed care innovations. However, since their inception there has been a lot written in academic literature either touting their benefits or pointing out their flaws. Other jurisdictions have begun adopting this model with little synthesized information on its benefits and risks, including most recently significant health system reforms in Ontario, Canada
Objectives: To present how contextualizing the findings from systematic reviews can be used to inform health system transformation, showing an application on accountable care organizations.
Methods: We conducted a systematic review on accountable care organizations. We selected this topic because of the paucity of synthesized evidence addressing this reform and its relevance to ongoing reforms in Ontario and abroad. We searched three databases from 2010 to February 2020: Medline, EMBASE and EconLit. To find gray literature, the electronic database search was supplemented by a hand search of relevant websites. We extracted data related to the type of ACO, time period study, study design, relevance to the quadruple aim, and the key findings. We use Cochrane EPOC Risk of Bias tool and the Maryland Scientific Methods Scale to assess the quality of the included studies. We then map the findings from the systematic review on the components of the health system reform in Ontario to determine where lessons can be used to inform its design and implementation.
Results: We found 10,630 non-duplicate potentially eligible articles from our search. Of these, 11 have been included for data extraction and ten of which apply a difference in difference methodology. Initial findings from the 11 studies focus on two of the four quadruple aims. In particular on improving patient health outcomes and reducing per capita costs. In general, the findings indicate modest improvements in patient health and a reduction in per capita costs, most of which can be attributed to a reduction in discretionary services.
Conclusions: A key component of rapid-learning and improvement is ensuring that research evidence can be easily used by decision makers to inform the design of a solution. The contextualization of findings from a systematic review can be used to support the rapid-learning cycle and to ensure that lessons learned can be applied to ongoing design of reforms elsewhere.