Evaluation of ARRA Comparative Effectiveness Research Dissemination Contract Efforts

A.1 Introduction

Patients and their health care providers have many options when deciding on a treatment plan. Sorting through large volumes of sometimes-conflicting information is difficult and time consuming for physicians and patients alike. Recognizing that research comparing health care treatment options should be reviewed objectively and widely disseminated, AHRQ has taken a leading role in developing patient-centered outcomes research (PCOR) and sharing it with decisionmakers, including clinicians, health care system administrators, business purchasers, and consumers. AHRQ reaches these priority audiences through targeted outreach and through its Effective Health Care Program (EHC Program). The EHC Program Web site serves as a digital repository for AHRQ's PCOR publications. The EHC Program helps clinicians and patients determine which drugs and other medical treatments work best for certain health conditions.

The research is designed to be patient-centered—that is, to enable the clinician and patient to work together to select treatment options based on valid, reliable information from a neutral third party. PCOR directly compares two or more health care interventions. Direct comparison of a particular treatment and an established standard of care or other realistic treatment option, as opposed to a placebo, allows assessment of how well a health care intervention works under real-world conditions. AHRQ has paid careful attention not only to how studies are conducted, but also to how results are communicated to health care decisionmakers, including patients.

AHRQ is testing new approaches to disseminating "patient-centered outcomes research" (PCOR) that promote awareness of the Effective Health Care (EHC) Program and, collectively, reach AHRQ's priority audiences. These strategies include academic detailing, continuing education, media and marketing, partnership development at national and regional levels, and "virtual centers." To implement these strategies, AHRQ has executed four dissemination contracts: Academic Detailing (AD), Online Continuing Education (CE), National Initiative for Promoting Evidence-Based Health Information (NI), and Regional Partnership Development Offices (RO).

This dissemination evaluation is meant to assess over time how effectively the new strategies enhance awareness, knowledge, use, and perceived benefits of CER generally and of EHC Program products specifically. The following model (Exhibit A.1) depicts AHRQ's framework for the dissemination strategies:

Exhibit A.1. Patient-Centered Outcomes Research (PCOR) Dissemination Framework Logic Model²¹

To achieve project goals, IMPAQ/Battelle, the evaluation contractor, obtains and analyzes dissemination contractors' quarterly metrics; conducts provider and consumer surveys and focus groups; conducts focus groups with health care system decisionmakers, health care purchasers, and policymakers; and reviews the EHC Program Web site and Publications Clearinghouse data.

A.2 General Research Approach

Our approach includes four components: (1) collecting quarterly metrics from the dissemination contractors; (2) conducting surveys with two key audiences (clinicians and consumers/patients) to capture awareness, understanding, behavior change, and benefits; (3) conducting follow-up focus groups with three strata of clinicians and consumers/patients;²³ and (4) conducting mini focus groups with health system decisionmakers, purchasers, and policymakers to address the research questions for those audiences.

Whereas the dissemination contractors' quarterly metrics will provide insights on reach and dissemination, our initiatives will focus on understanding, knowledge, use, and benefits.

A.3 Research Questions and Goals

The goal of the data collection is to evaluate the four dissemination strategies to create awareness of CER and specific CER topics, with the ultimate impact of creating and increasing knowledge, promotion of CER utilization and behavior change, and benefits of using CER. This report focuses on data collection through surveys with consumers/patients at two points in time.

The surveys will assess (1) levels of awareness, understanding, use, and perceived benefits of CER in general as well as topic-specific CER; (2) if and in what way the levels of awareness, understanding, use, and perceived benefits of CER are changing; and (3) trends in awareness of AHRQ's EHC Program.

²¹ Overview: AHRQ, OCKT, ARRA. Presented at the CER Dissemination Kick-Off Meeting, September 2010. Rockville, MD: Agency for Healthcare Research and Quality.

²² The three strata of clinicians and consumers/patients include (1) those who report awareness of CER and have self-reported use of CER; (2) those who report awareness of CER and self-reported non-use of CER; and (3) those who report no awareness of CER.

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