Despite many initiatives over the past three decades to improve healthcare quality and outcomes in the United States, progress remains slow, particularly for chronic disease care, where many patients still receive the recommended care only about half the time. Even when current """"""""best practices"""""""" are followed, outcomes in many population groups are far from optimal. Chronic disease care and outcomes for patients in California are no exception, where the performance rates for many standard chronic care quality measures, such as control of high LDL cholesterol or blood pressure, rank substantially below those of other states, despite the fact that California has one of the highest concentrations of managed care in the country. In response, the California Office of Managed Care, healthcare industry leaders, employer groups, and other key stakeholders initiated the Right Care Initiative (RCI)-a novel, public- private partnership to improve care and outcomes in California that spans the entire state, with the nine participating commercial health plans responsible for the care of more than 15 million residents or one third of the state's population. The RCI seeks to improve cardiovascular care and outcomes by promoting evidence-based practices and, when evidence is lacking, by comparing the effectiveness of usual and novel approaches to help providers provide the right care to the right patient at the right time in the right setting. And while RCI emphasizes improving cardiovascular care within healthcare settings, it also values prevention beyond the clinic walls-emphasizing collaborative approaches between multiple stakeholders at the community and regional level. Now in its second year, RCI health plans and other entities have begun sharing and pooling data and reviewing promising practices to identify opportunities for interventions to improve outcomes at local and regional levels. Although RCI is off to a promising start, it currently lacks the organizational and technical infrastructure to effectively design, implement, and evaluate the range of multisite, multilevel interventions being considered. The Go Grant will allow us to rapidly implement the infrastructure RCI needs to initiate studies and obtain additional funding on an ongoing basis. Specifically, we propose to establish a research center-the California Comparative Effectiveness and Outcomes Improvement (CEOI) Center-that would support the goals of the RCI while also significantly increasing the available evidence base on the comparative effectiveness of different strategies for improving the primary and secondary prevention of cardiovascular disease (CVD). Once operational, the CEOI would be able to support a wide range of interventions and comparative studies. And by capitalizing on existing research and the data infrastructure of participating members, CEOI is likely to yield substantial returns, both with respect to new knowledge generated and actual improvements in delivery and outcomes of care. Indications are also good that once the CEOI is operational obtaining additional funding from public and private sources will not be difficult. Indeed, because of the size and scale of the RCI healthcare networks involved in CEOI research projects, practices that prove effective are likely to be widely disseminated and to have a significant impact on population health far more quickly than usual. This impact is likely to extend beyond California, since many of the regional health plans involved are part of larger national plans that together care for more than a quarter of the U.S population. The likely spread of effective practices beyond California through these networks is increased by the fact that RAND and other partner organizations involved already have strong working relationships with those national plans and other regional quality or translational research initiatives. While the CEOI will initially support efforts of the RCI and focus on preventing CVD, we expect it will gradually expand its scope and capacity to support comparative effectiveness studies for entities not formally part of the RCI and to include care for health conditions besides CVD.
We propose to develop sustainable statewide infrastructure for Comparative Effectiveness Research on primary and secondary prevention of cardiovascular disease (CVD) among managed care populations. Our project builds on the Right Care Initiative (RCI)-an existing public-private, multidisciplinary collaboration of health plans, provider groups, public health authorities, and other key stakeholders. RCI was established to address poor performance in clinical outcomes of chronic conditions, including CVD. Now in its second year, health plans and other entities that are part of RCI have begun sharing and pooling data and reviewing promising practices to identify opportunities for interventions to improve outcomes at local and regional levels. Although RCI is off to a promising start, it lacks the organizational and technical infrastructure necessary to effectively design, implement, and evaluate the range of multisite, multilevel interventions being considered. The Go Grant will allow us to rapidly implement this infrastructure, initiate studies, and obtain additional funding for a sustainable statewide laboratory for practice- and community-based comparative effectiveness research and a center for innovation and dissemination of evidence-based practices.
