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Staff

Rosina Pradhananga, M.P.H.

Senior Manager

Rosina Pradhananga, M.P.H. is a Senior Manager at AcademyHealth, where she oversees projects focused on health services research, population health, and data science. She directs community building work for the AcademyHealth and ABIM Foundation Research Community on Low-Value Care through program development and evaluation. She manages a PCORI supported initiative for which she has helped promote consensus building efforts and led analyses on priorities to advance low-value care measurement in research and in practice. Further, she contributes to projects aimed at improving research methods transparency and augmenting the utility of patient registries for research. She has also managed projects focused on big data analytics for health care research and provided research support to a diverse child health portfolio.

Prior to joining AcademyHealth, she served as a Teaching Fellow in Economics at Yale College. In her previous work at Botswana Harvard AIDS Institute Partnership and Brown University, Ms. Pradhananga provided assistance for field research involving randomized trials on HIV/AIDS treatment in Botswana and tuberculosis care in India. She holds a Master of Public Health degree with concentrations in epidemiology of microbial diseases and global health from Yale University.

Authored by Rosina Pradhananga, M.P.H.

Program

Advancing Research to Reduce Low-Value Care

The problem of overuse, unnecessary care, or low-value care is increasingly a focus of the national health policy conversation. Estimates suggest that as much as one-third of health care spending in the United States is of low-value or wasteful. Many factors contribute to the problem, including increased patient demand, information asymmetry, perverse financial incentives for providers, and a culture of “more is better than less.”

In order to advance research development and to inform efforts to reduce overuse in the United States and globally, AcademyHealth and the ABIM Foundation have been partnering since 2014. Initially assessing the landscape of research being conducted on low-value care, we then focused on priorities for studies of interventions to reduce low-value care, which were then disseminated to multiple research funders. From these initial efforts, the partnership has evolved with development of a research community on low-value care composed of diverse stakeholders to coordinate efforts in low-value care research and an initiative to develop priorities for patient-centered low-value care measures.

ABIM Foundation Staff and Consultants:

Pilots & Programs

Research Community on Low-Value Care
AcademyHealth and the ABIM Foundation launched the Research Community on Low-Value Care in April 2016. The community is composed of key stakeholders whose contributions and engagement are essential to advance low-value care research.

Defining Patient-Centered Metrics for Low Value Care. Phase I: Establishing Priorities
One of the major barriers to reducing low-value care is our ability to identify instances of such care. In response to this significant need, and with support from the Patient-Centered Outcomes Research Institute (PCORI) Eugene Washington PCORI Engagement Award, AcademyHealth and the ABIM Foundation have been spearheading deliberative dialogues and priority setting with multiple stakeholder groups to assess the current state of measures and future research needs to develop, test, and implement measures that will help identify low-value care while taking into account patient perspectives.

Reports & Publications

Interventions Aimed at Reducing Use of Low-Value Health Services: A Systematic Review

The effectiveness of different types of interventions to reduce low-value care has been insufficiently summarized to allow for translation to practice. In this paper, Dr. Carrie Colla and authors systematically reviews the literature on the effectiveness of interventions to reduce low-value care and the quality of those studies.

Defining Value in Health Care Resource Utilization: Articulating the Role of the Patient

Authors Shannon Brownlee and Amy Berman explore the challenges in understanding the term value from multiple perspectives. To understand the role of patients and the public in relation to value-based care and payments, we first need to understand the term value and its unique meaning from the perspective of payers, providers, and patients.

Sponsors/Funder/Partner

ABIM Foundation LogoU.S. Department of Veteran Affairs Logo

 

Program

Defining Patient-Centered Metrics for Low Value Care

Phase I: Establishing Priorities

Research estimates indicate that approximately a third of health expenditures in the United States is attributed to services that are of low-value, are unnecessary, and/or can be deleterious to patients by posing physical or psychological harm. The substantial share of resources diverted to ineffective services underscores the need to reduce or eliminate such care. Although the parameters of low-value care continue to be debated, a common understanding encompasses tests, treatments, and procedures for which “the potential for harm exceeds the possible benefit.” Beyond a consensus on low-value care, remedying the issue requires appropriate measures, tools, and data infrastructure to identify, monitor, and evaluate low-value care as well as evidence to reduce such care. Therefore, as part of an ongoing partnership, AcademyHealth and the ABIM Foundation have led a multi-stakeholder engagement initiative through virtual and in-person collaborations to set priorities for developing and refining low-value care measures that account for patients’ perspective on the value of care delivered.

Training and Resources

Webinar: Measuring Low-Value Care: Priorities for Patient-Centered Metrics

AcademyHealth, in partnership with the ABIM Foundation, has developed a set of priorities through engagement of multi-stakeholder groups to develop, test, and use measures of low-value care that are sensitive to patient’s values. During this webinar participants discuss the rationale, scope, methods, and implications of the prioritization project.

Steering Committee

David Atkins, M.D., M.P.H.
VA Health Services Research and Development Service (HSR&D)
David Baker, M.D., M.P.H., F.A.C.P.

The Join Commission
Mary Barton, M.D., M.P.P.

National Committee for Quality Assurance
Amy Berman, B.S., R.N.
The John A. Hartford Foundation
Shannon Brownlee, M.Sc.

Lown Institute
Diana Buist, Ph.D., M.P.H.
Group Health Research Institute
Helen Burstin, M.D., M.P.H., F.A.C.P.
National Quality Forum
Joyce Dubow, M.U.P.
National Quality Forum
Susan Dorr Goold, M.D., M.H.S.A., M.A.
University of Michigan
Eve Kerr, M.D.
University of Michigan
Ann Arbor Center for Clinical Management Research
Meredith Rosenthal, Ph.D.
Harvard T.H. Chan School of Public Health
Lewis Sandy, M.D., F.A.C.P.
United Health Group
Nora Wells
Family Voices

This project was funded through a Patient-Centered Outcomes Research Institute (PCORI) Engagement Award Initiative (3409). The content does not necessarily represent the views of the Patient-Centered Outcomes Research Institute (PCORI), its Board of Governors, or Methodology Committee.

Publications & Resources

Past Event

Webinar: Measuring Low-Value Care: Priorities for Patient-Centered Metrics

AcademyHealth, in partnership with the ABIM Foundation, has developed a set of priorities through engagement of multi-stakeholder groups to develop, test, and use measures of low-value care that are sensitive to patient’s values. This webinar encompases a discussion of the rationale and scope of the project, the prioritization methods, and implications of the prioritization endeavors for low-value care measurement
Date & Time Tuesday, September 5, 2017 1:00 – 2:30 p.m. ET Location Online
Program

Global Programs and Initiatives

​AcademyHealth’s global engagement cuts across its existing programs, allowing our members to meet and collaborate with peers who share their professional interests around the world.

Across the wide spectrum of approaches to organizing, financing, and improving national health care systems, researchers and policymakers globally are finding that there are specific issues where innovations and experiences in one country can provide useful insights for improving health or healthcare, particularly at the regional and local level. Rather than creating a separate program for its international/global efforts, AcademyHealth’s global engagement cuts across its existing programs, allowing our members to meet and collaborate with peers who share their professional interests around the world. In addition to specific collaborative projects both at home and abroad, AcademyHealth’s workshops, conferences, and advisory committees often include relevant non-U.S. experts to promote shared learning and address common interests in health services and policy research.

External Stakeholders

 

Events
 

December 2016 9th Annual Conference on the Science of Dissemination and Implementation in Health
A forum for discussing the science of dissemination and implementation, the 9th Annual Conference aims to grow the research base by bridging the gap between evidence, practice, and policy in health and medicine. One of the nine tracks for the conference is Global Dissemination & Implementation.

November 2016, Fourth Global Symposium on Health Systems Research Health Systems Global
Health Systems Global organizes a symposium every two years to bring together its members with the full range of players involved in health systems and policy research. Participants will include researchers, policy-makers, funders, implementers, civil society and other stakeholders from relevant national and regional associations and professional organizations. Presentations from AcademyHealth staff will also be featured at the symposium.

Past Events

Reports & Publications

 

Global Public Health Systems Innovations: A Scan of Promising Practices (2015)

The United States spends more money on health care than any other nation, but the citizens of many other countries live longer and healthier lives than those in the United States. Studies also show that countries that invest more in social and community programs have better health care outcomes and also healthier populations. To explore how other countries’ health improvement efforts could inform similar efforts in the United States, AcademyHealth, with support from the Robert Wood Johnson Foundation, reviewed and synthesized promising approaches to public health systems innovations in countries that are responding to changing population needs by transforming their public health, health care, and social service systems.

Improving Quality and Efficiency in Health Care through Comparative Effectiveness Analyses: An International Perspective (2014)

The combination of rising health care costs, efforts to achieve universal or near-universal coverage globally, as well as better outcomes drives demand to spend health care funds efficiently and in accordance with each country’s priorities. This paper provides an overview of Health Technology Assessment activities in Europe, Canada, and Australia and examines the new public investments in Comparative Effectiveness Research in the United States. It also seeks to place the new United States federal investments in evidence generation in the context of the rather different investments that are predominantly focused on HTA in other industrialized countries.

Training & Resources

Searching for Effective Innovations I: Reducing Low-Value Care

This was the first in a series of three webinars, produced in partnership with The Commonwealth Fund, focused on high-priority topics in system transformation for which there is substantial international innovation and a learning opportunity for both U.S. and non-U.S. audiences. This webinar featured the latest evidence and experience on reducing low-value care from experts in Australia, Canada, and the United States.

Searching for Effective Innovations II: Long-Term Services and Supports

This webinar explored the current landscape of long-term services and supports (LTSS) in the United States and globally, promising innovations for improving the quality of LTSS, and current challenges in transforming the care provided to be people in need of these services.

Searching for Effective Innovations III: Improving Care for Complex Patients

This webinar focused on improving care for complex patients from experts in the United States and around the world and explored the current landscape of caring for complex patients, highlighted some emerging innovations to improve care, and discussed the challenges that still remain.

 

Pilots & Programs

Global Health and Health Care Interest Group

AcademyHealth’s Global Health and Health Care Interest Group (IG), the newest IG, is a network to connect researchers, practitioners, policymakers, and trainees interested in health services and systems research (HSR) in a global context. The Group’s mission is to foster the global development, dissemination, and use of HSR to improve the quality, efficiency, effectiveness, and outcomes of care and the health status and quality of life globally. This IG was approved by AcademyHealth's Membership Committee (a sub-committee of the Board of Directors) in June 2015. The IG is in provisional status for the next three years, and will be working to grow its visibility through various events.

Program

Registry of Patient Registries

​Patient registries offer significant opportunities for conducting clinical research.

AHRQ logo

In December 2012, the Agency for Healthcare Research and Quality (AHRQ) launched the Registry of Patient Registries (RoPR), which is a database of existing patient registries that was designed with extensive stakeholder participation to promote collaboration, reduce redundancy, and improve transparency in registry-based research. In partnership with AHRQ, L&M Policy Research, and Truven Health Analytics, AcademyHealth facilitates implementation of RoPR and its related projects, with a particular focus on developing a virtual Community of Practice (CoP) to facilitate discussion of relevant issues related to registry design and use of registry data among diverse stakeholders.

Sponsor/Funder/Partner

Training & Resources

  • 2014 Registries for Evaluating Patient Outcomes: A User's Guide: 3rd Edition
    This User’s Guide is intended to support the design, implementation, analysis, interpretation, and quality evaluation of registries created to increase understanding of patient outcomes. Although registries can serve many purposes, this guide focuses on registries created for one or more of the following purposes: to describe the natural history of disease, to determine clinical effectiveness or cost-effectiveness of health care products and services, to measure or monitor safety and harm, and/or to measure quality of care.
     
  • 2014 Outcome Measure Framework (OMF) Design Document
    Because standardized outcome measures do not exist for most condition areas, clinical studies often use different outcome measures or different definitions for the same outcome measures. The use of different definitions can have a substantial impact on study findings and introduce challenges when comparing or aggregating data across studies, leading to uncertainty when interpreting study findings in the context of existing evidence. The Outcome Measures Framework (OMF) provides a model and tool for the collection and display of information on outcome measures currently being used in patient registries, supports searching for and comparing identified outcome measures, and minimizes user burden. Further, as a content model, the OMF can serve as a standard approach to developing outcome measurement systems in multiple disease areas. The OMF tool is intended to collect and display information on outcome measures used in patient registries, with the goals of characterizing what registries currently collect and supporting long-term efforts to standardize outcome measures.

Pilots & Programs

Web-Based Collaborative Registries Forum
AcademyHealth is leading the development of an online Community of Practice for RoPR, the primary objective of which is to facilitate discussion of relevant issues related to registry design and use of registry data, among individual or groups that are currently involved with registries, as well as those whom may be interested in creating or using registries. The Web-forum also offers a repository of resources that are relevant for a range of registry producers and end-users.

Harmonization of Outcomes Using the Outcome Measures Framework

The RoPR project is also seeking to harmonize clinical definitions and outcome measures used in patient registries across five clinical areas, using the RoPR Outcome Measures Framework (OMF). The OMF is a conceptual model for classifying existing outcome measures that are relevant to patients and providers across most clinical conditions. Harmonizing these outcome measures is the key to improving the ability of registries to connect to other health IT systems. Through extensive stakeholder engagement, the harmonization will be conducted within select five clinical areas, and for each we will, 1) compare outcome measures to identify areas of harmonization; 2) work toward harmonization at series of in-person and web meetings; 3) produce common library of outcome measures for public comment; and 4) finalize library with feedback and post for public use.