U.S. still needs to treat health care delivery as a science, says AHRQ director

Carolyn Clancy, MD, director of the federal Agency for Healthcare Research and Quality (AHRQ), says that although the U.S. "leads the way" in science to develop medical methods, the country still needs to treat health care delivery as a science.

Health care should emulate Starbucks in teamwork, Clancy told a standing-room audience at Pharmacy Hall at the University of Maryland School of Pharmacy. "They get it. You order a drink at the cashier, even one of those complicated ones. [The cashier] repeats it back to you and writes it on the cup. Then she repeats it to the person making it, who also repeats it. Most of medicine has not done that. They do a better job at Starbucks."

Delivering the annual Andrew G. Dumez Memorial Lecture, "Research Meets Practice at the RX: Keeping Patients and Consumers at the Center of Care," Clancy provided a high-level view of the current challenges to improve the quality of care, as well as the pharmacists' roles in those challenges. As a producer of what Clancy called "benchmark" reports for health care industry and policymakers, AHRQ "supports research that helps people make more informed decisions and improves the quality of health care services," according to its website.

Clancy praised the current collaborative trend in health care research, which is designed to inform health care decisions by providing evidence on the effectiveness, benefits, and harms of different treatment options. The evidence is generated from research studies that compare drugs, medical devices, tests, surgeries, or ways to deliver health care. Such "patient-centered research," she said, greases the skids of scientific advances into actual clinical practice and usable information for clinicians and patients.

During the creation of the American Recovery and Reinvestment Act of 2009, "All parties agreed," she said, that "patient-centered care needs to involve more than clinical intervention. It also needs to include such things as drug-to-drug interaction, care management, avoiding [hospital stays]" and more.

Clancy said a recent AHRQ report found that progress has been made in data collection in the health care system as more providers are collecting and storing patient data. The team concept in health care transcends the "my data" mentality of the past, she said. "We are getting to a point when data are ubiquitous, allowing for more success in using comparative effectiveness as a tool, with improved methods that can support learning and improvement at the front lines of care delivery."

Addressing the pharmacy students in attendance, Clancy said, "If there was ever a time when we need you, it is now. It is becoming increasingly important to safety and quality is to do medicine as a team sport. And the pharmacist is a vital member of the team."

As a young physician working at a free clinic in Richmond, Va., in the 1980s, Clancy "learned how much better it was to have a pharmacist on our team." One day, immediately after seeing a patient, she overheard a pharmacist in the next room say to the patient, "'Tell me what you heard [from the doctor].' It was so powerful and important, I never forgot it."