optimizing health care delivery and outcomes richard a. hansen, phd gilliland professor and head...

Optimizing Health Care Delivery and Outcomes

Richard A. Hansen, PhDGilliland Professor and Head

Department of Health Outcomes Research and Policy

Health Spending and Outcomes

State ranking on health system performance Heart disease mortality rates for age 40

Healthcare Quality and Outcomes

Complex patientsComplex care

Complex systemsComplex treatments

Healthcare is Complex

Complex Patients…

…or complex care?Maciejewski et al., JGIM 2014; Hansen et al., Annals of Pharmacotherapy (in press)

Grant s AHRQ 1R21HS019445-01 AHRQ 1R01HS023099-01

Complex Care 

Emergency Room Visits

Probability Number

of 1+ Visits of Visits

Odds Ratio (95%CI) IRR (95%CI)

Probability of

Hospital Admission

Odds Ratio (95% CI)

1 Condition (lagged) Reference Reference Reference

2 Conditions (lagged) 1.02 (0.80, 1.29) 0.98 (0.83, 1.15) 1.07 (0.88, 1.29)

3+ Conditions (lagged) 1.38 (0.99, 1.91) 0.86 (0.71, 1.04) 1.11 (0.84, 1.46)

1 Prescriber (lagged) Reference Reference Reference

2 Prescribers (lagged) 1.24 (0.99, 1.56) 1.15 (0.98, 1.35) 1.31 (1.09, 1.57)*

3 Prescribers (lagged) 1.58 (1.17, 2.13)* 1.18 (0.99, 1.41) 1.31 (1.01, 1.69) *

4+ Prescribers(lagged) 1.96 (1.39, 2.75)*** 1.38 (1.13, 1.70)* 1.47 (1.08, 2.01) *

Grant s AHRQ 1R21HS019445-01 AHRQ 1R01HS023099-01

Maciejewski et al., JGIM 2014; Hansen et al., Annals of Pharmacotherapy (in press)

Complex systems

Drug-related risk of bleeding across 200 million patients represented in U.S. data repositories

Hansen et al., RSM (in press)Hansen et al., Drug Safety (2013)Fox et al., JBI (2013)

Grants: FNIH HANSE11OMOPNPC (No Number)

Richard A. Hansenrah0019@auburn.edu

Current and Recent Funding

Funding Opportunities

Complex patients and conditions• AHRQ 1R21HS019445-01 (Duke)• AHRQ 1R01HS023099-01 (UNC)

Complex treatments and drug safety• FDA 1U01FD005272-01 (Auburn)• FNIH HANSE11OMOP (Auburn)• National Pharmaceutical Council

• NIH (R01 & R18 in review)• PCORI, AHRQ, CDC, FDA

Interdisciplinary collaboration is key…