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Joakim Ramsberg

2014-2015 Harkness Fellow Chief Scientific Officer Vårdanalys

Placement: Harvard Pilgrim Health Care Institute

Mentor: Richard Platt, M.D., M.Sc. (Harvard Pilgrim Health Care Institute)

Co-mentor: Joe Selby, M.D., M.P.H. (Patient-Centered Outcomes Research Institute)

Project Title: Randomization in Routine Care to Create a Learning Health Care System

Joakim Ramsberg, Ph.D., is a 2015–16 Swedish Harkness Fellow in Health Care Policy and Practice. He is currently chief scientific officer of Vårdanalys (The Swedish Agency for Health and Care Services Analysis), where he leads projects that evaluate national clinical guidelines, examine disease registries, and assess government reforms to increase access and strengthen psychiatric care. He is an affiliated researcher at Karolinska Institutet in Solna. Ramsberg has served as elected president of the Swedish Health Economics Association and was for six years a member of the Scientific Advisory Committee for the Swedish Council on Technology Assessment in Health Care (SBU). He has been a member of several governmental, international, and research advisory committees e.g. at the European Commission and The Organization for Economic Co-operation and Development. He received a Ph.D. in economics from the Stockholm School of Economics.

Project Abstract

In embedded trials, patients in ordinary health care are randomized to different treatments and then routinely collected clinical information in data-sources such as disease registries or electronic health records (EHR) is used to evaluate effectiveness of interventions. These trials hold opportunity to address the need for evidence about e.g., effectiveness in real-life clinical practice, safety, and quality of medical care to guide informed clinical decisions at a fraction of the cost of a regular trial. Embedded trials are still rare, but interest in embedded trials and comparative effectiveness research is exploding. Some believe that the vast quantities of data already or soon to be available in EHR will enable a “learning healthcare system”. However, there is a paucity of knowledge and experience in both methods and practical means to implement these strategies in health care systems. For that reason it is vitally important to learn from the experiences in completed and ongoing pilot projects. Ramsberg aims to identify barriers and facilitators of embedded trials, compare specific approaches used in the U.S. and Sweden, and explore the role of these trials in healthcare systems. Methods will include reviewing literature and other documents, case studies of a variety of organizations representing national initiatives, research funding agencies and health systems, such as NIH Collaboratory, Patient-Centered Outcomes Research Institute and Kaiser Permanente. Furthermore, an economic analysis of embedded trials will increase understanding of the value of embedded clinical trials from a health system perspective by analyzing costs and benefits of embedded trials. Ramsberg’s research findings will inform the current literature on embedded trials, and will have policy implications for both Sweden and the U.S.

Career Activity since Fellowship: 

Current Position: Principal Secretary, Commission on Financing, Pricing and Reimbursement of Pharmaceuticals, Swedish Ministry of Social Affairs (updated 04/2017)

Email: [email protected]