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CENTER FOR HEALTHCARE DELIVERY SCIENCES Department of Medicine Brigham and Women s Hospital and Harvard Medical School PROGRESS REPORT July 2014 Niteesh K Choudhry MD PhD Executive Director nchoudhry partners org www c4hds org
                                                                   CENTER FOR HEALTHCARE DELIVERY SCIENCES Department     ...
CENTER FOR HEALTHCARE DELIVERY SCIENCES Motivation and Mission Optimizing how we engage patients and providers and deliver care are central priorities in our learning healthcare system Many organizations are experimenting with innovative and promising models to address these issues Unfortunately few of these have undergone rigorous and or independent evaluation to determine their value with regard to outcomes of direct relevance to payers providers patients or funders This is especially true for early stage interventions for which refinement and credible evaluation may help determine whether or not to expend additional time and money on their development The CHDS was created with support from the Brigham and Women s Hospital BWH Department of Medicine and its Division of Pharmacoepidemiology and Pharmacoeconomics to addresses these deficiencies by bring together clinical innovators evaluation experts behavioral scientists technology developers and implementation partners with the shared mission of 1 Designing implementing and or rigorously evaluating novel ways of maximizing healthcare value 2 Developing and refining methodologies for conducting delivery system evaluation 3 Training the next generation of delivery science academics and implementers Areas of focus Effectively engaging patients and providers in health quality improvement has been increasingly recognized as central to successful care transformation Because there remain many opportunities to refine how to achieve greater engagement we have chosen to focus CHDS s activities on the development refinement and testing of solutions for increasing engagement and restructuring care that are scalable across settings and which could help address multiple related engagement problems such as medication adherence smoking cessation and weight loss From a methodological perspective we are principally interested in the use of low cost clinical trials embedded in real world delivery systems Our work is heavily influenced by the experiences of our faculty leading these types of studies These include MI FREEE which was conducted in partnership with Aetna and evaluated the use of financial incentives for reducing vascular events after myocardial infarction REMIND which is assessing the benefit of low cost reminder devices for chronic disease medications www c4hds org 2
CENTER FOR HEALTHCARE DELIVERY SCIENCES         Motivation     and     Mission      Optimizing     how     we     engage  ...
CENTER FOR HEALTHCARE DELIVERY SCIENCES among approximately 45 000 beneficiaries of CVS Caremark and STIC 2 IT which is a NIH supported trial in development with Atrius Health that will evaluate the impact of a technologically enabled pharmacist intervention to improve outcomes for patients with common chronic conditions SOLUTIONS patient interactions with their own care PROBLEMS non adherence obesity FINANCIAL INCENTIVES smoking REMINDERS readmissions FEEDBACK TOOLS patient interaction with health information interactions between patients and providers interactions between patients and others SHARED DECISION MAKING ALTERNATIVE PRIMARY CARE LITERACY INTERVENTIONS SOCIAL MEDIA AND ONLINE COMMUNITIES BIOMETRIC MONITORING OPTIONS PEER MENTORING narcotic abuse While we develop novel and creative patient and provider engagement strategies of our own we also seek to foster collaborations with external healthcare innovators to refine their solutions and to evaluate with them in partnership with payers provider organizations and or other implementation organizations Current projects In the months since its inception CDHS has launched several projects These include A large scale trial of Medicare beneficiaries being conducted in partnership with the Center for Medicare and Medicaid Services the Center for Disease Control and the U S Behavioral Insights Team that will evaluate the use of commitment techniques to increase uptake of the flu vaccination A randomized evaluation of the accelerated adoption of primary care practice characteristics associated with higher quality and lower spending being conducted in partnership with the Stanford Center for Clinical Excellent Research A small randomized controlled trial evaluating the impact of SMS text based reminders to increase exercise among patients after myocardial infarction www c4hds org 3
CENTER FOR HEALTHCARE DELIVERY SCIENCES         among     approximately     45,000     beneficiaries     of     CVS     Ca...
CENTER FOR HEALTHCARE DELIVERY SCIENCES Faculty and personnel Identifying and recruiting exceptional faculty trainees and staff are central priorities for CHDS We are particularly interested in the recruitment and mentoring of early stage investigators who show great promise as there is no clear academic career path for trainees who want to pursue careers in delivery and implementation science In parallel with our search for such core faculty we have already received enthusiastic commitment from 16 more senior faculty to provide guidance on CHDS s activities and collaboration on specific projects These faculty affiliates come from within BWH including the Department of Medicine s Divisions of Pharmacoepidemiology and Pharmacoeconomics and General Internal Medicine as well as the Department of Emergency Department as well as the Hospitalist Program the broader Harvard community including MGH and the Department of Health Care Policy at HMS other academic institutions including Dartmouth the University of Pennsylvania and Stanford private intuitions including Google Ventures Merck and CVS Caremark We have also attracted several exceptionally talented fellows from BWH HMS and Harvard Business School to work with CHDS on a part time basis They have been instrumental in both the strategic and initial academic endeavors Finally a recent graduate of BWH s Deland Fellows program has been serving as interim Chief of Staff a search for a permanent individual to fill this role is underway Implementation partners In an effort to establish partnerships within the BWH and Partners community we have met with the leadership of the Brigham and Women s Physician Organization the Center for Clinical Excellence and Population Health Management at both BWH and Partners Healthcare In additional to gauging general reactions and suggested refinements to CHDS s mission the specific purpose of these meetings was to identify opportunities for potential collaborative pilots A promising area of investigation that appears to meet the needs of these organizations and the interests of CHDS is the testing of engagement strategies on BWH and or Partners own employees BWH Partners has a clear interest and a financial incentive to improve health outcomes and productivity as well as to reduce unnecessary spending www c4hds org 4
CENTER FOR HEALTHCARE DELIVERY SCIENCES         Faculty     and     personnel      Identifying     and     recruiting     ...
CENTER FOR HEALTHCARE DELIVERY SCIENCES for its own employees Many Partners employees also receive care from Partners physicians thereby making clinic or care site based interventions feasible In this same spirit work place interventions are uniquely possible in this context We are the process of developing specific proposals for consideration by the individuals we have already met as well as key decision makers in the BWH leadership including in Human Resources Externally we have had the unique opportunity to interact with many organizations that have a strong interest in improving patient and provider engagement including the Center for Disease Control and Prevention the White House Office of Science Technology and Policy the Center for Evidence Based Policy the U S Behavioral Insights Team and Stanford s Clinical Excellence Research Center As described above we have launched several projects with these organizations and have others under development Fellowship program In order to train and foster the next generation of delivery science researchers we plan to offer a novel fellowship program consisting of training in health services research epidemiology biostatistics and biodesign pre selected thesis projects that use a multidisciplinary team based approach mentorship from academics industry leaders clinicians and thought leaders in medicine health policy and technology The fellowship program will provide formal training through courses offered by Harvard Catalyst the Harvard School of Public Health and other Harvard graduate schools Enrollment in a Harvard graduate degree program will be highly encouraged In addition to project based and peer learning trainees will be supervised by world class faculty mentors and affiliates To formalize the process of solutions development we have also begun discussions with Stanford s Clinical Excellence Research Center who have uniquely adapted training in biodesign a systematic approach to needs finding and the invention and implementation of new biomedical technologies to care delivery problems We hope to launch our first fellowship class for the summer of 2015 and have met with the BWH Internal Medicine program directors and the Harvard Vanguard Medical Associate residency class to discuss these opportunities www c4hds org 5
CENTER FOR HEALTHCARE DELIVERY SCIENCES         for     its     own     employees.     Many     Partners     employees    ...
CENTER FOR HEALTHCARE DELIVERY SCIENCES Funding Developing a model for sustainable funding is a top priority for CHDS Our ultimate goal is to be adequately resourced from a diversity of sources that we will be able to collaborate with implementation partners to develop refine deploy and evaluate new methods of engaging patients and providers without needing to ask them for direct financial support We are currently pursuing funding from three sources 1 Grants from public agencies and foundations for specific projects 2 Endowment support from philanthropists who an inspired by our mission 3 Contracts from insurers venture capitalist and technology developers who are interested in the academic evaluation of care innovations To this end we are in the final stages of securing our first project specific grant We have meet several philanthropists who are informally advising us about how best to position CHDS s offerings to attract the level of funding that we will require to properly establish our Center After these meetings we will formally solicit the help of the BWH Development Office We have also met with payers and venture capitalists with other meetings forthcoming to pursue contract funding Our faculty has an extensive track record of working with private funders to support the design and evaluation of studies to evaluate care delivery innovations We have received great encouragement that venture capitalist and other similar entities also seek such independent academically rigorous evaluation and to have the results of these analyses published in the peer reviewed literature This is especially true for care innovations early in the development process in order to determine whether or not to expend additional resources on their refinement We are currently further exploring this avenue of funding Public outreach Having launched our website www c4hds org we are now in the process of writing and designing our communication material establishing a social media presence and increasing awareness through our network of collaborators www c4hds org 6
CENTER FOR HEALTHCARE DELIVERY SCIENCES               Funding      Developing     a     model     for     sustainable     ...