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5 Developing the Test Bed: Linking Integrated Service Delivery Systems
Pages 217-242

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From page 217...
... Katz outlines the efforts of the National Institutes of Health (NIH) Roadmap for Medical Research to accelerate biomedical research on a basic level as well as accelerate translational research by connecting existing research networks and maintaining necessary infrastructure for more efficient conduct of clinical research through the National Electronics and Clinical Trials Research network (NECTAR)
From page 218...
... The NIH Roadmap Strategy was to build on the paradigm of bringing basic science and discovery to clinical practice. Roadmap initiatives are grouped under three main headings: New Pathways to Discovery, Research Teams of the Future, and Reengineering the Clinical Research Enterprise.
From page 219...
... This is clearly a sea change in terms of what can go on at academic medical centers. Most academic research centers remain structured in the same way they were 50 years ago and the Clinical and Translational Science Awards are meant to catalyze change -- breaking silos, breaking barriers, and breaking conventions.
From page 220...
... What is needed is leadership, commitment, passion, and a commitment to funding. Funding in particular will drive the development of needed linkages and infrastructure for a learning healthcare system.
From page 221...
... ACTION provides health services in a wide variety of organizational care settings to at least 100 million Americans. The partnerships span all states and provide access to large numbers of providers, major health plans, hospitals, long-term care facilities, ambulatory care settings, and other care sites.
From page 222...
... IDSRN and ACTION represent networks of healthcare delivery-based partnerships in which hospitals, ambulatory care facilities, long-term care facilities, and health plans work in conjunction with health services consultants and researchers through five-year master contracts. Contractors (partners)
From page 223...
... 22 DEVELOPING THE TEST BED organizations that conducted the research used the results to improve the quality of care delivery. Part of ACTION's charge is to extend that kind of uptake more broadly, even nationwide where possible.
From page 224...
... A learning healthcare system such as HMORN faces five key questions: FIGURE 5-1 Sites in the HMO Research Network. 5-1 Reversed image (as refquested)
From page 225...
... Answering these questions illuminates the unique features of HMORN and sets the stage for discussing both the network's potential and the priorities for using it as a real-time test bed, or a learning healthcare system. Structured Real-Time Learning The HMORN seeks to achieve two-way (bidirectional or reciprocal)
From page 226...
... . Fit with Structured Real-Time Learning Healthcare systems can -- and in fact do -- serve as natural laboratories for applied research questions: thus they have an ongoing role in efforts to optimize health and health care.
From page 227...
... . • The Vaccine Safety Datalink is a collaborative project between the National Immunization Program of the Centers for Disease Control and Prevention (CDC)
From page 228...
... Ten HMORN health plans make up the largest component of the FDA's population-based drug safety surveillance program. In infectious diseases, five plans have developed methods for early identification and reporting of acute illness clusters that might represent outbreaks of influenza, severe
From page 229...
... that could eventually be integrated into these portals. Finally, at the levels of both health plans and research centers, we are participating in the dialogue about the structure, function, and standards that would compose a national healthcare infrastructure.
From page 230...
... In systems that enjoy high levels of trust from patients and healthcare professionals, clinical trials can have high enrollment rates and excellent follow-up rates. The HMORN's NIH Roadmap project has developed infrastructure and tools designed to determine easily how feasible a given clinical trial is in subject availability, budget, more efficient coordination of human subjects review processes, enrollment manuals, data collection processes, adherence to Health Insurance Portability and Accountability Act (HIPAA)
From page 231...
... 2 DEVELOPING THE TEST BED lessons that will benefit not only members of HMORN but U.S. health care overall.
From page 232...
... In summary, we believe the HMO Research Network affords the possibility of a structured real-time learning test bed that approaches the ideal. This paper emphasizes that HMORN is uniquely poised to take advantage of opportunities for two-way learning, and we have described several areas in which the Network and its members have conducted -- and can further conduct -- research that will improve the development and application of evidence to improve healthcare quality and effectiveness.
From page 233...
... These failures are complex in origin, and the corrections needed to remedy them will not be simple. However, one element of the solution that offers promise has largely been absent from public debates on health sector problems -- namely, care delivery system redesign and, in particular, redesign of physician practice.
From page 234...
... 2 THE LEARNING HEALTHCARE SYSTEM and founded a not-for-profit organization called the Council of Accountable Physician Practices. A look at the roster of CAPP members shows that they are located throughout the nation and indicates that MSMGs have been successful in a variety of different geographies and settings: Austin Regional Clinic, Texas Billings Clinic, Montana Cleveland Clinic, Ohio Dean Health System, Wisconsin Duluth Clinic, Minnesota Everett Clinic, Washington Fallon Clinic, Massachusetts Geisinger Clinic, Pennsylania Group Health Permanente, Idaho, Washington Harvard Vanguard Medical Associates, Massachusetts HealthCare Partners Medical Group, Southern California HealthPartners, Minnesota Henry Ford Medical Group, Michigan Intermountain Health Care, Utah Jackson Clinic, Tennessee Lahey Clinic, Massachusetts Marshfield Clinic, Wisconsin Mayo Clinic, Arizona, Florida, Minnesota Mayo Health System, Iowa, Minnesota, Wisconsin Nemours, Delaware, Florida, Maryland, New Jersey, Pennsylania Ochsner Clinic, Louisiana Palo Alto Medical Foundation, Northern California Permanente Federation, Northern and Southern California, Colorado, District of Columbia, Georgia, Hawaii, Maryland, Ohio, Oregon, Virginia, Washington Scott and White, Texas Sharp Rees-Stealy Medical Group, Southern California Virginia Mason Clinic, Washington Wenatchee Valley Medical Center, Washington Since 2002, CAPP has gathered evidence from its members and from the medical literature about the achievements of multispecialty medical groups and is supporting further research to refine the understanding of key success factors.
From page 235...
... CAPP's 35 MSMGs share a common vision as learning organizations dedicated to the improvement of clinical care. Their features include physician leadership and governance; commitment to evidence-based care management processes; well-developed quality improvement systems; team-based care; the use of advanced clinical information technology; and the collection, analysis, and distribution of clinical performance information.
From page 236...
... Multispecialty medical groups are at the forefront of using health information technology (HIT) and electronic health records (EHR)
From page 237...
... Multispecialty medical groups can fill what are currently research gaps between clinical trial research, epidemiological research, and the real-world delivery of care. The multispecialty medical group is a practically oriented healthcare delivery system that translates what is known from research into what is done in practice and, ultimately, what improves the outcomes and efficiency of care.
From page 238...
... Several issues critical to improvement of the care delivery system could well be examined in such a research agenda by formulating studies using multispecialty medical groups as the test bed. The IOM should make recommendations in these specific areas: • Encourage studies using common measurement sets across multiple deliv ery system models in a way that can compare their impact on coordination of care, clinical quality, patient satisfaction, and efficiency of resource use.
From page 239...
... 2006. Contentment with quality of life among breast cancer survivors with and without contralateral prophylactic mastectomy.
From page 240...
... 2005. Laboratory monitoring of drugs at initiation of therapy in ambulatory care.
From page 241...
... 2003. Practical clinical trials: increasing the value of clini cal research for decision making in clinical and health policy.


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