Thursday, July 21, 2011

Never Mind Health Services Research, How About Health Delivery Research?

Imagine the following scenario:

A patient with a chronic condition is not being treated with a potentially life-extending medication.  In response, the patient's physician's office is telephoned by a nurse with a friendly alert.  Someone at the office takes the message and promises to tell the doctor and...... nothing happens.

Sound familiar?

No one who has worked in the clinical side of population health and disease management industry would be surprised by this anecdote.  The reasons for such lapses are myriad, including overworked and distracted physicians, intruding clinical priorities, lack of information, incomplete information transfers and patient misidentification.  Yet, while the Disease Management Care Blog and colleagues think they know what the problem is, they have no idea on how to consistently overcome it.  Does it take more money?  Patient engagement?  Something else?

Enter this timely article by Drs. Pronovost and Goeschel writing in the Commentary section of the current issue of JAMA.  Noting that biomedical research has been focused for too long on biomedical advances, they argue that it's time to start asking questions about achieving health care outcomes.  In other words, we need "health delivery research," so that we can figure out why patients only receive about half of all recommended therapies.

Health delivery research finds the links between classic clinical research and improved health by determining how barriers can be removed, how teamwork can be enhanced, what feedback should be used and how behaviors can be changed.  It determines the best outcome that should be achieved and - unlike classic "prospective" hypothesis testing - works backwards to find the elements that achieve success.

According to the authors, "HDR" has must have two characteristics to succeed:

1) It has to occur side by side with the ongoing practice of medicine,


2) it has to involve social scientists and systems engineers in the research "mix."

"Hear hear!" says the DMCB.  This is precisely the kind of research that has been sponsored by the population health management service providers.  Yet, there is only so much they can do.  The notion that HDR should become a national priority is a wonderful idea.  Hopefully policy makers, foundations and the many agencies overseeing the Fed's expanded health research funding are paying attention.


Anonymous said...

If there was a way for these prompts to be given at the the right moment (ie when provider and patient are face to face in an appointment), then patient preferenced care could be enhanced. The burgeoning asynchronous communication that is in common use today may be convenient for the senders but does not translate into better synchronous care during an encounter. Another error of omission as alluded to in the previous post.

GlassHospital said...

Jim Kim @ dartmouth has been bully pulpiting this concept, and d'mouth now offering a masters in said.