This proposal aims to help accelerate the transition to a higher performing healthcare system by studying important clinical conditions to advance our understanding of the factors that influence the implementation of innovations - evidence-based and less so - in healthcare. The research extends collaborations between Dartmouth, the University of California at Berkeley, Harvard, and the High Value Healthcare Collaborative. The findings will help guide the development and use of evidence from patient-centered outcomes research. The research is rooted in three frameworks. First, we recognize the key role of four major factors that influence the implementation of innovations: the external environment (e.g., state policies), the characteristics of the organizations adopting the innovation (e.g., degree of integration), the internal organizational processes selected to implement the innovations (e.g., physician payment), and the characteristics of the innovation itself. Second, we acknowledge the diversity of innovations; the relative importance of different factors that influence adoption may vary across the key decision-makers involved: biomedical innovations target diseases and are generally adopted by physicians; care delivery innovations target patient groups defined by function or illness severity and are largely adopted by managers; patient engagement innovations focus on changing patient roles. Third, different types of organizations may be more or less able to respond to external influences or adopt different internal processes to improve care. The approach builds on these frameworks to study the use of innovations and their impact on health, health care and costs. The Data Core will conduct a National Survey of Healthcare Organizations and Systems and will identify, track and characterize health systems, and measure their performance through national and clinically enriched databases. Project One will evaluate how environmental factors influence clinical integration, adoption of new payment models, and how Organizations use evidence: Project Two will evaluate the internal mechanisms that health systems use to increase clinicians' adoption of evidence-based practices and how and why systems adopt these approaches. Project Three will study the factors that influence the use of more or less effective biomedical innovations. Project Four will study the factors that influence the use of care delivery innovations and how the implementation of these innovations can be improved. Project Five examines the environmental and organizational factors associated with the use of interventions to enhance patient engagement and measure patient-centered outcomes of care.

Public Health Relevance

The uneven quality of US healthcare and the adverse impact of rising healthcare costs are widely acknowledged, and the underlying causes are increasingly recognized. Public and private initiatives now underway to target these causes are leading to rapid changes in how health care is organized and delivered. This proposal is designed to learn from these changes to develop guidance for policy makers, employers, and health system leaders to help accelerate the transition to a higher-performing healthcare system.

Agency
National Institute of Health (NIH)
Institute
Agency for Healthcare Research and Quality (AHRQ)
Type
Research Program--Cooperative Agreements (U19)
Project #
5U19HS024075-05
Application #
9768325
Study Section
Special Emphasis Panel (ZHS1)
Program Officer
Guo, Jing
Project Start
2015-09-01
Project End
2020-08-31
Budget Start
2019-09-01
Budget End
2020-08-31
Support Year
5
Fiscal Year
2019
Total Cost
Indirect Cost
Name
Dartmouth College
Department
Public Health & Prev Medicine
Type
Schools of Medicine
DUNS #
041027822
City
Hanover
State
NH
Country
United States
Zip Code
03755
Comfort, Leeann N; Shortell, Stephen M; Rodriguez, Hector P et al. (2018) Medicare Accountable Care Organizations of Diverse Structures Achieve Comparable Quality and Cost Performance. Health Serv Res :
Ivey, Susan L; Shortell, Stephen M; Rodriguez, Hector P et al. (2018) Patient Engagement in ACO Practices and Patient-reported Outcomes Among Adults With Co-occurring Chronic Disease and Mental Health Conditions. Med Care 56:551-556
Lewis, Valerie A; D'Aunno, Thomas; Murray, Genevra F et al. (2018) The Hidden Roles That Management Partners Play In Accountable Care Organizations. Health Aff (Millwood) 37:292-298
Mishra, Manish K; Saunders, Catherine H; Rodriguez, Hector P et al. (2018) How do healthcare professionals working in accountable care organisations understand patient activation and engagement? Qualitative interviews across two time points. BMJ Open 8:e023068
Kennedy, Gregory; Lewis, Valerie A; Kundu, Souma et al. (2018) Accountable Care Organizations and Post-Acute Care: A Focus on Preferred SNF Networks. Med Care Res Rev :1077558718781117
Woloshin, Steven; Schwartz, Lisa M; Bagley, Pamela J et al. (2018) Characteristics of Interim Publications of Randomized Clinical Trials and Comparison With Final Publications. JAMA 319:404-406
Ahluwalia, Sangeeta C; Harris, Benjamin J; Lewis, Valerie A et al. (2018) End-of-Life Care Planning in Accountable Care Organizations: Associations with Organizational Characteristics and Capabilities. Health Serv Res 53:1662-1681
Martin, Brook I; Lurie, Jon D; Farrokhi, Farrokh R et al. (2018) Early Effects of Medicare's Bundled Payment for Care Improvement Program for Lumbar Fusion. Spine (Phila Pa 1976) 43:705-711
Fraze, Taressa K; Lewis, Valerie A; Tierney, Emily et al. (2018) Quality of Care Improves for Patients with Diabetes in Medicare Shared Savings Accountable Care Organizations: Organizational Characteristics Associated with Performance. Popul Health Manag 21:401-408
Briggs, Adam D M; Alderwick, Hugh; Fisher, Elliott S (2018) Overcoming Challenges to US Payment Reform: Could a Place-Based Approach Help? JAMA 319:1545-1546

Showing the most recent 10 out of 22 publications