Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery:...
Transcript of Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery:...
![Page 1: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/1.jpg)
Transforming Health Care Delivery: The Importance of Care
Coordination to Population Health
Richard C. Wender, MDAlumni Professor and Chair
Department of Family & Community MedicineThomas Jefferson University
Past President, American Cancer Society
![Page 2: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/2.jpg)
The Truth……
![Page 3: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/3.jpg)
Our nation’s health isunconscionably poor
![Page 4: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/4.jpg)
...resulting in 30% of our rising health care costs
We are the 9th heaviest nation on earth...
![Page 5: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/5.jpg)
We are the most disparate high resource country…..
…..with the highest income gap between highest & lowest quintiles
![Page 6: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/6.jpg)
A higher percentage of U.S. occupants live alone than in any high resource nation in the world….
….and unmarried men, living alone, have a 10 year shorter life expectancy than married men
![Page 7: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/7.jpg)
…but percent of new adolescent smokers has stabilized
Tobacco use has declined…
![Page 8: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/8.jpg)
And, yes, we spend more money per person on health care than any other nation ….
….but rank 28th in healthy life expectancy
www.americashealthranking.org/2008
![Page 9: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/9.jpg)
….and 19th in age-adjusted amenable mortality rates….out of 19 OECD (high resource) nations
www.americashealthranking.org/2008
![Page 10: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/10.jpg)
….and 39th in infant mortality rates
www.americashealthranking.org/2008
![Page 11: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/11.jpg)
And that’s not all…
Without disruptive, dramatic health care insurance reform, today’s 45,000,000 uninsured Americans will grow to 54,000,000 by 2019
www.cbsnews.com/stories/2009
![Page 12: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/12.jpg)
19
34
4942
0
25
50
75
Total Insured all year Insured now,time uninsured in
past year
Uninsured now
Only Two of Five Americans Are Very Satisfied with the Quality of Health Care
Source: The Commonwealth Fund Biennial Health Insurance Survey (2005).
Percent of adults ages 19–64 who are very satisfied
![Page 13: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/13.jpg)
Our economic crisis and our health crisis are inextricably linked
It is our health, not just our health care system that is frighteningly poor
![Page 14: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/14.jpg)
Causes Of Rising Health Care Costs
Popular nominations– Defensive medicine– Aging of the
population– American attitude
The True Causes– Misaligned incentives– Payment for volume of
care and procedures– Commercialization
and profit seeking– Emerging chronic
illness burden
![Page 15: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/15.jpg)
Rising Costs: The Bitter Truth
Ultimately, Costs Are Going Up Because Medical Interventions Actually…………
![Page 16: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/16.jpg)
Work
![Page 17: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/17.jpg)
Copyright ©2008 American Cancer Society
From Jemal, A. et al. CA Cancer J Clin 2008;58:71-96.
FIGURE 6 Death Rates* for Cancer and Heart Disease for Ages Younger than 85 and 85 and Older, 1975 to 2004
![Page 18: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/18.jpg)
Simply delivering the preventive and management services that are proven to work, can save millions of lives
![Page 19: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/19.jpg)
The Impact of Prevention on Reducing the Burden of Cardiovascular Disease
• 78% of adults ages 20-80 are eligible for a prevention activity
• If 100% received these activities, 63% fewer MI’s and 31% fewer CVA’s would occur
• Bridging just half of the quality gap can prevent 36% of MI’s and 20% of CVA’s
Kahn R, Robertson RM, Smith R, Eddy D. Circulation 2008; 118:576-585
![Page 20: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/20.jpg)
![Page 21: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/21.jpg)
Crossing the Quality Chasm
Recommendation 1:All health care organizations … should adopt as their explicit purpose to continually reduce the burden of illness, injury and disability, and to improve the health and functioning of the people of the United States
![Page 22: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/22.jpg)
Recommendation 2:All health care organizations … should pursue six major aims: specifically, health care should be safe, effective, patient- centered, timely, efficient and equitable
![Page 23: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/23.jpg)
“Clinicians and institutions should actively collaborate and communicate to ensure an appropriate exchange of information and coordination of care.”
![Page 24: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/24.jpg)
Researchers at AHRQ contracted with Stanford to conduct a comprehensive review of care coordination. They propose this definition:
![Page 25: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/25.jpg)
“Care coordination is the deliberate organization of patient care activities…to facilitate the appropriate delivery of health care services.”
Closing the Quality Gap: A Critical Analysis of Quality Improvement StrategiesTechnical Review (Publication No. 04(07), 0051-7) June 2007
![Page 26: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/26.jpg)
This definition encompasses many diverse approaches and components
![Page 27: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/27.jpg)
Does Care Coordination Improve Health?
Multiple systematic reviews provide evidence of patient benefit resulting from:
• multidisciplinary teams• disease management• case management
![Page 28: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/28.jpg)
Care Coordination Works
• Improved service continuity for severely mentally ill patients
• Reduced mortality and hospital admissions for patients with CAD
• Symptom reduction for terminally ill patients• Reduced mortality and dependency in stroke
patients• Reduced glyco-hemoglobin levelsAnd many others
![Page 29: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/29.jpg)
Who Should Coodinate Care?
• Care coordination in its various forms has been provided by many entities:– Payers– Hospital case managers– Care management companies– Public health agencies– Foundations
![Page 30: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/30.jpg)
Care Coordination Works – But We Provide It Inconsistently
Most Americans can only get care coordination if they:
Have a specific condition … and are insured by a specific plan … or are part of a specific public health program or experiment
![Page 31: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/31.jpg)
How Can We Provide Care Coordination for All?
Primary care practices as care coordinators …
an appealing idea
![Page 32: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/32.jpg)
A Focus on Primary Care is Associated With:
• Better health outcomes
• Lower costs
• Greater equity in health
![Page 33: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/33.jpg)
An orientation to primary care reduces sociodemographic and socioeconomic disparities (inequities)
• In access to health services• In population health
![Page 34: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/34.jpg)
More specialists mean higher spending
![Page 35: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/35.jpg)
While GPs are associated with less spending
![Page 36: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/36.jpg)
As it turns out, cost is inversely related to quality
![Page 37: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/37.jpg)
While more GPs predict higher quality ranking
![Page 38: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/38.jpg)
And more specialists predict lower quality ranking
![Page 39: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/39.jpg)
The Ecology of Medical Care
• Half of all physician visits are to generalist clinicians
• Most visits for common, serious conditions are to primary care practices
• Primary care infrastructure consists of small, relatively independent practices
Green LA, Freyer GE Jr, et al NEJM 344(2001):2021-25
![Page 40: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/40.jpg)
Primary Care Practices: Culture and Financial Reality
“Climates permeated with stress and overwork”• Most work on margins of financial viability
– Little time for self-reflection– Little or no training in quality improvement and
organizational management
Grumbach K and Bodenheimer J. JAMA (2002):889-93
Crabtree BF. Healthcare Manage Rev, Vol 281(2003):279-83
![Page 41: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/41.jpg)
And now, a new idea on the horizon
The sun is rising on a new idea . . .
![Page 42: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/42.jpg)
Your Medical Home
![Page 43: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/43.jpg)
The Medical Home Is Something Qualitatively Different
Usual Primary CareRelies on the clinicianCare provided to those who come inPerformance is assumedInnovation is infrequent
Draws from the communitiesRefers to mental health services
Medical HomeRelies on the teamCare provided for all
Performance is measuredInnovation occurs regularlyPartners with communities
Includes mental health services
![Page 44: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/44.jpg)
Source: The Commonwealth Fund 2006 Quality of Care Survey
55
74
52*
38*
0
25
50
75
100
Total Medical home Regular source ofcare, not a medical
home
No regular source ofcare/ER
Source: Commonwealth Fund 2006 Health Care Quality Survey.
The Majority of Adults with a Medical Home Always Get the Care They Need
Percent of adults 18–64 reporting always getting care they need when they need it
Note: Medical home includes having a regular provider or place of care, reporting no difficulty contacting provider by phone or getting advice and medical care on weekends or evenings, and always or often finding office visits well organized and running on time.* Compared with medical home, differences remain statistically significant after adjusting for income or insurance.
![Page 45: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/45.jpg)
Source: The Commonwealth Fund 2006 Quality of Care Survey
Adults with a Medical Home Are More Likelyto Report Checking Their Blood Pressure Regularly
and Keeping It in Control
2942
25
1510
17
56 48 58
0
25
50
75
100
Total Medical home Regular source of care, nota medical home
Does not check BPChecks BP, not controlledChecks BP, controlled
Percent of adults 18–64with high blood pressure
Source: Commonwealth Fund 2006 Health Care Quality Survey.
Note: Medical home includes having a regular provider or place of care, reporting no difficulty contacting provider by phone or getting advice and medical care on weekends or evenings, and always or often finding office visits well organized and running on time.
![Page 46: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/46.jpg)
64646665
49485452
22 23 25 21
0
25
50
75
100
Total White African American Hispanic
Medical homeRegular source of care, not a medical homeNo regular source of care/ER
When African Americans and HispanicsHave Medical Homes They Are Just as Likely as Whites
to Receive Reminders for Preventive Care Visits
Percent of adults 18–64 receiving a reminderto schedule a preventive visit by doctors’ office
Source: Commonwealth Fund 2006 Health Care Quality Survey.
Note: Medical home includes having a regular provider or place of care, reporting no difficulty contacting provider by phone or getting advice and medical care on weekends or evenings, and always or often finding office visits well organized and running on time.
![Page 47: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/47.jpg)
Building A Medical Home in an Academic Center:
10 Lessons Learned …..in 5 minutes
![Page 48: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/48.jpg)
Background
• Pa. Chronic Care Commission Pilot Projects – 2008
• All non-Medicare insurers participating• One of 32 practices chosen to participate in
pilot project– One of three with a residency program– The largest practice (70 clinicians, 75,000
visits) in the collaborative
![Page 49: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/49.jpg)
On January 29, 2009, we earned recognition as a Level 3 Patient Centered Primary Care Medical Home from the National Center for Quality Assurance (NCQA)
![Page 50: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/50.jpg)
Lesson 1: Building and sustaining a medical home requires a business model
![Page 51: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/51.jpg)
Business Models Supporting Medical Homes
• 9 enhanced payment models are being used around the country
• Each uses some combination of:– NCQA recognition– Pay for performance– Upfront investment (e.g. support for case
manager)– Shared savings
![Page 52: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/52.jpg)
Lesson 2: Wise investment of enhanced payment is needed to achieve optimal outcomes
![Page 53: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/53.jpg)
Where to Invest
• The right people yield greatest results (as opposed to technology)– Case management– Patient outreach– Health education– Mental health worker– Quality coordinator
![Page 54: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/54.jpg)
Lesson 3: “If you build it, they will come”
![Page 55: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/55.jpg)
Since We’ve Started, Lots of People Want In
• Community-based private mental health company• Jefferson Department of Psychiatry• A patient education, empowerment, & decision
support software company• Community based tobacco cessation & physical
activity project• School of Pharmacy• End-of-life pharmacy benefits & management not-
for profit
![Page 56: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/56.jpg)
Lesson 4: “I hate measurement”
![Page 57: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/57.jpg)
Quality Measurement
• If you’ve never measured it, the odds are your first score will be low
• You grow tough
Bring It On!
![Page 58: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/58.jpg)
Lesson 5: All facets of the medical home matter
![Page 59: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/59.jpg)
Do not overly focus on caring for a single chronic illness. Every aspect of the Medical Home Model matters:– Enhanced access– Opportunistic care– Outreach– Community partnership– Case Management
![Page 60: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/60.jpg)
Lesson 6: Financial supporters will want to see evidence of cost savings in a short time!
![Page 61: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/61.jpg)
The two greatest risks to the success of the Medical Home initiative are:
– They will be judged too quickly
– They will be judged only by cost saving
We are seeing both things happen
![Page 62: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/62.jpg)
Lesson 7: If you do a fabulous job …but only for the patients who come in for visits, you’ll get good solid, not spectacular, outcomes
![Page 63: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/63.jpg)
• Outreach, outreach, outreach
• Outreach requires resources
• Medical Homes require a business model
![Page 64: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/64.jpg)
Lesson 8: Don’t feel confined by the primary goal of the project
![Page 65: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/65.jpg)
We’ve deployed our new staff to address vaccination rates, cancer screening & diabetic care
![Page 66: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/66.jpg)
Lesson 9: You need to free up staff and give them time to think, plan and innovate
![Page 67: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/67.jpg)
We’ve had fantastic non-financial return on this investment. Time will tell regarding financial return
![Page 68: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/68.jpg)
Lesson 10: This work demands the time, energy, and passion of leaders
![Page 69: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/69.jpg)
This is one of the hardest jobs you’ll ever take on …..and one of the most fun
![Page 70: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/70.jpg)
Primary care clinicians cannot serve as care coordinators . . .alone
![Page 71: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/71.jpg)
![Page 72: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/72.jpg)
Public Health Community Engagement
Clinical CareDelivery
Primary care is the bridge between…
![Page 73: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/73.jpg)
What Will It Take To Coordinate Care?•
Purchasers should request and expect it
•
Insurers should pay for quality and provide the support and data to achieve it.
•
Health systems need to invest in technology that facilitates communication and commit to
improving population health•
We need new methods to provide quality
incentives for specialists•
And we need Primary Care Clinicians to
transform their practices to provide Medical Homes for all.
![Page 74: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/74.jpg)
Care coordination demands a shared commitment to achieving optimal health
outcomesCare coordination demands Medical Homes
functioning within a broader Medical Community
![Page 75: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/75.jpg)
The country is watching
Now is the time…
![Page 76: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/76.jpg)
![Page 77: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/77.jpg)
NCQA Recognition: 9 Criteria
• Access and Communication• Patient Tracking and Registry Functions• Case Management• Patient Self-Management Support• Electronic Prescribing*• Test Tracking• Referral Tracking• Performance Reporting and Improvement• Advanced Electronic Communication*
* Not Required
![Page 78: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/78.jpg)
High Hopes…
• Medical Homes are expected to:– Improve chronic illness by
• Engaging patients• Mobilizing teams• Addressing prevention• Incorporating mental health services• Partnering with communities
And…help control health care costs
![Page 79: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/79.jpg)
Characteristics of High Performing Practice
• Leadership• A culture of improvement• Greater staff involvement• Higher investment in people
– Greater investment in technology has not, yet, been demonstrated to promote prevention, including CRC screening
Orzano AJ, et al. Improving outcomes for high risk diabetes using information systems. J Am B of Fam Med 20(3) 295-51 2007 May-Jun
![Page 80: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/80.jpg)
On January 29, 2009, we earned recognition as a Level 3 Patient Centered Primary Care Medical Home from the National Center for Quality Assurance (NCQA)
– The first Department of Family Medicine in the nation to earn this recognition
![Page 81: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/81.jpg)
It’s People That Make A Home
• Create a joyful practice
• Have fun trying new things
• Measure what you’re doing and see if it works
![Page 82: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/82.jpg)
Indicators of a Medical Home (adults 18–64)
Total Percent by Race
IndicatorEstimated millions Percent White
African American Hispanic
Asian American
Regular doctor or source of care 142 80 85 79 57 84
Among those with a regular doctor or source of care . . .
Not difficult to contact provider over telephone
121 85 88 82 76 84
Not difficult to get care or medical advice after hours
92 65 65 69 60 66
Doctors’ office visits are always or often well organized and running on time
93 66 68 65 60 62
All four indicators of medical home 47 27 28 34 15 26
Source: Commonwealth Fund 2006 Health Care Quality Survey.
![Page 83: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/83.jpg)
Source: The Commonwealth Fund 2006 Quality of Care Survey
Indicators of a Medical Home by Usual Health Care Setting
(adults 18–64)
Usual Health Care Setting
Indicator TotalDoctors’
office
Community health
center or public clinic
Other settings*
Regular doctor or source of care 80% 95% 78% 63%
Among those with a regular doctor or source of care . . .
Not difficult to contact provider over telephone 85 87 77 77
Not difficult to get care or medical advice after hours 65 67 54 69
Always or often find visits to doctors’ office well organized and running on time
66 68 56 60
All four indicators of a medical home 27 32 21 22
Source: Commonwealth Fund 2006 Health Care Quality Survey.
* Includes hospital outpatient departments and other settings.
![Page 84: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/84.jpg)
Source: The Commonwealth Fund 2006 Quality of Care Survey
54 55
3644
28*30
5056
0
25
50
75
100
Total White AfricanAmerican
Hispanic Total White AfricanAmerican
Hispanic
Percent of adults 18–64 receiving a reminderto schedule a preventive visit by doctor’s office
When Insured, Minorities Are Just as Likely as Whites to Receive Reminders for Preventive Care Visits;
Rates Are Low for All Uninsured Adults, Especially Hispanics
Insured all year Any time uninsured
Source: Commonwealth Fund 2006 Health Care Quality Survey.
* Compared with whites, differences are statistically significant.
![Page 85: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/85.jpg)
Source: The Commonwealth Fund 2006 Quality of Care Survey
15 16
54 58 45
42
59
27 28 26
20 2143
15*34*
0
25
50
75
100
Total White AfricanAmerican
Hispanic Asian American
Medical homeRegular source of care, not a medical homeNo regular source of care/ER
Percent of adults 18–64
Source: Commonwealth Fund 2006 Health Care Quality Survey.
African Americans and Hispanics Are More Likely to Lack a Regular Provider or Source of Care;
Hispanics Are Least Likely to Have a Medical Home
Note: Medical home includes having a regular provider or place of care, reporting no difficulty contacting provider by phone or getting advice and medical care on weekends or evenings, and always or often finding office visits well organized and running on time.* Compared with whites, differences remain statistically significant after adjusting for income and insurance.
![Page 86: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/86.jpg)
Source: The Commonwealth Fund 2006 Quality of Care Survey
77747776
586462
55*43444643
0
25
50
75
100
Total White African American Hispanic
Medical homeRegular source of care, not a medical homeNo regular source of care/ER
African American and Hispanic Adults Who Have Medical Homes Have Rapid Access to Medical Appointments
Percent of adults 18–64 able to getan appointment same or next day
Source: Commonwealth Fund 2006 Health Care Quality Survey.
Note: Medical home includes having a regular provider or place of care, reporting no difficulty contacting provider by phone or getting advice and medical care on weekends or evenings, and always or often finding office visits well organized and running on time.* Compared with whites, differences are significant within category of medical home.
![Page 87: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/87.jpg)
Source: The Commonwealth Fund 2006 Quality of Care Survey
Adults Who Are Sent Reminders Are More Likely to Receive Preventive Screening
Women ages 40–64 who received
a mammogram in past two years
Source: Commonwealth Fund 2006 Health Care Quality Survey.
82 7970
37*
62*
50*
0
25
50
75
100
Reminder No reminder
Adults ages 18–64 who had their
cholesterol checked in past five years
Men ages 40–64 who received a screen
for prostate cancer in past two years
Percent
* Compared with reminders, differences remain statistically significant after adjusting for income or insurance.
![Page 88: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/88.jpg)
Source: The Commonwealth Fund 2006 Quality of Care Survey
49
6552*
22*
0
25
50
75
100
Total Medical home Regular source ofcare, not a medical
home
No regular sourceof care/ER
Source: Commonwealth Fund 2006 Health Care Quality Survey.
Nearly Two-Thirds of Adults with Medical Homes Receive Reminders for Preventive Care
Percent of adults 18–64 receiving a reminderto schedule a preventive visit by doctors’ office
Note: Medical home includes having a regular provider or place of care, reporting no difficulty contacting provider by phone or getting advice and medical care on weekends or evenings, and always or often finding office visits well organized and running on time.* Compared with medical home, differences remain statistically significant after adjusting for income or insurance.
![Page 89: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/89.jpg)
Source: The Commonwealth Fund 2006 Quality of Care Survey
6676 72
34*
0
25
50
75
100
Total Medical home Regular source ofcare, not a medical
home
No regular sourceof care/ER
Source: Commonwealth Fund 2006 Health Care Quality Survey.
Missed Opportunities for Preventive Care for Adults Who Lack a Regular Source of Care: Just One-Third Had Their Cholesterol Screened
Percent of adults 18–64 who had theircholesterol checked in past five years
Note: Medical home includes having a regular provider or place of care, reporting no difficulty contacting provider by phone or getting advice and medical care on weekends or evenings, and always or often finding office visits well organized and running on time.* Compared with medical home, differences remain statistically significant after adjusting for income or insurance.
![Page 90: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/90.jpg)
Source: The Commonwealth Fund 2006 Quality of Care Survey
69737576 73697172
34 36 36 36
0
25
50
75
100
Total White African American Hispanic
Medical homeRegular source of care, not a medical homeNo regular source of care/ER
African Americans and Hispanics with Medical Homes Are Equally as Likely as Whites to Receive Cholesterol Checks
Source: Commonwealth Fund 2006 Health Care Quality Survey.
Percent of adults 18–64 who had theircholesterol checked in past five years
Note: Medical home includes having a regular provider or place of care, reporting no difficulty contacting provider by phone or getting advice and medical care on weekends or evenings, and always or often finding office visits well organized and running on time.
![Page 91: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/91.jpg)
Source: The Commonwealth Fund 2006 Quality of Care Survey
12 8
57 60 49 57
32 32
102617
55
34*20*31
0
25
50
75
100
Total White AfricanAmerican
Hispanic Asian American
Medical homeRegular source of care, not a medical homeNo regular source of care/ER
Source: Commonwealth Fund 2006 Health Care Quality Survey.
Percent of adults 18–64with a chronic disease
Only One-Third of Patients withChronic Conditions Have Medical Homes;
Hispanics Are Least Likely to Have a Medical Home
Note: Medical home includes having a regular provider or place of care, reporting no difficulty contacting provider by phone or getting advice and medical care on weekends or evenings, and always or often finding office visits well organized and running on time.* Compared with whites, differences remain statistically significant after adjusting for income and insurance.
![Page 92: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/92.jpg)
Source: The Commonwealth Fund 2006 Quality of Care Survey
3531
36
48*54*
0
25
50
75
Total White AfricanAmerican
Hispanic Asian American
About Half or More of Hispanics and Asian Americans with Chronic Conditions Were Not Given Plans
to Manage Their Condition at Home
Percent of adults ages 18–64 with any chronic condition who were not given a plan from a doctor or nurse to manage condition at home
Source: Commonwealth Fund 2006 Health Care Quality Survey.
* Compared with whites, differences remain statistically significant after adjusting for income or insurance.
![Page 93: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/93.jpg)
Source: The Commonwealth Fund 2006 Quality of Care Survey
3523
35
65*
0
25
50
75
100
Total Medical home Regular source ofcare, not a medical
home
No regular sourceof care/ER
Source: Commonwealth Fund 2006 Health Care Quality Survey.
Less than One-Quarter of Adults with Medical Homes Did Not Receive Plans to Manage Their Conditions at Home
Percent of adults ages 18–64 with any chronic condition who were not given a plan from a doctor or nurse to manage condition at home
Note: Medical home includes having a regular provider or place of care, reporting no difficulty contacting provider by phone or getting advice and medical care on weekends or evenings, and always or often finding office visits well organized and running on time.* Compared with medical home, differences remain statistically significant after adjusting for income or insurance.
![Page 94: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/94.jpg)
Source: The Commonwealth Fund 2006 Quality of Care Survey
8065
73 69
39* 34*
0
25
50
75
100
Insured all year Any time uninsured
Medical home
Regular source of care, not a medical homeNo regular source of care/ER
Percent of obese or overweight adults 18–64 whowere counseled on diet and exercise by doctor
Adults with a Medical Home Have Higher Rates of Counseling on Diet and Exercise Even When Uninsured
Source: Commonwealth Fund 2006 Health Care Quality Survey.
Note: Medical home includes having a regular provider or place of care, reporting no difficulty contacting provider by phone or getting advice and medical care on weekends or evenings, and always or often finding office visits well organized and running on time.* Compared with medical home, differences are statistically significant.
![Page 95: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/95.jpg)
Source: The Commonwealth Fund 2006 Quality of Care Survey
Missed Opportunities for Blood PressureManagement Exist Across All Groups, Especially Hispanics
29 31
15 10 23 39
56 59 50
2327
37*
0
25
50
75
100
Total White African American Hispanic
Does not check BPChecks BP, not controlledChecks BP, controlled
Source: Commonwealth Fund 2006 Health Care Quality Survey.
Percent of adults 18–64with high blood pressure
* Compared with whites, differences remain statistically significant after adjusting for income and insurance.
![Page 96: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/96.jpg)
Source: The Commonwealth Fund 2006 Quality of Care Survey
73807773
5165
5858
0
25
50
75
100Medical home Regular source of care, not a medical home
Percent of adults ages 18–64 who haveseen a specialist in past two years
Patients with a Medical Home Report Better Coordination Between Their Regular Provider and Specialist
Source: Commonwealth Fund 2006 Health Care Quality Survey.
Regular provider helped decide
who to see
Regular provider communicated with specialist about medical
history
After seeing specialist, regular provider seemed
up to date
Regular provider helped you understand
information from specialist care
Note: Medical home includes having a regular provider or place of care, reporting no difficulty contacting provider by phone or getting advice and medical care on weekends or evenings, and always or often finding office visits well organized and running on time.
![Page 97: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/97.jpg)
Source: The Commonwealth Fund 2006 Quality of Care Survey
Uninsured any time46.8 million
Insured, income below 200% poverty22.2 million
Community health center
20%
Source: Commonwealth Fund 2006 Health Care Quality Survey.
ER12%
Doctor’s office65%
Doctor’s office41%
Community health center
20%
ER4%
Hospital outpatient
5%
Hospital outpatient
4%
No regular place of care
15%
No regular place of care
2%Other6%
Other6%
Community Health Centers Serve Large Numbers of Uninsured Adults and Insured Adults with Low Incomes
Note: Percentages may not sum to 100% because of rounding.
![Page 98: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/98.jpg)
Source: The Commonwealth Fund 2006 Quality of Care Survey
Percent of adults 18–64
69
77
75
11
9
13
9
6
10
12
5
3
4
6
5
4
62*
44* 21*
7
12
8
12*
1
15
Total
White
Asian American
African American
Hispanic
Doctor's office Community health center Hospital outpatient/OtherER No regular place of care
Hispanics and African Americans Are More Likely to Rely on Community Health Centers
as Their Regular Place of Care
Source: Commonwealth Fund 2006 Health Care Quality Survey.
* Compared with whites, differences remain statistically significant after adjusting for insurance or income.
![Page 99: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/99.jpg)
Source: The Commonwealth Fund 2006 Quality of Care Survey
56
74
4555
32
49
2535
0
25
50
75
100
Preventive reminders Cholesterol checked
Doctor's officeCommunity health centerOther regular source of careNo regular source of care/ER
Preventive Care Reminders and Cholesterol Screening Are More Common in Doctors’ Offices,
But Community Health Centers Are Not Far Behind
Percent of adults 18–64
Source: Commonwealth Fund 2006 Health Care Quality Survey.
![Page 100: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/100.jpg)
Source: The Commonwealth Fund 2006 Quality of Care Survey
7864
75
59
31*38*
0
25
50
75
100
Insured all year Any time uninsured
Medical home
Regular source of care, not a medical homeNo regular source of care/ER
Even When Uninsured, Adults with a Medical Home Have Higher Rates of Cholesterol Screening
Percent of adults 18–64 who had their cholesterol checked in past five years
Source: Commonwealth Fund 2006 Health Care Quality Survey.
Note: Medical home includes having a regular provider or place of care, reporting no difficulty contacting provider by phone or getting advice and medical care on weekends or evenings, and always or often finding office visits well organized and running on time.* Compared with medical home, differences are statistically significant.
![Page 101: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/101.jpg)
Source: The Commonwealth Fund 2006 Quality of Care Survey
3531
36
48*54*
0
25
50
75
Total White AfricanAmerican
Hispanic Asian American
About Half or More of Hispanics and Asian Americans with Chronic Conditions Were Not Given Plans
to Manage Their Condition at Home
Percent of adults ages 18–64 with any chronic condition who were not given a plan from a doctor or nurse to manage condition at home
Source: Commonwealth Fund 2006 Health Care Quality Survey.
* Compared with whites, differences remain statistically significant after adjusting for income or insurance.
![Page 102: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/102.jpg)
Source: The Commonwealth Fund 2006 Quality of Care Survey
3523
35
65*
0
25
50
75
100
Total Medical home Regular source ofcare, not a medical
home
No regular sourceof care/ER
Source: Commonwealth Fund 2006 Health Care Quality Survey.
Less than One-Quarter of Adults with Medical Homes Did Not Receive Plans to Manage Their Conditions at Home
Percent of adults ages 18–64 with any chronic condition who were not given a plan from a doctor or nurse to manage condition at home
Note: Medical home includes having a regular provider or place of care, reporting no difficulty contacting provider by phone or getting advice and medical care on weekends or evenings, and always or often finding office visits well organized and running on time.* Compared with medical home, differences remain statistically significant after adjusting for income or insurance.
![Page 103: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/103.jpg)
Source: The Commonwealth Fund 2006 Quality of Care Survey
8065
73 69
39* 34*
0
25
50
75
100
Insured all year Any time uninsured
Medical home
Regular source of care, not a medical homeNo regular source of care/ER
Percent of obese or overweight adults 18–64 whowere counseled on diet and exercise by doctor
Adults with a Medical Home Have Higher Rates of Counseling on Diet and Exercise Even When Uninsured
Source: Commonwealth Fund 2006 Health Care Quality Survey.
Note: Medical home includes having a regular provider or place of care, reporting no difficulty contacting provider by phone or getting advice and medical care on weekends or evenings, and always or often finding office visits well organized and running on time.* Compared with medical home, differences are statistically significant.
![Page 104: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/104.jpg)
Source: The Commonwealth Fund 2006 Quality of Care Survey
73807773
5165
5858
0
25
50
75
100Medical home Regular source of care, not a medical home
Percent of adults ages 18–64 who haveseen a specialist in past two years
Patients with a Medical Home Report Better Coordination Between Their Regular Provider and Specialist
Source: Commonwealth Fund 2006 Health Care Quality Survey.
Regular provider helped decide
who to see
Regular provider communicated with specialist about medical
history
After seeing specialist, regular provider seemed
up to date
Regular provider helped you understand
information from specialist care
Note: Medical home includes having a regular provider or place of care, reporting no difficulty contacting provider by phone or getting advice and medical care on weekends or evenings, and always or often finding office visits well organized and running on time.
![Page 105: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/105.jpg)
Source: The Commonwealth Fund 2006 Quality of Care Survey
7864
75
59
31*38*
0
25
50
75
100
Insured all year Any time uninsured
Medical home
Regular source of care, not a medical homeNo regular source of care/ER
Even When Uninsured, Adults with a Medical Home Have Higher Rates of Cholesterol Screening
Percent of adults 18–64 who had their cholesterol checked in past five years
Source: Commonwealth Fund 2006 Health Care Quality Survey.
Note: Medical home includes having a regular provider or place of care, reporting no difficulty contacting provider by phone or getting advice and medical care on weekends or evenings, and always or often finding office visits well organized and running on time.* Compared with medical home, differences are statistically significant.
![Page 106: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/106.jpg)
The Goals Of Health Care Delivery Transformation
• Extension of quality of life–With a measurable impact on public
health• Lessening of health disparities without
compromising care of the majority• Enhanced prevention• Improved high quality, safe care for all
![Page 107: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/107.jpg)
How Can We Affordably Enhance Preventive Care and Disease Management, Narrow Disparities, and Extend Quality of Life?
• We must facilitate community action and change
• We must provide high quality primary care for all
![Page 108: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/108.jpg)
Why Must We Transform Communities?
No clinical office or hospital-based intervention can prevent over-eating and inactivity
No clinical intervention can prevent violence, provide a secure place to live, or stop teens from trying cigarettes or substances
![Page 109: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/109.jpg)
DFCM/TJU/TJUHPublic HealthCommunity
Medicine/Health
1) Care to vulnerable populations
2) Health promotion through programs and community engagement and partnerships
COMMUNITY MEDICINE/HEALTH
Epidemiology
Biostatistics
Environmental Health
Health Services Research
Social/Behavioral Determinants
Primary Care
South Philadelphia
•Point Breeze
•Dixon House
•South East Philadelphia Collaborative
•Churches
North Philadelphia
•Project Home
•Federation
•Churches
West Philadelphia
•TOCFWH
•Belmont
•Churches
•Senior Centers
Mazzoni
Jeff HOPE
YES
Refugee Clinic
PATHWAYS
Wellness Center
Senior Centers
Center for Urban Health
![Page 110: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/110.jpg)
Why Must We Enhance Primary Care?
• Delivery• Systems based on primary care achieve
better health outcomes at lower cost–We can’t afford any other approach
![Page 111: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/111.jpg)
Percent Spending On Primary Care
Program/Plan % Spent on Primary Care
Most U.S. health care plans 6-7%
Kaiser Permanente and Group Health 12-13%
Geisinger Clinic 8.3%
Britain 24%
Kaiser Permanente Northwest 21%
![Page 112: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/112.jpg)
And now, a new idea on the horizon
The sun is rising on a new idea . . .
![Page 113: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/113.jpg)
The Research Revolution
Department of Family and Community Medicine
Richard C. Wender, MDAlumni Professor and Chair
![Page 114: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/114.jpg)
An analysis of more then 50 years of research funding from the NIH suggests that it has helped to avert up to 1.35 million deaths per year
from: cardiovascular disease, stroke, cancer and diabetes
Menton, KG et al. www.pnas.org/cgi/
![Page 115: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/115.jpg)
NIH funding has had a dramatic positive effect on
public health
![Page 116: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/116.jpg)
…….or not
4
![Page 117: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/117.jpg)
Donald Forsdyle 23 Jun 2009TheResearch Engine
![Page 118: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/118.jpg)
And shouldn’t we ultimately judge the success of our
research enterprise by the health outcomes of our
population?
![Page 119: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/119.jpg)
Change in US Death Rates* from 1991 to 2006
* Age-adjusted to 2000 US standard population.Sources: 1950 Mortality Data - CDC/NCHS, NVSS, Mortality Revised.2006 Mortality Data: US Mortality Data 2006, NCHS, Centers for Disease Control and Prevention, 2009.
17.8
63.334.8
313.0
215.1
43.6
180.7200.2
0
100
200
300
400
Heart diseases Cerebrovasculardiseases
Influenza &pneumonia
Cancer
19912006
Rate Per 100,000
![Page 120: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/120.jpg)
Since 1971, Americans have spent close to $300 billion in
fighting cancer
![Page 121: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/121.jpg)
Cancer Death Rates* Among Men, US,1930‐2005
*Age-adjusted to the 2000 US standard population.Source: US Mortality Data 1960-2005, US Mortality Volumes 1930-1959,National Center for Health Statistics, Centers for Disease Control and Prevention, 2008.
0
20
40
60
80
10019
30
1935
1940
1945
1950
1955
1960
1965
1970
1975
1980
1985
1990
1995
2000
2005
Lung & bronchus
Colon & rectum
Stomach
Rate Per 100,000
Prostate
Pancreas
LiverLeukemia
![Page 122: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/122.jpg)
Cancer Death Rates* Among Women, US,1930‐2005
*Age-adjusted to the 2000 US standard population.Source: US Mortality Data 1960-2005, US Mortality Volumes 1930-1959,National Center for Health Statistics, Centers for Disease Control and Prevention, 2008.
0
20
40
60
80
10019
30
1935
1940
1945
1950
1955
1960
1965
1970
1975
1980
1985
1990
1995
2000
2005
Lung & bronchus
Colon & rectum
Uterus
Stomach
Breast
Ovary
Pancreas
Rate Per 100,000
![Page 123: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/123.jpg)
“ When you break down the Big Four cancers by stages, long‐
term survival for advanced cancer has barely budged since
the 1970’s”
Clifton Lee Fortune Magazine March 22, 2004
![Page 124: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/124.jpg)
“Through 2004, the cancer community published 150,855 experimental
studies . . . . . . . .
…on mice
![Page 125: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/125.jpg)
“ . . . Many more cancer deaths can be averted by concerted action to
control tobacco and obesity, by redoubling efforts in mammography
and colorectal cancer screening, and by enacting policies to close gaps in
access to cancer detection and treatment services”
Byers E et al Cancer 2006
![Page 126: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/126.jpg)
Flat NIH budget from 2004‐ 2008 created acute research distress
![Page 127: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/127.jpg)
Funding for clinical research is 1/3 of NIH budget
Funding for true translational research, far lower
![Page 128: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/128.jpg)
Making a living seeking NIH and CIHR funding through the current
peer review process can be a scary and frustrating experience
![Page 129: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/129.jpg)
I wonder what is was like…
In The Beginning…
![Page 130: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/130.jpg)
The first research project
![Page 131: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/131.jpg)
![Page 132: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/132.jpg)
![Page 133: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/133.jpg)
Adam
![Page 134: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/134.jpg)
![Page 135: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/135.jpg)
The effect of deception in a group of educationally
naïve humans
![Page 136: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/136.jpg)
The apple
![Page 137: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/137.jpg)
![Page 138: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/138.jpg)
Dear God:
Fascinating and innovative! But the title is not working for us. Too long and “researchy”. And we definitely don’t get the apple. Why not something exotic, like….
![Page 139: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/139.jpg)
The Pomegranate
![Page 140: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/140.jpg)
God prepared a resubmission
![Page 141: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/141.jpg)
The effect of deception in a group of educationally
naïve humans
![Page 142: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/142.jpg)
The Effect of Deception in a group of Educationally
Naïve humans
….or………
![Page 143: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/143.jpg)
The EDEN
Project
![Page 144: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/144.jpg)
The apple
![Page 145: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/145.jpg)
The Pomegranate
![Page 146: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/146.jpg)
Dear God:
We are writing to you about the EDEN project. We LOVE it!!!!! But what’s the deal with the pomegranate…Why not something more simple and delicious – like…
![Page 147: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/147.jpg)
The apple
![Page 148: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/148.jpg)
God responded
“But the Angels are the ones who wanted the pomegranate”
![Page 149: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/149.jpg)
That was the Angels from California. We sent the resubmission to a different review group.
![Page 150: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/150.jpg)
![Page 151: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/151.jpg)
The apple is BACK!
![Page 152: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/152.jpg)
Human beings’
insatiatible drive to acquire new
knowledge was confirmed
![Page 153: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/153.jpg)
God thought
“We need a neater way to investigate questions about
human behavior”
![Page 154: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/154.jpg)
A neater
way to
investigate questions about human
behavior
![Page 155: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/155.jpg)
A Neater
way to Investigate
questions
about Human
behavior
….or………
![Page 156: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/156.jpg)
NIH
![Page 157: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/157.jpg)
NIH Funding 2006
99.59%
0.41%
Family Medicine
All Other Departments
![Page 158: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/158.jpg)
NIH Funding 2007
99.58%
0.42%
Family Medicine
All Other Departments
![Page 159: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/159.jpg)
NIH Funding 2008
99.57%
0.43%
Family Medicine
All Other Departments
![Page 160: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/160.jpg)
Students interested in becoming researchers don’t choose family medicine
Johannes Kepler
(1571-1630)
10
![Page 161: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/161.jpg)
“Only 1.4% of medical students graduating from MD/PhD
programs from 2000 –
2006 chose family medicine as their career
paths – by far the lowest of any specialty”
Seeharsen DA, Weaver SP. Fam Med 2009Andriole DA et al. JAMA 2008
![Page 162: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/162.jpg)
Many family medicine academic programs do not conduct research
9
Paul Dirac (1902-1984)
![Page 163: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/163.jpg)
In 2007, only 44 or 120 departments of family medicine
sponsored an NIH Principle Investigator
![Page 164: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/164.jpg)
Family medicine academic leaders underestimate what it takes to succeed
8
Edwin Hubble (1889-1953)
![Page 165: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/165.jpg)
![Page 166: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/166.jpg)
The majority of Family Medicine NIH funded investigators have a Masters or PhD
One‐year “faculty development” fellowships will not do the trick
Rabinowitz et al. Ann of Fam Med 2006
![Page 167: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/167.jpg)
More and more are competing for less and less
7
Emil Fisher (1852-1919)
![Page 168: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/168.jpg)
Number of NIH Awards: FY1995‐2007
35,8
05
36,4
47
37,2
70
37,4
01
36,4
41
34,6
13
32,8
50
31,0
3529,2
54
27,6
21
26,2
21
25,0
62
24,3
64
29,0
61
28,6
22
28,7
43
28,0
04
27,1
25
26,0
77
24,7
74
23,3
42
22,1
04
21,0
62
20,4
15
0
5,000
10,000
15,000
20,000
25,000
30,000
35,000
40,000
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006Est.
2007Est.
Aw
ards
RPG R01+R29
![Page 169: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/169.jpg)
Success Rates For All Competing NIH Grants: FY1995‐2005
29.9
%
24.6
%
22.3
%
31.2
%
32.1
%
32.4
%
31.1
%
30.5
%
31.5
%
27.9
%
26.8
%
22.2
%
24.9
%
29.7
%
30.2
%
31.3
%
31.5
%
30.4
%
29.6
%
31.4
%
26.7
%
25.2
% 16.8
%
20.6
%
21.2
%
21.9
%
22.2
%
21.5
%
22.5
%
21.1
%
19.1
%
18.1
%
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
RPG R01+R29 R01 (From Previously Unfunded Scientists)
![Page 170: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/170.jpg)
We are generalists and proud of it!6
James Clerk Maxwell (1831-1879)
![Page 171: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/171.jpg)
But NIH Does Not Support Generalism
![Page 172: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/172.jpg)
![Page 173: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/173.jpg)
“NIH is ‘two‐thirds basic science’ and ‘disease‐based’
. . . family
physicians have ‘no natural home for seeking funding’”
![Page 174: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/174.jpg)
Family medicine research mentors are few and far between
5
Louis Pasteur (1882-1895)
![Page 175: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/175.jpg)
Mentored career development awards are an important bridge to
becoming an independent investigator
But: obtaining funding requires
a skilled mentor with a proven track record
![Page 176: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/176.jpg)
NIH Funding in Family Medicine – the 2003 Awards
•
146 total awards to 109 PI’s•
57 to PI’s
in “core”
family medicine
department•
44 awards to family physicians–17
family physicians were PI’s
on
RO1 grants
![Page 177: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/177.jpg)
Family medicine research infrastructure has no business model
4
Charles Darwin (1809-1882)
![Page 178: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/178.jpg)
Department Chairs should divert surplus or profit from clinical work
to support research infrastructure and growth
…….but we have no clinical surplus or profit
![Page 179: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/179.jpg)
Clinical research is really, really hard to do
3
Sir Isaac Newton (1643-1727)
![Page 180: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/180.jpg)
And population based research in the community is a bear!
![Page 181: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/181.jpg)
“…clinical research has become increasingly difficult to do
and…the scientific community …must recast its entire system of clinical research”
http://nihroadmap.nih.gov
![Page 182: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/182.jpg)
Experiments take longer.Publications are delayed.Costs are high.
![Page 183: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/183.jpg)
Academic Health Centers invest in surer research bets
2
Galileo Galilei
(1564-1642)
![Page 184: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/184.jpg)
Compare the recruitment “packages” for Chairs of Pathology to Chairs of
Family Medicine
![Page 185: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/185.jpg)
I boldly negotiated a reduction in the planned budget cut
![Page 186: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/186.jpg)
And the number one obstacle to growing Family Medicine
research is . . .
![Page 187: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/187.jpg)
Academia continues to question the value of primary care services and, thus,
primary care research
1
Albert Einstein (1879-1955)
![Page 188: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/188.jpg)
Where does
primary care matter?
![Page 189: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/189.jpg)
The Impact of Prevention on Reducing the Burden of Cardiovascular Disease
•
78% of adults ages 20‐80 are eligible for a prevention activity
•
If 100% received these activities, 63% fewer MI’s
and 31% fewer CVA’s
would
occur•
Bridging just half of the quality gap can
prevent 36% of MI’s
and 20% of CVA’s
Kahn R, Robertson RM, Smith R, Eddy D. Circulation 2008; 118:576-585
![Page 190: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/190.jpg)
A physician recommendation is the strongest predictor of whether
or not a patient is screened for colon or breast cancer
Smith RA Wender RC. CA Cancer J Clin 2007 Jan-Feb;57(1):4-5
![Page 191: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/191.jpg)
Why Is Primary Care Important?
Starfield 09/0404-134
Better health outcomes
Lower costs
Greater equity in health
Starfield 09/04PC 2945
![Page 192: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/192.jpg)
74767474
50525352
343138
44
0
25
50
75
100
Total W hite African Am erican Hispanic
Medica l hom eRegular source o f care , not a m edica l hom eNo regu lar source o f care /ER
Racial and Ethnic Differences in Getting Needed Medical Care Are Eliminated When Adults Have Medical Homes
Percent of adults 18–64 reporting always getting care they need when they need it
Note: Medical home includes having a regular provider or place of care, reporting no difficulty contacting provider by phone or getting advice and medical care on weekends or evenings, and always or often finding office visits well organized and running on time.Source: Commonwealth Fund 2006 Health Care Quality Survey.
![Page 193: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/193.jpg)
Skepticism about primary care performance and value
persists
![Page 194: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/194.jpg)
“Errors in diagnosis of depression lead to our under
diagnosis in primary care” Mitchell AJ, Vaze
A, Rao S. The Lancet Vol
374 Issue 9690 p.609‐619, Aug 2009“Often, clinicians fail to discuss health related
behaviors during ambulatory visits”
Ma J, et al. Prev
Med 2004, 34:815‐822
“Primary care clinicians often fail to follow practice
guidelines when treating patients with sore throats”
Linder JA, et al. Arch Int
Med166:1374‐1379. July 2006“Primary care providers often prescribe antiviral
medications inappropriately for influenza patients”
Linder JA, et al. J. of Gen Int
Med 24(4) pp504‐510 Feb 2009
“…weight loss counseling occurred with 11% of overweight
adults and 8% of overweight children”
Scott JG, et al. Preventive Medicine Vol
38 Issue 6 June 2004, p 819‐827
![Page 195: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/195.jpg)
But one central harsh reality is stoking the fires of a change in our research enterprise
![Page 196: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/196.jpg)
Our nation’s health isunconscionably poor . . . and Canada has a long way to
go
![Page 197: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/197.jpg)
MORTALITY DUE TO:LifeExpectancy
PrematureMortality Cancer
CirculatoryDisease Diabetes
InfantMortality
Canada B B B B C B
UnitedStates D D B D C C
Japan A A A A A A
The Canadian and US Health Report Cards
http://www.conferenceboard.ca/hcp/details/health.aspx
![Page 198: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/198.jpg)
Despite spending more on health care research than any
nation on earth, the US remains the least healthy high resource
country
![Page 199: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/199.jpg)
And the epidemic of over‐eating and sedentary living threatens
progress for all the major killers
![Page 200: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/200.jpg)
...resulting in 30% of our rising health care costs (Canadians rank 35th)
The US is the 9th
heaviest nation on earth...
![Page 201: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/201.jpg)
…but percent of new adolescent smokers
has stabilized‐
17.9% of all
Canadians smoke
Tobacco use has declined…
![Page 202: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/202.jpg)
The seeds of a research revolution have been sown
![Page 203: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/203.jpg)
There Are Four Components to the Research Revolution
•
Promotion of clinical research – the NIH Roadmap
•
Investment in high‐risk research•
The dream of personalized medicine
•
Creation of a new infrastructure for translational research
–Clinical and Translational Science Awards
![Page 204: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/204.jpg)
The NIH Roadmap for Medical Research
•
Launched in September 2004•
To address roadblocks to research
•
To transform the way research is conducted
•
Programs are expected to have “exceptionally high potential to transform the manner in which biomedical research is conducted”
![Page 205: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/205.jpg)
The NIH Roadmap
•
Faster high‐risk/high reward research•
Enable the development of
transformative tools and methodologies
•
Fill fundamental knowledge gaps•
Change academic culture to foster
collaboration
![Page 206: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/206.jpg)
Personalized medicine – the use of genetic information to predict risk and therapeutic response
![Page 207: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/207.jpg)
The Inherent Tension of the Research Revolution
84
![Page 208: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/208.jpg)
Clinical and Translational Science Awards
•
By 2012, NIH expects to fund 60 centers with a budget of
over $500 million a year
![Page 209: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/209.jpg)
Clinical and Translational Science Awards
The goal is to“…help deliver improved medical
care to the entire population, helping to disseminate new
technologies and new advances into clinical practice”
Clinical and Translational Science Awards http://ctsaweb.org
![Page 210: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/210.jpg)
Clinical and Translational Screening Awards
No funding “event”
has created more opportunities for
Departments of Family Medicine to become engaged in the
central research enterprises of their academic centers
![Page 211: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/211.jpg)
Woolf SH JAMA 2008
![Page 212: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/212.jpg)
“U.S. patients receive only half of recommended services”
“The second area of translational research seeks to close that gap…by
improving access, reorganizing and coordinating systems of care”
![Page 213: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/213.jpg)
New Treatments Are Important, But…..
“…patients might benefit even more‐ and more patients might benefit – if the health care system performed
better in delivering existing treatments than in producing new ones”
![Page 214: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/214.jpg)
The Agency for Healthcare Research and Quality
“…the ultimate goal of AHRQ is research translation –
that is, making
sure that findings from AHRQ research are widely disseminated and
ready to be used in everyday health care decision‐making”
http://www.ahrq.gov/research
![Page 215: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/215.jpg)
And, for the first time in years, a new model recognizing the
value of high performing primary care has been proposed
![Page 216: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/216.jpg)
Your Medical Home
![Page 217: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/217.jpg)
Plan Do Study
Act
•
Practice transformation demands measurement
•
Proven practices must be disseminated
•
New collaborations are needed
![Page 218: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/218.jpg)
•
Initiate the research process at the start
of practice transformation
–An over‐arching IRB covering Medical Home development
–Separate IRB’s
for each sub‐ project
![Page 219: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/219.jpg)
The Scientist and the Clinician
![Page 220: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/220.jpg)
We need practice transformers to attend NAPCRG
…and researchers to attend the Conference on Practice
Improvement
![Page 221: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/221.jpg)
Practice Based Research Networks (PBRN’s) are one of the vital tools to
answering the full spectrum of translational research questions
‐
They require more federal support
![Page 222: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/222.jpg)
Every practice should consider joining a PBRN
![Page 223: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/223.jpg)
Service Research‐
An emerging opportunity
![Page 224: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/224.jpg)
What Is Service Research?
Service‐Research is a method of research based on collaborative efforts
with communities, community service agencies, and government to design,
implement, and evaluate programs addressing an important need
![Page 225: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/225.jpg)
Service‐Research Leads With Service
Much service research focuses on how to deliver proven
interventions
to hard to reach populations
![Page 226: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/226.jpg)
Public health intervention and clinical practice improvement
constitute new realms of research
![Page 227: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/227.jpg)
New Design and Analysis Methods are Needed
•
Evaluations usually require, at a minimum, multi‐method approaches,
both qualitative and quantitative•
Design methods, such as sequential
cluster analysis, (comparing different clusters to each other as opposed to
individuals), are often required.•
Professional researchers are a must
![Page 228: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/228.jpg)
Service‐Research relies on a diverse set of federal and non‐federal funders
•
Not‐for‐profit community service agencies
•
Foundations•
AHRQ
•
CDC
![Page 229: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/229.jpg)
These grants and contracts almost universally rely on collaborations
•
The Academic Health Center may or may not be permitted to be the
applicant
![Page 230: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/230.jpg)
The CDC Mission Statement
“CDC’s mission is to collaborate to create the expertise, information, and
tools that people and communities need to protect their health – through
health promotion, prevention of disease, injury and disability, and
preparedness for new health threats”www.cdc.gov
![Page 231: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/231.jpg)
“State Supplemental Funding for Healthy Communities, Tobacco
Control, Diabetes Prevention and Control, and Behavioral Risk Factor
Surveillance System”
Eligible Applicants: States
![Page 232: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/232.jpg)
“HIV Prevention Projects for Community Agencies”
Eligible Applicants: Non‐profit organizations (other than institutions
of higher education)
![Page 233: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/233.jpg)
Barriers
•
Funding looks different than the NIH RO1 mechanism
–
Dollars may be less–
Spread over more collaborators
–
Indirects are often less attractive
![Page 234: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/234.jpg)
Barriers
•
Thus, AHC’s need different structures to compete for, attract and afford Service‐
Research grants and contracts–
Interdisciplinary centers that are
prepared to implement programs, provide service and evaluate projects in
multiple areas
![Page 235: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/235.jpg)
Myths
“Service‐Research isn’t research”
“It’s not intellectually challenging”
“It doesn’t generate new knowledge”
![Page 236: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/236.jpg)
Challenges
Sustainability
A challenge formost public healthprograms
Dissemination
Hard to find thebusiness model
![Page 237: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/237.jpg)
Service‐Research – Business Model
Often requires flexibility to conduct projects in a variety of areas
Funding per project is often lowIndirects are often low
Thus, funding from multiple projects is often necessary
![Page 238: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/238.jpg)
Service‐Research without careful evaluation leading to publication
…………..is just service
![Page 239: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/239.jpg)
Service‐Research REQUIRES teams–Make sure that professional
researchers are a part of the team
![Page 240: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/240.jpg)
The New Research Team
biostatisticians
epidemiologists
behavioral scientists
public health scientists
clinicians
anthropologists
social marketers
nurses
physical therapists
occupational therapists
legal experts
community leaders
patients
the public
basic researchers
…and many more
![Page 241: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/241.jpg)
There is not enough NIH & CIHR money to fund all important
research
Service‐Research offers an important opportunity to enhance our research capacity
![Page 242: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/242.jpg)
Receiving your marching orders:
What role will each of us need to play in the research revolution?
![Page 243: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/243.jpg)
Health care reform and health care research reform are inexorably linked
Health care reform
Health care reform
Health care research reform
![Page 244: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/244.jpg)
Finding someone to pay for diffusion into multiple practices
outside
of a research context has proven very difficult
![Page 245: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/245.jpg)
The lack of trust that primary care and community‐based
interventions can be sustained has sapped enthusiasm for
primary care and public health research
![Page 246: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/246.jpg)
First…..advocate for
health reform
![Page 247: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/247.jpg)
Second…accept the challenge
![Page 248: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/248.jpg)
Senior, experienced
researchers are our greatest asset
in the research revolution
![Page 249: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/249.jpg)
To Senior Researchers
•
The mantle of responsibility is heavy:
– Stay funded–Publish–Mentor junior investigators–Advocate for primary care and public
health research support– Find sustaining financial models
![Page 250: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/250.jpg)
Junior investigators
are our greatest hope
![Page 251: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/251.jpg)
To Junior Investigators
•
Improving health is what matters
–Research without publications and presentation isn’t research
…….and will not attract funding
![Page 252: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/252.jpg)
•
A Family Medicine residency does not provide the skills you need to be a career
researcher•
A research fellowship must be focused and
long enough•
Masters or PhD is helpful, if not vital
•
Mentored research awards are an important option
Be Prepared!
![Page 253: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/253.jpg)
Be Relentless!
Successful researchers have a need
to know, a need
to bring
about change…
hang in there – stay the course add a long
stratight
road??)
![Page 254: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/254.jpg)
Department Chairs must be the Chiefs of Staff in the research
revolution
![Page 255: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/255.jpg)
To Department Chairs and Academic Leaders
Now is the moment to move research towards the top of our
Departments’
agendas
![Page 256: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/256.jpg)
Research mentors who care about populations are in every department, in
almost every school
The Courtship of Mentors
Find them, engage them……
heck, marry them if you have to…
![Page 257: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/257.jpg)
Three of our Key Senior Mentors Are:
•
A behavioral psychologist in the department of Oncology
•
An occupational therapist in the Jefferson School of Health Professions
•
A pediatric‐adult nephrologist
in the Division of Nephrology
![Page 258: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/258.jpg)
And Chairs………
“No matter how little you think you know about medical home, practice transformation, disparity reduction, and community engagement, you
probably know more than anyone else”‐Tamsen
Basford, University of Arizona
Become the go‐to person in your AHC
![Page 259: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/259.jpg)
Have the courage to use department surplus to
invest in research…and, that’s right, we need to
figure out how to generate that surplus
![Page 260: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/260.jpg)
Levels of Engagement With AHC
Advocate for AHC’s
to:1.
Define their mission to care for a population
2.
Embrace a population health research agendaWe need to make the business case for research transformation
3.
Realign incentives to support collaboration and research teams
![Page 261: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/261.jpg)
We must find a way to celebrate, reward, promote and even grant
tenure
to the career co‐ investigator
![Page 262: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/262.jpg)
The Chair’s Prime Directive
![Page 263: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/263.jpg)
A culture of scholarship
![Page 264: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/264.jpg)
A culture of investigation
![Page 265: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/265.jpg)
A research revolution has begun
It will continue with or without us
![Page 266: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/266.jpg)
Public Health Community Engagement
Clinical CareDelivery
Medical Home is the bridge between…
![Page 267: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/267.jpg)
![Page 268: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/268.jpg)
“We need a new model in healthcare – one that is much more efficient and effective
and is constantly evolving based on evidence that is produced by the system
itself. We need continuous introduction of incremental and innovative treatments,
powered by data concerning the delivery systems, insurance coverage methods,
effectiveness, and benefits of care.”
R. A. Rudick, D. M. Cosgrove, A radical proposal: Integrate clinical investigation into the U.S. health care system. Sci. Transl. Med. 1, 4cm4 (2009).
![Page 269: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/269.jpg)
The health of the public cannot improve…will not improve
without broad changes in public policy and a spirit of social
altruism
![Page 270: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/270.jpg)
But we will also fail to realize our potential to improve public health without a powerful link to clinical care
delivery…to screening, chronic disease management, to effective therapy for
tobacco use, over‐eating, and sedentary living, and to the integration, at last, of behavioral, community, and physical well‐
being within a re‐designed medical home built on a foundation of knowledge,
evidence, and passion.
![Page 271: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/271.jpg)
Train Narrative
“…that the medical research train is moving towards its
destination at 20 miles per hour sounds great, unless you know
that trains are capable of much greater speeds!”
![Page 272: Transforming Health Care Delivery: The Importance of Care ... · Transforming Health Care Delivery: The Importance of Care Coordination to Population Health Richard C. Wender, MD](https://reader033.fdocuments.in/reader033/viewer/2022053022/604e4db2ac9e84547908ec30/html5/thumbnails/272.jpg)
Disparity Montage Narrative
We cannot solve North America’s major health care challenges within
the walls of an office. NIH and CIHR cannot fund all of the work that
must be done