How Would You Build an Academic Medical System to Bridge Research and Care if You Could Start from Scratch? Clay Johnston, MD, PhD Dell Medical School
What proportion of the major clinical decisions are based on real evidence? A. <10% B. 10-24% C. 25-49% D. 50-79% E. 80-90% F. >90%
Improved Health
Research Investment by Sector H. Moses et al , JAMA. 2015;313(2):174-189
Health Services Research Funding
Health Services Research Funding $0.2 billion from PCORI
Health Services Research Funding $0.2 billion from PCORI $1.4 billion from NIH
Health Services Research Funding $0.2 billion from PCORI $1.4 billion from NIH – 4% of NIH budget
Health Services Research Funding $0.2 billion from PCORI $1.4 billion from NIH – 4% of NIH budget – Less than spent on stem-cell research
2016 $10,800 78.6 y
Care Research
Care Research
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Apply for grant Get grant Change health Important results
Broken research system
Dell Medical School: Opportunity to start from scratch Photo: Christopher Sherman
Rethink Research
Care Research
Care Research
Care Research
Care Research
Care Research
Example: Joint Pain Complete redesign of care Appropriate triage Counseling PT/training Risk factor management Constant measurement and adaptation
Person Measurement of outcomes Payment for value Design Clinical Team care Technology expertise
Innovating to improve the model Does an interview designed to enhance the patient-caregiver empathic bond improve patient satisfaction? Pseudo-randomized trial Found NO effect on satisfaction, pain, or outcomes
Innovating to improve the model Does an initial telemedicine visit improve satisfaction and outcomes? True randomized trial, just beginning
Innovating to improve the model Can we reduce physician distraction and improve the patient experience?
Innovating to improve the model Can we reduce complications by replacing the saw?
New approaches to education
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