Healthcare Delivery
Research Blog


The “How Do We Assess Quality in the Age of Precision Medicine?” session at the ASCO Quality Symposium on February 26, 2016, provided a nice overview of the challenges physicians and delivery systems are encountering as precision cancer approaches move from the lab and clinical trials into community use. 

I would describe the first challenge as too much data and too little evidence.  The session chair, Allison Kurian from Stanford, noted that her genetics clinic has gotten substantially more complicated since the days when tests for germline mutations of BRCA1/2 were the only service offered.  A multiplex panel for somatic mutations in tumors may currently test for as many as 70 mutations.  Whole genome sequencing identifies innumerable variants, most of them of unknown significance.  Decisions must... Read more

Precision medicinehealthcare delivery

In the past few weeks I have visited with faculty, fellows, and students at several local universities and have talked with peer reviewers attending a recent NIH study section.  A number of people have shared with me their perception that NCI no longer funds R21.  Hopefully this blog will clarify the situation.

Last year senior NCI leaders made a decision to allow the omnibus R21 program announcement (PA) to expire.  This PA allowed investigators to submit applications with any idea they developed.  Allowing this PA to expire was a difficult decision undertaken only after extensive discussion and evaluation of the NCI grant portfolio.  My understanding is that there was an ever increasing volume of high quality R21 for a limited pool of funding.  In addition, some of these applications did not address program priorities.  Senior leadership also questioned whether some of these R21 applications could have been submitted as small R01.  I imagine it was hard for our senior... Read more


I recently attended a course at the Harvard Business School called Strategy for Health Care Delivery , which is based on this text.  The main thrust of the course and book is that health care delivery will improve only if we focus on what has value for the patient and design the system accordingly.  Such a system would have six components:

healthcare delivery

Two studies published in December 2015 using data from the Medical Expenditure Panel Survey  highlight the financial hardships and economic burden associated with cancer in the United States.  The first study led by Robin Yabroff (formerly of HDRP) and published in the Journal of Clinical Oncology, looks at material financial hardship – measured by borrowing money/going into debt, filing for bankruptcy, being unable to cover costs of medical care, or making other financial sacrifices due to cancer – and found that hardship was more common among cancer survivors that were younger (18-64 years of age).  Psychological financial hardship (e.g. worrying about paying bills) was also more common among this group.  The second study led by Zhiyuan Zheng... Read more

Economic burden

Last Wednesday, January 6, 2016, I had an opportunity to attend a presentation about NIH’s work with IBM’s Watson.  Several groups at NIH have been exploring how Watson might benefit our operations and serve our intramural and extramural research communities.  The presentation featured work that Mike Lauer, who is Deputy Director for Extramural Research, has been involved in.


The first example pertained to using Watson to do impact analyses of NIH funding.  Our approach at the moment tends to be pretty crude, usually number of publications from a grant or initiative.  Humans had determined that less than two-thirds of clinical trials at the National Heart Lung and Blood Institute had published results within 30 months after they were closed.  They identified... Read more