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
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:
HDRP and the ECRI Institute co-hosted the conference, Cancer Care Delivery in a Rapidly Changing Healthcare System, on November 17-18, 2015. Over the two days, we heard from some of the nation’s leaders in cancer care delivery who discussed how research evidence is used to make decisions. HDRP Acting Associate Director, Dr. Ann Geiger, closed the conference with several insightful remarks about health care delivery research that are worth highlighting. First, she commented that our understanding of the biology of cancer is rapidly evolving, and that there may be unrealistic expectations about how quickly precision medicine can deliver improved outcomes. While patients currently live with cancer for years, if not decades, there continues to be dialogue about “waging a war... Read more
In a case-based manuscript we tell the story of Ms. Young’s journey from a routine doctor’s visit to a breast cancer diagnosis and examine the coordination of her care among multiple health care providers. With the implementation of the Patient Protection and Affordable Care Act increased attention is directed towards delivering healthcare that is safe, effective, equitable, timely and patient-centered. Better coordination of patient care gives rise to changes in our healthcare delivery system, emergence of Patient Centered Medical Homes and practitioners who strive to deliver better care through teamwork.
Ms. Young’s case study integrates knowledge of health care teams in cancer care delivery. The authors evaluate how principles of interdependence among healthcare team providers can contribute to better patient outcomes.
Does your healthcare delivery environment practice principles of teamwork? If not, are you interested in learning more about... Read more
The first question many people ask about our new Healthcare Delivery Research Program concerns the title. Why was the term “healthcare delivery research” used? Below are some of my personal reflections about this choice of terminology.
I came to NCI to serve as Chief of the Health Services and Economics Branch. There were two other Branches focused on work that could be considered to fall mainly under the rubric of “health services research.” They were the Outcomes Research Branch and the Patterns of Care Research Branch. I was concerned that combining the three groups into a “Health Services Research Program” would fail to indicate the expansion of this field of research within the Division of Cancer Control and Population Sciences (DCCPS).
Throughout the fall of 2015, I and others began to talk about plans to create a new group within the Division of Cancer Control and Population Sciences. We heard from some national research leaders that the term “health... Read more