SLIDE 1 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
SLIDE 2 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%
SLIDE 3
SLIDE 5 Research Investment by Sector
- H. Moses et al, JAMA. 2015;313(2):174-189
SLIDE 6
Health Services Research Funding
SLIDE 7
Health Services Research Funding
$0.2 billion from PCORI
SLIDE 8
Health Services Research Funding
$0.2 billion from PCORI $1.4 billion from NIH
SLIDE 9
Health Services Research Funding
$0.2 billion from PCORI $1.4 billion from NIH
– 4% of NIH budget
SLIDE 10
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
SLIDE 11
SLIDE 12
SLIDE 13 2016 $10,800 78.6 y
SLIDE 14
Care Research
SLIDE 15
Care Research
SLIDE 16
SLIDE 18 Apply for grant Get grant
SLIDE 19 Apply for grant Get grant Important results
SLIDE 20 Apply for grant Get grant Important results Change health
SLIDE 21
Broken research system
SLIDE 22
SLIDE 23 Dell Medical School: Opportunity to start from scratch
Photo: Christopher Sherman
SLIDE 24
Rethink Research
SLIDE 25
Care Research
SLIDE 26
Care Research
SLIDE 27
Care Research
SLIDE 28
Care Research
SLIDE 29
Care Research
SLIDE 30
SLIDE 31
SLIDE 32
SLIDE 33
SLIDE 34
SLIDE 35
SLIDE 36
SLIDE 37
SLIDE 38
SLIDE 39
SLIDE 40 Example: Joint Pain
Complete redesign of care
Appropriate triage Counseling PT/training Risk factor management Constant measurement and adaptation
SLIDE 41 Measurement of outcomes Payment for value
Clinical expertise Team care
Design
Technology
Person
SLIDE 42 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
SLIDE 43 Innovating to improve the model
Does an initial telemedicine visit improve satisfaction and outcomes?
True randomized trial, just beginning
SLIDE 44
Innovating to improve the model
Can we reduce physician distraction and improve the patient experience?
SLIDE 45
Innovating to improve the model
Can we reduce complications by replacing the saw?
SLIDE 46
SLIDE 47
New approaches to education
SLIDE 48
