Oiling the Engine of Health Care Reform
Imagine having basal cell carcinoma as it spreads across your face for more than two years.
Uninsured, you seek help through a community clinic and within about two weeks, you're scheduled for a series of surgeries at OHSU. This was reality for one patient brought to OHSU through Project Access NOW, a community referral system that relies on a network of volunteer physicians, clinics and hospitals to provide services for low-income and uninsured people.
While OHSU clinicians directly serve the community by providing such care, many of our faculty members are also involved in health policy discussions. Below are a few projects out of many that highlight how School of Medicine faculty and staff provide oil for the engine of health care reform.
Medical Home Work
David Dorr, M.D. R '02, M.S., Associate Professor, Department of Medical Informatics & Clinical Epidemiology, is heading up a pilot project to provide measurable data on the effectiveness of the medical home concept in Oregon—and to then disseminate the results nationally. Transforming Outcomes for Patients through Medical home Evaluation & reDesign (TOPMED) is a $1.6 million, three-year partnership with the Gordon and Betty Moore Foundation to analyze and identify—through comparisons—the most effective primary care delivery models, especially for older adults with multiple chronic conditions. TOPMED is working with eight clinics in diverse health care settings.
The Oregon Legislature created the Health Evidence Review Commission (HERC) during the 2011 legislative session to continue almost two decades of work maintaining a list of prioritized health services; disseminating evidence-based guidelines for use by providers, consumers and purchasers; and conducting comparative effectiveness research of health technologies. Three of the appointees to the HERC made by Governor John Kitzhaber, M.D. '73, are OHSU-affiliated: Lisa Dodson, M.D. R '91, Associate Professor, Department of Family Medicine; Mark Gibson, Director, Center for Evidence-based Policy; and Somnath Saha, M.D., M.P.H., Associate Professor, Department of Medicine.
Does family insurance coverage correlate with health care access for children? Jennifer DeVoe, M.D. R '04, D.Phil., has been steadfast and prolific in her investigation of this question—with some unsettling results. Among many other articles, Dr. DeVoe, Associate Professor, Department of Family Medicine, most recently published a paper in the Annals of Family Medicine that recommended policy reforms to ensure access to health care for all family members.
Yale School of Medicine chose the Oregon Evidence-based Practice Center (EPC) at OHSU as one of two research centers that will independently review all clinical studies of a controversial product used in spinal surgeries to promote bone growth. The Oregon EPC is a national leader in comparative effectiveness reviews such as this. The review will be made public and will provide scientific information for practicing clinicians, national societies and the Food and Drug Administration, which approved the product in 2002.
Achieving the "Triple Aim"
One of OHSU's newest centers is the Center for Health Systems Effectiveness (CHSE), led by John McConnell, Ph.D., Associate Professor, Department of Emergency Medicine. CHSE undertakes research to achieve the Triple Aim of improving population health, improving patient experience and reducing per capita costs of care. "The capacity for society to contain the rising costs of health care, and to continue delivering care that benefits the entire population, requires analysis and data-driven action," said Dr. McConnell. "The way to get there is to track the simultaneous and evolving interactions between patients, providers and payors."
Pictured: Jennifer DeVoe, MD R '04, D.Phil., Associate Professor of Family Medicine, examines the role of insurance coverage in children's health care access.