PA-20-072: Accelerating the Use of Evidence-based Innovation in Healthcare Systems

项目摘要 该提案旨在通过研究帮助加速向更高性能的医疗保健系统的过渡 重要的临床条件促进我们对影响执行的因素的理解 医疗保健领域的创新--以证据为基础，而不是那么简单。该研究扩大了两国之间的合作 达特茅斯大学、加州大学伯克利分校、哈佛大学和高价值医疗合作组织。这个 研究结果将有助于指导以患者为中心的结果研究证据的开发和使用。 这项研究植根于三个框架。首先，我们认识到以下四个主要因素的关键作用 影响创新实施的因素：外部环境(如国家政策)、特征 在采用创新的组织中(例如，整合程度)，内部组织流程 选择实施创新(例如，医生支付)，以及创新本身的特征。 第二，我们承认创新的多样性；影响创新的不同因素的相对重要性 采用情况可能因涉及的关键决策者而异：生物医学创新针对疾病，并 通常被医生采用；护理提供创新针对根据功能或疾病定义的患者群体 严重性，并在很大程度上被经理采用；患者参与度创新侧重于改变患者 角色。第三，不同类型的组织可能或多或少能够对外部影响或 采用不同的内部流程来改善护理。 该方法建立在这些框架的基础上，以研究创新的使用及其对健康的影响 照顾和费用。数据核心将对医疗组织和系统进行全国调查，并 将确定、跟踪和确定卫生系统的特点，并通过国家和 临床丰富的数据库。项目一将评估环境因素如何影响临床 整合、采用新的支付模式，以及组织如何使用证据。第二个项目将评估 卫生系统用来增加临床医生采用循证实践的内部机制 以及系统如何以及为什么采用这些方法。项目三将研究影响使用的因素。 或多或少有效的生物医学创新。项目四将研究影响使用的因素 护理提供创新以及如何改进这些创新的实施。项目五 审查与使用干预措施相关的环境和组织因素 患者参与度和衡量以患者为中心的护理结果。

Project Summary This proposal aims to help accelerate the transition to a higher performing healthcare system by studying important clinical conditions to advance our understanding of the factors that influence the implementation of innovations – evidence-based and less so – in healthcare. The research extends collaborations between Dartmouth, the University of California at Berkeley, Harvard, and the High Value Healthcare Collaborative. The findings will help guide the development and use of evidence from patient-centered outcomes research. The research is rooted in three frameworks. First, we recognize the key role of four major factors that influence the implementation of innovations: the external environment (e.g., state policies), the characteristics of the organizations adopting the innovation (e.g., degree of integration), the internal organizational processes selected to implement the innovations (e.g., physician payment), and the characteristics of the innovation itself. Second, we acknowledge the diversity of innovations; the relative importance of different factors that influence adoption may vary across the key decision-makers involved: biomedical innovations target diseases and are generally adopted by physicians; care delivery innovations target patient groups defined by function or illness severity and are largely adopted by managers; patient engagement innovations focus on changing patient roles. Third, different types of organizations may be more or less able to respond to external influences or adopt different internal processes to improve care. The approach builds on these frameworks to study the use of innovations and their impact on health, health care and costs. The Data Core will conduct a National Survey of Healthcare Organizations and Systems and will identify, track and characterize health systems, and measure their performance through national and clinically enriched databases. Project One will evaluate how environmental factors influence clinical integration, adoption of new payment models, and how organizations use evidence. Project Two will evaluate the internal mechanisms that health systems use to increase clinicians’ adoption of evidence-based practices and how and why systems adopt these approaches. Project Three will study the factors that influence the use of more or less effective biomedical innovations. Project Four will study the factors that influence the use of care delivery innovations and how the implementation of these innovations can be improved. Project Five examines the environmental and organizational factors associated with the use of interventions to enhance patient engagement and measure patient-centered outcomes of care.