Center for Innovation to Implementation (Ci2i): Fostering High Value Health Care

描述（由申请人提供）： 美国的医疗保健系统面临着双重挑战：持续的质量差距和成本增长快于经济增长。价值的统一概念，或每花费一美元所取得的健康成果，同时应对这些挑战。创新实施中心（Ci 2 i）的使命将是通过更好地获取、质量和更明智地使用资源，开展卫生服务研究，以追求高价值的卫生保健。Ci 2 i将有三个主题研究目标（重点领域）： “促进高价值的精神卫生保健（例如，物质使用障碍）， 使用不足是常见的， “促进慢性病的高价值医疗专业护理（例如，心脏、肝脏和肾脏疾病）， 昂贵的住院、手术和药物需要更好的管理， “通过更好的建模和信息学，推进评估和提高价值的方法。 这些临床领域共同提供了具有价值机会的不同领域的可概括组合。所产生的方法创新将支持Ci 2 i的工作，并推进这一领域的调查。虽然我们专注于专科护理，但我们的工作范围并不局限于专家办公室;提高价值可能意味着将目前在专科环境中提供的一些护理转变为成本更低、更容易获得的场所，如初级护理甚至自我护理。“价值前沿”的概念，或资源的最佳配置-鉴于目前的技术-以产生健康，指导我们的研究议程。我们将研究退伍军人健康管理局（VHA）目前在价值边界以下运作的地方，以确定创新的机会。然后，我们将评估临床和组织创新，无论是移动到前沿护理或更根本地改变护理通过扩大前沿，特别是通过使用面向提供者的信息。在这样做的过程中，Ci 2 i将利用我们的斯坦福大学和加州旧金山大学弗朗西斯科的学术分支机构非常肥沃的当地环境，以提高成本效益建模，实施科学和结构化的卫生系统重新设计。 除了以价值为导向的研究外，Ci 2 i还将更广泛地推进卫生服务研究，特别支持对妇女和老年退伍军人特殊人群的研究。它将继续帕洛阿尔托的传统，作为一个领导者，在职业发展的初级调查员在当地和全国通过创新使用远程辅导和协作。促进他们的职业发展将是Ci 2 i致力于培养下一代高价值医疗保健调查人员的核心。 核心研究人员与实施研究中心和交付系统合作伙伴的广泛、深入和长期的联系网络将确保我们测试的创新与卫生系统需求相关。三个提高质量研究倡议（QUERI）的本地存在将有助于移交证明创新的研究，以研究其实施和更广泛的传播。Ci 2 i将提供基础设施支持 这些和其他卫生服务研究人员全国致力于有一个在VHA的继续旅程中的作用，成为一个学习型组织，提供高价值的护理。在其所有 Ci 2 i旨在成为新一代卫生服务研究的典范，以支持退伍军人的健康。

DESCRIPTION (provided by applicant): The U.S. health care system faces dual challenges: a continuing quality chasm and costs that are growing faster than the economy. The unifying concept of value, or health outcomes achieved per dollar spent, simultaneously addresses these challenges. The mission of the Center for Innovation to Implementation (Ci2i) will be to produce health services research in pursuit of high-value health care through better access, quality and wiser use of resources. Ci2i will have three thematic research goals (focus areas): " Fostering high-value mental health care (e.g., substance use disorder) where suboptimal access and underuse are common, " Fostering high-value medical specialty care for chronic disease (e.g., heart, liver, and renal disease), where costly hospitalizations, procedures and drugs demand better management, and " Advancing methods to assess and improve value through better modeling and informatics. Together, these clinical areas provide a generalizable portfolio of diverse domains in which value opportunities lie. The methodological innovations produced will support Ci2i's work and advance this field of inquiry. Though we concentrate on specialty care, our purview is not confined to specialists' offices; improving value may mean transforming some care now delivered in specialty settings to lower cost, more accessible venues, such as primary care or even self-care. The concept of the "Value Frontier," or the optimal allocation of resources- given current technology-to produce health, guides our research agenda. We will examine where the Veterans Health Administration (VHA) currently operates below the Value Frontier, to identify opportunities for innovation. We will then evaluate clinical and organizational innovations that either move care towards the frontier or transform care more fundamentally by expanding the frontier, particularly through the use of provider-facing informatics. In so doing, Ci2i will take advantage of the exceptionally fertile local environment at our academic affiliates of Stanford University and the University of California San Francisco for enhancing cost-effectiveness modeling, implementation science and structured health systems redesign. In addition to value-oriented research, Ci2i will advance health services research more generally, with particular support for research into the special populations of women and older Veterans. It will continue Palo Alto's tradition as a leader in career development of junior investigators locally and nationally through innovative use of distance mentoring and collaboration. Promoting their career development will be central to Ci2i's commitment to growing the next generation of high value health care investigators. Core investigators' extensive, deep and longstanding network of connections to implementation research centers and delivery system partners will ensure that the innovations we test are relevant to health system needs. The local presence of three Quality Enhancement Research Initiatives (QUERI's) will facilitate hand-off of proven innovations for study of their implementation and for wider dissemination. Ci2i will provide infrastructure support to these and other health services researchers nationwide committed to having a role in VHA's continued journey toward being a learning organization that delivers high-value care. In all of its endeavors, Ci2i is designed to be a model for the new breed of health services research built for both rigor and relevance in support of Veterans' health.