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

描述(由申请人提供)： 美国的医疗体系面临着双重挑战：持续的质量鸿沟和比经济增长更快的成本。统一的价值概念，或每一美元所取得的健康结果，同时解决了这些挑战。创新到实施中心(Ci2i)的使命将是通过更好地获取、质量和更明智地使用资源来开展医疗服务研究，以追求高价值的医疗保健。Ci2i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)，在次优获取和使用不足普遍的地方”，促进针对慢性病(例如，心脏、肝脏和肾脏疾病)的高价值医疗专科护理，在这些疾病中，昂贵的住院、程序和药物需要更好的管理，以及“改进方法，通过更好的建模和信息学来评估和提高价值。总而言之，这些临床领域提供了一个可概括的不同领域的组合，其中存在价值机会。产生的方法创新将支持Ci2i的工作，并推动这一调查领域的发展。虽然我们专注于专科护理，但我们的职权范围并不局限于专科医生的办公室；提高价值可能意味着将一些目前在专科环境中提供的护理转变为成本更低、更容易获得的场所，如初级保健甚至自我护理。“价值前沿”的概念，或资源的最佳分配--考虑到当前的技术--来生产健康，指导着我们的研究议程。我们将检查退伍军人健康管理局(VHA)目前在哪些方面低于价值前沿，以确定创新的机会。然后，我们将评估临床和组织创新，这些创新要么将医疗保健推向前沿，要么通过扩大前沿更根本地改变医疗保健，特别是通过使用面向提供者的信息学。通过这样做，Ci2i将利用我们在斯坦福大学和加州大学旧金山分校的学术附属机构异常肥沃的本地环境，加强成本效益建模、实施科学和结构化医疗系统重新设计。除了以价值为导向的研究外，Ci2i还将更广泛地推进卫生服务研究，特别是支持对妇女和老年退伍军人这一特殊群体的研究。它将延续帕洛阿尔托作为地方和国家初级调查人员职业发展领导者的传统，通过创新地使用远程指导和合作。促进他们的职业发展将是Ci2i致力于培养下一代高价值医疗保健研究人员的核心。核心调查人员与实施研究中心和交付系统合作伙伴建立了广泛、深入和长期的联系网络，将确保我们测试的创新与医疗系统需求相关。三个质量增强研究计划(QUERI‘s)在当地的存在将有助于移交已证明有效的创新，以研究其实施情况并进行更广泛的传播。Ci2i将提供基础设施支持 对于这些和其他卫生服务，全国范围内的研究人员承诺在VHA继续成为一个提供高价值医疗服务的学习型组织的过程中发挥作用。在它的所有方面 努力，Ci2i旨在成为支持退伍军人健康的严谨和相关性的新型医疗服务研究的典范。

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.