Accelerating the Use of Evidence-based Innovation in Healthcare Systems

 描述(由申请人提供)：这项建议旨在通过研究重要的临床条件，促进我们对影响医疗创新实施的因素(基于证据和不那么重要)的理解，以帮助加快向更高表现的医疗保健系统的过渡。这项研究扩展了达特茅斯大学、加州大学伯克利分校、哈佛大学和高价值医疗合作组织之间的合作。这些发现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，我们认识到影响创新实施的四个主要因素的关键作用：外部环境(例如国家政策)、采用创新的组织的特征(例如整合程度)、选择实施创新的内部组织流程(例如医生支付)以及创新本身的特征。其次，我们承认创新的多样性；影响采用的不同因素的相对重要性可能在涉及的关键决策者中有所不同：生物医学创新针对疾病，通常被医生采用；护理提供创新针对根据功能或疾病严重程度定义的患者群体，主要被管理者采用；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应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、医疗保健和成本的影响。数据核心将对医疗保健组织和系统进行一次全国调查，并将识别、跟踪和描述医疗系统，并通过国家和临床丰富的数据库衡量其表现。项目一将评估环境因素如何影响临床整合、新支付模式的采用，以及组织如何使用证据：项目二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或多或少有效的生物医学创新的因素。项目四将研究影响护理服务创新使用的因素，以及如何改进这些创新的实施。项目五考察了与使用干预措施提高患者参与度和衡量以患者为中心的护理结果相关的环境和组织因素。

 DESCRIPTION (provided by applicant): 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.