The Dartmouth Center for Health Care Delivery Science
Building Blocks for a Better Health Care Delivery System
from Skylight, Summer 2010
A loved one who is suffering from a serious complication of diabetes is admitted to the hospital. Incomplete information is relayed from one of the patient’s specialists to the hospital care team. As a result, a key medication needed to treat a pre-existing condition is not included in his medical record. The patient gets sicker. He requires more tests and treatments, and a longer hospitalization, before he is able to recover and can be discharged.
This type of scenario happens all too frequently in the day-to-day interactions between patients and our health care system. It also illustrates the direct relationship between the quality of the care we receive and the costs of that care. It’s estimated that about 30 percent of the $2.5 trillion spent on health care every year in the U.S. is used ineffectively due to issues such as hospital errors, readmissions, and unnecessary and/or inappropriate tests and procedures.
For more than 30 years, researchers at The Dartmouth Institute for Health Policy and Clinical Practice (TDI, formerly the Center for Evaluative Clinical Sciences) have been the recognized leaders in diagnosing what ails our nation’s health care system. For example, their Dartmouth Atlas of Health Care has shown glaring variations in how medical resources are used across the country, demonstrating that more care and more expensive care don’t guarantee high-quality care.
Applying science
Tackling the twin challenges of improving care and lowering costs in a health care system as large and complex as ours requires an innovative approach that applies the right resources and diversity of discipline.
In May, Dartmouth College President Jim Yong Kim announced the creation of a new science—in the formation of the The Dartmouth Center for Health Care Delivery Science—which will build on the foundational work of The Dartmouth Institute. “We’ve made huge progress in the last century in the basic, clinical, and evaluative sciences,” says Dartmouth-Hitchcock Co-President James N. Weinstein, DO, MS, who will head up the new Center with Kim, and also serves as the Director of The Dartmouth Institute.
“What we need is a new field that brings the best minds—from management, systems thinking, anthropology, sociology, the medical humanities, environmental science, economics, health services research and medicine—to focus on delivery,” says Kim.
With a track record of creating innovative models of clinical care such as the Spine Center, the first-in-the-nation Center for Shared Decision-Making, and the Comprehensive Breast Program, Dartmouth-Hitchcock is already a leader in reforming health care delivery. “This is a fantastic opportunity to build new partnerships across the Dartmouth community, and take advantage of President Kim’s experience in tackling the challenge of health care delivery in some of the most difficult settings in the world,” says Weinstein.
The new Center will focus on five areas: research, education, collaboration, implementation and outreach, drawing on the expertise of faculty from the Tuck School of Business, Thayer School of Engineering, and the Arts and Sciences. The Dartmouth Institute and Dartmouth-Hitchcock will be central partners in the work of the Center, as will Dartmouth Medical School, both in research and in the education of medical students.
“We’ll have a new, expanded medical curriculum that will take students in our M.D. program beyond traditional medical school training and give them grounding in this exciting new science,” says William R. Green, PhD, Dean of Dartmouth Medical School. “This will give them a unique understanding of what it takes to provide quality, value-based care, and an opportunity to be change agents in the care settings in which they work—whether that’s here at Dartmouth or at other leading institutions across the country.”
Unique partnership
"This is the first time that a college and academic health system have come together in this way to address health care delivery. “We feel so lucky to be partnering with Dartmouth-Hitchcock,” says Kim, a Harvard-trained physician and co-founder of Partners in Health, a nonprofit organization that provides health care to underserved areas of the world. “It’s not often that a president of a hospital or clinic, in the case of Dr. Weinstein, is also one of the leading practitioners in the field of health care delivery science. That gives us a unique opportunity.”
“But at the end of the day, we have to prove that we can take our ideas and actually implement them,” he adds. “And it starts right here at home. So Dartmouth-Hitchcock is going to be the place where we can demonstrate to others that what we’re turning into practice actually leads to greater access, lower costs, and higher quality.”
The launching of the new Center is especially timely, given passage of health care reform legislation that will expand health coverage to 32 million Americans by 2014. “To handle this increased demand and critical need for services, the care we provide must become more efficient, with consistent quality and safety, based on evidence, best practices, patient preferences, and value,” Weinstein says.
New curriculum
As its first order of business, the Center will establish a new Masters program in Health Care Delivery Science—an 18-month course of study for health care managers, administrators, and providers with high potential to become change agents—to be offered jointly by The Dartmouth Institute and the Tuck School of Business. Executive education and distance learning will be incorporated into the new degree program, which will enroll its first students (about 50) in July, 2011.
Other plans for the Center include an expanded research agenda, new undergraduate offerings, national and global outreach, and collaboration across universities and leading health care institutions to innovate and implement improvements in care delivery.
