development of the hmo research network: development of the hmo research network: insights and...
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Development of the HMO Development of the HMO Research Network: Research Network:
Insights and Lessons Learned
Texas Medicaid Managed Care Quality ForumTexas Medicaid Managed Care Quality ForumFebruary 23, 2011
Sarah M. Greene, MPH
Group Health Research Institute
OverviewOverview
What is the HMO Research Network?
How does it work?
What insights from our research network experience might be applicable in other settings?
In the beginning…(1994)In the beginning…(1994) Frequent research partnerships among a small group of
scientists based at a handful (n = 10) of integrated delivery systems
“Let’s form a Network!”
Coalition of the willing
Shared commitment to non-proprietary, public domain research
Objective: To improve population health and health care through collaborative research, dissemination, and sharing of best practices and methodologies
Health Systems + Research Centers = Health Systems + Research Centers =
Hallmarks of Member SitesHallmarks of Member Sites
Stable presence in community
Mature
Comprehensive data
Defined population base
Commitment to research in the public’s interest
Combined population ~11M
Mix of healthcare delivery arrangements
Characteristics of our PopulationCharacteristics of our Population
Then and Now: MilestonesThen and Now: Milestones CDC funds Vaccine Safety Datalink (mid-1990s)
Founding member’s sabbatical at NIH (1997)
Establishment of the HMO Cancer Research Network
Spawned development of other topical networks in pharmacoepidemiology, CVD, mental health
Infrastructure building contract in 2005 – codified processes, created resources
Surfeit of ARRA funding, still more topic-specific networks (asthma, diabetes, hepatitis C)
Today: Invited by Francis Collins to propose a “Collaboratory” to facilitate broad platform of population-based research
370 researchersWhat do they do?
Many Networks within the NetworkMany Networks within the Network
HMOHMOResearchResearchNetworkNetwork
TBDTBD RNRNCRNCRN
CERTCERT MHRNMHRN
CVRNCVRN DRNDRN
SPANSPAN
AsthmaAsthma PGRNPGRN
DiabetesDiabetes Hep CHep C
How Does It Work? How Does It Work? GovernanceGovernance Fairly informal
Has functioned largely as an alliance of willing collaborators with little formal organizational structure
Board of Governors (1 Center Director/site) provides overall leadership; Chair rotates every 2 years
Committees oversee data development, stewardship of HMORN’s key assets (scientists, infrastructure, etc.)
Financial contributions from each support some centralized administration functions (accounting, communication, web)
Topical Research Networks are linked but still autonomous
Adolescence – changes are on the horizon
How Does It Work? How Does It Work? DataData
Model of choice: the “Virtual Data Warehouse” (VDW)
Could also call it a Distributed Data Warehouse - the data are real enough
but each site maintains its native data at its own site until needed for approved research activities
The VDW is…
…a series of dataset standards and automated processes at each of 11 sites,
that allow a SAS program written at one site to be run against all the others quickly
and with a minimum of site-specific customization
Schematic of How the VDW worksSchematic of How the VDW works
Leadership through VDW Oversight Committee – Leadership through VDW Oversight Committee – technical and scientific experts who prioritize, set technical and scientific experts who prioritize, set
milestones, identify quality assurance issuesmilestones, identify quality assurance issues
VDW Successes, Persistent ChallengesVDW Successes, Persistent Challenges Assuages concerns related to
centralized data repository
All sites have functional version of VDW with 6 data areas
Enables rapid turnaround on feasibility requests ““How may ____ cases were How may ____ cases were
there at sites X, Y, Z in 2001?”there at sites X, Y, Z in 2001?”
Ongoing opportunity to improve data quality
Aggregation across dozens of underlying legacy datasets
Yes, we do use it for research
Highly dependent on health system; no control over health system migrating to a new EHR
Site-to-site VDW implementation varies (for many reasons)
Significant investment of time and resources at site level
Federated data model defies easy explanation
Misperceptions are common – assume it’s automated (it’s NOT!)
Two-way communication as anomalies are identified
The HMORN TodayThe HMORN Today
Demonstrated success of HMORN projects = visibility
Member $$ assessments
initiated
Dedicated contract to build HMORN-
wide infrastructure
Health reform debate, ARRA and
CER priorities
Membership growth and scientific
synergies
Scientific,Operational,& Financial
Growth!
And And growing growing
painspains
Insights, Implications, Lessons
Unique features of delivery system researchUnique features of delivery system research
Why do we do this?
Advantages of scientific evidence from large, integrated health plans:
Reflects care in real-world, everyday settings
Follows large, stable, diverse populations over time; generalizable
Provides access to data on health outcomes and thecost of care – “the whole picture”
Ideal: Learning Health Care SystemsIdeal: Learning Health Care Systems
““Meaningful Use” of Research FindingsMeaningful Use” of Research Findings
The HMORN enables reciprocal or bidirectional learning between the health research enterprise and national priorities, as well as between research and health systems
Hard, messy workHard, messy work Knowledge translation = holy grail of biomedicine
MDs: 75 studies and 12 journals/day just to keep up
Shared vision and purpose
Commitment to dissemination and diffusion of findings
Sustainable financial model
Vigilance about collaboration’s “burden to benefit ratio”
Alignment of approaches to data use/aggregation/sharing
Evaluation – check-in systematically w/research teams
Bring researchers & practitioners/providers together as often as possible to share views, ideas
Recognize and leverage diversity within the Network (of the population, the research disciplines, the practice settings)
Ingredients for Research Network SuccessIngredients for Research Network Success
