Academics and Care Delivery: A Necessary Symbiosis in an Era of Reform

(Note: I originally wrote the following content in April 2012 for the Wing of Zock, the blog run by the Association of American Medical Colleges).

At the 2011 AAMC Annual Meeting in Denver, I participated in a panel called “Organizing for Success during Reform,” which showcased a variety of care and research initiatives designed to align academics with the goals of health care reform at AMCs throughout the country. In some way, I think this may be the wrong question. Rather than asking how to align academics with health care reform, we need to start with a stronger alignment with health care.

My core message was the desirability (if not outright necessity) of aligning our academic infrastructure with the core mission of the health system. The growth of Carolinas HealthCare System (CHS) over the past 30 years has been dramatic: from a single public hospital, to 33 hospitals in two states and over 9 million patient visits. This growth creates the potential for an incredible clinical laboratory. We have access to patients representing all aspects of diversity: ethnic, economic, urban/rural.

During the same period, our research and education programs have grown as well. It is our fundamental belief that the academic programs planted in the middle of a strong health care system create great opportunity to strengthen our education and research efforts. At the same time, the academic core should produce real value back to the system…specifically by enhancing our ability to deliver high-quality, efficient patient care to a broad geography. Regardless of the outcome of health care reform, we believe this is a model for the academic health system (as opposed to academic medical center) of the future.

A case in point: Several academic medical centers in North Carolina participated in a study on lung cancer funded by the American Cancer Society. The study showed that African-Americans who are diagnosed with lung cancer have a delay in definitive treatment from the time of diagnosis compared to Caucasians; one of many health care disparities documented in the literature. The identification of these disparities is good and important work. However, the academic health system of the future will have the vertical integration necessary not only to identify a care delivery problem, but to correct it.

So how can we actively work to build this linkage between organizational mission and academic capability? I outlined one small step in that direction: the formation of Carolinas HealthCare System Research Centers of Excellence (COE). We developed an internal RFP process to select and fund two COEs. Applications were based on the following criteria: Investigators had to represent more than one specialty. More important, there had to be evidence of geographic diversity. That is, the investigators were expected to produce a realistic plan to leverage the scope and scale of CHS to begin to work in our large clinical laboratory. Finally, as part of the outcome measures, successful applications were expected to have a measurable impact on one of the six Institute of Medicine Aims for Improvement.

To date, one center has been funded: the Carolinas Trauma Network Research Center of Excellence. This center builds on a substantial base of clinical and academic excellence. Its objectives are:

▪ To develop and maintain an efficient multidisciplinary infrastructure to support the conduct of trauma-related research across the continuum of care provided by CHS

▪ To facilitate collaboration across disciplines, facilities, and scientific methods to contribute to the evidence base in trauma care

▪ To identify and prioritize the most critical issues challenging delivery of care for trauma patients across all CHS facilities

▪ To contribute to the science of conducting trauma research on challenging patients in challenging environments

▪ To use Comparative Effectiveness Research strategies to identify the safest, most effective, and least costly treatments for injured patients

▪ To leverage the strengths of this COE and CHS to attract external funding to support trauma related basic and translational science, clinical research, and population-based/implementation research.

In a way, the funding of the COEs is an experiment in itself. Can we deliberately drive synergies between the care delivery system and academic excellence? As a large, mission-oriented organization, it is our responsibility to try.