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D-H Launches "Living Laboratory" to Drive Health Care Innovation

D-H Launches "Living Laboratory" to Drive Health Care Innovation

A new population health initiative at Dartmouth-Hitchcock (D-H) is developing innovative ways of delivering care and accelerating the process for implementing those innovations, in a "collaborative living laboratory."

The Population Health Collaboratory at D-H leverages the care provided through the clinical delivery of the D-H health system, the academic strengths of Dartmouth College and its graduate and professional schools, the work of The Dartmouth Institute for Health Policy and Clinical Practice, and the financial and workforce resources of D-H and community health organizations, all to create solutions to high-cost and complex patient care, says the Collaboratory's inaugural director, Stephen J. Bartels, MD, MS.

"We want to rapidly identify and test new models of care, new technologies, and new uses of predictive analytics and actionable patient reported measures, to improve care," says Bartels. "This is about innovation. It's about improving health and health care in a learning academic health system and in the community by accelerated development, testing, and implementation."

According to Bartels, this research will also produce results more quickly than the traditional academic research model, which Bartels notes can often take more than 15 years from idea to implementation in practice.

The bulk of the Collaboratory's initial funding has come from D-H's Population Health Innovation Fund, established by Dartmouth-Hitchcock's Trustees in 2014 to advance innovations and improvements in population health. Each year, the Trustees may allocate a percentage of the return on D-H's investment portfolio to the Fund, which is managed by the D-H Population Health Management Council (PHMC).

"Greater collaboration between our health system and the communities we serve is critical to our mission of advancing population health," notes D-H Trustee Chair Anne-Lee Verville. "By creating the Population Health Innovation Fund, we open new possibilities to better meet the health needs of our region."

Dartmouth-Hitchcock CEO and President Dr. James N. Weinstein added: "Dartmouth-Hitchcock is creating a sustainable health system that will improve the lives of the people and communities we serve, for generations to come. The Innovation Fund is critical to accelerating our progress from a health care system to a health system, built around the needs of our patients and their families."

"The PHMC feels strongly that the Collaboratory is an important project to support," says Robert A. Greene, MD, MHCDS, FACP, Executive Vice President and Chief Population Health Management Officer at D-H. "Dartmouth-Hitchcock is focused on health, not just health care, and the Collaboratory will help us to deliver that care in the right place in the right way, by considering a person's health care needs along with their environment, financial limitations, support network and other variables."

Redesigning primary care for the special needs of older adults is one of the first areas of focus, which Bartels notes "is obviously aligned with a very important priority for Dartmouth-Hitchcock because of our region's demographics." Bartels, the Herman O. West Professor of Geriatrics at the Geisel School of Medicine at Dartmouth and director of the Dartmouth Centers for Health and Aging, says the Collaboratory hopes to "transform geriatric care across the primary care setting in the region," and has received a $2.5 million grant from the Health Resources and Services Administration (HRSA) to help fund their Geriatric Workforce Enhancement Program.

A related effort – a partnership with the geriatric specialty team in general internal medicine – will focus on reducing hospitalizations and the use of emergency services among elderly D-H patients in the Upper Connecticut River Valley area who have been identified as high-risk and high utilizers of these services. In the initial pilot phase, 10-20 at-risk elderly patients who live at home or in residential care facilities will be assigned a primary care team for one year, and will have weekly contact with a health coach and receive regular home visits.

"It's about innovative models of care, and discovering what works better—health coaches, remote sensing technology, use of smartphones —for managing a chronic health condition," Bartels says. "We're looking at how we successfully re-engineer care to work with older adults with complex multiple health conditions. Our goal is to answer the question of what levels of involvement from family members and health outreach coaches is going to keep that person out of the hospital while still improving their health?"

In addition to geriatric primary care, Bartels says the early work of the Collaboratory will focus on other new approaches and populations. For example, the Collaboratory will be engaged in developing and evaluating innovative approaches to integrating mental health and substance use treatment into primary care, including targeting the emerging epidemic of opiate misuse in northern New England. The Collaboratory will also be studying the experience of patients and providers using new technologies such as ImagineCare in improving health outcomes.

"We're at an exciting place to think about the way we deliver care," Bartels says. "And to use our great talent, both clinically and academically, to test new approaches rapidly. Over time, we seek to be recognized as the nation's leading population health living laboratory, where we co-create knowledge and health in partnership with patients, scientists, clinicians and communities. That's its promise – an idea that harnesses the best qualities of our learning academic health system."

About Dartmouth-Hitchcock

Dartmouth-Hitchcock (D-H) is a nonprofit academic health system that serves a patient population of 1.2 million in New England. Anchored by Dartmouth-Hitchcock Medical Center in Lebanon, NH, the system includes the Norris Cotton Cancer Center, one of only 41 Comprehensive Cancer Centers in the nation; the Children's Hospital at Dartmouth-Hitchcock; affiliate hospitals in Keene and New London, NH, and Windsor, VT; and 24 Dartmouth-Hitchcock Clinics that provide ambulatory services across New Hampshire and Vermont. D-H provides access to more than 1,000 primary care doctors and specialists in almost every area of medicine. In partnership with the Audrey and Theodor Geisel School of Medicine at Dartmouth and the White River Junction VA Medical Center in White River Junction, VT, it trains nearly 400 residents and fellows annually, and performs world-class research.

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