state of the department of population medicine...suzanne and robert fletcher prize in population...
TRANSCRIPT
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State of the Department of Population Medicine
Richard PlattProfessor and Chair
Executive Director, HPHCI
▪ Mission: Improve health care delivery and population health through innovative research and teaching
Answering the need for a new approach
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Teaching Center- a hotbed of inspiration and initiative
“…alliances between medical schools and large HMOs can create vibrant practice settings for teaching and research…”
The ‘90s: Research and Teaching Take Off
▪ 1994: 1st Federal award, an FDA pharmacoepidemiology cooperative agreement
▪ 1996: Launch of the Thomas O. Pyle and Robert H. Ebert Fellowships
▪ 1998: NIH funds what will later be named Project Viva
▪ Leadership of 5 HMS courses– Patient/Doctor I & II
– Epidemiology and Critical Reading of the Literature
– Nutrition and Preventive Medicine
– Ambulatory Care Clerkship
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Areas of focus
1. Comparative effectiveness research Identifying best treatments for individuals and populations
2. Delivery systems based research Improving clinical care processes and outcomes
3. Prevention research Reduce the risk of acquiring disease and/or prevent its consequences
4. Policy research Assess the impact of health policies, financing, and administration
5. Surveillance and public health research Develop methods to use health care data to support public health
Cross-cutting strengths in data and methods
DPM’s Major Research Partners
▪ Health plans
▪ Practices
▪ Hospitals
▪ Health departments
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DPM’s Research Groups
Founding DirectorTracy Lieu
Associate DirectorAlison Galbraith
Interim DirectorAnn Chen Wu
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DPM’s Research Groups
FOUNDING DIRECTOR
Matt GillmanASSOCIATE DIRECTOR
Jason BlockDIRECTOR
Emily Oken
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DPM’s Research Groups
FOUNDING DIRECTOR
Steve Soumerai
Health Policy and Insurance Research
DIRECTOR
Frank Wharam
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DPM’s Research Groups
Therapeutics and Infectious Disease Epidemiology
Patient Oriented Research in the Epidemiology of Skin Diseases
Therapeutics Research and Infectious Disease Epidemiology
TIDE 2009TIDE 2017
DIRECTOR
Richard Platt
Therapeutics and Infectious Disease Epidemiology
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DPM’s Research Groups
Therapeutics and Infectious Disease Epidemiology
Patient Oriented Research in the Epidemiology of Skin Diseases
Biostatistics
Biostatistics center
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Areas of focus
1. Comparative effectiveness research Identifying best treatments for individuals and populations
Huang NEJM 2013:368:2255
• Cluster randomized trial• 43 hospitals, 74 ICUs, 74,256 admissions• Universal decolonization resulted in a
44% decrease in bloodstream infections• Adopted by most US hospitals
Clinical Trials to Prevent Healthcare Associated Infection
Therapeutics and Infectious Disease Epidemiology
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Areas of focus
1. Comparative effectiveness research Identifying best treatments for individuals and populations
2. Delivery systems based research Improving clinical care processes and outcomes
Cross-cutting strengths in data and methods
Childhood Infections
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Collaborating Organizations
Department of Ambulatory Care and Prevention,
Harvard Medical School
Massachusetts Department of Public Health
Blue Cross and Blue Shield of Massachusetts
Harvard Pilgrim Health Care
Tufts Health Plan
Massachusetts Division of Medical Assistance
Endorsed By
U.S. Centers for Disease Control
Massachusetts Chapter of the American Academy of
Pediatrics
Funded by the U.S. Agency for Healthcare Research and Quality
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GRANDIOSITE FLEXIBILITE
TENACITE
The REACHMass Creed
Asthma Care
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▪ High Five – a cluster randomized trial in pediatric practices to prevent and manage overweight in children
▪ Reduced TV watching, but not BMI
Distributed Research Networks: PCORnet
Therapeutics and Infectious Disease Epidemiology
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Using PCORnet’s Electronic Health Records
▪ PCORnet Antibiotics and Childhood Growth study
▪ Assess effect of antibiotic prescribing on height/weight
▪ Uses electronic health records of 700,000 children in 37 PCORnet institutions
▪ PIs: Matt Gillman, Jason Block at DPM, Chris Forrest at Penn 15 Investigators, 37 institutions
▪ Coordinating Center at HPHC Institute
Therapeutics and Infectious Disease Epidemiology
Distributed Pragmatic Trial Networks: NIH Collaboratory
Therapeutics and Infectious Disease Epidemiology
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Advising countries and global health organizations
Areas of focus
1. Comparative effectiveness research Identifying best treatments for individuals and populations
2. Delivery systems based research Improving clinical care processes and outcomes
3. Prevention research Reduce the risk of acquiring disease and/or prevent its consequences
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▪ Prospective study of mothers and children
▪ 1999-2002 recruited women in early pregnancy from 8 Atrius practices
▪ 2128 live singleton births, 1576 remain enrolled as of 2017
▪ In-person visits x2 in pregnancy, after delivery, and in infancy, early childhood, mid-childhood, early teen, and (ongoing) mid-teen (ages 16+)
▪ 175+ publications, 40+ grants (continuous NIH funding)
Project Viva: a study of health for the next generation
Project Viva
Cohort leadership and analyses
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Elucidating the links between behaviors and health
Changes in the food environment over time: examining 40 years of data in the Framingham Heart Study.
Elucidating the links between the food environment and health
0
1
2
3
4
5
6
1971-1975 1979-1983 1983-1987 1987-1991 1991-1995 1995-1998 1998-2001 2005-2008
Co
un
ts
Counts of Establishments on Commute from Work to Home
Fast Food
Supermarkets
James Int J Behav Nutr Phys Act. 2017;14:84
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Developing policies to promote healthy lifestyle
Areas of focus
1. Comparative effectiveness research Identifying best treatments for individuals and populations
2. Delivery systems based research Improving clinical care processes and outcomes
3. Prevention research Reduce the risk of acquiring disease and/or prevent its consequences
4. Policy research Assess the impact of health policies, financing, and administration
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Vaccine Cost-effectiveness and Decision-making
Led to the Gates Foundation adding pneumococcal vaccine to its global health program
Vaccine Financing
“The current vaccine financing system has resulted in gaps for underinsured children in the United States, many of whom are now unable to receive publicly purchased vaccines in either the private or public sectors.”
Lee. JAMA 2007; 298: 638
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Asthma Health Policy
Unintended effects of medication policy
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Innovative Longitudinal Methods
-10%
0%
10%
20%
30%
40%
50%
% v
isits m
isse
d
0 5 10 15 20Study month
intervention control I-C difference
Intervention, control, monthly differences - all patients
Monthly visits missed
UK: Pay for performance does
not improve care for patients with hypertension
Thailand: Universal health
coverage increases insulin use
Tanzania: Appointment system decreases
missed visits among HIV-infected pregnant
women
US: Triplicate prescription policy reduces benzodiazepine use, not hip fractures
Rigorous Analyses of High-deductible Health Insurance
Delays in Breast Cancer Care among High-deductible Plan Members
Women in high-deductible plans delay
breast cancer care
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Citations of DPM work▪ "Racial and ethnic differences in
obesity may also be partly explained by differences in risk factors during the prenatal period and early life.“ (p. 6) Taveras et al. Racial/Ethnic differences in early-life risk factors for childhood obesity. Pediatrics, 2010;125:686
▪ “…early introduction of solids (prior to six months) increases the risk for childhood obesity.” (p. 15) ibid
▪ “Between 1980 and 2001, the prevalence of overweight infants under six months almost doubled…” (p.11)Kim, J., et al. Trends in overweight from 1980 through 2001 among preschool-aged children enrolled in a health maintenance organization. Obesity, 2006;14:1107.
▪ “…television exposure was correlated with fast-food consumption in preschool children…” (p. 18)Taveras, E.M., et al. The association of television and video viewing with fast food intake by preschool-age children. Obesity 2006;14:2034
Policy impact
Areas of focus
1. Comparative effectiveness research Identifying best treatments for individuals and populations
2. Delivery systems based research Improving clinical care processes and outcomes
3. Prevention research Reduce the risk of acquiring disease and/or prevent its consequences
4. Policy research Assess the impact of health policies, financing, and administration
5. Surveillance and public health research Develop methods to use health care data to support public health
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Vaccine safety
Distributed Data Networks: Sentinel
Therapeutics and Infectious Disease Epidemiology
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Sentinel Partner Organizations
Lead – HPHC Institute
Data and
scientific partners
Scientific
partners
Therapeutics and Infectious Disease Epidemiology
50
Sentinel distributed database*
Populations with well-defined person-time for which most medically-attended events are known
▪ 223 million unique member IDs
▪ 425 million person-years of observation time
▪ 43 million people currently accruing new data
▪ 5.9 billion dispensings
▪ 7.2 billion unique encounters
▪ 42 million people with >1 laboratory test result
* As of January 2017
Therapeutics and Infectious Disease Epidemiology
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Therapeutics and Infectious Disease Epidemiology
Distributed EHR Networks for Public Health: MDPHnet
www.esphealth.org
Therapeutics and Infectious Disease Epidemiology
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MDPHnet: RiskScape – a public health dashboard
MDPHnet: Obesity – prevalence of BMI >30
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Critical Care Medicine 2013;41:2467-2475
Changing National Surveillance Strategy
Therapeutics and Infectious Disease Epidemiology
Cultivating skills and honing futures
▪ Courses for medical students
▪ Health Policy and Insurance Research Fellowship
▪ General Internal Medicine and Primary Care Fellowship
▪ Pediatric Health Services Research Fellowship
▪ Primary Care and Population Medicine Residency Program
▪ Medicines and Insurance Coverage (MedIC) Initiative
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A new course for students -- Watch this space!
Essentials of the Profession II
▪ Required month-long course for 3rd and 4th year HMS students
HPI Teaching Activities
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Fellowships and Awards
▪ Thomas O. Pyle Fellowship
▪ Ebert Fellowship
▪ Launch of Ebert Mid-Career Development Award
New prize
Suzanne and Robert Fletcher Prize in Population Medicine
▪ $1000 prize for the best paper on a topic in Population Medicine written by an HMS or HSDM student
▪ Papers will be judged by an expert panel of DPM faculty
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Endowed Chairs
Emily Oken, MD, MPH Michael Klompas, MD, MPH, FRCPC
Administration
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Directors of Administration
Kim Eberlein Carol Stolberg Ellen Edelberg Virginia Hinrichsen Sheila Fireman
Research Services Data Center
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Office of Sponsored Programs
The future: Areas of focus
1. Comparative effectiveness research Identifying best treatments for individuals and populations
2. Delivery systems based research Improving clinical care processes and outcomes
3. Prevention research Reduce the risk of acquiring disease and/or prevent its consequences
4. Policy research Assess the impact of health policies, financing, and administration
5. Surveillance and public health research Develop methods to use health care data to support public health
Cross-cutting strengths in data and methods
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