Dartmouth Named National Center of Excellence to Study Health Care Delivery and Outcomes

Dartmouth has been named one of three National Centers of Excellence by the Agency for Healthcare Research and Quality (AHRQ) to study health care delivery and patient outcomes.

The federal agency announced this week that the College has been awarded $17.5 million over the next five years to learn how high-performing health care systems promote evidence-based practices in delivering care.

Elliott Fisher, MD, MPH
Elliott Fisher, MD, MPH

“Almost everyone agrees that the U.S. health care system is fraught with waste, achieves variable quality, and fails to address important determinants of health. But few agree about exactly what to do,” says Elliott Fisher, the grant’s principal investigator and director of the Dartmouth Institute for Health Policy and Clinical Practice (TDI).

“This generous award will allow us to learn from the changes already under way in health systems across the country to develop guidance for policy makers, employers, and health system leaders to help accelerate the transition to a higher-performing health care system," he says.

Dartmouth is one of three centers awarded a total of $52 million from the agency, which is part of the U.S. Department of Health & Human Services.

Led by Fisher, the Dartmouth researchers will collaborate with colleagues from Harvard University, the University of California at Berkeley, and the High Value Healthcare Collaborative—which is a consortium of health care delivery systems working with TDI.

“Creating a sustainable, successful health care system will be one of society’s biggest challenges in the years to come,” says Provost Carolyn Dever. “This grant will enable Dartmouth to help advance our understanding of factors that influence successful implementation, foster innovation, and lead to important changes in health care systems nationwide, ultimately improving patient care.”

The research Dartmouth is undertaking builds on TDI’s decades-long work to evaluate health system performance, identify the sources of waste in health care, and offer solutions to the underlying problems. Led by Fisher and others at Dartmouth, TDI’s work has helped provide the motivation for U.S. health care reform and helped define the policy concepts that are being implemented in both public and private sectors, such as accountable care organizations. Dartmouth’s continued work to influence improvement in health care nationally is a priority of College President Phil Hanlon ’77.

The Dartmouth team includes Julie Bynum, Carrie Colla, Taressa Fraze, Valerie Lewis, Brooke Martin, Ellen Meara, Jeff Munson, James O’Malley, and Anna Tosteson, all of whom have appointments at TDI, which is part of the Geisel School of Medicine.

Meredith Rosenthal from Harvard; Lucy Savitz from Intermountain Health Care, in Salt Lake City, Utah; and Nilay Shah of the Mayo Clinic, which is based in Rochester, Minn., round out the Center of Excellence team working with Dartmouth.

The other two centers are the National Bureau of Economic Research in collaboration with the Health Research & Educational Trust, an affiliate of the American Hospital Association; and the RAND Corporation, in collaboration with Pennsylvania State University.

Each center will have a different focus. The Dartmouth group will conduct a national survey of health care organizations and systems to better understand the inner workings of systems, in particular how they implement biomedical, delivery, and patient-engagement innovation. Their findings will help guide the development and use of evidence from patient-centered outcomes research.

The three Centers of Excellence will study the way delivery systems disseminate and use patient-centered outcomes research and how evidence can be used to improve the performance of the U.S. health care system. The project is funded by the Patient-Centered Outcomes Research Trust Fund, which was created by the federal Affordable Care Act. The work is set to begin in September.

“This is a wonderful example of how multidisciplinary, multi-institutional research teams can work together to advance our understanding of health care and to help improve system performance,” says Professor Stephen Shortell, who, with Associate Professor Hector Rodriguez, leads the UC Berkeley team.

AHRQ will also fund a coordinating center to help facilitate collaboration among the three centers in the development of a national compendium of the performance of health care systems across the United States. The agency’s mission is to produce evidence that can be used to make health care safer, of higher quality, more accessible, more equitable, and more affordable, and to work within the U.S. Department of Health and Human Services and with other partners to make sure that the evidence is understood and used.