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Thom Walsh PhD, MS, MSPT thom.walsh@dartmouth.edu |   twitter.com/@thomwalsh

Developing Sustainable Methods of Health Care: A Global Challenge The Dartmouth Center for Health Care Delivery Science. Thom Walsh PhD, MS, MSPT thom.walsh@dartmouth.edu |   twitter.com/@thomwalsh. The Dartmouth Center for Health Care Delivery Science.

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Thom Walsh PhD, MS, MSPT thom.walsh@dartmouth.edu |   twitter.com/@thomwalsh

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  1. Developing Sustainable Methods of Health Care: A Global ChallengeThe Dartmouth Center for Health Care Delivery Science Thom Walsh PhD, MS, MSPTthom.walsh@dartmouth.edu |  twitter.com/@thomwalsh

  2. The Dartmouth Center for Health Care Delivery Science Created in 2010, the Dartmouth Center for Health Care Delivery Science draws upon unique resources from across disciplines, forming innovative global partnerships that bring the discipline of science to the questions of service delivery while building a deeper understanding of the personal dimension of health and health care.

  3. CEO Dartmouth-Hitchcock Health SystemJim Weinstein DO, MS “We must find a sustainable health system for patients, providers, payers, and our communities”

  4. A Health Care Delivery Science Post-Doc’s Life The Dartmouth Center for Health Care Delivery Science Master of Health Care Delivery Science Research

  5. Best Thinkers Across Disciplines Best Thinkers • Best Doers Across Contexts • Best Communicators Across Constituencies

  6. Best Thinkers Across Disciplines • Best Doers Across Contexts Best Doers • Best Communicators Across Constituencies

  7. Best Thinkers Across Disciplines • Best Doers Across Contexts • Best Communicators Across Constituencies Best Communicators

  8. Health Care Delivery Science Health Care Delivery Science D B The Implementation Gap Outcome A C Spending

  9. The Dartmouth Center for Health Care Delivery Science

  10. Across Countries and Contexts Dr. Lisa Adams in Rwanda Dr. Jaime Bayona in Tanzania Health Coaches in Peru

  11. Health & Health Care Clinical training teaches us to link outcomes and exposures • Upper respiratory infection  viruses • Cancer  carcinogens • Obesity  calories in/calories out

  12. There Is More to the Story… The Field Model

  13. McKinlay & McKinlay 2005[1997]. Pp. 7 - 19 Sociology of Health & Illness

  14. Haiti • Affordable housing and health: The $300 House Project • Medical education: weekly video lecture series in “grand rounds” style to seven sites in Haiti.

  15. Haiti: The $300 House Project Molly Bode at Dartmouth site visit for $300 House Project Cross-disciplinary approach to health care: Studio Art / Architecture, Thayer Engineering, Tuck Business, Undergraduate Arts & Sciences, Graduate Studies, Geisel School of Medicine

  16. The Epidemiologic Transition Wilkinson, R: Unhealthy Societies 1996

  17. The Epidemiologic Transition

  18. Medical Education in Haiti • Dartmouth, Haiti Medical Education (HME) Project & McGill University weekly video lecture series and curriculum development • Building an education network

  19. Peru: Partnership Overview Dartmouth undergraduate and medical students in Lima, Peru Oncology systems with National Cancer Institute Emergency preparedness Primary care Maternal mortality prevention Shared decision making Geisel, Tuck, Thayer, and Arts & Sciences collaborating on projects

  20. Rwanda Dr. Agnes Binagwaho, Minister of Health of Rwanda, receiving an honorary degree from Dartmouth President, Dr. Jim Yong Kim, in 2010.

  21. Moving from Infectious to Chronic Disease & Unintended Consequences

  22. The Distribution of Health Care Spending Per Condition for Similar Patients Adapted from “Cowboys and Pit Crews” by Atul Gawande, The New Yorker. May 26, 2011

  23. The Distribution of Quality Health Care Provision Per Condition for Similar Patients

  24. What We Believe Cost & Quality Curves Match

  25. Implication Curves match • Reducing health care spending impairs quality

  26. What the Data Tell Us Cost & Quality Curves Do Not Match Some Areas Provide Above Average Quality at Below Average Spending

  27. Implication Curves do not match • It is possible to reduce spending and improve quality

  28. Health Care Reform in China Dartmouth’s Approaches to Serve China Chinese Provinces • National & Regional Dartmouth Atlases • A High Value Health Care Collaborative • New Models of Primary Care • Leadership Training Programs

  29. Different Contexts • Developing, emerging, & sustaining economies • Single payer & multi-payer health care systems

  30. Similar Interventions • Assessment of variation as a catalyst for change • Networks • Improvement • Education • Reforming & revitalizing primary care • Community integrated care • Shared Decision Making

  31. Master of Health Care Delivery Science (MHCDS) Faculty

  32. Dartmouth College Master of Health Care Delivery Science

  33. On-Line Synchronous Platform

  34. Learning in Action 2013

  35. Break

  36. C. Monet(1840-1926) Research Focus

  37. The Value Equation V = OP / C Value = Patient Outcome / Cost of Care

  38. Bringing the Numerator to Life

  39. The Spine Center’s Data Collection

  40. Available and Actionable

  41. Case 1

  42. Case 1

  43. Case 2

  44. Case 2

  45. Case 3

  46. Case 3 Case 2

  47. The Value Equation V = OP / C Value = Patient Outcome / Cost of Care

  48. Preference Diagnosis http://www.kingsfund.org.uk/publications/patients%E2%80%99-preferences-matter

  49. Preference Diagnosis 71%of physicians rated “keeping my breast” as a top priority for women with breast CA 7%of women report “keeping my breast” as a top priority (Lee 2010)

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