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

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

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

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

39. Bringing the Numerator to Life

40. The Spine Center’s Data Collection

41. Available and Actionable

42. Case 1

43. Case 1

44. Case 2

45. Case 2

46. Case 3

47. Case 3 Case 2

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

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

50. 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)