Every day, healthcare organizations are faced with crucial decisions about improving their systems of care, but they often lack critical information needed to guide them. Research could help them provide better care more effectively and efficiently, leading to improved patient-centered outcomes.
Improving Healthcare Systems (IHS) is one of PCORI’s five national priorities for research. This priority focuses on comparing healthcare system–level approaches to improving the safety, effectiveness, patient-centeredness, timing, efficiency, equitability, and accessibility of care and healthcare practice.
Our IHS program funds and manages research studies, related to this priority, that will provide valuable knowledge to patients, their caregivers, and clinicians, as well as to other stakeholders, including healthcare leaders. The studies will address which features of systems lead to improved outcomes that are important to patients and their families. These projects must compare effectiveness of alternate features (e.g., innovative technologies, personnel deployments, incentives, organizational structures and policies) designed to optimize the quality, outcomes, and/or efficiency of care for the patients served.
Governmental policies and market forces can motivate healthcare systems to make clinical, organizational, workforce, and financing decisions that improve delivery of accessible, high-quality, efficient, and equitable care. Demographic and clinical characteristics of the populations served and the scope and mission of the system can also influence these parameters. Our IHS program has identified four major categories of innovation that have especially high potential to drive improvements in healthcare systems and outcomes. These IHS program intervention targets include:
- Information technology (IT) or other electronic technologies (e.g., interoperative electronic health records, telemedicine, patient-accessible medical records)
- Creative uses of incentives (e.g., offering free or subsidized self-care opportunities to patients, offering value-based payments to healthcare providers, shared savings)
- Novel deployment of personnel (e.g., multidisciplinary teams, peer navigators, community health workers, home-care physicians)
- Organizational structures and policies (e.g., standing orders)
Our program is interested in supporting studies designed, whenever possible, to determine the differential effect of systems-level innovations on specific subpopulations. These include people with multiple chronic conditions, mental or physical disability, frailty, low health literacy, innumeracy, unfamiliarity with the English language, low income, lack of access to primary care, and residence in rural and inner city locations.
We are also exploring combinations of drivers that may prove productive in improving healthcare systems.
Posted: September 10, 2014; Updated: March 22, 2017