The changing health care landscape, accelerated by the Affordable Care Act, has signaled a move of the federal government, as well as private insurers, from fee-for-service to value-based reimbursements. To ramp up for this change, academic health centers are creating larger, integrated care delivery systems through mergers and acquisitions of hospitals, physician practices, and potentially of digital health companies. Continue reading Health Care Mergers and Acquisitions: A Promising New Environment for Medical Research?
Reproducibility has emerged as a touchstone controversy within the scientific community, the public and the Congress over the past few years. In the wake of recent reports and headlines, science has come under intense scrutiny. But revelations about failure to reproduce experiments, alone, should not shake our trust in the legitimacy of the medical research enterprise. In fact, the attention may be a good thing. As scientists, we understand the complexities of science, but understanding among ourselves will not reassure the public and Congress. If we truly want to engender the public trust and enhance our own learning, let’s welcome this opportunity to address limitations and uncertainties and improve our processes and communication in science rather than overlooking, ignoring, suppressing or railing against the topic.
The term itself, “reproducibility,” can provoke an array of reactions – from immediate confidence (the results were reproducible and so are credible!) – to consideration of the context of the results (differences due to biological variables and applicability of the model, e.g. Were the results obtained in male humans, animals, and cells not generalizable to female species? Was the animal model simply not applicable to humans? Are there discrete differences in the population studied that masked important differences?) – to unfortunate misperceptions (science is fickle. The results must be fraudulent).
Perceptions in the public and in Congress shape policies. To that end, the NIH has just taken a big step toward ensuring reproducibility by increasing the requirements for rigor and transparency in the research that it funds.
At the 2015 GREAT Group and GRAND Professional Development Meeting, prior to the release of the new policy, NIH principal deputy director, Larry Tabak described the NIH’s proposed solutions within the policies to enhance reproducibility: 1) being accountable for adequately describing the methods or materials; 2) noting limitations in the study design; 3) considering all relevant biological variables in the scope of the research (the NIH specifically called out that sex is a biological variable and focusing studies on male animals and cells may obscure the importance of sex on biological processes and responses to interventions); 4) authenticating key biological and chemical resources; and 5) bearing in mind implicit biases in how the results are interpreted or disseminated. Thankfully, from the evidence available, fraud or misrepresentation of findings accounts for only a small percentage of the problems identified, and the scientific community and federal sponsors have effective means to address misconduct.
Navigating the reproducibility rapids goes beyond this policy. There are additional steps the entire research community can take to advance rigor and transparency; and that is by promoting and sharing negative findings as a rule. Beyond enhancing a sense of openness, there may be vital scientific knowledge residing in those negative findings – a legitimate source of “irreproducibility” that could help dissect when and for whom certain interventions may be promising and when and for whom they may not. And, isn’t that a clear signpost for building public trust?
This will take all of us. Sharing data (both negative and positive) would need to be a consideration in merits and promotions, welcomed for publication in respected journals, and established in trusted infrastructures and venues where data sharing is not a prohibitive time and resource burden for the scientists who do the work, or a concern for not protecting privacy in human studies.
In the end, navigating the reproducibility rapids may lead us not only to public confidence and supportive policies, but also to a “learning research system.”
This post originally appeared on aamc.org
Ann Bonham, PhD, is chief scientific officer at the Association of American Medical Colleges. She can be reached at firstname.lastname@example.org.
Several weeks ago, I was fortunate enough to attend a meeting at the Association of American Medical Colleges (AAMC) on a new mandatory payment model for joint replacement. I was the only resident physician among the more than 70 health professionals at the meeting. What I learned is that for most trainees in medical school and residency, little time is spent understanding the nuances of health care finance or practice management. Continue reading Left Behind: Why Excluding Residents from Delivery System Reform Hurts Us All
Highly activated patients take proactive, collaborative roles in maintaining their health. They are more likely to engage in healthy and preventive behaviors than their less activated counterparts, and incur lower health care costs. Higher activation often corresponds with improved health outcomes and greater patient satisfaction. However, increasing patient activation can be difficult, especially when patients face such additional challenges as low literacy, language and cultural barriers, and physical disabilities.
Patient activation is a fundamental component of the Patient-Centered Medical Home (PCMH), a care model that increases patient engagement with a team of health care providers through coordinated care and the use of technology. A clinical education and research project team led by Adina Kalet, MD, MPH at the NYU School of Medicine, Division of General Internal Medicine, part of the NYU Langone Medical Center (NYU Langone) is developing and testing an innovative Patient Empowerment Program (PEP) within NYU’s PCMH and linking it to the training of primary care residents. This work was supported by a Clinical Care Innovation Challenge Award from the Association of American Medical Colleges. Continue reading Activating Patients to Achieve Better Health Outcomes: Spotlight on NYU School of Medicine
Three in four physicians stated that unnecessary tests and procedures contribute to the high cost of health care in the United States, according to a survey conducted by PerryUndem Research/Communication. In recent years, medical societies and health care professionals alike have begun to speak out on the overutilization of tests and its harmful effects on health. Nilay Patel, MD, an internal medicine resident at Massachusetts General Hospital (MGH), understands that we must shift away from our “more is better” culture. That shift can start by equipping residents with the proper knowledge, skills, and tools to promote a culture of high-value care among their patients.
Cost-Value of Patient Care
Patel partnered with his faculty advisor, Ryan Thompson, MD, to investigate MGH residents’ knowledge of the relationship between cost and value due to residency program curriculum, and their consideration of cost–value during daily patient activities. The results were startling: Only 35 percent of residents felt that the current curriculum prepared them to consider the cost–value of patient care during delivery; fewer than 50 percent of residents considered cost–value of procedures and tests on a daily basis.
“These results verified that there was a need for a new, innovative curriculum to train internal medicine residents at MGH in the delivery of high-value care,” said Patel.
Patient safety is essential to addressing and improving the quality of our health care. The release of “To Err is Human,” the landmark report by the Institute of Medicine (IOM), highlighted the need for health care professionals to discuss patient safety in relation to medical errors. Continue reading Training Residents to Be Error Free
Part two of a five part series on the 2014 AAMC Clinical Care Innovation Challenge Pilot Award Winners
Several years ago in Brazil, medical student Anatalia Labilloy witnessed a newborn die in the delivery room when the care team could not properly perform neonatal resuscitation. The experience left an indelible memory with her. She was early in her medical training and she was anxious about encountering other occasions to resuscitate babies knowing what could happen. Now as a resident at Cincinnati Children’s Hospital Medical Center, Labilloy is practicing vital resuscitation skills to help babies breathe.
Part one of a five part series on the 2014 AAMC Clinical Care Innovation Challenge Pilot Award Winners
Imagine this video game scenario: a player explores a small town participating in everyday activities aimed to help them better understand and manage type 2 diabetes. The player wanders into the local town café, and is asked to pick out a snack that is suitable to their dietary needs.