Q & A with Veronique Roger, M.D., Director of the Center for the Science of Health Care Delivery

1. What is health care delivery science?

The science of health care delivery focuses on how patients actually receive care. From using engineering principles to determine the most efficient way to schedule patient appointments, to research focusing on the most successful, cost-effective means for delivering treatment, this discipline's aim is to enhance the patient's experience with health care by improving quality, outcomes and cost.

2. What is the Center for the Science of Health Care Delivery?

The Center for the Science of Health Care Delivery (CSHCD) is a new initiative that builds upon more than a century of health care delivery research at Mayo Clinic. The goal of the CSHCD is to focus and coordinate resources to analyze, evaluate and implement care delivery models that improve value for patients.

The center is highly focused on the "science" aspect of care delivery — not simply on anecdotal evidence that may suggest issues or solutions. Combining data analysis, engineering principles and health care delivery research, CSHCD will put its theories, models and care delivery methods through the scientific rigor necessary to determine whether or not they will improve patient care, outcomes and cost. Ideas developed and tested in the center can be seamlessly implemented into the Mayo Clinic practice.

3. Describe Mayo Clinic's experience with health care delivery science.

Mayo Clinic, which pioneered the first group practice of medicine, has applied health care delivery science principles since its inception. For example, Henry Plummer, M.D., an early partner of the Mayo brothers, developed the concept of a unified patient record in 1907. This record replaced individual patient notes that physicians had kept tucked away in their offices. The unified record included a patient's medical history, clinic visits and hospitalizations in a single paper file that traveled with the patient and was kept in a central location. This innovation allowed all providers easy access to a patient's critical health information and led to improved, integrated care for patients.

4. Why was this center created at Mayo Clinic?

American health care cries out for the discipline of health care delivery science because — as a whole — U.S. health care is disintegrated, uncoordinated and expensive.

As Congress continues to grapple with how to reform health care, Mayo Clinic is "just doing it" — starting with our own medical practice. We constantly strive to perfect our own processes and procedures because we believe that health care providers have a responsibility to lead this effort. By creating the CSHCD, Mayo Clinic is emphasizing the need to invest more resources into this discipline and accelerate the pace of improvement.

Through the center, Mayo Clinic will continue to lead the way in patient-centered health care innovation. By developing best care practices at Mayo Clinic and with partners across the country, Mayo Clinic will work to alleviate the nation's health care problems and improve the standard of care nationwide.

5. How is the center organized?

CSHCD encompasses four major programs. Each has a specific role to play in our quest to improve quality and add value to patient care.

• The Value Analysis Program examines quality measures, safety, cost, outcomes and other data to identify best practices. A key project within this program is the High-Value Health Care Collaborative, which was launched in late 2010 by a group of six leading health care organizations, including Mayo Clinic. Toward a goal of improving health while reducing costs, organizations in the collaborative are collecting and exchanging data on quality, outcomes and cost for expensive, high-variation conditions such has knee and hip replacement surgery. Through this initiative, researchers hope to identify the true cost of providing the best, evidence-based care.

  The collaborative recently submitted a paper for publication about best practices for knee replacement procedures, focusing on outcomes and success rates. The findings of this study may also have a positive impact on costs associated with this type of surgery, which is often performed on patients who rely on Medicare for their health care expenses. Future efforts of the collaborative will focus on diabetes care delivery, and pilot projects involving bariatric surgery practices are also under consideration.

• The Health Care Delivery Engineering Program applies principles from systems engineering, management and science to improve patient care. In this program, engineers will examine the behind-the-scenes systems and principles that shape a patient's experience and quality of care during a medical visit. For example, by correcting inefficiencies within appointment-scheduling processes, health care providers will be able to see more patients and to spend more time with those patients. One current engineering project involves creating statistical forecasting models that help predict patient appointment needs and physician availability – enabling patients to be seen and diagnosed more quickly.
• The Health Care Delivery Research Program will take a slightly different approach to achieving the center's goals by working to develop, study, test, implement and share new ways of providing patient-centered care. Program elements include behavioral and social science, health care analysis, knowledge synthesis, practice interventions and a scholars program. One area of focus is in shared decision making, where patients take an active role in developing their own treatment plans. By having a hand in the decision making process, patients become more engaged in their own health and are more likely to follow through with treatment recommendations.
• CSHCD recently added a Population Health Program, which works to improve the health of various community groups. The Southeast Minnesota Beacon Community is an example of work within this area. Beacon focuses on two health conditions: childhood asthma and adult Type II diabetes. Both are highly prevalent conditions that are associated with increased health care costs, restricted lives, complicating illnesses and loss of time at work or school. Beacon seeks to understand the scope of these two public health problems, obtain accurate patient counts to best determine how people are being served and how many are underserved in some way. Another goal is to connect all the health care systems that come in contact with these patients, using information technology to create a communication system for coordinating and improving care.