christiana care health system | Value institute

Value Institute 2013 Annual Report

Innovating

ImpactCare,

Maximizing

Value Institute FundamentalCommitments

To lead the way to better health,

better care and better value.

The Value Institute mission is to develop,

deliver and evaluate innovative solutions

impacting population health, patient

experience, system performance and

policy development.

The Value Institute is a diverse team of

experts collaborating in the discovery and

delivery of value-centered knowledge to

improve health.

Differentiation Statement

Vision statement

Mission stateMent

The CenTer for healTh Care Delivery SCienCeThe emerging field of health care delivery science research applies implementation science to patient-centered health care. This approach to understanding value implements new technology, health care practice and policies while simultaneously evaluating their impact on patients, health care providers, practices and systems. The resulting paradigm has the potential to transform how patients receive, experience and benefit from health care.

The CenTer for ouTComeS reSearChThe long-standing success of the Center for Outcomes Research provided a foundation for the Value Institute. This center has an established track record of conducting clinical trials, population health and epidemiological studies, and cost effectiveness research. It also functions as a data coordinating and statistical center for nationally funded multi-center research projects.

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Value Institute Centers

Lean Six Sigma proceSS improvement projectSacroSS chriStiana care

14

quaLity improvement projectS

111

Lean Six Sigma green BeLt candidateS

22

project team memBerS

100+

The CenTer for operaTional exCellenCe

The CenTer for QualiTy anD paTienT SafeTy

When I first heard President and CEO Dr. Bob

Laskowski describe his plan for a Value Institute

at Christiana Care in early 2011, I struggled a bit to

understand his concept of value as the institute’s

goal. Were we to focus on defining value in the

traditional way where value in health care denotes

quality over cost? Or should we concentrate on

established cost-effectiveness studies or perhaps

undertake more contemporary comparative

effectiveness research? It is no coincidence that

at the same time that he was making plans for a

Value Institute, Dr. Laskowski was articulating “The

Christiana Care Way,” which has become a directional

beacon for the health system:

This statement, rich with words such as expert,

effective, affordable and innovative, offers insights

into the meaning of value for us at Christiana Care.

The most important aspect of The Christiana Care

Way in defining value for us, however, is the central

focus that it places on our neighbors, our patients

and their families. Our neighbors and what they

expect from their medical care are the defining goals

of our work in the Value Institute.

We know that patients and their families expect

high-quality and effective medical care they can

afford. This is what they value. We know that medical

expertise is fully effective for our patients only

when it is provided with respect and compassion.

We understand the value that patients derive from

shared decision-making, patient autonomy and

attention to communication, trust and respect in

all aspects of their health care. For other decision-

makers, such as policymakers and payers, value in

health care is essential for the sustainability of our

care delivery system. For the Value Institute team

and our collaborators at Christiana Care, our patients’

expectations energize our work and inform our

goal of defining value across the full range of Value

Institute investigational and educational programs.

We also know that understanding how to reliably

deliver efficient and affordable medical care must be a

central component of this work.

Three pre-existing centers

of excellence with their

accompanying teams

formed the foundation

and infrastructure of the

Value Institute. The Center

for Outcomes Research,

established here in 2005

and led by Dr. Bill Weintraub, contributes an

experienced team of clinical outcomes researchers,

biostatisticians and data analysts along with their

academic sophistication and reputation. The center’s

principal focus is studies that accurately define the

impact of disease and the effectiveness of medical

care. Seema Sonnad, PhD, was recruited during the

past year from the University of Pennsylvania to join

these investigators as director of health services

research. Sharon Anderson, RN, MS, leads the Center

for Quality and Patient Safety and brings to the Value

Institute not only her team of Quality Assurance

and Performance Improvement professionals but

also her passionate leadership as a patient safety

and quality champion. The Center for Quality and

“We serve our neighbors as respectful, expert,

caring partners in their health. We do this

by creating innovative, effective, affordable

systems of care that our neighbors value.”

From the Executive Director

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Patient Safety conducts work focused on creating a

safe culture, achieving high reliability and leveraging

technology. Vernon Alders, MBA, MSW, leads the

third foundational component of the Value Institute,

incorporating his team of specialists in the Center

for Operational Excellence, contributing expertise in

system analysis, rapid cycle improvement programs

and Lean Six Sigma projects to improve the efficiency

of the processes used to deliver care.

The fourth Center of Excellence envisioned at

the outset of the Value Institute in 2011 has been

operationalized this past year. Dr. Eric Jackson,

Jr. came to Christiana Care Health System from

Johns Hopkins one year ago to direct the Center for

Health Care Delivery Science and serve as associate

director of the Value Institute. This center, under Dr.

Jackson’s innovative leadership, will take a new path

toward defining value for our patients. Combining

performance improvement projects with evaluative

science methodology, his Center for Health Care

Delivery Science will create and analyze system-

based processes of care that our patients value.

His team will work in the new and highly relevant

area of implementation science, a contemporary

investigative space emphasizing pragmatic and

innovative solutions to challenging clinical issues.

Much has been accomplished this past year.

Existing teams have been strengthened through

relocation and realignment in some instances and

expansion in other cases. New investigators and

program leaders have been recruited to the Value

Institute, with backgrounds and expertise in health

policy, health economics, information technology

and data analytics along with traditional clinical

research. This new team was brought together for

the development of a strategic plan. In that process,

goals for the Value Institute were jointly developed

and the essential patient- and family-focus of our

work was accepted by all. The Value Institute team

is ready and eager to move forward with confidence

in our ability to increase value for our neighbors and

patients while following the guiding principles of The

Christiana Care Way.

Tim Gardner, M.D.

Executive Director, Value Institute

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Timothy Gardner, M.D., Executive Director, Value Institute; Medical Director, Center for Heart and Vascular Health

people, plaCeS, SpaCeS Location on the hospital campus paved the way to expanding the Value Institute. The additions of the Center for Health Care Delivery Science and the health services research teams complement the pre-existing strength of the Center for Operational Excellence, the Center for Quality and Patient Safety and the Center for Outcomes Research. New positions encompassing economics, law, sociology, public health, IT and biostatistics have been filled in our first year, almost doubling the size of the existing core team.

value inSTiTuTe SCholarS Inspired by The Christiana Care Way, “to serve our neighbors as respectful, expert, caring partners in their health,” Value Institute Scholars apply their clinical experience to produce high-quality, high-impact research. Our Research Scholars have training and skills in clinical and health services research, and our Clinical Scholars use their daily interactions with patients to generate research ideas and to implement projects.

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Innovating Care

empLoyeeS to date

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U.S. Sen. Tom Carper of Delaware (center) visited the Value Institute in August 2013.

Value Institute Scholar Edmondo Robinson, M.D., MS, MBA, Associate Chief Medical Officer and Physician-in-Chief of Wilmington Hospital, speaks on access to health care at the opening of the new Wilmington Hospital South Tower.

our empLoyeeS originate from 6 different countrieS on 3 continentS

6/3 departmentS

17

22 scholars

48mds32

phds dmd pharmd8

jd1 1 1

maSter’S degreeS

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value inSTiTuTe SCholarS by The numberS

12added thiS year

SpeciaLtieS

GranTS Obtaining a broad range of grant funding allows the Value Institute to create knowledge that improves patient care and outcomes.

ConSulTaTionS The Value Institute receives requests for collaboration and research assistance from departments throughout the Christiana Care Health System and from our external partners. Alignment with annual operating plan goals and staffing capabilities allows us to prioritize projects and respond to our collaborators in a timely fashion.

projeCTS The Value Institute pursues an ambitious research agenda with the long-term goal of positively impacting patients and the community while extending Christiana Care’s research presence on a national and global level.

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naTional SponSorS inCluDe

• Agency for Healthcare Research & Quality

• Centers for Disease Prevention and Control

• Centers for Medicare & Medicaid Services

• Department of Defense

• National Institutes of Health

_NHLBI (National Heart, Lung, and Blood Institute)

_NIGMS (National Institute of General Medical Sciences)

privaTe SponSorS inCluDe

• AstraZeneca

• Daxor

• Osler Fund

• Sanofi-Aventis

• Simons Foundation

RequesTeR compLeTes consuLTaTIon RequesT web foRm

RequesT ReceIVed by admInIsTRaTIVe Team foR documenTaTIon

dIscussed aT pRojecT GoVeRnance meeTInG

assIGned To Team membeR

70diverSe and high-impact vaLue inStitute reSearch projectS in the LaSt year

utiLization of thiS proceSS haS aLLowed uS to review 103 conSuLtation requeStS from 40 inveStigatorS acroSS 18 departmentS in 10 monthS.

an infinite numBer of LiveS changed and famiLieS touched

251613

active grantS

different SponSorS

miLLion doLLarS in active grantS

returned to requester for additional information

SyStemS & ProceSS ImProvement

CardiovasCular disease

InfectIous DIsease

SubStance abuSe

Home Care

Global HealtH

Infrastructure Grants

kidney disease

Pain

Women’s & Children’s health

publiCaTionS The Value Institute is engaged in building evidence-based health care innovations, representing a new way of measuring patient and system outcomes. Our goal is to apply rigorous science to expand knowledge that will improve outcomes for individual patients and populations. Making these advances available to other clinicians, health systems and ultimately patients across the globe drives the Value Institute’s goal of increasing Christiana Care’s contributions to the peer-reviewed literature.

ConferenCe preSenTaTionS

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Maximizing Impact

leveraGinG TeChnoloGy

Recognizing that the process

of managing information

during the publication

process is challenging, the

Value Institute worked with

the Medical Libraries of

Christiana Care to acquire

two supporting technologies.

Mendeley® functions as

a reference manager, PDF

organizer and collaboration

network. PubsHub™ provides

valuable data, including time

to publication and journal

influence helping researchers

decide which journals and

conferences are the best

outlets for their work.

100+puBLicationS Since auguSt 2012

10 women & chILdRen

10 emeRGency

& TRauma

15socIaL

scIences, quaLITy &

safeTy

9other

13surgery

27caRdIoLoGy

19MeDICINe

SPeCIALtIeS

publiCaTionS by SpeCialTy

29 vaLue inStitute SchoLarS

from 11 different departmentS

have Brought Both the innovative

work we are doing, and the vaLue

inStitute itSeLf, to the attention

of reSearcherS and cLinicianS

through 50 unique conference

preSentationS in 4 countrieS.

eDuCaTion Expanded Value Institute Academy classroom and online courses, student research opportunities and a growing group of investigators allow a broad range of formal, experiential and mentoring based learning opportunities.

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The Value Institute co-sponsored the annual INBRE Scholars Research Day. Above, VI summer intern Leslie Carandang presents her research. Below, Tom Bauer, M.D., Section Chief of Thoracic Surgery and a Value Institute Scholar, opens the 2013 event.

Value Institute team members offer mentoring-based learning opportunities. Here, long-time Chair of Surgery and Senior Consultant for Advances in Medicine, Michael Rhodes, M.D. (center), addresses Value Institute staff including Beth Ivey, Senior Systems Analyst (left) and Pan Wu, PhD, Senior Biostatistician (right).

The value inSTiTuTe aCaDemy anD value inSTiTuTe SCholarS

LeARNINgNetwORkINgresearch

VIacademy

onLIneLeaRnInG

VI basedsummeR

sTudenTs

InbRe sTudenTs29

sTudenTs17

unIVeRsITIes

VIacademy

cLassRoomsessIons

816 new

LeaRneRs

CollaboraTinG beyonD ChriSTiana Care Value Institute researchers have established partnerships with collaborators representing the continuum of corporate entities, health care providers and research associations.

Global enGaGemenT Value Institute investigators are engaged in collaborative global health initiatives on the continents of Africa and Asia. Team members are playing key roles in the study of cardiovascular outcomes in China and the implementation and evaluation of innovative anesthesiology technology in low resource countries in Africa.

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Increasing Value

CollaboraTorS

Delaware parTnerS

• AI DuPont/Nemours

• Delaware Bioscience Association

• Delaware Health Sciences Alliance

• University of Delaware

univerSiTieS

• Duke University

• Johns Hopkins University

• Medical University of South Carolina

• Northwestern University

• thomas Jefferson University

• University of Pennsylvania

• University of Virginia

• wake Forest University

inDuSTry parTnerS

• Booz Allen Hamilton, Inc.

• ColdLight Solutions, LLC

• gradian Health Systems®

• HealthCore, Inc.

• Medecision®

• Swets

naTional reSearCh neTworkS

• HOMeRUN (Hospital Medicine Re-engineering Network)

• SHeA (Society for Healthcare epidemiology of America)

patientS enroLLed in an epidemioLogicaL Survey on cardiovaScuLar diSeaSe and itS riSk factorS in china with inveStigatorS from chriStiana care and Beijing univerSity

20,000patientS enroLLed in a piLot Study Being conducted in Sierra Leone with inveStigatorS from chriStiana care and johnS hopkinS univerSity

1,400+

Mobile provider training lab in Sierra Leone uses simulation to teach safe use of Universal Anesthesia Machine (developed by Gradian Health Systems®).

GueST SpeakerS The Value Institute invited local and national subject matter experts to provide new insights to Christiana Care clinicians and researchers. These speakers serve as a conduit to external collaborations, while their talks reinforce the urgent need, shared by all stakeholders, for value-based research in the health care industry.

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different LectureS hoSted By the vaLue inStitute

20LectureS from externaL SuBject matter expertS repreSenting academia, induStry and government

11additionaL SuBject matter expert preSentationS from our chriStiana care coLLeagueS

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Here with Value Institute Associate Director Eric Jackson, Jr., M.D., MBA (left), quality-based health care expert Don Berwick, M.D., MPP, delivered the keynote address at the May 2013 Value Symposium: “Transforming Health Care in America: Making the Triple Aim a Reality.”

Robert Laskowski, M.D., MBA, President and CEO, Christiana Care, leads a Value Symposium panel discussion with Don Berwick, M.D., MPP, President and CEO, Institute for Healthcare Improvement; Bettina Riveros, JD, Health Policy Advisor to Gov. Jack Markell and Chair of the Delaware Health Care Commission; former Delaware Gov. Pierre S. “Pete” du Pont IV, board member of the Delaware Public Policy Institute; Stephen Kushner D.O., President of the Medical Society of Delaware and a physician at the Medical Group of Christiana Care’s Hockessin Family Medicine Office; and Timothy Gardner, M.D., Executive Director of the Value Institute.

Lynn Sha (right), Senior Health Policy Advisor to U.S. Sen. Tom Carper, learns about the Value Institute from James Williams, an INBRE summer intern; Sudhakar Satti, M.D., a Christiana Care neuro-interventional surgeon and Value Institute Scholar; and Value Institute Research Associate Jennifer Goldsack, MChem, MA (Oxon), MS.

Value InstituteChristiana Care Health SystemJohn H. Ammon Medical Education Center2nd Floor, Suite 2E554755 Ogletown-Stanton RoadNewark, Delaware 19718

302-733-4380 | Phone302-733-5884 | Fax

TheValueInstitute@ChristianaCare.orgwww.ChristianaCare.org/ValueInstitute

Value Institute Leadership TeamTimothy Gardner, M.D.Executive Director

Eric Jackson, Jr., M.D., MBAAssociate Director

Vernon Alders, MBA, MSW Sharon Anderson, RN, MSClaudine Jurkovitz, M.D., MPHPaul Kolm, PhDMichael Rhodes, M.D.Herbert ScherrerSeema Sonnad, PhDWilliam Weintraub, M.D.

Christiana Care is a private, not-for-profit regional health care system and relies in part on the generosity of individuals, foundations and corporations to fulfill its mission. To learn more about how you can support our mission, please visit christianacare.org/donors.