Health Care Delivery Research

  • Victor M. Montori, M.D.
    • Director, Health Care Delivery Research Program

Victor M. Montori, M.D.: My name is Victor Montori and I am director of the Health Care Delivery Research Program, one of the program components of the Center for the Science of Healthcare Delivery at Mayo Clinic. I'm an endocrinologist. I take care of patients with diabetes, but I also do research. In that capacity, I work in the center to advance the ways in which we can conduct research to improve the care we deliver to patients.

The Health Care Delivery Research Program, or HEATHER for short, has four approaches, or four ways, in which it can improve the way care is experienced, care is delivered, how the population can have better health and better health care, and how we can do it while using fewer resources. The first approach is by learning what is already known, what is it that we know works, what is it that we already know doesn't work, and what are the gaps in knowledge that require further study. This is important because it prevents us from wasting resources and rediscovering the wheel. That is a resource that is available to our clinicians and folks who are interested in finding out better ways of delivering care that are already known or to justify new work in an area of discovery. Another component looks to understand what is already known in a different way. It takes the data that has accumulated from taking care of thousands of patients not only at Mayo but across the nation and uses that information to identify new associations, new observations, new links that then can lead to understanding the impacts of policies on the way patients are cared for and the impacts of the way care takes place routinely on those policies.

The third component has to do with changing the way care is delivered, doing experiments in the way care is delivered, in the way care is experienced by patients directly. And finally we have another component that allows us to understand that experience by interviewing patients, by observing patients and their interactions with doctors or with family members or with the rest of their life, by collecting information directly from patients that reflect how they are doing with their condition, with their disease, and how they are experiencing the care we deliver at Mayo.

Put together all these capabilities, and the center will offer any of our partners, internal or external, the opportunity to further understand how best and how most efficiently we can deliver care that is centered around the patient, that is focused on advancing the patient's goals, and is able to do that with the best use or the optimal use of resources. Underlying all this there is a training program, the HEATHER's scholars program, that supports all these activities by taking our clinicians who have an interest and a passion in this area and providing them with an environment that mentors them in research and gives them the tools that they need to become the leaders in this area in the future.

The Health Care Delivery Research Program in the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery undertakes patient-centered research that focuses on the entire patient journey, not a single disease, test or treatment.

The program strives to develop, study, test, implement and ultimately share new models of patient-centered health care delivery. Through practice, study and research, the program works to find ways to improve patient care at an individual level in order to create positive patient outcomes.

The program's work is practice-based and aims to integrate clinical practice with the patient's community. Topics studied include health care access, use, disparities and adherence; comparative effectiveness; quality of care; the impact of policies on clinical practice (and vice versa); and the overall patient care experience.

Research in the Health Care Delivery Research Program's five focus areas will not only result in new insights, but also their translation into new models of affordable, effective, patient-centered health care.

Knowledge synthesis

The knowledge synthesis area works to summarize the available evidence on a particular topic. The Center for the Science of Health Care Delivery offers this service to Mayo's clinical practice to ensure that resources are not wasted pursuing questions that have already been answered elsewhere, as well as identify gaps in knowledge or implementation that Mayo can fill.

Knowledge synthesis greatly strengthens Mayo's ability to develop clinical guidelines based on evidence and best practices.

Practice interventions

In this focus area, the program is implementing and evaluating patient-centered interventions in normal clinical practice settings.

This has the potential to improve the lives of people with chronic conditions to the extent that those conditions reflect the systemic defects of poorly integrated systems of care that do not adequately take into account patients' needs. Minimizing the burden of treatment and increasing the coping ability of patients will result in a more customized model of health care delivery that perfectly fits each patient.

Today, such work is taking place through the Shared Decision Making National Resource Center at Mayo Clinic, as well as in comparative effectiveness translational trials related to diabetes in the Southeastern Minnesota Beacon Community. Through the use of design elements and visual tools, this area is creating and refining new approaches to engaging both clinicians and patients in decision making.

Behavioral and social science research

This area uses behavioral and social science methods to understand patient-centered health care; measure how such care is accessed, delivered and experienced; and study factors that enable or hinder the incorporation of innovations into routine clinical practice.

Methods used within this area include patient-reported outcomes, survey research and qualitative research. It's currently supporting a patient-reported outcomes project as part of the Southeastern Minnesota Beacon Community.

Health Care Delivery Scholars Research Program

To train the next generation of health services researchers, the Health Care Delivery Research Scholars Program offers mentored training opportunities in health services research to clinically trained doctoral-level fellows and junior faculty.

In addition to creating an academic home to nurture latent talent, the program is developing a unique cadre of clinician-researchers who are passionate about delivering the best health care to each patient.

Practice and policy analysis

In an effort to better understand how to create and measure value, this area models health care practice and policies while also evaluating their impact on patients, health care professionals, practices and systems.

Among other projects, it today supports the High-Value Health Care Collaborative, part of the center's Value Analysis Program. It also adds evaluation rigor to the other areas within the Health Care Delivery Research Program.