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Vital Signs

A "clarion call" from the North Country, thanks to a $35-million donation

By Jennifer Durgin

The new initiative will draw on expertise from across campus, including DMS (in the foreground) and DHMC (not in this view).

For three decades, researchers at Dartmouth Medical School have been diagnosing what's wrong with the U.S. health-care system. Their chief complaint—that an estimated 30% of health-care dollars are wasted—became a rallying cry in the recent debate over reform. Now, thanks to a $35-million gift from an anonymous donor, they'll be joining forces with other experts from across Dartmouth to transform the U.S. health-care system.

Best: On May 17, Dartmouth president Dr. Jim Yong Kim announced the formation of the Dartmouth Center for Health Care Delivery Science. Simply put, the science of health-care delivery is about figuring out the best way to provide effective, appropriate care at a reasonable cost. It's about answering such questions as "What's the best way to hand off information from one physician to another?" Or "How can the medical payment system be changed to reward quality instead of promoting procedures that drive up costs and may not improve health?"

On the continuum of health-care sciences, there are basic scientists who reveal the underpinnings of normal and abnormal biological function; clinical and translational researchers who apply that knowledge to the development of new treatments; and policy analysts who study the quality and outcomes of interventions. But there has not been a field that asks what Kim calls "the fundamental question" of how best to deliver care.

"To look at health-care delivery as a science is really appealing to those of us who have spent our careers in research," says Dr. William Green, the dean of the Medical School and an immunology researcher.

Cost: "The real rocket science now in health care," Kim is fond of saying, "is cost and quality." The problem is "so complicated," he adds, that it calls for an all-hands-on-deck approach.

Core: That's why the Center is bringing together faculty from the Medical School, the Tuck School of Business and Thayer School of Engineering, and Arts and Sciences. The Dartmouth Institute for Health Policy and Clinical Practice (TDI) and DHMC will be core partners in the effort. Faculty with expertise in management, systems thinking and engineering, sociology, anthropology, economics, medicine, and health policy will collaborate on research, new degree programs, the implementation of new delivery models, and advocacy for reform.

The Center will be led by Kim and Dr. James Weinstein, who also heads TDI and shares the Dartmouth-Hitchcock presidency with Nancy Formella.

Kim has been calling for this new field of study since his arrival at Dartmouth in July 2009. And he has been solving health-care delivery problems internationally for almost as long as Dartmouth researchers have been documenting variation and waste in the U.S. system. (For more on Kim's background, see "Public health pioneer Jim Yong Kim is named president of Dartmouth.")

The real rocket science now in health care is cost and quality.

Care: Meanwhile, D-H has become a leader in transparency, quality, outcomes reporting, and innovative models of care—such as the Spine Center and Center for Shared Decision-Making.

"We've been the academic voice pointing to the problems," Weinstein told Bloomberg.com, one of many media outlets to cover the announcement. "We now need to be the academic voice that points to solutions."

With education at the core of Dartmouth's mission, the curricular offerings of the Center will be "as important as anything in terms of having an impact," says Green. The science of health-care delivery will be woven into the M.D. program in some form, he says, most likely in the fourth year, though "some exposure on day one is important," too.

There will also be a master's of health care delivery science, aimed at health-care administrators and other professionals, and a journal for the new field.

Clarion: The Center, Kim told Bloomberg.com, is "a clarion call to colleges and universities throughout the country and . . . the world. . . . In five years, if we're the only center for health-care delivery science, we'll be very disappointed."


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