The Community As A Learning Health System. Larry A. Green, MD University of Colorado Denver September 20, 2012. May 2012. This Presentation. Recall some things we think we know that might guide further practice based research.
Larry A. Green, MD
University of ColoradoDenver
September 20, 2012
McGinnis JM, Foege WH. Actual Causes of Death in the United States. JAMA 1993;270:2207-12.
Mokdad AH, Marks JS, Stroup DF, Gerberding JL. Actual Causes of Death in the United States, 2000. JAMA 2004;291:1230-1245.
Starfield. Milbank Quarterly, 2005
Number of AHRQ-registered PBRNs: 136 (as of July 2012)
Descriptive information about primary-care PBRNs (N = 116)
Descriptive information about primary care PBRNs (N = 116)
From what –to—what?
Profit Healthy Communities
Technicians/Lineworkers Personal Physicians
Produce Inequities Relieve Disparitites
Shrinking Scope Comprehensive Scope
PH+MH+PC+FM Reunited-Integrated Platform
Biologic Science All Relevant Science
Little Data Big Data
Fuzzy Boundaries Multilateral Compacts
Pay for Fragments Blended/Bundled Payment
Heroic Physician Championship Team
Weak Infrastructure New Infrastructure
Passive Recipients Voracious Explorers
Randomizing Confounders Using Confounders
A Learning Health System
State Public Health
Health Information Organization
Health Data Stewardship: What, Why, Who, How--An NCVHS Primer (2009)
Joint Project of the Population Health and Privacy, Security and Confidentiality Subcommittees
“Getting data into the hands of communities and ensuring they have tools and capacities to use them could move the nation toward realizing the public benefits of the informatics revolution.”
The Community as a Learning System for Health,
NCVHS, December 2011, p. 7
Integration of primary care and public health could enhance the capacity of both sectors to carry out their missions and link with other stakeholders to catalyze a collaborative, intersectoral movement toward improved population health
The committee finds that in its current state, the infrastructure for both primary care and public health is inadequate to achieve the nation’s population health objectives.
No single best solution for achieving integration can be prescribed . . . will require substantial local adaptation
13 Contemporary Grand Challenges comprising an integrated action plan to re-invigorate community-centered health systems.
The Personal Physician+PCMH=
“True Public Health Professional”
Grand challenge 2:
Foster the ongoing development of integrated, comprehensive care practices (patient-centered medical homes), accessible for all groups in a community, through the creation of explicit partnerships with public health professionals and communities of solution
Because our people are waiting for us to make the trip and show up —as the best personal physicians, working from a robust and efficient platform, achieving the primary care function that is essential to sustainable, high performance healthcare.