Learning Health Care Systems: Leading Through Research

Abstract

The Health Maintenance Organization Research Network (HMORN), a consortium of 19 health care delivery systems with integrated research centers, held their 18th annual conference in Seattle, Washington from April 29 to May 2, 2012. Group Health Research Institute hosted the conference, “Learning health care systems: Leading through research”. The 2012 theme was chosen to reflect the critical role of collaboration among researchers, clinicians and health systems to improve health care nationally. Over 500 researchers and health care professionals participated in this conference. Representatives from the NCI, NHLBI, NIMH, and PCORI met with researchers to advance the quality and breadth of public domain research in HMOs. In this article we summarize information about the HMORN and its 18th annual conference.

The Health Maintenance Organization Research Network (HMORN), established in 1994, is a national consortium of 19 nationally and internationally recognized research centers that work within or in close partnership with integrated health systems with defined populations. Collectively, the 19 member organizations cover about 16 million individuals via a diversity of plans. HMORN sites are committed to conducting public domain non-proprietary clinical, epidemiologic, behavioral, and health services research using study populations receiving care within health maintenance organizations (HMOs). Sites in the HMORN have led and/or participated in major national research projects including the RAND Health Insurance Experiment, the Women’s Health Initiative, and the eMERGE (Electronic Medical Records and Genomics) project, among many others. The HMORN has also established topical research networks in cancer, cardiovascular disease, mental health, asthma, diabetes, and vaccine safety.

Inspection and analysis of health and health care utilization data from the 19 sites is made possible by a functional Virtual Data Warehouse (VDW) maintained locally, but available for collaborative research projects by the member organizations. The Network’s mission is to use its collective scientific strengths to integrate research and practice to improve health care and overall health among diverse populations.

The network has been organizing annual conferences since 1995 with the purpose of advancing the quality, scope and transparency of public domain research conducted within member organizations and with external partners. The meeting provides a forum for HMORN investigators and their collaborators, who often represent non-HMORN member health care systems and universities, to present research findings, hold working meetings, and communicate with collaborators, funding agencies and other stakeholders. The 18th annual HMORN conference was hosted by the Group Health Research Institute in Seattle, Washington from April 29 through May 2, 2012.

The theme for the conference was “Learning health systems: Leading through research.” The Institute of Medicine has advanced the notion of the learning health care system, where research influences practice and practice influences research (figure 1).¹ The members of the HMORN, with their shared culture of evidence-based medicine, clinically-based research, and translation of research to practice, can be ideal learning health care systems in action.

Figure 1.

Learning health care systems.¹ Reproduced with permission from Radcliffe Publishing.

The formal agenda included keynote addresses from nationally recognized leaders in the fields of health care delivery and health care research, and scientific research presentations by nationally recognized researchers. The opening plenary lecture, “Why professions must lead in health care reform,” was given by Don Berwick, MD, MPP, FRCP. Dr. Berwick, a leading expert in healthy policy, was president and CEO of the Institute for Health Care Improvement (IHI) for nearly 20 years, and is the past administrator for the Centers for Medicare & Medicaid services. Dr. Berwick spoke passionately from his own experience about why controlling costs is an issue of professional ethics. He shared his belief that eliminating six major categories of waste (overtreatment, failures in care coordination and in execution of care processes, excess administrative costs and prices, and fraud and abuse) could free up at least one fifth of our nation’s total health care spending. That alone could make our health care system sustainable – avoiding potential harm from proposed cuts in provider payments, health care benefits, and eligibility for coverage. Dr. Berwick also endorsed the “Choosing Wisely” initiative, which is gaining ground among national medical specialty societies, including cardiologists and radiologists. Sponsored by the American Board of Internal Medicine Foundation, the initiative promotes conversations among physicians and their patients to improve care and eliminate unnecessary tests and treatments.

The second plenary was a Learning Health Care Systems roundtable discussion, moderated by John Steiner, MD, MPH, senior director, Institute for Health Research, Kaiser Permanente, Colorado. Three institutions, Group Health, Geisinger Health System, and HealthPartners Research Foundation, were represented by their respective chief executive officers and health research institution directors. These leaders engaged in a series of questions from Dr. Steiner and the audience to show how these health plans and research leaders work together to improve health care.

Additional plenary sessions followed on each day of the conference. The “State of the Network” was presented as a town hall meeting. The current HMORN Board of Governors Executive Committee gave an update on new directions and infrastructure being developed by the HMORN, followed by a question and answer period with the audience. The early career investigators plenary session carried forward a tradition of honoring outstanding work from HMORN junior investigators. This year’s four honorees presented talks about their abstracts, which were selected by a competitive process, and each was awarded with a plaque. The final plenary was given by Joseph V. Selby, MD, MPH, executive director, Patient-Centered Outcomes Research Institute (PCORI). In his talk, “From Populations to Patients,” he discussed PCORI’s mission and priorities,² and what to expect from this new institute. PCORI’s focus on research guided by patients, caregivers, and the health care community is intended to ensure that funded research studies provide answers to practical questions, that studied outcomes are important to patients, that the patients studied represent those who require the information and come from relevant settings, and the heterogeneity in effectiveness is carefully examined.

The conference included 21 concurrent sessions with oral presentations and two scientific poster sessions reflecting a broad range of topics such as cancer research, managing cardiovascular disease, clinical research informatics, the Virtual Data Warehouse, genetics, prevention and wellness, pharmacoepidemiology, comparative effectiveness research, behavior change interventions, mental health, health care disparities, chronic illness and multimorbidity, mega-epidemiology, diabetes, obesity, health services, learning health care systems, and research administration. The conference also provided more than 40 ancillary sessions for working groups and study meetings, including gatherings of the growing number of research networks within the HMORN. In all, over 200 scientific abstracts were featured; a selection of them is presented within this special issue of Clinical Medicine & Research.

Conversation Cafés provided informal meeting time for discussions on 13 potential areas of collaborative research, administrative challenges, and analytic methods. In this event, small groups were formed based on topics of interest to the group. These sessions were designed to stimulate spontaneous conversations and data sharing that could lead to future collaborative research projects and manuscripts.

Ancillary meetings were held to advance ongoing collaborative research projects. These 49 project-specific meetings were used to develop strategies and infrastructure, and discuss operational issues and findings from ongoing research projects funded by NIH, NIMH, NCI, NHLBI, AHRQ, and others. Many of these working meetings were focused around the HMORN’s condition-specific research networks such as the Cancer Research Network, Cardiovascular Research Network, and the Mental Health Network. These meetings are key to stimulating new projects that advance collaborative opportunities and the science of health care research.

To learn more about the HMORN please visit www.hmoresearchnetwork.org. The 19th Annual HMO Research Network Conference will be hosted by Kaiser Permanent Northern California’s Division of Research in San Francisco, April 16–18, 2013. The theme of 2013 conference is “Advancing Research in the Era of Health Care Reform.”