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Health Services & Economics Study Examples

Study Examples | Key Publications | Intro

Here's a sampling of the leading research Group Health Center for Health Studies (CHS) is conducting in this area:

• Coordinated Clinical Studies Network (CCSN): Re-engineering the Clinical Research Enterprise
• Cancer Care Outcomes Research and Surveillance (CanCORS)
• Cost of Smoking
• Cost-Effectiveness of Systematic Depression Treatment
• Long-Term Cost and Outcomes of Breast Cancer Screening
• Improving Access to Improve Quality: Evaluation of the Group Health Access Initiative

Coordinated Clinical Studies Network (CCSN): Re-engineering the Clinical Research Enterprise

• Principal Investigator: Eric B. Larson, MD, MPH
• Co-investigators: Paul A. Fishman, PhD; Denise M. Boudreau, PhD; Robert J. Reid, MD, PhD; James D. Ralston, MD, PhD; Sarah M. Greene, MPH

Investigators at CHS are leading the development of the Coordinated Clinical Studies Network (CCSN), an unparalleled research facility for clinical and health services research that builds on the current capacity of the HMO Research Network. The National Institutes of Health (NIH) recently awarded CHS a three-year, $3.5 million contract to establish the CCSN among 12 integrated health systems in the Network. These health systems provide comprehensive services, ranging from prevention to palliation, to a defined population of more than 10 million people (nearly 4 percent of the U.S. population) in every region of the United States. The CCSN is part of the NIH’s initiative to re-engineer the clinical research process by enhancing the productivity and efficiency of clinical research in the United States. Expanding and integrating the work of the Cancer Research Network (CRN), the CCSN is: establishing a powerful, shared informatics platform supporting clinical research into this population; reducing scientific, administrative and economic barriers to multi-site collaboration in clinical studies; establishing Web-based operations that will support communication efforts and common data collection and analysis protocols; and building common institutional review board (IRB), patient retention and recruitment, and clinical studies procedures. The CCSN will conduct translational research, exploring how health care innovations work in real practice among large populations.

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Cancer Care Outcomes Research and Surveillance (CanCORS)

• Co-Principal Investigators: Scott D. Ramsey, MD, PhD, Fred Hutchinson Cancer Research Center; Margaret T. Mandelson, PhD

Five CRN sites, including Group Health, participate as a primary data collection resource in the Cancer Care Outcomes Research and Surveillance (CanCORS) consortium. In a special research study, the CRN CanCORS team is aggregating cost data to determine:

• Phase-specific and lifetime costs of care attributable to colorectal and lung cancer
• The proportion of total cancer-attributable costs spent on initial therapy versus second- and third-line therapies for each cancer, stratified by stage at diagnosis
• The relationship between type of initial therapy and subsequent lifetime costs of care attributable to cancer

CHS receives $1.3 million over five years from the National Cancer Institute (NCI) for its CanCORS research, including this cost study.

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Cost of Smoking

• Principal Investigator: Paul A. Fishman, PhD

Previous studies have shown that soon after people quit smoking, they cost a health care system more than caring for a current smoker. Initial studies at Group Health have suggested that this trend reverses over time, however. Eventually the quitter is less expensive than the smoker. This project extends that research an additional year. It also compares the estimated health services utilization and cost among quitters, current smokers, and people who have never smoked. A $140,000 grant from GlaxoSmithKline supports this research.

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Cost-Effectiveness of Systematic Depression Treatment

• Principal Investigator: Gregory E. Simon, MD, MPH
• Co-investigators: Paul A. Fishman, PhD; Laura E. Ichikawa, MS; Carolyn M. Rutter, PhD

This project, funded by a $100,000 grant from the Robert Wood Johnson Foundation, combines data from eight previous Group Health-based studies of organized care programs for primary care patients with depression. These data will be used to extend previous work on the cost-effectiveness of depression treatment by examining:

• How improved depression treatment affects overall use of health services
• The effect of improved depression treatment on lost work productivity
• How the availability of generic antidepressant drugs affects cost-effectiveness
• Alternative statistical models for examining treatment effectiveness
• The effect of pre-existing illness (risk adjustment) on measure of cost-effectiveness
• Comparison of treatment costs to patients' willingness to pay for improved health

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Long-Term Cost and Outcomes of Breast Cancer Screening

• Principal Investigator: Paul A. Fishman, PhD

With a three-year, $787,000 grant from the NCI, researchers are exploring the long-term costs and effectiveness of various efforts to promote participation in breast cancer screening programs, mainly mammography. The study evaluates the patterns of mammography use over time by examining women's choices to have mammograms based on their socio-demographics, cancer risk factors, and perceived barriers to screening. They researchers will then examine whether a brief intervention, delivered eight years ago, made any difference. They will focus particularly on whether addressing barriers that women might experience when considering breast cancer screening affects the choices they make over the long haul. Based on these findings, the investigators plan to develop a strategy for targeting promotional strategies to raise mammography use based on women's perceived risk of breast cancer, barriers to mammography use, and personal history of preventive health care.

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Improving Access to Improve Quality: Evaluation of the Group Health Access Initiative

• Principal Investigator: David E. Grembowski, PhD, University of Washington (UW) School of Public Health and Community Medicine
• Group Health Co-investigators: Eric B. Larson, MD, MPH; Paul A. Fishman, PhD; James D. Ralston, MD, MPH
• Co-investigators: Douglas A. Conrad, PhD; Diane P. Martin, PhD, UW School of Public Health and Community Medicine

The Robert Wood Johnson Foundation has granted the UW School of Public Health and Community Medicine $656,000 to evaluate over two years the impact of Group Health Cooperative’s recent innovations to improve access and quality of care for its members. These changes, collectively called the "access initiative," include: offering people same-day appointments with primary physicians; giving them direct access to most specialists (without going through primary care doctors); letting them see their own medical histories, appointment schedules, immunization records, and other health care information, and encouraging e-mail communication with doctors, over a secure member Web site called MyGroupHealth (www.ghc.org); a $40-million clinical information system that offers providers up-to-the-minute patient health information, such as lab, X-ray, and pharmaceutical data; and new incentives for physicians based on measures of productivity, cost, and quality. The researchers are using Group Health’s automated databases, member and physician satisfaction surveys, patient visit surveys, and in-depth interviews with care providers to determine how the access initiative is affecting cost, utilization of services, quality of care, member enrollment, and patient and provider satisfaction.

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Study Examples | Key Publications | Intro