The best ad for health services research in some time

In the past few years, I’ve had a number of meetings with philanthropic organizations. They usually have a big donor, or some money themselves, and they want to hear about what we do to see if it’s something they’d like to fund. I’ve gotten pretty good at pitching our work, but inevitably someone asks me, “but what disease are you going to cure?”

It’s frustrating, because obviously we’re not going to do that. I’m not a basic science researcher. I’m a health services researcher. I’m not trying to cure a disease; I’m trying to get the health care we know works to as many people as possible in the most efficient manner.

I get that it’s attractive to be on the front lines of a major breakthrough. If you had funded the bit of research that finally ended a major disease, your name would be quite well known. But those instances are rare. Really rare. I also get that it’s much easier to understand that a researcher caring for a child with cancer needs your support more than my clinical decision support system does. I may have improved the way we screen and care for maternal depression, or domestic violence, or smoking in parents, or anemia in children, but these tales are about baby steps. They’re not as exciting or as immediately compelling. They don’t have the impact of a drug or procedure in saving a life.

I bring this up because Ezra Klein has a longform piece out on a care model in Pennsylvania, not too far from where I grew up, that is using nurses to manage Medicare patients better. There’s no new science. There’s no new medicine. It’s health services work – reorganizing the way we care for patients – and it’s making a huge difference in terms of quality and costs. Medicare is about to shut it down. Here’s why (emphasis mine):

Brenner puts it more vividly. “There is a bias in medicine against talking to people and for cutting, scanning and chopping into them. If this was a pill or or a machine with these results it would be front-page news in the Wall Street Journal. If we could get these results for your grandmother, you’d say, ‘Of course I want that.’ But then you’d say, what are the risks? Does she need to have chemotherapy? Does she need to be put in a scanner? Is it a surgery? And you’d say, no, you just have to have a nurse come visit her every week.”

That’s the problem with health services research in a nutshell. When I tell people that we get results from talking to people, from getting the pieces of the system better coordinated, by advising physicians better, just by improving communication – then their eyes glaze over. They don’t see it as “real” research, or “real” care. It’s soft. But it works.

The basic science guys looking for a cure? They’re trying to hit a grand slam. And once in a blue moon, they may succeed. It will be exciting; everyone will talk about it. But it’s unlikely to happen soon. My group, on the other hand? We’re just hitting singles over and over again. We’ve gotten really good at it. We’re not flashy, and we’re not as exciting, but day in and day out, we’re putting up real results. At some point, you have to decide which strategy is going to win more often.

Go read Ezra’s whole piece. It’s worth it.


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