Altarum’s internally funded research and development program is designed to build a base of knowledge and innovative tools that we apply in our work; to promote a culture of intellectual curiosity, entrepreneurship, and partnership; and to enhance the innovative and objective health systems research that we conduct. The research and development program is guided by Altarum’s strategic research and investment plan, which identifies three research focus areas: culture of health, health equity, and innovative care delivery.
The following are the current ongoing IRAD projects as of November 1, 2010.
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Project
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IRAD Description
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Principle Investigator
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Socio-ecological Data Warehouse and Modeling.
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While many qualitative assessments have been made, little is known on the quantitative relationships among the multiple determinants of health and individual and population health outcomes. Reasons for the lack of progress include a lack of appropriately linked data, formal models of causation linking culture, society, and health; appropriate measures of neighborhood, community, work, and other factors; and, a lack of dynamic modeling approaches. This research area addresses this complex area by developing a new data warehouse of linked individual and aggregate contextual variables; matching this with new research strategies including multi-level models and simulation; and developing new hypotheses on the social transmission of health and disease using simulation tools. Target intermediate products include new conceptual models of context and causality; new multi-level model estimates on specific conditions and contextual risks; and new visual models of dynamic change in populations.
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Community Interventions and Knowledge Translation
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Community-based interventions for health promotion have a somewhat spotty history when it comes to demonstrating outcomes. At the same time, many interventions have not been examined or evaluated formally for their health or structural impact, or even appropriately documented; further, community interventions are complex, and require thoughtful exploration of “best practices” and evidence in design, implementation, scale, participation, sustainability, and other factors. Short term projects include a web-based directory of current and ongoing community-based health promotion programs; a project to collect and examine the literature on community-based interventions, including new interviews with program participants especially for unpublished studies, to gain a better understanding of what lessons can usefully be drawn on multi-sectoral interventions; and, a knowledge base of case studies on translating community intervention results into evidence usable by policy makers.
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Modeling and Demonstrating “Optimal Transformation” of Healthcare Markets: Leveraging Health Systems Change to Improve Access, Quality, and Affordability
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This project will implement and bring to the field an evidence-based and actionable strategic innovation model for health system reform across the care- and cost- spectrum to: 1) model and develop estimates based on “best evidence for best outcomes” in national and local health care markets; 2) demonstrate, evaluate and bring to scale “optimal transformation” in three prototypical health care markets—through partnerships with local business coalitions on health care; and 3) develop and implement education, outreach and communications regarding the demonstration through traditional media, online and social networking channels. This model empowers consumers to become better informed and actively engaged in their health and health care decision making; leverages innovative, new delivery approaches; and aligns the organization and financing of care with financial and non-financial incentives to achieve quality, affordable and sustainable health care.
The project is developing a market model using core county-level measures of supply and demand, and incorporating measures of health equity and social determinants from the Health Equity and Culture of Health focus areas. These data will be supplemented by claims data on health care utilization and cost; employer data on direct and indirect costs, and productivity of the workforce; and other local level data as available in three market areas to be selected in with partners, including the National Business Coalition on Health. Altarum proposes to work with NBCH coalition member sites to identify and implement evidence-based and best practices for optimal transformation of markets (addressing market incentives, new delivery approaches and alignments, and consumer centric care and decision making) in three diverse locales. Information about these practices and their expected or demonstrated outcomes will be maintained in a database maintained in house. Altarum will conduct pre/post evaluation and monitoring over a 1-2 year demonstration period.
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Policy “Sandbox” for Visualizing Population Health
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Even as the multiple determinants of health prove an elusive target, enough is known and knowable about the relationships among factors to provide policy makers with a visual sandbox for observing current conditions and health outcomes, and for performing simple what-if analyses and comparisons. Such a model would reinforce understanding of health in all policies and enable policy makers, community leaders, and the public to see where their community stands, and where it could be. As an initial step, readily available health and contextual variables at the county level will be used to display and compare data using web-based mapping software. An underlying model of structural and contextual variables and their relationship to outcomes will be developed, and users will be allowed to alter coefficients (e.g. educational spending, attainment, and a latent variable of health activation) interactively. The end vision is a web-based tool where users can visualize a specific area with a fine-grained level of detail, alter specific parameters and/or interaction effects, and view the results over time using spatially-enabled dynamic simulation.
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This project will pilot and evaluate a readily available, accessible, and noninvasive approach using cell phone and PDA technologies to support therapeutic interventions for veterans with post traumatic stress disorder (PTSD), traumatic brain injury (TBI) and other behavioral health disorders. These interventions are designed to help veterans and providers manage and prevent behavioral health issues that affect veterans, their families, and care and treatment providers, and facilitate veterans’ transition to community life. The pilot will be tested with 30 veterans and 5 clinicians and has potential for scalability to larger numbers of veterans transitioning to community life nationwide. Altarum is undertaking the project in partnership with The Pathway Home, a California-based community rehabilitation facility for veterans returning from active duty in Iraq and Afghanistan, and Life:WIRE and Brain Checkers technologies.
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Exploring Measures of Health Equity
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This project reflects a strategy‐driven internal research and development (IRAD) project within the Health Equity (HE) focus research area which seeks to utilize a systematic approach to identify and analyze the critical contextual factors within the macro social structure influencing the equitable distribution of social resources that have either a direct or indirect impact on diverse populations, including those traditionally described as “underserved.” Compelling and emergent evidence indicate that optimal health is not merely a function of health care utilization and having access to affordable health care, but largely related to the social context in which people live, where they work and the positions they have, where they practice their faith, and other social and economic attributes that are shaped by social and political institutions. Focusing on a health equity framework, which recognizes that disparities in health are fundamentally linked with wealth, privilege and/or power, several activities will be implemented.
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Michelle Surdoval
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Community of Practice
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This project will create a Community of Practice (CoP) which will focus on action‐oriented research (i.e., best and promising) and analysis related to reducing health disparities and improving the quality of life for culturally and linguistically underrepresented persons. Representing leaders in the field drawn from various sectors, this CoP will be of interest to policymakers, change agents, and those interested in influencing policy at a variety of levels: state, local and community agencies responsible for minority health issues; legislative staff with responsibility for or an interest in minority or immigrant health; policy advocates who work with state agencies or legislative bodies; non‐profits and community based organizations that influence change in their states. We hope to build a geographically diverse group composed of individuals at all levels of the policy process – novice through expert. Six state health departments—California, Massachusetts, Oklahoma, Oregon, Virginia, and Washington—have begun organizational efforts to develop comprehensive strategies and policy related initiatives to reduce systematic gaps in health and healthcare.
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Aldrenna Williams
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The Built Environment and Health
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This project will be based on a population health approach, a perspective that recognizes the primary importance of broad social and economic influences as determinants of health and wellbeing. The focus of this IRAD will address a critical health issue that is not impervious to race, ethnicity, age, or gender— obesity. According to recent reports, obesity has reached astronomical proportions in the last two decades. Dietary consumption is just one of the many factors that have been shown to contribute to the onset of overweight and obesity. Nevertheless, food consumption is not just based on personal choice or individual behaviors but is influenced by an array of interrelated determinants, including social and economic conditions (such as education, income and social supports); physical environment factors (i.e., marketing and advertising); access to health services; gender roles and culture—traditions and values held by families.
A growing body of evidence has documented that food accessibility—convenience stores, supermarkets, fast‐food outlets— vary substantially by residential location. Low‐income and predominantly minority residential areas have fewer grocery stores and supermarkets, lower quality products sold in food retail outlets, and greater access to fast‐food restaurants. This project seeks to incorporate an action-oriented, multi-method research design which integrates macro and micro environmental influences on obesogenic behaviors.
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Systems Science Methods for Addressing the Treatment-Prevention Trade-Off
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This proposed IRAD project develops a dynamic model of the impacts of alternative investments in treatment and prevention (including investments in research to develop new treatment and prevention interventions) as a useful tool in increasing our understanding of these interactions and tradeoffs. It use would improve our knowledge of the ways in which alternative allocations of funds interact to produce an overall effectiveness associated with such allocations.
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Research to Practice: Altarum's Systems Change Model
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Since the roll-out of SCM Orientation trainings, it has become clear that staff are still learning how to best apply and utilize the model and related tools in their work. To address this gap, the IRAD team wants to create a plan that includes a curriculum on "Habits of Systems Thinking" and how to apply the model. The research interest is to assess the effect of training and evaluate the impact it has on staff productivity and performance.
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Demonstrating Decent Care Values in Health Care Services
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This project will demonstrate translation of decent care values at the practice level, and to examine whether and how decent care values can be implemented as patient- and consumer-centric systems of care. This demonstration project will begin to establish the evidence base for the implementation and application of decent care in real health care settings. The demonstration will include several activities: regional meetings in three WHO regions; provision of technical assistance; development of tools and guidelines; evaluation and monitoring; and dissemination and diffusion of project findings and products. To this end, Altarum will work with WHO as it convenes three regional meetings on decent care. Participants in these meetings will become the applicant pool for the demonstration grants; WHO will invite grantees to respond to an RFA, and will work with Altarum in identifying and selecting those organizations best-positioned to participate in this endeavor. Modest demonstration project contract or grant funds (approximately $15K each) will be supplied to the grantees by Altarum through this IRAD or by an external funding partner sources such as the Diana, Princess of Wales Foundation or USAID. Altarum, along with expert consultants and the International Advisory Workgroup, will provide support and guidance for the entire demonstration.
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Antigone Dempsey, Jesse Milan, Janice Schuster
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Evaluation of Autism Training for Primary Care
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Across the United States, there has been a dramatic increase in the number of children diagnosed with autism spectrum disorders (ASDs), with too few specialists or Primary Care Physicians who can provide assessment and ongoing care for this population. Working with two developmental/behavioral pediatricians in Portland, we are evaluating a series of training workshops being offered to primary care pediatric practices in different geographic regions of Maine, covering recognition, referral and assessment, and follow-up care for children with ASDs, to assess the workshop's effectiveness in increasing participants' knowledge and comfort levels. We have developed and piloted two evaluation tools: a pre-training survey, to assess pediatricians' knowledge base and their level of comfort caring for children with autism spectrum disorders, and a follow-up survey, to be administered 3 to 6 months after the workshop, to assess how the information has been applied in their practices. This project is being funded by Altarum with the long-term goal of developing a training and evaluation package that might be more broadly useful to MCHB or other state agencies.
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Adolescent Health Report Card
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This IRAD project would culminate in the publication and dissemination of a 'report card' that describes the state of adolescent health, safety, and well-being in the United States overall, and in each of the 50 states and the District of Columbia. Comparisons among sub-populations of adolescents would also be included in the analysis and presentation, primarily at the national level. Such groups may include adolescent children of veterans or children of different racial and ethnic groups. The report card could then be used by local, state, and/or national governments and organizations to advocate for systems changes (including policies, practices, and resources) aimed at improving adolescent health and well-being. As author of the proposed adolescent health report card, Altarum Institute's reputation as a leader in this health field would also be elevated, thereby positioning the Institute for increasing expansion into the adolescent health arena.
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Jennifer Pooler
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Participatory Strategic Planning (COMPASS)
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The primary purpose of this project continues to be to develop and test an innovative participatory strategic planning model designed to strengthen health systems. In Phase II, this model was developed and presented at the 2008 American Public Health Association (APHA) Annual Meeting and Exposition. It is entitled, Compass: A Guide for Creating Collective Action that Lasts.
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Developing an Oral Health Medicaid Portability Model for Migrant and Seasonal Head Start Children
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This initiative aims to successfully pilot two Medicaid portability models, both of which rely only on interstate agreements (since Medicaid is a state-administered program) and stakeholder partnership/collaboration. Successful implementation of these pilot models will be significant, as this has been a 30-year struggle, and can position Altarum Institute as the vehicle for replicating these models elsewhere, enabling a "ripple effect" to other farm worker children and adults, and adapting these models to other mobile populations (such as Veterans, individuals/families experiencing homelessness, construction workers).
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Naomi Tein
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| Handbook for Mortals: Guidance for People Facing Serious Illness | People facing the end of life, either their own or a loved one’s, are often at a loss for what to do—what to expect; where to find help; and, most of all, how to live well despite life-limiting illness. Today, growing awareness of the importance of hospice and palliative medicine offers new insights and strategies for helping people to face the end of life. To keep pace with changes in the field, Handbook for Mortals: Guidance for People Facing Serious Illness, 2nd edition, has been updated and will be published by Oxford University Press in January 2011. Since 1997 when the 1st edition was published, thousands of people have benefited from the book’s insights and information, from its comfort and guidance, and from the hope and inspiration that it offers to people living with serious illness. | Janice Lynch Schuster |
| Extending Clinical Data Standardization |
Standardization of clinical trial data has become a high priority for both government and industry as decision makers in both arenas realize that allowing each investigator or institution to determine what and how to collect data in an idiosyncratic manner has limited value. Final datasets in this format may only be understood by the study team, and without consistent documentation, formats or data values, it is not applicable to a wider audience. This situation prevents re-analysis, data sharing and cross study analyses. Large sums of money are spent on research data that cannot be reused. Corporate consolidation is common within the pharmaceutical industry. However, licensed products’ supporting clinical trial data obtained in an acquisition may not be easily found or may not be understandable to the purchasing company. If questions arise about product safety, data from the earlier legacy studies may not be available, leaving the latter unable to respond to potential regulatory questions, placing them in a difficult position. To assist in addressing this problem, KAI is utilizing the knowledge gained from the two funded Phase 1 research efforts (Harmonization of KAI's Clinical Trial Standards with the National Cancer Institutes (NCI) Biomedial Research Data Infrastructure and Development of Pain Common Data Elements and Corresponding Case Report Forms) and combining them into a single research effort to provide expand clinical data standardization efforts in multiple ways. |
Yun Lu, Scott Brand |
| National ZIP Code Drive-time Public Use Dataset |
Understanding the adequacy of health network resources to meet the needs of a subscriber population requires an understanding of the proximity of the network resource to the intended population being served. Proximity has historically been analyzed using linear distance-based measures. This has largely been due to the ease of calculating distances versus the difficult and time consuming process to compute more relevant travel-time measures. As geospatial software applications have matured over the last decade and become more mainstream, many health care organizations are switching from distance to drive-time based measures to manage and evaluate the adequacy of their health care networks. Two of the largest Federal Health Care organizations, the VHA and MHS, both have adopted drive-time measures to evaluate the adequacy of their health networks in serving their beneficiaries. This IRAD will create a National ZIP Code drive-time dataset constructed from U.S. Census and ESRI road network data that will be available in SAS data set and flat file format. This data set can easily be made available to any health care researcher or manager, providing them the ability to analyze and understand the dynamics of drive-time proximity to healthcare services. Researchers and managers will be able to answer the majority of drive-time proximity related questions without the services of specially trained staff and commercial software applications. |
Jim Laramie |
