Effective health care delivery is essential to improving health outcomes, global health leaders said at the Dartmouth Colloquium on Global Health on Friday. The colloquium, held at Dartmouth-Hitchcock Medical Center as part of Dartmouth Medical School's alumni reunion weekend, brought together Dartmouth alumni and professors who are leaders in global health, in addition to College President Jim Yong Kim, to address the intersection of basic science and policy issues in worldwide health care.
Kim suggested the creation of a Dartmouth Institute for Global Health Care Delivery Science during his presentation, emphasizing that he was not yet proposing a policy change or allocating funding. The institute which Kim posited as a future goal for Dartmouth would study the delivery of health services in the United States and abroad.
"I think that [the institute] will be an absolute requirement if we are going to save the U.S. government from collapsing under the weight of Medicare and Medicaid payments," Kim said, adding later, "I think that it could be the greatest humanitarian-linked-with-academic exercise the world has ever seen."
Dartmouth is already home to the Global Health Initiative, which was founded in 2004 as a collaboration between the John Sloan Dickey Center for International Understanding and Dartmouth Medical School to promote research and educate students about global health. The College's Dartmouth Institute for Health Policy and Clinical Practice whose research is now at the center of the health care reform debate in Washington was founded in 1988.
Kim also called for a new emphasis on the science of health care delivery in academia.
"The notion that clinical science is a legitimate science is relatively new," Kim said. "I think it is time to establish health care delivery science."
Robert Bollinger DMS '84, director of the Johns Hopkins Center for Clinical Global Health Education, highlighted the importance of improving health care capacity, which involves providers' ability to distribute drugs and supplies to patients.
"We have plenty of drugs and bed nets now," Bollinger said. "What we need to focus on is building health care capacity, the human capacity."
Bollinger and his colleagues at Johns Hopkins created an electronic educational and clinical tool for doctors in developing countries called eMocha. The handheld device allows health care professionals to manage patient data and access training tools created by Johns Hopkins doctors.
C. Fordham von Reyn '67 DMS '69, director of Dartmouth's DARDAR Health Study, discussed the role of clinician education in improving global health care. DARDAR, a partnership between Dartmouth Medical school and the city of Dar es Salaam, Tanzania, has helped 10 Tanzanian students obtain their master's of public health or Ph.D at Dartmouth, von Reyn said.
Examining data about the effectiveness of health care delivery at the clinical and systemic levels is also a key component of improving health outcomes, David Goodman DMS '96, co-principal investigator on the Dartmouth Atlas of Health Care, said.
The Atlas uses Medicare data to track disparities in health care costs and performance across the United States.
"There's value in having finer and finer resolution, because action needs to occur in hospitals and clinics," Goodman said. "If you've seen one health care system, you've seen one health care system."
All of the speakers said Dartmouth is particularly well-positioned to be a leader in the study of health care delivery.
"We have an opportunity to do something here at Dartmouth that's truly unique, and I think that ultimately it will shape our response to global health problems," Kim said. "I think it can potentially shape our response to medical education and the education of health care professionals around the world."
Bollinger expressed a similar sentiment, saying that Dartmouth is a "unique place to weigh in on" health care delivery outcomes. Bollinger pointed to the Dartmouth Atlas of Health Care as a way the College is already helping to measure health care outcomes. Over the course of its 20-year existence, the Atlas has become applicable to new fields, including global health, Goodman said.
"The idea that it might have some relevance to sub-Saharan Africa, we wouldn't have considered that an important question at [the time the project was created]," Goodman said.
Niranjan Bose DMS '04, of the Bill and Melinda Gates Foundation, also spoke at the colloquium.
Assistant Surgeon General Anne Schuchat DMS '84 was scheduled to appear at the event, but canceled due to her role as coordinator of the United States' H1N1 prevention initiative, according to Theresa Bryant, director of DMS alumni relations.
