Thesis Presentations

After just day one (of four) of the thesis presentations, I have to say I am impressed. Not only was it nice to see high quality, well-presented work, but it was even better to finally see what everyone had been up to all term! What was the most impressive was the wide variety of topics that students undertook from program evaluations on the elderly by examining the Bridge program here at DHMC to how to treat malnourished children in Mahipat-Mau, India. Students performed systematic reviews on soft drink consumption and obesity and wrote grant proposals to further explore the maternity leave policy here in the U.S. This session really showed me the great breadth of knowledge we have all learned this year and the innumerable applications for it all. Although everyone chose one track and focused on a specific topic, we all have the skill set to evaluate programs, implement action plans, perform research, write grant proposals and so much more. I can honestly say I am looking forward to seeing more (and the fact we're getting more yummy snacks tomorrow doesn't hurt either.)

-Shannon

Beyond domestic health policy

While TDI is a key player in domestic health care reform debates, and thought-leaders here often focus on comparisons between the U.S. healthcare system and those in other developed nations, healthcare policy and practice in developing nations receives attention as well. For example, we've had speakers lecture on the health traumas facing Sudanese refugees, the ongoing threat of HIV/AIDS in sub-Saharan Africa, and the issue of chronic diseases compounding infectious disease burden in many developing nations.

A number of students built on these lectures by focusing thesis projects on health issues in developing countries. One paper looked at primary care in Afghanistan, another studied HIV/AIDS patients in Ethiopia. Although I focused my thesis on domestic issues, I'm interested in financially feasible solutions to health issues, and a number of health programs in developing nations have recently piqued my interest. I find mHealth initiatives particularly compelling. (As does the United Nations. Check out their report on mHealth projects in developing nations.)

For some of us, using mobile health technology means perusing WebMD on an iPhone in search of a suitably severe – but not too nasty – affliction that will explain an absence from work. In developing nations, a number of projects combine cell phones and health care resources for very different reasons. Indeed, mobile health (mHealth) technology initiatives are helping patients in these countries return to work, avoid disease, and maximize limited health care resources.

Project Masilueke is an example. The mHealth initiative fights HIV/AIDS in South Africa by sending text message reminders of scheduled clinic appointments. Planned developments include “virtual call centers” with highly-adherent HIV+ patients advising others on medication regimens. Early patient outcomes are positive. A beta test showed that the project helped triple call volume at an HIV/AIDS helpline. In a country where HIV prevalence is estimated at 25% but only 3% knows their status, Project Masilueke promises notable improvements in patient health.

Along with individual patients, mHealth initiatives also benefit other stakeholders. These include private corporations. Among the supporters of Project Masilueke, Nokia lends telecommunications services, and National Geographic is documenting the initiative. These corporate entities stand to gain subscribers, licensing revenues, and brand recognition. With the large and growing population of mobile phone users in the developing world – South Africa has nearly 100% penetration – the potential for scaling and profit will continue attracting corporate interest in mHealth, and mobile phones will continue to help some play hooky and others save lives.

The U.N. report also lists other stakeholders that benefit from mHealth projects. These include:

Stakeholder - Benefit
Patient (Mobile Subscriber) - Improved health outcomes
Health Care Provider - More efficient and effective delivery of services
NGO - Advance organizational mission, attract funding
Foundations - Advance organizational mission
Government - More efficient health care provision, more effective government
Equipment Provider - Device revenue generation, improved brand recognition
Service Provider - Revenue from service fees, increased subscriber base
Application Solutions Provider - Revenue from additional applications license fees
Content Management - Increase in volume of readership or revenue
Platform Provider - Revenue from sales

-Sam W.

TDI profs. consulted for health care policy

Here's an update on TDI in DC:
This article describes Elliott Fisher's concept for Accountable Care Organizations. Dr. Fisher is on the faculty here at TDI and will be presenting his idea to the Senate this afternoon.

-Sam W.

The Possibilities at TDI: A Dream Come True

My desire in coming to The Dartmouth Institute (TDI) was to gain the knowledge and skill set to ultimately become an effective health policy researcher and assist in the appropriate reform of U.S. health care. This desire has certainly come true; the opportunities at TDI to begin achieving your career goals are endless. I thought I'd relate one particular opportunity I had while studying here.

As MPH students, we are obviously required to complete a thesis. While the requirements are strict, there are various tracks you can pursue depending on your unique academic/career interests (e.g. Analysis of a Population Health (PH) Problem, PH Intervention Plan, PH Research Grant Proposal, etc.). Since I wanted to pursue a career in health policy research, I chose the grant proposal track and spent the last 6 months working on it. While not required, I wanted to ultimately submit it to the NIH for funding, and so I worked with two orthopaedic surgeon scientists and a biostatistician as my content experts to better ensure its success.

Long story short, after an intense last month of writing and editing according to their critiques, we just submitted it to the NIH last week! It was a very satisfying feeling. If funded, we will be getting $1 million over 2 years to study outcomes of total knee and hip replacement in the United States--the number one cost-driver for Medicare inpatient services. In the end, we hope to generate knowledge that will inform all stakeholders (the orthopaedic community, patients, and policy-makers) and significantly improve these outcomes, while decreasing cummulative costs by reducing the need for revisions (repeat procedures).

I can't wait to see the NIH's decision and hopefully begin working to literally fulfill the motto at TDI to generate "knowledge that informs change."