Center for Healthcare Delivery Sciences team.

Many highly effective health interventions are never widely adopted into routine care— sometimes because patients do not follow-through on what has been recommended or because caregivers do not practice as the evidence would indicate they should.

For example, only about 40 percent of adults receive a flu vaccine and only half of patients who have had a heart attack continue to take their cardiac medications over the long-term. Overcoming these gaps in health care implementation requires patients and health care providers to be more actively involved in the delivery of health care.

The Center for Healthcare Delivery Sciences (C4HDS), a newly created research center within the Department of Medicine, is working to address this problem by design, implementation and rigorous evaluation of novel ways to engage patients and providers in care delivery.

Under the leadership of hospitalist Niteesh K. Choudhry, MD, PhD, Division of Pharmacoepidemiology and Pharmacoeconomics, the C4HDS team focuses on interventions that have the potential to be scaled across settings and could help address multiple related engagement problems including medication adherence, smoking cessation and narcotic misuse.

“The ultimate goal for the studies initiated by C4HDS is to create effective, simple and easily scalable interventions,” said Choudhry. “In addition, wherever possible, we want those interventions to address lynchpin challenges: behaviors that can simultaneously address related problems— such as extended disability and hospital readmission.”

Choudhry said C4HDS wants the studies to be undertaken in the same conditions— with the same distractions, impediments and pitfalls— as physicians and patients would experience.

“They are, after all, intended to solve practical, real-world problems,” he said. “Our studies creatively blend rigorous research approaches with the operational realities faced by organizations that deliver and pay for health care.”

Studies currently underway at the center include randomized evaluations of the impact of: text messaging to increase medication adherence; written commitment devices and “nudges” to increase influenza vaccination rates among Medicare beneficiaries; Electronic Medical Record-based tools to prevent opioid over prescribing; and a smart phone application to help patients with poorly controlled hypertension manage their medication regimens and track their disease control.

The center’s two-year fellowship program in Implementation Research trains the next generation of delivery science academics and researchers. “The center is a unique place for those interested in improving health care quality to gain the expertise and knowledge to conduct pragmatic clinical trials and evaluate novel strategies in a rigorous manner,” said Roya Ghazinouri, DPT, a physical therapist with extensive expertise in quality improvement, who directs the operations at the center.

To learn more about C4HDS and ways to collaborate with the center, email rghazinouri@bwh.harvard.edu.