Overview
Founded in 2003, the Geisinger Center for Health Research is primarily responsible for fostering and advancing system-wide research, advancing research programs within clinical departments, and devising new models of care that advance Geisinger's primary mission of improving the efficiency and quality of care to patients. The Center conducts research in a number of traditional areas including: - Studies of the effectiveness of treatments and health services
- Descriptive epidemiology and disease etiology
- Health services and health economics
- Behavioral health in primary care
- Population-based and clinical genomics
- Understanding and addressing rural population needs
A unique aspect of Geisinger is the relative ease with which research projects can be initiated, opening boundaries in pursuing ideas that are simply not possible in other settings. The logistics of conducting research are simplified through the Center's access to resources, capabilities, and collaborative relations, including:
Leadership
Since January 2003, The Center has been under the guidance of Walter "Buzz" Stewart, PhD, MPH, Associate Chief Research Officer. Earlier in his career, Dr. Stewart founded IMR, a clinical trials and survey research company. In 1998, IMR was acquired by AdvancePCS where he was Vice-President of Clinical Research and Development. Dr. Stewart also started the AdvancePCS Center for Work and Health, increasing awareness of the impact of illness in the workplace. Prior to his tenure with AdvancePCS, Dr. Stewart was a full-time faculty member of the Johns Hopkins Bloomberg School of Public Health. An expert on neuro-epidemiology, Dr. Stewart has spent his career understanding the debilitating effects of common episodic conditions like migraine headaches and other pain conditions and on the neurodegenerative effects of adult lead exposure. Dr. Stewart has authored more than 200 journal articles and book chapters. He earned his Ph.D. in epidemiology from Johns Hopkins University, an MPH from the University of California, Los Angeles and a bachelor's degree in the neurosciences from University of California, Riverside.
Center building
The Center's permanent home, a 63,000-square-foot state-of-the-art facility nestled in the rolling hills of central Pennsylvania, will house 120 staff, including 17 full time researchers and 10 clinician investigators who will provide a link to clinical departments. Common space on the first floor of the building is designed to meet the growing need for lecture and meeting space, distance interactive lectures and learning, and conferences.
Resources and capabilities
The substantial research opportunities at Geisinger are made possible by a rich array of resources and capabilities. Geisinger encompasses a number of distinct health care resources that provide a real world setting for research. These include the Geisinger Clinic (i.e., multi-clinic, multi-specialty practice), the Geisinger Health Plan (an insurance company), Geisinger Laboratory, and the Information Technology Division, to name a few. These and other resources are described in this section.
Geisinger Clinics throughout Central and Northeastern Pennsylvania
Geisinger Clinic (GC) formed in 1981, is a Pennsylvania not-for-profit corporation operating a multispecialty group medical practice - one of the largest ambulatory care programs in Pennsylvania. The Clinic's mission is to provide convenient, high quality healthcare services and healthcare education to its patients and members of the communities it serves. GC physicians and physician's assistants currently total 768 (expected to grow 10% by the end of 2005), treating patients at its three main hospitals (Geisinger Medical Center, Geisinger Wyoming Valley and Geisinger South Wilkes-Barre), Marworth Alcohol and Chemical Dependency Treatment Center, and 42 outpatient community practice site locations. In addition to the hospitals, ambulatory surgery is performed at Outpatient Surgery Center Rt. 315, Wilkes-Barre, and Geisinger Medical Center Ambulatory Surgery Center, Danville, which opened in 2005. Historically, the Geisinger Clinic (GC) and Geisinger Health Plan (GHP) patient populations were essentially one in the same. Since 2000, the GC and GHP have operated as independent entities. Today, approximately 30% of the GC patients are members of GHP; approximately 50% of the GHP members have a primary care physician in GC. The latter is important, as it opens research opportunities to evaluate the cost and outcomes effectiveness of the electronic health record (EHR) in GC. Patients who have a primary care physician within GC can be compared to peer clinics without an EHR on cost of care and clinical outcomes. We are exploring relations with other insurers to broaden the database that can be used to explore the impact of the EHR. Over the years, the Clinic has also launched systematic data collection initiatives in defined clinical areas, creating cohorts as a product of care delivery. Specific examples of cohorts include a longitudinal sample of bone mineral density measures on over 10,000 women, longitudinal outcomes data on more than 2,000 rheumatological patients, and longitudinal clinical and functional outcomes data on more than 4,000 obese patients, including 25% who have had bariatric surgery. Top of page
The Electronic Health Record (EHR)
Geisinger is one of the country's "most wired" health care companies with an electronic health record (EHR) in all outpatient clinics, patient portal, and other digital means of delivering care. From 1996 through 2001, the EPICare EHR system was installed in all Geisinger Clinic community practice sites and specialty clinics. In 2006, the EHR will have been installed in the two Geisinger hospitals. The EHR affords unique opportunities to conduct research. To date, the EHR database contains information on more than three million patients. Patient information from a variety of sources is routinely integrated into a common database and includes: - Age, gender, height, weight
- Lifestyle (e.g., smoking, alcohol, etc)
- Clinical measures (e.g., BP, pulmonary function, BMD)
- Digital imaging (MRI, CT, X-ray)
- ICD-9 diagnoses with any lab, imaging, or prescription order
- Clinical notes
- A single state-of-the art laboratory unit, in place since 1993, collects and processes all lab and pathology material and has maintained a digital database since 1995.
In addition to these data resources, two other initiatives are underway. First, a plan is being developed to digitize historical paper records, extending longitudinal information on patients to several decades. Second, a number of research initiatives are leading to the development of patient reported data capture using computerized questionnaires (e.g., touch screens) and use of digital pen technology to capture data on paper-based forms. Patients have access to their record through the MyGeisinger Internet portal. Patients can securely access their EHR and email their doctor's office. Efforts are underway to develop and test structured approaches to e-encounters and evaluate the cost and quality benefits. In addition, several research projects are exploring the effectiveness of delivering on-line disease management services via the patient portal. With appropriate approval, Non-Geisinger physicians also have access to a patient's record through "EMRLink," receive similar access to their patient's record, can communicate electronically with Geisinger specialists, and can directly access the charts of the patients they refer to Geisinger physicians. Currently, 232 non-Geisinger practices use EMRLink. A new web-based pilot project connects patients directly to their doctors, and a new service gives referring physicians the ability to communicate electronically with Geisinger specialists and to directly access the charts of their referred patients. Top of page
Geisinger Health Plan (GHP)
Geisinger Health Plan, created in the mid-1980's, is one of the Health System's core businesses. A not-for-profit health maintenance organization, GHP has approximately 205,000 enrollees in 38 counties of northeastern and central Pennsylvania - one of the nation's largest rural HMOs. GHP's provider network includes more than 1,800 primary care physicians in more than 700 sites, as well as 62 participating hospitals. Specialists and allied health providers total more than 5,900. GHP's network includes both Geisinger providers and other providers. Approximately half of GHP's members have their healthcare delivered outside the Geisinger system. Current products offered include a commercial HMO for individuals and employer groups of all sizes, a Medicare risk plan (Geisinger Health Plan Gold), a preferred provider organization, third-party administration services for self-insured employers, and an indemnity plan for employees residing outside the traditional service area. GHP offers a wide range of programs designed to coordinate care for those with chronic conditions, such as hypertension, chronic obstructive pulmonary disease, osteoporosis and asthma. In 2003, GHPs programs for congestive heart failure, hypertension and diabetes received full accreditation from the National Commission for Quality Assurance (NCQA). This makes GHP the first HMO in the east, and the fourth in the U.S., to receive accreditation from NCQA for disease management programs. In an overall evaluation of the Health Plan, NCQA has awarded GHP its highest accreditation status of Excellent for service and clinical quality that meet or exceed NCQA's rigorous requirements for consumer protection and quality improvement. As part of the accreditation process, GHP conducts yearly measures of a wide number of health care quality variables. This includes using the Health Plan Employer Data and Information Set "1 methodology, a set of quality performance measures designed to enable purchases to reliably compare the performance of different managed care plans. GHP also participates in the Consumer Assessment of Health Plans Survey." Top of page
Large and stable regional population
The Geisinger Clinic and Geisinger Health Plan provide care to patients in a 38 county region of Central and Northeastern Pennsylvania. Approximately 2 million people reside in this region. The base population in the 31-county Geisinger Clinic service area is very stable. Recent census data indicate that, with the exception of two counties, the out migration rate is 4% every five years. The primary care population of the Clinic is similar to the regional resident population. A total of 46% of the patient population is 45+ years of age compared to 42% in the region; 21% are 65+ compared to 17%. The proportion of males, however, is lower (i.e., 41% vs. 49%), primarily due to relatively fewer young adult males, compared to females. The patient base is predominantly (95%) Caucasian, like that of the region. However, access to information on race in the electronic health record provides a means to oversample non-Caucasian populations, predominantly comprised of African Americans, to equal their proportion in the US population.
Top of page Internal collaborative relationships
A unique research strength of Geisinger is the strong collaborative relationships that have formed between the Center and other divisions and departments. These relationships are key to opening substantial research opportunities and to rapidly promoting the translation of research to practice. Specific relationships include:
Information Technology (IT) Division: Directed by James Walker, M.D., an expert in the clinical application of the electronic health record and other digital information, the IT division has over 80 staff. Dr. Walker and Dr. Stewart have formed an expert IT-Research team to ensure that new IT development needs for research projects are addressed in a timely fashion. The IT-Research team is gaining leading edge expertise in devising novel ways to leverage the EHR through the design of clinically and care-specific electronic modules. These modules are usually external to the EHR but interact with the EHR. Devising and testing new models of care typically involves "engineering" changes to both the EHR (i.e., development of new modules) and the process flow in the clinic.
Division of Clinical Effectiveness (CE): Directed by Mark Selna, MD, an expert in health care systems evaluation and systems level care delivery (e.g., disease management). The CE division has 70 staff and oversees quality, safety, and efficiency performance. Dr. Selna also directs Geisinger's involvement in the CMS pay-for-performance demonstration project. The CE and the Center define common areas of collaboration that represent system level needs for improving care (e.g., early detection of Congestive Heart Failure and continuous management) quality and efficiency and substantial research opportunities. These common areas of collaboration leverage significant system resources (e.g., large patient populations, system level patient surveys) to enhance the feasibility and importance of research initiatives.
Community Practice (CP) Division: Directed by Steven Pierdon, MD, the CP Division includes 42 medium to large community practice sites. CP is a pivotal Center partner. Increasingly, the CP sites are a focus of health services (e.g., pilot testing new models of care) and clinical trials research. Dr. Dreiling has fostered a strong relationship between the Center and the CP leadership and motivated multi-site clinical trials and pilot testing of new health care models in specific clinic sites. Dr. Dreiling and the CP leadership have a strong interest in exploring delivery models that simultaneously improve the quality and efficiency of care delivery. Top of page
System-wide clinical laboratory
Directed by Conrad Schuerch, MD, the Geisinger Medical Laboratory (GML) consists of a highly standardized and integrated network of two hospital laboratories and 50 regional site laboratories. Testing in this "distributed laboratory" utilizes shared laboratory information system (LIS) test codes from standardized testing methodology across several different-sized networked instruments on a wide area network (figure 1). Chemistry, immunology, and hematology instruments thus produce harmonized test results delivered by the LIS to the EpicCare electronic health record (EHR), no matter where the testing is performed in the Geisinger Health System. Besides delivering standardized results, very concise and retrievable longitudinal data have been archived "live" online since 1997. Thus, performing serial clinical outcome studies is greatly facilitated by accessible quality population lab data. System-wide laboratory data are used for studies of longitudinal change and cross-sectional studies. For example, creatinine values performed across the GML distributed lab from 2003 were extracted and converted to estimated glomerular filtration rate (est GFR) values as per National Kidney Foundation guidelines (Figure 1). Patients at risk for chronic renal disease can be compared to controls on risk factor data that can be extracted from the electronic health record or by direct interview. This type of data mining of consistent laboratory data has been employed for population studies of cardiovascular disease risk factors, thyroid screening, and several other pertinent laboratory population studies. |  |
Since 1985, GML has ensured standardization of specimen handling and informatics logistics. Pre-analytical standardization of specimen collection has allowed for consistent processing of specimens from Geisinger clinic sites. Standardized specimen container type, transport, location tracking, and storage for 3,000+ patient encounters per day produces a resource for capturing quality serum, RNA, and DNA specimens prior to discard. A bio-repository has been created within the Geisinger Health System using patient specimens from routine office visits. Because of the high degree of standardization by GML across sites, obtaining specimens for the bio-repository is very efficient. Figure 1. 
Geisinger is a participating member of the Pennsylvania Cancer Alliance Bioinformatics Consortium, a collaborative dedicated to reducing the burden of cancer on the citizens of the Commonwealth of Pennsylvania by collecting, analyzing, and sharing tissue sample information among cancer researchers. Patients undergoing biopsies for certain types of cancer will be asked if they would like to donate leftover tissue from their biopsies to the Geisinger Biospecimen Bank. Geisinger's own cancer researchers will use the tissue, but their analyses (which will be anonymous and de-identified) will also go into the Consortium databank that its researchers can access. Patient participation is optional, but it represents a unique opportunity for them to be part of an effort that has the goal of improving cancer research and treatment.
Other participants in the consortium include the University of Pittsburgh Cancer Institute, Philadelphia's Thomas Jefferson University's Kimmel Cancer Center, Fox Chase Cancer Center, University of Pennsylvania's Abramson Cancer Center, the Wistar Institute, and the Penn State Cancer Institute. The Pittsburgh Life Sciences Greenhouse, which promotes the development and growth of biotechnology companies, is providing funding for the initiative. Ardais Corporation, located in Lexington, Massachusetts, is providing the tissue banking expertise and software for the project.
Geisinger's contribution to the consortium is important because tissue banks have traditionally not included patients from rural areas. Tissue samples have generally come from academic research centers located in large metropolitan areas. With analyses available from such a wide area, it will be easier for researchers to study unusual forms of cancer. Initially, the consortium is focusing on breast cancer, prostate cancer and melanoma (a serious form of skin cancer).
The National Cancer Institute plans to eventually create a national biospecimen network and is evaluating statewide networks for a pilot program that could boost the state's development of life science jobs Tissue banks that represent a balanced population (urban and rural) are a real plus for Pennsylvania. Geisinger's collaboration will demonstrate a regional effort that allows community hospitals to work with academic medical centers as part of the cancer research enterprise.
Top of page System-wide clinical trials ability
The Center is responsible for managing clinical trials within the Geisinger System. In collaboration with the Information Technology Division, the Center is developing a centralized process to manage clinical trials and other studies. In part, this effort involves the installation of electronic data capture tools. Efforts are underway to complete the installation of these tools by the end of 2005.
The Weis Center for molecular and cellular biology
The Sigfried and Janet Weis Center for Research provides a focus for laboratory research and research training at Geisinger and supports the clinical staff in their research programs. The Weis Center, located on the campus of the Geisinger Medical Center in Danville, PA, is a modern 65,000 square foot facility that contains laboratories equipped with state-of-the-art instrumentation, plus conference areas, offices, and informal meeting areas. The Weis Center houses eleven full time investigators plus their research and support staffs. Core and shared facilities available in the Weis Center include DNA sequence analysis, protein mass spectrometry, confocal microscopy, and gene-chip microarray analysis. Weis Center scientists investigate a range of topics of biomedical importance, including cardiovascular biology, neuroscience, cancer, and developmental biology, with a focus on molecular and cellular mechanisms and cellular signaling. A significant fraction of the research carried out in the Weis Center is supported by grants from the National Institutes of Health.
The Weis Center for Research also houses the Geisinger Clinic Genomics Core, which is a key component of a system-wide research program in Genomic Medicine. The goal of this research is to elucidate the role of genetic variation in human health and disease. The Genomics Core provides essential support in sample preparation, storage, and tracking, genotype analysis, and research project design and data analysis. Top of page
DNA and Serum Biobank
Geisinger is developing a system-wide DNA and serial serum biobank. Five features of the Geisinger system make it an ideal environment for genomics research: - A large and very stable regional population
- Longitudinal medical data, supplemented by paper records dating back 30 years
- A system-wide laboratory medicine division that brings all blood samples to a central location in Danville
- Proven methods for obtaining consent from patients to bank blood (i.e., DNA, serum and whole blood) collected for clinical purposes. In a series of pilot tests, approximately 90% of patients who have had blood drawn during a clinical encounter give consent for long-term banking of the blood leftover after lab testing is complete.
- A Genomics Core located in the Weis Research Center.
Efforts are underway to build a 200,000 sample biobank that will include serial serum sample. Sample collection will focus on primary care patients. Top of page Regional health information network
Although ready access to clinical information is often cited as a capability to improve care quality and efficiency, adoption rates of automated systems to make such information available is low. In it's Report To The President: Revolutionizing Health Care Through Information Technology, the President's Information Technology Advisory Committee listed four major barriers to Information Technology (IT) adoption: 1) regulatory, 2) technical (especially deployment), 3) cultural and 4) financial (real or perceived). Overcoming these barriers is a major issue, both within and among organizations. Geisinger's Information Technology Division and the Center are involved in a region wide effort to create the infrastructure for a region wide health information network. The intention is to provide access to more complete clinical information as a first step toward better coordination of care and ultimately to facilitate region wide adoption of an Electronic Health Record (EHR). With funding from an AHRQ Planning grant (1 P20 HS015457-01), GHS has been collaborating closely with two local hospitals and local physician practices to create a Local Health Information Infrastructure (LHII) to support more complete and timely access to clinical information, as well as an organizational structure for governance Regional Health Information Organization (RHIO). The Center was recently awarded an AHRQ RHIO implementation grant. The strategy we are pursuing offers hospitals a low barrier to entry with a minimum (but valued) means of securely communicating health related information among providers. We believe that incremental growth in the breadth and capability of a rural LHII is likely to promote adoption, provide the foundation for modest but progressive change over time, and eventually motivate all regional providers to participate. The LHII will leverage systems and data sources already in place (or those already planned) to avoid high start-up costs. The success of this initiative will ultimately move the region toward the long-term goal of improving healthcare quality and efficiency, and promote further adoption of IT that ensures the best outcomes, using the most appropriate resources. Moreover, this effort will pave the way for a region-wide research consortium, expanding the network of providers and patients who have access to research opportunities.
Industry relations
Industry (e.g., pharmaceutical, devise manufacturing, diagnostics, information technology, etc.) funded studies can often serve a valuable role in evolving a new research endeavor, especially when a research application requires pilot data or extensive testing prior to gaining grant support from NIH or other such agencies. Industry sponsored programs often provide means to gain valuable preliminary data suitable for NIH Grants to fully test research hypotheses. Mr. Scott Taylor, Associate Director, Industry Relations, has years of experience working with researchers and providing a link to industry funding, while ensuring integrity of the process, the study plan, and the science. Mr. Taylor understands the needs of scientists and industry and provides valuable insight and services in building successful research relationships. His unit is responsible for working with investigators in the Center and exploring options for industry supported research, contracting, and ongoing management of industry relations. Government relations
Led by Mark Reisinger, Geisinger's Government Relations capacity facilitates investigators/researchers ability to interact with policy makers and legislators at the State and Federal levels thereby enabling investigators to participate more fully in the formulation of public policy. The goal is to integrate research efforts with topical policy and legislative issues so that Geisinger research efforts can directly impact the policy debate. Success is achieved through the acquisition of state and federal funding for research and program endeavors. Top of page
Ventures division
Geisinger Ventures is a newly formed division comprising six staff with expertise in diverse areas of health care including information technology and genomics. Geisinger Ventures' primary purpose is to advance Geisinger's goals related to patient care and research; facilitate the commercialization of technologies, business and information services, and systems of care for the public good; promote economic development in communities within Central and Northeastern Pennsylvania; and enhance the Geisinger brand. In so doing, the Ventures Division facilitates incubation of innovative ideas, licenses and commercializes intellectual property, helps develop business plans and catalyzes growth of for-profit companies to generate income to be reinvested in Geisinger Health System's core programs. Geisinger Ventures' responsibilities include: "vetting" venture opportunities; assuming operating roles in for-profit ventures; serving as a key source of deal flow for the early stage investment community; building on system relationships with venture capitalists, state, and other private sources to fund ventures; and interacting with local, state, and federal government representatives for economic development purposes and access to grants.
Areas of recent interest include: Clinical Trial Services; Information Services; Biobanking; Genomics; Healthcare Information Technology; and new health services delivery models. Top of page
Sample of profile projects
Stroke
Title: Developing a Stroke Care Educational Resource Center for Rural Health
Investigators: Linda Famiglio, MD; Jonathan Hosey, MD; Stuart Hoffman, DO; Walter Stewart, PhD
Funding: Health Resources and Services Administration/Office for the Advancement of Technology
Study 1: Determine gaps in stroke resources in the 31 county areas. Surveyed 54 hospitals in 31 county areas to determine resources available for stroke care. Use distance education/ communication methods to achieve consensus among hospitals on gaps in emergency care.
Study 2: Telephone survey to determine knowledge of stroke symptoms and attitude toward quick response. Assess current consumer knowledge about stroke warning signs. Assess current attitudes and beliefs among consumers regarding the need to seek care immediately in response to stroke signs and symptoms. Identify sources of health information most often used by adult residents of the 31 county service areas. Deliver education to consumers on stroke signs and symptoms, risk factors, and the response plan relevant to their area.
Study 3: Paper Survey to determine knowledge of stroke signs and symptoms and attitude toward response time. Also included learning preferences. Assess current knowledge among EMS personnel of stroke warning sings, risk factors and appropriate action in response to stroke. Assess current attitudes and beliefs among EMS personnel regarding acute management of stroke. Deliver a series of web based educational reinforcements to accredited courses on stroke management for EMS personnel, focusing in on stroke signs and symptoms and emergency care for acute stroke victims.
Study 4: Assess current knowledge of stroke assessment and care management among physicians who provide emergency care or acute in-hospital care for stroke victims. Assess current attitudes and beliefs about stroke among physicians who provide emergency and acute care to stroke victims. Deliver educational materials to and facilitate communication among physicians who provide emergency care using electronic media.
Study 5: Deliver education to consumers on stroke signs and symptoms, risk factors, and the response plan relevant to their area. Deliver a series of web based educational reinforcements to accredited courses on stroke management for EMS personnel, focusing in on stroke signs and symptoms and emergency care for acute stroke victims. Deliver educational materials to and facilitate communication among physicians who provide emergency care using electronic media.
Hypertension
Title: Evaluation of Hypertension Treatment, Compliance and Outcomes using Diovan
Investigators: Michael Halpern, MD; Jordana Schmier, MA; Walter Stewart, PhD
Funding: Exponent - Novartis
Study: The purpose of this study is to evaluate the impact of antihypertensive medication Diovan (an ARB) versus other antihypertensive medications (ARBs, ACEIs, CCBs) or combinations of such medications on longitudinal treatment patterns, compliance, outcomes and resource utilization. Besides the demographics and clinical characteristics of patients in each medication group, risk groups, comorbidities, complications of hypertension, practice type of physician. Geisinger Clinic's Electronic Health Record (EHR) and GHP Amysis claims database will be the primary sources of data for this study. All individuals in this data set with at least one elevated blood pressure reading. The antihypertension treatment patterns over time will be assessed through the patient's EHR for each medication group (Diovan, other ARBs, ACEIs, and CCBs). Medication compliance will be assessed using the medication possession ratio (MPR). The MPR is calculated by the number of days of therapy dispensed to a patient divided by the number of days between subsequent prescriptions. The proportion of patients who achieve normalization of blood pressure in each medication group will be determined. An analysis using a time dependent model will evaluate both the overall rate of change in blood pressure outcomes and the time to achieve these outcomes. Resource utilization and costs will be assessed for Diovan patients as well as patients in each medication group. Costs will be applied to each unit of resource utilization based on standard national values.
Malpractice
Title: Physician Satisfaction Ratings and Risk of Legal Claims
Investigators: Robert Spahr, MD; Craig Wood, MS; Zahra Daar, MS; Walter Stewart, PhD
Funding: Internal Geisinger Funding
Study: The purpose of this study is to determine if physician's patient satisfaction scores predict productivity and/or malpractice claims. A longitudinal research database will be maintained that includes satisfaction data, malpractice data and RVU productivity measures.
Cardiovascular disease
Title: Cardiovascular Risk Assessment and Management (eCVD)
Investigators: Walter Stewart, PhD; James Walker ,MD; Vitaly Geyfman, DO
Funding: Roche Diagnostics
Study: Development of a clinical system suitable for primary care to monitor and manage cardiovascular disease (CVD) risk, evaluate risk of a heart attack during routine encounters among patients seeking care in primary care settings. Educate patients during routine primary care encounters about risk factors for CVD and management of these risk factors. Group primary care patients by CVD risk strata, where the strata are defined by differences in the primary care protocol for managing and treating risk. Engage patients at elevated risk of a heart attack, or with a diagnosis of CHF or CAD, to set goals for reducing their risk of a heart attack or reduce their disease progression.
Title: Physician Decision Support for Cardiovascular Risk Management (eCVD)
Investigators: James Walker, MD; Walter Stewart ,PhD; Vitaly Geyfman, DO.
Funding: Roche Diagnostics
Study: Development of a clinical system suitable for primary care to monitor and manage cardiovascular disease (CVD) risk. Provide physicians and other clinical staff with decision support on how best to manage a patient's risk of CVD. Routinely monitor patient progress towards achieving goals in reducing their risk of CVD and CVD progression. Motivate patients to achieve goals in reducing their risk of CVD and CVD progression.
Title: Formulary Prescribing Model
Investigators: Walter Stewart, PhD; James Walker, MD
Funding: Pfizer
Study: The overall aim of this study is to evaluate the impact of this multi-list patient specific formulary in Geisinger outpatient clinics on physicians and patient. Evaluate the impact of a point-of-care prescribing module designed to help patients understand their treatment options. Measure patient adherence to lipid lowering medications. Assess physician and patient satisfaction with the prescribing process. Determine if clinical outcomes (e.g., HDL and LDL) are associated with variation in access to prescriptions (i.e., specific drugs and co-pay) among patients who seek care from the same physicians but who vary by insurer. Assess the impact of the prescribing model on efficiency as defined by a change in the number of pharmacy related calls. Top of page
Cardiovascular disease/Diabetes
Title: Health e-Technologies Initiative
Investigators: Walter Stewart, PhD; Nirav R. Shah, MD, MPH; James Walker, MD
Funding: Robert Wood Johnson Foundation
Study: A randomized controlled trial of an electronic intervention delivered via the MyGeisinger patient portal designed to motivate patient activation and to support self-management among 6,000 patients with chronic disease. Enrolled patients have one or more of the following conditions: cardiovascular disease, congestive heart failure, and/or diabetes mellitus. The specific aims of the study are to determine if e-portal interventions influence measures of patient activation, patient self-management, treatment adherence, patient satisfaction with care, and disease-specific knowledge; process measures relevant to appropriate care; and clinical markers of cardiovascular or diabetes morbidity and risk.
Autism
Title: Early Detection of Autism Spectrum Disorder
Investigators: Walter Stewart, PhD; Thomas Challman, MD; Scott Myers, MD
Funding: This research was supported by grant 1 H61MC01675-01-00 (9/1/2003- 8/31/2005) from the Health Services Resources Administration (HRSA).
Study 1: The purpose of this study is to establish routine screening for developmental disorders in pediatric practices. We developed and tested SEARCH (Screening Evaluation for Autism Related Disorders in Children), a brief, parent-completed screening questionnaire for detection of autism spectrum disorders among children age 24-60 months.
Current autism screening tools may not be suitable for primary care settings (direct observation required, narrow age range, high false positive rates, etc). In the Geisinger Clinic, we were interested in establishing routine screening for developmental disorders in pediatric practices with the long term interest of using a parent completed computerized questionnaire. As none of the current instruments were deemed acceptable for screening by primary care clinics at Geisinger, we developed SEARCH (Screening Evaluation for Autism and Related Disorders in Children). SEARCH is a brief, parent-completed screening questionnaire for the detection of autism spectrum disorders (ASD) among children age 24-60 months.
Study 2: The purpose of this study is to develop and test a sustainable model of care for the Geisinger Neurodevelopmental Pediatric Clinic. The proposed model was designed to increase access to expert care by increasing the efficiency of the assessment and the evaluation process while maintaining or improving satisfaction with care.
Study 3: The purpose of this study is to adopt a chronic disease management model of care. This goal was addressed in four phases: 1) Provide parents with an automated report after an encounter, 2) Develop a website for parents of children with Autism Spectrum Disorders, 3) Assess professional needs and gaps in care through interviews with professionals, 4) Assess parent satisfaction, timeliness of obtaining care, continuity of care, and gaps through parent-completed questionnaires.
Genomics
Title: Geisinger Osteoporosis Project
Investigators: Glenn Gerhard, MD; Eric Newman,MD; Xin Chu, PhD; Walter Stewart, PhD; Barbara Payton, PhD
Funding: Internal - Geisinger Endowment
Study: The purpose of this study is to identify genes associated with low, medium, and high bone mineral density (BMD) through analysis of DNA obtained from female patients referred to Geisinger Clinic for BMD evaluation by dual-energy x-ray absorptiometry (DEXA). Identifying genetic markers related to bone mineral density could provide the foundation for targeted therapeutics or result in the development of new diagnostic tests.
Title: Patient Focus Group
Investigators: Walter Stewart, PhD; Glenn Gerhard, MD
Funding: Internal - Geisinger Endowment
Study: The aim of this study is to understand knowledge, attitudes, and beliefs of GHS patients who seek care from Geisinger Clinic, regarding development of a DNA and serum repository and clinical database. The information obtained from these focus groups and surveys will provide pivotal information on the region specific issues involved in initiating a large-scale study.
Title: Primary Care Study of Health and Risk of Disease
Investigators: Glenn Gerhard, MD; Eric Newman, MD; Xin Chu,PhD; Walter Stewart, PhD; Barbara Payton, PhD
Funding: Internal - Geisinger Endowment
Study: The purpose of this study is to pilot test a clinic-based protocol for obtaining informed consent and DNA and serum from a sample of 500 patients who seek care from a community practice clinic. Our main goal is to identify procedures that minimally impact the flow of medical care and that can easily be applied to other community practice sites. We will pilot test two procedures with the Berwick community practice clinic, selected as a representative clinic in the Geisinger Health System.
Obesity
Title: Risk Mediators of Metabolic Syndrome and Non Alcoholic Steato-Hepatitis (NASH) - Prospective Study
Investigators: Christopher Still, DO; Glenn Gerhard, MD; Walter Stewart, PhD; Anthony Petrick, MD; William Strodel, MD; Mary Jane Reed, MD; Jay Jones, PhD; Barbra Payton, PhD
Funding: Internal - Geisinger Endowment
Study: This study directly addresses two important health problems, obesity and Non-alcoholic Steatohepatitis (NASH). Over 60% of the adult population in the U.S. is overweight or obese. Of the 20-30% adults who have excess fat accumulation in the liver (primarily in the obese), an estimated 10% meet current diagnostic criteria for non-alcoholic steatohepatitis (NASH). NASH can lead to liver fibrosis and, ultimately, irreversible cirrhosis. The overal plan for this study involves a prospective recruitment of new patients seeking care in the Nutrition and Weight Management Clinic. The goals of this study are to create a research quality database, demonstrate the feasibility of a research strategy for a larger study, develop and implement research protocols for data gathering and tissues preservation for future studies, and to perform genetic analysis to identify risk factors for NASH.
Title: Risk Mediators of Metabolic Syndrome and Non Alcoholic Steato-Hepatitis (NASH) - Retrospective Study
Investigators: Christopher Still, DO; Glenn Gerhard, MD; Walter Stewart, PhD; Anthony Petrick, MD; William Strodel, MD; Mary Jane Reed, MD; Jay Jones, PhD; Barbra Payton, PhD
Funding: Internal - Geisinger Endowment
Study: This study directly addresses two important health problems, obesity and Non-alcoholic Steatohepatitis (NASH). Over 60% of the adult population in the U.S. is overweight or obese. Of the 20-30% adults who have excess fat accumulation in the liver (primarily in the obese), an estimated 10% meet current diagnostic criteria for non-alcoholic steatohepatitis (NASH). NASH can lead to liver fibrosis and, ultimately, irreversible cirrhosis. The overall plan for this study involves a prospective recruitment of new patients seeking care in the Nutrition and Weight Management Clinic and a related retrospective study of patients that have been seen in the past.
Obesity prevention
Title: Integrated Online Health Curriculum
Investigators: William Cochran, MD; Walter Stewart, PhD
Funding: Degenstein Foundation
Study: The purpose of this study is to adapt current elementary school health curriculum to an online format and integrate it into core academic subject areas. Aging
Title: An electronic medical record (EMR)-based intervention to reduce polypharmacy and falls in an ambulatory rural elderly population.
Investigators: Valerie Weber, MD; Allen White, PhD; Rodney McIlvried, MD
Funding: Agency for Healthcare Research and Quality (AHRQ).
Study: The objectives of this study were to evaluate an EMR-based intervention to reduce medication use in an ambulatory elderly population at risk for falls, and to determine whether the intervention could reduce the number of falls and overall health costs in this population.
Methods: Geisiner's EMR database was queried to select patients meeting the following inclusion criteria: age greater than 70, four or more active medications, and one or more psychoactive medications. In addition, all patients were community-dwelling and seen by a Geisinger Health System primary care physician and had Geisinger Health Plan (GHP) Medicare + Choice insurance. Patients were randomized by clinic site to avoid confounding by physician. Either a pharmacist or geriatrician, using a standardized tool, did a medication inventory via chart review. Individualized suggestions regarding medications, often focused on the use of psychoactive medications, were made, and a message was sent to the physician via the EMR. A link to a fall evaluation practice guideline was included as part of the message. Patients were contacted by telephone and were questioned regarding the occurrence of falls at months 1, 3, 6, 9, and 12. Fall-related diagnoses and pharmacy data were both collected through the EMR. Claims related cost data was collected via the GHP claims database. A combination of descriptive analyses and multivariate regression models were used to evaluate differences between the two groups adjusting for baseline medication patterns and comorbidities.
Results: The intervention group had lower utilization of psychoactive medications and fewer new psychoactive medications than the comparison group. Those differences were larger for those who were prescribed more psychoactive medications at baseline. The intervention was also associated with a reduction in fall risk, with those in the intervention group only 0.38 times as likely to have one or more fall-related diagnoses (p < 0.05). There was no significant difference in healthcare costs seen between the two groups, however the lack of availability of nursing home cost data limited our ability to conduct cost effectiveness analysis.
This study was presented nationally at both SGIM and Academy Health, in 2005. Write up for publication is in progress. Top of page
Institutes
The Center grew out of a vision to take Geisinger Health System's (GHS) unique institutional resources and integrated delivery system based on a multispecialty group practice, strengths in informatics, and a stable patient population and build an integrated research program. Specific areas of focus include health services, information technology, epidemiology, effectiveness research, population genomics, and other topics focused on defined populations with the intention of discovering and testing effective means of improving and protecting health. As the Center continues its building process, defined population needs have been identified, either because they represent a significant regional health problem that is also relevant to the US population or because of gaps between the care provided and what is theoretically possible as defined by best practice (to directly benefit patients and the well-being of GHS). The Center decides to create an Institute when a disease state or clinical problem satisfies these criteria and it can leverage synergies among a unique combination of resources. To this end, three Institutes have been initiated and are described below. In addition, rural advocacy is an important system wide program area of focus.
Outcomes Institute
Directed by Robert Langer, MD, the Outcomes Institute oversees secondary data analysis relevant to effectiveness of care and treatments and initiates prospective studies to test new treatments and care delivery processes. The Institute integrates health services research with clinical care, maintaining a direct and iterative link between investigative findings and clinical practice. Given the growing body of longitudinal data captured by the EHR, the Institute is increasingly able to study the effectiveness of treatments and contribute to a broader understanding of the value of medications in practice, providing a balance to evidence from more traditional efficacy studies. The Institute collaborates and plans research with clinical departments and with other key divisions including Clinical Effectiveness, Disease Management within the Geisinger Health Plan, and Information Technology. The Institute capitalizes on the unique strengths of Geisinger in building enterprise outcomes research capability. These strengths include a priority for outcomes research, strong relations with practitioners, advanced outpatient electronic medical records, electronic interface and data systems infrastructure, integrated data on medical encounters, lab, pharmacy, imaging, and a highly stable, large population base. In addition to effectiveness studies, other areas of interest include safety studies, pharmaco-economic research, intervention studies focused on the use of health information technology as a means to deliver quality outcomes at a lower cost, and epidemiologic risk assessment.
Institute on Aging (In development)
In the next several decades, GHS's population will continue to age at a rate faster than the rest of the U.S., become increasingly burdened by chronic disease, and will remain to a large extent rural. The growing force from this demographic pressure is predictable. Initiation of an integrated program focused on aging, under an Institute on Aging (like the overall Center, building success in research, garnering external recognition and publication of work, and achieving financial self-sufficiency) will measure the success of the Institute. As one of the nation's oldest states with nearly 20% of the population aged 65 and older, Pennsylvania is already at the forefront of meeting the challenge of caring for an aging population. Because Pennsylvania also has the largest proportion of rural elders, and Geisinger is one of the nation's few rural integrated delivery systems, the System has a unique opportunity to define, amplify, and address the health care needs of a rural aging population. With the System's electronic infrastructure, including recent efforts to build one of the first regional health information networks (RHIN), Geisinger is poised to make substantial contributions to defining 21st century health care models and to address fundamental health care issues and population needs for the region and nation's elderly. In addition, there are issues that an Institute on Aging can leverage as a natural outgrowth of its work in the policy aspects of health care funding; particularly as the country faces tensions surrounding prescription drug costs, Medicare funding, and the costs of nursing home care. It is expected that health policy work would be included as part of the core mission of the Institute. The work of the Institute will be of major importance to an understanding of how to provide cost-effective care to our rural, aging population in an era of increasing cost constraints. The Institute on Aging will be able to build on Geisinger's strong governmental contacts and national relationships including the National Rural Health networks. The Institute would also consolidate work on aging-related areas being done throughout the System, including General Internal Medicine/Geriatrics, the Community Practice Service Line, the Medicine Subspecialties, LIFE-Geisinger, (PACE--first site in Scranton in progress), and explore ways to optimize use of health information technology and work on the RHIN. Geriatric Surgery, an area in which Geisinger has expertise due to the contributions of Dr. Mark Katlic, will be included within the Institute. The goal of this multidiscipline surgical focus will be to improve care of the elderly surgical patient through education and research. Top of page Institute on Obesity
The nation and Pennsylvania suffer from an epidemic of overweight that has been underway for over 20 years. The epidemic is unabated, affecting all age groups. The primary goal of the Institute on Obesity will be to coordinate population-based and laboratory-based research efforts and clinical programs into an integrated research and delivery system-wide program. The Institute will leverage the numerous system resources and will be responsible for ongoing recruitment of other investigators to supplement program needs in research and intervention. This section provides an overview of current investigators, ongoing and proposed research initiatives, clinical resources, and the Director's position description.
Current and developing research activities
Molecular profiling in hepatic fibrosis: Most liver cancers occur in patients with liver cirrhosis, a leading cause of death in the United States. Hepatic fibrosis leading to cirrhosis is therefore a pre-malignant condition for hepatocellular carcinoma. Viral hepatitis, alcohol abuse, and non-alcoholic steatohepatitis (NASH) are the most common causes of hepatic fibrosis. Little work has been done on NASH related hepatic fibrosis (NHF). NASH is a common but often unrecognized liver disorder primarily occurring in obese patients. Liver histology assessed on biopsy is the only definitive and clinically accepted method to make the diagnosis of NASH. We plan to develop clinically useful biomarkers for NHF and to identify potential therapeutic targets for inhibiting and/or reversing the progression of NHF by exploiting an ongoing clinical research program in obesity in the Center for Nutrition and Weight Management at Geisinger. Bioinformatics methods and tools to analyze gene expression data in the context of a comprehensive research database of clinical information will be developed in collaboration with the Informatics for Integrating Biology and the Bedside (i2b2) National Center for Biomedical Computing (NCBC) at Brigham and Women's Hospital in Boston. New informatics approaches will be used to define the relationship between NHF and gene expression profiles in liver and blood to provide candidate biomarkers for further study. Biomarker development in non-alcoholic steatohepatitis: An estimated 2% to 3% of all adults have undiagnosed nonalcoholic steatohepatitis (NASH) in the liver, a liver biopsy, in which a needle is inserted through the skin into the liver, is the only way to diagnose NASH. Our long-term objectives are to develop clinically useful biomarkers for NASH. NASH is a common but often unrecognized liver disorder primarily occurring in obese patients. Liver histology assessed on biopsy is the only definitive and clinically accepted method to make the diagnosis of NASH. The molecular basis for how NASH develops and progresses is poorly understood. We plan to define the relationship between NASH and gene expression profiles in liver and blood for biomarker development. Bioinformatics methods and tools to analyze gene expression data in the context of a comprehensive research database of clinical information will be developed in collaboration with the Informatics for Integrating Biology and the Bedside (i2b2) National Center for Biomedical Computing (NCBC) at Brigham and Women's Hospital in Boston. Protein and/or RNA based biomarkers will then be developed from selected candidate genes. Oxidative stress and obesity: Obesity related complications, including diabetes, metabolic syndrome, vascular disease, and non-alcoholic steatohepatitis (NASH), are increasingly important health problems. While multifactorial in nature, oxidative stress resulting from overproduction of reactive oxygen species (ROS) in the mitochondria has been implicated in these conditions. With a potentially central role in generating ROS, by contributing to the generation of the highly reactive hydroxyl radical, iron has been implicated in a number of disorders related to oxidative stress, including complications of obesity. Levels of hepatic non-heme iron and lipid peroxidation, as well as the mitochondrial generation of hydrogen peroxide, protein carbonyl content, and 8 oxoguanine levels will be measured in liver and skeletal muscle in obese patients undergoing bariatric surgery. The results from these studies may set the stage for clinical trials targeting iron-related oxidative stress in obesity and related complications. School-based Obesity Prevention Program: This project expands on a former school-based program to prevent obesity in elementary school children, originally developed by William Cochran (W.E.I.G.H. of the World). The current project adds structure and standardization to the program content and procedures. It incorporates innovation through the use of an online delivery system, leveraging Geisinger's IT capabilities. The program enhancements have the potential to serve as a national model through its alignment with the CDC's Coordinated School Health Model and the inclusion of rigorous evaluation tools appropriate for educators and administrators for tracking program performance and effect on federally mandated academic benchmarks. This program has currently generated two grant proposal submissions with two more planned for this year.
Weight Trends Database: This project seeks to explore and document prevalence trends of obesity in the Geisinger patient population and stimulate research program development in defined cohorts. Using EHR data on BMI, efforts have been organized around four age groups of interest: preschoolers (2-5 years), children (ages 6 - 11 years), adolescents (ages 12 - 18 years), and adults (greater than 18 years). Analysis of variation in overweight and obesity by age, birth cohort, and geographic location are providing the foundation for a number of spin-off projects. This project is expected to serve as preliminary work for research proposal preparation. Portions of this work have been included in four submitted proposals (NIH, VHR Health Foundation, Robert Wood Johnson Foundation, and Geisinger's ACR Targeted Research Grants).
Action for Healthy Kids (AFHK) Qualitative Analysis: This project is an "in-kind" donation to the PA AFHK State Team. Its purpose is to qualitatively analyze data that were gathered as part of an effectiveness survey for a tool kit designed by Penn State and the PA Department of Education to teach parents about nutrition and childhood obesity. It is expected to result in recognition of Geisinger as a contributing author to a state publication to be posted on the AFHK national website.
Commonwealth Universal Research Enhancement (CURE) Grant - Parent Intervention:
This project is in the proposal development phase and aims to intervene on parents of infants and preschoolers who are at high risk of obesity. Data routinely gathered in the EHR will be used in a predictive model to identify infants at high risk. The focus of the proposal will be to test the efficacy of low-cost interventions directed to the parents. A randomized controlled trials design will be used to the hypothesis that intervention early in life before a child is overweight leads to sustained host resistance. An important features of the proposed design is to determine how the built environment influences or modifies the effect of the intervention itself.
PANA (Pennsylvania Advocates for Nutrition and Activity) Editorials: This work is in discussion with Geisinger and PANA PR representatives. Its purpose is to produce a series of editorials that support a social marketing approach to community wide obesity prevention through raising awareness of the nature and extent of obesity in PA and possible statewide solutions. Although not fully developed, the direction and intent of these editorials is to support a potential environmental intervention on a broad level (regional and state). They serve as an early foundation-building device for collaboration between Geisinger, the PA Department of Health, and the CDC (through PANA) with the possibility of future funding for Geisinger-led projects through the state's CDC grant. Top of page
Clinical programs
Center for Nutrition and Weight Management: The Center for Nutrition and Weight Management is under the leadership of Christopher Still, DO. Dr. Still, Medical Director of the Center of Nutrition and Weight Management at Geisinger Medical Center. Additional clinical researchers in a variety of subspecialties support his work in clinical nutrition. Active investigative trials available for patient enrollment include: - Geisinger's weight management program. This study is tracking outcomes of enrollees; specifically reduction in weight as well as improvement in co-morbidities (i.e., DM, sleep apnea, high cholesterol) and reduction in health care utilization.
- Obesity-related disorders in rural Pennsylvania pediatric population.
- Morbid obesity in trauma.
- A double-blind, randomized, placebo-controlled, multi-center study to assess the safety, tolerability, and efficacy of L-00753721 in obese patients.
- Determination of the sensitivity and specificity of hepatic ultrasound and non-invasive tests for the diagnosis of NASH.
Pending studies in the pediatric population include: - Preventing mitochondrial oxidative stress in diabetes and obesity
- Collaborations with national Centers for Biomedical computing
- Development of Disease Biomarkers for NASH
- Secondary analyses in obesity, diabetes, obesity, digestive and kidney diseases
- Proteomics: diabetes, obesity, and obesity and endocrine, digestive, kidney urologic and hematologic diseases
Weight Management Clinic: The Weight Management Clinic at Geisinger Medical Center is a comprehensive physician-directed program. The goal of the program is to provide treatment for patients suffering from obesity with associated medical problems such as diabetes, sleep apnea and high cholesterol. A physician or physician assistant and registered dietitian specializing in obesity treatment provides initial medical consultation. An individualized program is prescribed consisting of diet, exercise, behavior modification, and if appropriate medications and/or weight loss surgery. The goal of treatment is to improve the health of patients through modest, sustained weight reduction. A loss of 15-20% of starting body weight is encouraged. State-of-the-art equipment can be used to allow for a precise, personalized dietary program: - MedGem - accurately measures metabolic rate, avoiding problems associated with population-based estimates.
- Bioelectric Impedance Analysis.
Case volumes currently associated with programs under the Obesity Institute umbrella are: - 40-50 new patients per week in weight management clinic
- 1,000 bariatric patients since March 2001
- > 4,000 patients in medical management database
Malnutrition Clinic: The Malnutrition Clinic is designed to meet the needs of patients requiring specialized nutrition support or medical nutritional management. A team consisting of a nutrition support-certified physician, nurse and a dietitian, along with a physician assistant and pharmacist, collaborate to provide comprehensive multidisciplinary care. Services include: - Consultation for the initiation and management of total parenteral nutrition (TPN) for inpatients and outpatients
- Nutritional assessment and management of patients with malabsorption, short bowel syndrome, wasting syndrome or inflammatory bowel disease
Home Tube Feeding Clinic: The Home Tube Feeding Clinic provides services to those who require enteral nutrition (tube feeding) as an outpatient. The nutrition support-certified dietitian and nurse provide the following services under the physician's supervision: - Nutrition assessment and tube feeding recommendations
- Enteral access care and replacement
Weight Loss Surgery: For patients with clinically severe obesity, bariatric surgery is an option available at Geisinger to improve health and quality of life. Geisinger's Center for Nutrition and Weight Management integrates a well-established bariatric surgery program within a large comprehensive weight management clinic that has been in existence since 2004. The center, which sees over 5,000 obese patients annually, has integrated bariatric surgery (gastric bypass and gastric banding) into its treatment algorithm. An Internist specializing in bariatric medicine initially sees patients in consultation. If patients are deemed candidates for bariatric surgery, they are placed in a comprehensive, 6-month, program including a series individual and group sessions by a variety of providers. Prior to surgery, patients are required to loose 10% of their presenting weight, stop smoking 60 days prior to surgery, read a book and work through 10 behavioral modification modules, attend 2 educational classes and 2 support groups. The patients also undergo a comprehensive medical and psychological evaluation prior to surgery. In addition to the Internist, the bariatric surgery "team" is comprised of a bariatric medicine Fellow, 2 mid level providers, 4 dietitians, 3 psychologists, 2 research coordinators and 4 bariatric surgeons. Post-operatively, patients are followed initially in combination with the bariatric surgeons and then indefinitely by the medical team ensure optimal outcomes. Patients not interested in or not meeting specific insurance criteria for bariatric surgery, are provided a comprehensive medical approach encompassing diet, exercise, behavior modification and, if appropriate, the use of pharmacotherapy. Top of page
Rural advocacy
Geisinger Health System is located in a predominantly rural area and it is well positioned to conduct original research and policy analysis relevant to rural health care needs. An important focus of the Center is to provide policy guidance to improve the health of rural communities and their residents throughout the region, state and nation by: - Focusing on the health effects of environmental exposures in the region, with a particular focus on water contamination in the Susquehanna River Basin
- Testing sustainable and more efficient models of care that improve access and can be replicated for all rural populations throughout Pennsylvania
- Testing sustainable and more efficient models of care that improve access and can be replicated for all rural populations throughout Pennsylvania
- Disseminating health research outcomes data to legislators, policy makers, health providers, and health administrators
- Strengthening the network of rural providers by encouraging partnerships and identifying opportunities for collaboration and cooperation
- Providing a voice for rural health providers in advocating for necessary regulatory and legislative initiatives and policies
- Advocating for the unique health needs of a rural population
- Acting as a liaison between health care providers, academia, government, and the patient population
- The unique health care challenges in rural populations are a central focus of discussion and discovery within the Center.
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