Department of Population Health Sciences De… · 2016 department of population health sciences...

2016

DepartmentofPopulationHealthSciences

PROPOSALTOESTABLISHANEWDEPARTMENTINTHESCHOOLOF

MEDICINE

LESLEYCURTIS,PHD

SURESHBALU,MS,MBA

HAYDENBOSWORTH,PHD

ASHLEYDUNHAM,MSPH,PHD

ADRIANHERNANDEZ,MD,MHS

KEVINWEINFURT,PHD

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ExecutiveSummary Thescienceofpopulationhealthexamineshealthoutcomes,underlyingdeterminantsofhealth,anddiseasestatesinpopulationsdefinedbymanyfactorsincludinggeography,ethnicity,employment,orthehealthcaresystemsinwhichpeopleseekcare.Improvingthehealthofapopulationdemandsamulti-facetedapproachthatexaminestheunderlyingcausesofhealth,usesdataregardingenvironmental,social,behavioral,physical,andgeneticdeterminantsofhealthtoimprovehealth,andinformspoliciesthatshapeaccessto,financinganddeliveryofhighqualityhealthcare.Thechallengeofimprovingpopulationhealthrequiresamultidisciplinaryeffortthatincludesepidemiology,healthservicesresearchandpolicy,clinicalinformatics,healtheconomics,behavioralscience,andimplementationscience.TheimportanceofmultidisciplinaryapproachestoimprovinghealthhasbeenhighlightedintheNationalInstituteofHealth’s(NIH)PrecisionMedicineInitiativeandtheWhiteHouse‘sCancerMoonshot2020.AtDuke,themultidisciplinaryeffortisalignedwiththeUniversity’sstrategicplan,KnowledgeinServiceofSociety,andwiththeDukeHealthStrategicFramework.SchoolofMedicineAuthorization.InOctober,2015,NancyAndrews,MD,PhD,DeanoftheDukeSchoolofMedicine,authorizedamultidisciplinaryworkinggroup(Appendix1)toexplorethecreationofanewbasicsciencedepartmentintheSchoolofMedicinecomposedofnon-clinicalscholarsinepidemiology,healthservicesresearchandpolicy,healtheconomics,behavioralscience,andimplementationscience.Theworkinggroupestablishedguidingprinciplesforitsdeliberations,metwithkeyleadersandstakeholdersfromaroundtheUniversity,andpresenteditsreporttotheDeanonMarch1,2016.WithsupportfromtheChancellor,theDeanestablishedtheCenterforPopulationHealthSciencesasalaunchingpadforthenewdepartment,pendingitsapprovalbytheBoardofTrustees.PleaseseeAppendix4forLettersofSupportfromChancellorWashingtonandDeanAndrews.DepartmentStructureandLeadership.TheDepartmentofPopulationHealthScienceswillbeabasicsciencedepartmentintheSchoolofMedicine,housingtenured,tenuretrack,andnon-tenuretrackfacultywithdoctoraltraininginepidemiology,publichealth,healthservicesresearchandpolicy,implementationscience,andrelateddisciplines.ClinicalfacultyandfacultyfromotherdepartmentsintheUniversitymayhavesecondaryappointmentsinthedepartment.WhentheDepartmentisapproved,32facultyareexpectedtotransitionfromclinicaldepartmentsintheSchoolofMedicinetothenewdepartment.AlthoughtheDepartmentmaybeorganizedindivisionsorcores,interdisciplinaryworkwithdepartmentsandinstitutesacrosstheSchoolofMedicineandUniversitywillbeencouraged.TheSchoolofMedicinewillundertakeanationalsearchfortheChairwhowillbeexpectedtocarefullyconsideropportunitiestomaximizecooperationandcollaborationtoachievesynergybetweenentitieswithintheUniversity.NationalModel.Withinmostuniversities,avarietyofentitiesconductpopulationandpublichealthresearchandteaching,includingschoolsofpublichealth,departmentsordivisionswithinaschoolofmedicine,andschooloruniversity-wideinstitutesorcenters.Oftheschoolsofmedicinerankedinthetop20byUSNewsandWorldReport(2015),18arehousedinuniversitiesthatoperateeitheraschoolofpublichealth(n=8),department(n=5),oruniversity-wideinstitutefocusedonpublichealthorpopulationhealthscience(n=5).OnlyDukeandUC-SanDiegodonothavesuchentities.Themost

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recentschoolofpublichealth(UniversityofWashington)wasestablishedin1970;allothershaveexistedformorethan50years.Institutes,centers,anddepartmentsestablishedinthelast10yearsreflectnewerterminology,usingpopulationhealthratherthanpublichealth.

Research.Thescienceofpopulationhealthexamineshealthoutcomes,underlyingdeterminantsofhealth,anddiseasestatesinpopulationsdefinedbygeography,ethnicity,employment,orplaceofhealthcare.TheSchoolalreadyhasaconsiderablenumberofoutstandingfacultyresearchersinpopulationhealthsciences,definedheretoincludeepidemiology,healthservicesresearchandpolicy,healthbehavior,clinicaldecisionsciences,implementationscience,measurementscience,andbioethics.BasedonourreviewofDuke’sextantstrengthsandopportunities,wehaveidentifiedthreesignatureinitiativestobedeveloped:measurementscience,implementationscience,andscientificengagementwiththehealthsystemtoadvancestrategicpriorities.TheseinitiativesleverageexistingbutunderdevelopedDukestrengths,areatthefoundationofpopulationhealthimprovement,andaregeneralizablebeyondDuke.Todeveloptheseareas,weproposetosupporteffortforcurrentDukefacultytoleadeachinitiative,newfacultyhirestoincreaseourcapacityforworkintheseareas,andspecializedresearchstaffwhowillformthecoresrequiredtoconducttheresearch.Toincreasethelikelihoodofexternalfundingtosupporttheseinitiatives,wehaveallocatedfundstosupportthenecessarypreparatorywork.Education.TheeducationalprogramsoftheDepartmentofPopulationHealthScienceswillpreparethenextgenerationofscientistsandhealthpractitionerstoadvancethehealthofpopulationsthroughthediscoveryandtranslationofknowledgeintopolicyandpractice.Whenapproved,theDepartmentwillproposeaMasterofScienceandDoctorofPhilosophyforconsiderationbytheDukeUniversitySchoolofGraduateStudies.Additionaleducationalofferingswillincludeapopulationhealthsciencestrackfor3rdyearmedicalstudentsandpost-graduatecertificateprogramsgearedtowardcurrentandemerginghealthcareleaders.Theseprogramswilleducateparticipantsaboutthesystemsandtoolsrequiredtounderstandthechangingmarketplace,developandevaluatenewmodelsofcaredelivery,andengagepatientsandproviders.Service.Historically,accesstoelectronichealthdataatDukeforresearchpurposeshasbeeninefficientduetothesiloednatureofdataandexpertise.ThereisinterestacrosstheUniversitytoprovideasharedresourcetoeasilyaccesselectronicdata(inparticular,MedicareclaimsdataandDukeHealthelectronichealthrecorddata)inasecure,robustenvironmentwithuniformapproachestogovernanceandregulatoryrequirements.TheCenterforPopulationHealthSciencesproposesanelectronichealthdatacore,housedinPACE(ProtectedAnalyticComputingEnvironment),thatwillprovideaccesstoMedicareclaimsandDukeHealthelectronichealthrecorddataforauthenticatedusersconductinghealthservicesresearchandqualityimprovement.Additionally,thecorewillprovideaccesstoeducationandregulatorysupport,technicalexpertisetoprocessandintegratedataset,andanalyticalguidancefromexperiencedanalysts.Impact.Integrationofexpertiseanddevelopmentofinfrastructurewithinasingledepartmentwillacceleratecollaboration,createefficiencies,provideanacademichomefornon-clinicalfaculty,

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establishamorecohesiveframeworkforfacultymentoring,andgeneratenewsourcesofresearchandeducationfunding.Fromareputationalandfinancialperspective,however,thecreationofanewdepartmentcouldnegativelyimpactexistingdepartmentsandinstitutesintheshortterm,asfacultyandtheirfundedportfoliosareconsolidatedintothenewDepartment.TheanticipatedimpactontheDepartmentsofMedicineandPsychiatryismodestbecausethefederalfundingportfoliosofPopulationHealthSciencesfacultyaresmallrelativetototalfederalfundingreceivedbyMedicineandPsychiatry.ThepotentialimpactontheDepartmentofCommunityandFamilyMedicinemaybemoresubstantial.Approachestomitigatethepotentialnegativeimpactarebeingdevelopedincollaborationwithclinicalchairsandinstitutedirectors.AdministrativeSupport.TheDepartmentwillneedavarietyofadministrativeservicesthatitwillbuildin-houseandsharewithotherbasicsciencedepartmentsandinstitutes.Thesewillinclude:proposaldevelopment&grantsadministration,populationresearchadministration,HR/Visa/Effortreporting,finance,educationalprogramcoordination,IT,marketingandcommunications,andbusinessandfinancialmanagement.AllMissionsBudget.Basedoncurrentprojectionsandreasonableassumptions,theall-missionsbudgetsuggeststhataninvestmentofapproximately$8.25mover4yearswillberequiredtoestablishanoperationaldepartment.Althoughthebudgetrepresentsourbestestimatebasedoncurrentinformation,uncertaintyexistswithrespecttothetimingoffacultytransitionsandtheirresearchportfolios;thespeedoffacultyrecruitmentwhichwouldappropriatelydelayinitiationofresearchprogram;andthetimingoftheapprovalofthemaster’sprogram.Astheseuncertaintiesarereduced,thebudgetwillbeupdatedaccordingly.

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SchoolofMedicineAuthorizationInOctober,2015,NancyAndrews,MD,PhD,DeanoftheDukeSchoolofMedicine,authorizedamultidisciplinaryworkinggroup(Appendix1)toexplorethecreationofanewbasicsciencedepartmentintheSchoolofMedicinecomposedofnon-clinicalscholarsinepidemiology,healthservicesresearchandpolicy,healtheconomics,behavioralscience,andimplementationscience.Theworkinggroupestablishedguidingprinciplesforitsdeliberations,metwithkeyleadersandstakeholdersfromaroundtheUniversity,andpresenteditsreporttotheDeanonMarch1,2016.WithsupportfromtheChancellor,theDeanestablishedtheCenterforPopulationHealthSciencesasalaunchingpadforthenewdepartment,pendingitsapprovalbytheDukeUniversityBoardofTrustees.TheCenterforPopulationHealthSciencesisledbyLesleyCurtis,PhD,Director,withfacultyleadershipfromHaydenBosworth,PhD,AdrianHernandez,MD,MHS,andKevinWeinfurt,PhD.AshleyDunham,MSPH,PhDservesasManagingDirector,andSureshBalu,MS,MBAadvisestheCenterregardingstrategyandinnovation.DepartmentStructureandLeadershipTheDepartmentofPopulationHealthScienceswillresideintheSchoolofMedicine,andwillbeabasicsciencedepartment.Itwillhousetenured,tenuretrack,andnon-tenuretrackfacultywithdoctoraltraininginepidemiology,publichealth,healthservicesresearchandpolicy,implementationscience,behavioralhealthsciences,andrelateddisciplines.Facultymemberswhoseactivitiesincludeclinicalresponsibilitieswillhavetheirprimaryappointmentinaclinicaldepartment,andmayhaveasecondaryappointmentintheDepartmentofPopulationHealthSciences.TheChairwillappointfaculty,withapprovalfromtheDeanandtheSchoolofMedicineAppointments,PromotionandTenureCommittee.Theleadershipteamhasidentified32facultymemberswhocouldpotentiallytransitionfromclinicaldepartmentsintheSchoolofMedicinetothenewdepartment(Table1).Ninefacultyarefullprofessors,12areassociateprofessors,7areassistantprofessors,and4areinstructors.Collectively,theybringdeepexpertiseinhealthservicesresearchandpolicy,epidemiology,implementationscience,healthmeasurement,healthbehavior,andbioethics.Overall,28facultyarecurrentlyhousedinMedicine,3areinCommunityandFamilyMedicine,andoneisinPsychiatryandBehavioralSciences.ThemajorityofthesefacultyareclusteredwithintheVAHealthServicesResearchandDevelopmentGroup(n=10)andtheDukeClinicalResearchInstitute(n=15).Collaborationsandinteractionswithinunitsarestrongandactivitiesacrossunitsincludementoring,researchproposaldevelopment,andsharedteachingresponsibilities.Theresearchfociofproposedfacultyarewellalignedwiththemissionofthenewdepartment.Thereisahighlevelofenthusiasmamongthefacultyabouttheproposeddepartmentandtheyhavebeenengagedindividuallyandinsmallgroupstosolicitinputandrefineprioritiesforthedepartment.Weanticipaterecruitingapproximately10newfacultyoverafive-yearperiodtoacceleratedevelopmentofthethreesignatureinitiativesnotedbelow:measurementscience,implementationscience,andscientificengagementwiththehealthsystemaroundstrategicpriorities.TheseinitiativesleverageexistingbutunderdevelopedDukestrengths,areatthefoundationofpopulationhealth

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Table1:ProposedFacultyintheDepartmentofPopulationHealthSciences

Name AreasofExcellence

Professor Bosworth,Hayden Healthbehavior,Healthservicesresearch,ImplementationscienceCurtis,Lesley HealthservicesresearchMaciejewski,Matthew HealthservicesresearchOstbye,Truls Epidemiology,HealthservicesresearchPollak,Kathryn Clinicaldecisionsciences,HealthbehaviorReed,Shelby Clinicaldecisionsciences,HealthmeasurementSanders,Gillian Clinicaldecisionsciences,Wei,Qingyi EpidemiologyWeinfurt,Kevin Bioethics,Healthmeasurement

AssociateProfessor Beskow,Laura BioethicsCorneli,Amy Bioethics,HealthbehaviorCowper,Patricia HealthservicesresearchDupre,Matthew HealthservicesresearchEisenstein,Eric HealthservicesresearchGierisch,Jennifer HealthbehaviorHaga,Susanne HealthservicesresearchJackson,George Epidemiology,Healthservicesresearch,ImplementationscienceO’Meara,Wendy Epidemiology,HealthservicesresearchSteinhauser,Karen HealthmeasurementVanHoutven,Courtney HealthservicesresearchWang,Virginia Healthservicesresearch

AssistantProfessor Belsky,Dan EpidemiologyBhavsar,Nrupen Epidemiology,HealthservicesresearchDinan,Michaela HealthservicesresearchO’Brien,Emily Epidemiology,HealthservicesresearchSmith,Valerie HealthservicesresearchSorensen,Corinna HealthservicesresearchZullig,Leah Implementationscience

Instructor Hammill,Brad HealthservicesresearchJohnson,Reed Clinicaldecisionsciences,HealthmeasurementSkinner,Asheley Healthservicesresearch,ImplementationscienceSperber,Nina Healthservicesresearch,Healthmeasurement

improvement,andaregeneralizablebeyondDuke.Aswerecruitfaculty,wewilladherecloselytoDukeUniversitySchoolofMedicine’sfacultydiversityandinclusionpolicies.WewillworkwithDr.KevinThomas,AssistantDeanforUnderrepresentedFacultyDevelopment,toincorporateinitiativesto

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promotediversityandtoensuretheacademicsuccessofunderrepresentedfacultyandstaffinthenewdepartment.AlthoughtheDepartmentmaybesubdividedintodivisionsorcores,interdisciplinaryworkwithintheDepartment,otherSchoolofMedicinedepartments,andtheUniversitywillbestronglyencouraged.FacultywithprimaryappointmentsintheDepartmentofPopulationHealthScienceswillshareacommonspacetopromoteanenvironmentofsharedmethods,mutualsupportandacohesivesenseofidentity.TheSchoolofMedicinewillundertakeanationalsearchfortheChairwhowillbeexpectedtocarefullyconsideropportunitiestomaximizecooperationandcollaborationtoachievesynergybetweenentitieswithintheUniversity.SelectingaChairwiththesequalitieswillbeanessentialstepintherecruitmentprocess,andcandidatesforthepositionofChairwillbeinformedofthisexpectation.NationalModelWithinmostuniversities,avarietyofentitiesconductpopulationandpublichealthresearchandteaching,includingschoolsofpublichealth,departmentsordivisionswithinaschoolofmedicine,andschooloruniversity-wideinstitutesorcenters.Oftheschoolsofmedicinerankedinthetop20byUSNewsandWorldReport(2015),18arehousedinuniversitiesthatoperateeitheraschoolofpublichealth(n=8),department(n=5),oruniversity-wideinstitutefocusedonpublichealthorpopulationhealthscience(n=5).OnlyDukeandUC-SanDiegodonothavesuchentities.Themostrecentschoolofpublichealth(UniversityofWashington)wasestablishedin1970;allothershaveexistedformorethan50years.Institutes,centers,anddepartmentsestablishedinthelast10yearsreflectnewerterminology,usingpopulationhealthratherthanpublichealth.

Table2summarizesinformationaboutpopulationandpublichealthresearchentities,organization,andgraduateprogramsintop-rankedschoolsofmedicine.Mostpopulation/publichealthprogramsofferedanMSandPhDattheminimum,andsomeofferedresearchandappliedmaster’sdegreesinhealthcaremanagement,healthadministration,andclinicalresearchdegreesintendedforphysicians.Morerecentlyestablishedinstitutes,centersanddepartmentsincludedemergingfieldssuchasimplementationanddecisionscience,comparativeeffectivenessresearch,bioethicsandmentalhealth.Thoughrelationshipsbetweenapopulationhealthresearchandeducationentityoftheuniversityandahealthcaresystemexistatmanyschools,examplesofarobustsymbioticrelationshipbetweenthetwowerescarce.Publicandpopulationhealthentitiesareoftenbroad,university-wideendeavorsdrawingfrommultipledisciplines,whetherhousedinaschoolofmedicineoraschoolofpublichealth.Anotablefunctionofthenewerentitieswastolinkpreexistingnumerousinstitutesandcenterswhowereengagedinthistypeofresearch.Moreover,publicandpopulationhealthresearchisincreasinglyfocusingonappliedmethodsandapproaches.Mostentitiescontainedbetween5-8subdivisionsreflectingpriorityresearchareassuchasepidemiology,biostatistics,healthpolicy,behavioralhealthandenvironmentalhealth.Withinmorerecentlyestablishedentities,subdivisionswerefocusedon

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appliedmethodsandapproachestohealthresearch(e.g.implementationanddecisionscience,comparativeeffectivenessresearch)andratherthanonspecificdiseasegroupsorpopulations.

Table2:PopulationandPublicHealthResearchEntitiesinTop-RankedSchoolsofMedicine

InstitutionSchoolofPublicHealth

Center/Institute

DepartmentofPublicorPopHealth

Startyear1

Graduatedegreesgranted

Divisions

Rank2 MS PhD Epi HP SB HSR Other1 Harvard • • 1913 • • • • • • •2 Stanford • 2012 • • • • 3 JohnsHopkins • 1916 • • • • • •3 UCSF • 2006 • • •

SOM • •

5 UniversityofPennsylvania

• •HP

1993 • • •

6 WashingtonUniversityinStLouis

• • • •

7 Yale • • 1915 • • • • • •8 Columbia • 1922 • • • • •8 Duke •

GH

10 UniversityofChicago

• 1993 • • •SOM

•SOM

10 UniversityofMichiganAnnArbor

• 1941 • • • • • •

10 UniversityofWashington

• 1970 • • • • •

13 UCLA • 1961 • • • • •14 NewYork

University • 2012 • • • • • •

14 VanderbiltUniversity

• • •Inst

•Inst

16 UniversityofPittsburg

• 1948 • • • • •

17 UC-SanDiego • • 18 Cornell •3 1927 • •

SOM•

SOM•

SOM•

SOM19 Northwestern • • • •20 Icahn • • • • •

1Startyearofprimarypublicorpopulationhealthentity2SOMRanking,2015USNews&WorldReportshttp://tinyurl.com/dzn9s83CornellUniversity’sDepartmentofHealthcarePolicyandResearchwasformerlytheDepartmentofPublicHealth

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ResearchAreasofExcellence

Thefieldofpopulationhealthaimstoanswercomplexquestionsaboutthedriversofhealthinapopulationandrequirestheintegrationofcontributionsfrommanydisciplines.TheSchoolalreadyhasaconsiderablenumberofoutstandingfacultyresearchersinpopulationhealthsciences,definedheretoincludeepidemiology,healthservicesresearchandpolicy,healthbehavior,clinicaldecisionsciences,implementationscience,measurementscience,andbioethics.Currently,thefacultymemberswhopursuetheresearchsummarizedinTable3arehousedinMedicine,Psychiatry,CommunityandFamilyMedicine,andotherdepartments,andtheresearchinfrastructurethatsupportsthesefacultyspansacrossmultipleunconnectedenvironments.Forexample,manyfacultyaremembersofCancerControlandPopulationSciencesintheDukeCancerInstitute(DCI)andhaveaccesstoDCIsharedresourcesandpilotfunds.OtherexistingresourcesforresearchincludenationaldatabasesfromtheNIH,Veteran’sAdministration(VA),theCentersforMedicare&MedicaidServices(CMS),andtheNationalCancerInstitute’sSurveillance,Epidemiology,andEndResultsprogram,nationalclinicalqualityimprovementregistries,andlocalDukehealthcaresystemdata.Additionally,facultyleadmajorpopulationhealthstudiescoveringawiderangeofconditionsandriskfactorssponsoredbyNationalInstitutesofHealth,PatientCenteredOutcomesResearchInitiative,AgencyforHealthcareResearchandQuality,FoodandDrugAdministration,VA,industrypartners,andfoundations.LandscapeforPartnerships

ThelandscapeforpartnershipsatDukefortheDepartmentofPopulationHealthSciencescomprisesbothinternalandexternalgroupsconductingresearchinhealthservices,healthpolicy,globalhealth,epidemiology,behavioralscience,healtheconomics,andimplementationscience.Internally,existinginstitutesandcentersactivelyworkintheareasofglobalhealth(DukeGlobalHealthInstitute),behavioralscience(DepartmentsofCommunityandFamilyMedicine,Medicine,andPsychiatry),healthservicesresearchandepidemiology(DukeClinicalResearchInstitute,DukeCancerInstitute,DepartmentsofMedicineandPsychiatry,VACenterforHealthServicesResearch,SocialScienceResearchInstitute[SSRI]),andhealthpolicy(SanfordSchool,FuquaSchoolofBusiness,theRobertJ.MargolisCenterforHealthPolicy,theDukeCenterforHealthPolicyandInequalitiesResearch,theDukeUniversityPopulationResearchInstitute,DepartmentofMedicine).TheCenterforPopulationHealthScienceshasbeguntobuildsubstantivepartnershipswithseveraldepartments,schools,centers,andinstitutes.WiththeCenterforCommunityandPopulationHealthImprovement,weco-sponsoramonthlypopulationhealthseminarseriesthathighlightsinnovativestudiesandinitiativesaimedatimprovingthehealthofspecificpopulations,andalsojointlysponsoraData&MedicineColloquiumwiththeSocialScienceResearchInstitute.Additionally,withsupportfromtheDean,theSurgicalCenterforOutcomesResearch(SCORES)andtheCenterforPopulation

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Table3:SelectedResearchContributionsbyProposedFaculty

Bioethics

Researchonconflictsofinterestinclinicalresearchhasledtoimprovementsinthedisclosureofinvestigators’financialrelationshipstoparticipantsinresearch.(Weinfurt)

Researchincorporatingtheperspectivesofmultiplestakeholdershasledtothedevelopmentofasimplifiedconsentformforbiobankingresearch.(Beskow&Weinfurt)

ClinicalDecisionSciences(CDS)

ResearchonthetradeoffspatientsarewillingtomakebetweenrisksandbenefitsbecamethebasisforrecentguidancereleasedbytheFDA’sCenterforDevices.(Johnson)

Epidemiology

AlargestudyofolderadultsintheU.S.wasthefirsttoshowthecumulativeimpactofunemploymentonrisksforacutemyocardialinfarction.(Dupre)

Newmethodsformeasuringbiologicalagingallowedresearcherstoobservethat,byyoungadulthood,humansareagingatdifferentrates.Furthermore,fasteragingduringyoungadulthoodresultsinimpairedphysicalfunctioningandearlycognitivedeclinethatarealreadymanifestbymidlife.(Belsky)

HealthBehavior

Researchdemonstratedthatwhenphysiciansuseeffectivecommunicationtechniques,overweightpatientsweremorelikelytoloseweightthreemonthsaftertheirvisit.(Pollak)

InHIVpreventionstudies,behavioralresearchersidentifiedreasonswhystudyparticipantsdidnotadheretothestudymedications.ThisresearchhasshiftedtheparadigmoffutureHIV-preventiontrialstobetterassessandpreventnonadherence.(Corneli)

AstudyofpeoplewhomigratedfromapacificatolltoNewZealanddemonstratedadverseeffectsof"westernization"onobesity,cardiovasculardisease,diabetesandgout.(Ostbye)

HealthMeasurement

Researchersdevelopedthemostcomprehensivesystemtodateformeasuringtheeffectsofchronicdiseasesandtheirtreatmentsonsexualfunction.(Weinfurt)

HealthServicesResearchandPolicy

Thefirstexperimentalstudyofperformance-basedincentivesinsub-SaharanAfricafoundthatanovelapproachtoincentivesledtobettermanagementoffever.(O’Meara)

AseriesofstudiesintheVeteransAffairs(VA)healthcaresystemofcolorectalcancercarefoundthat,overall,theVAprovidescarethatisconsistentwithbestpracticesandissimilaracrossracialgroups.(Zullig)

Researchevaluatedthefirstpopulation-basedimplementationofavalue-basedinsurancedesign,usingBlueCrossBlueShieldofNC.ThisworksignificantlyinfluencedsubsequentpolicyworkbytheCentersforMedicareandMedicaidServicesandtheCenterforDiseaseControl.(Maciejewski)

ImplementationScience

Mixed-methodsresearchevaluatedoneofthefirsteffortsintheU.S.todevelopaproactive,population-basedprogramforlungcancerscreening.(Jackson)

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HealthSciencessponsoraquarterlytransdisciplinaryresearchcolloquiumfocusedonsurgicalhealthservicesresearch.Theinauguralgatheringincludedmorethan50facultywithrepresentationfromDepartmentsofSurgery,Medicine,Psychiatry,Biostatistics&Bioinformatics,theDukeCancerInstitute,theDukeClinicalResearchInstitute,andtheVAHealthServicesResearchgroup.JointrecruitmentofkeyfacultyisunderdevelopmentwiththeDepartmentofSurgery,theDukeCancerInstitute,andtheDukeClinicalResearchInstitute.Creatingpartnershipswithcampus-baseddepartments,centers,andinstitutesisapriorityaswell.Manycampus-basedfacultyconducthealthservicesresearch,butmakingconnectionswithpotentialcollaboratorsandresearchresourcesintheSchoolofMedicinecanbechallenging.TheDepartmentwillaimtoserveasaportalforcampus-basedhealthservicesresearchersandfacilitateconnectionstofacultyandresearchresources.Developingstrongcollaborationswithcampus-basedfacultywill,inturn,enhancetheinterdisciplinarityoftheDepartment’sresearchprograms.Inaddition,buildingpartnershipswithinstitutionalentitiesfocusedoninstitutionaldiversitywillfacilitatethedevelopmentofresearchprogramsfocusedondiversepopulations.Inturn,thoseresearchprogramsmightservetoattractdiversefaculty.Externally,theresearchlandscapeincludescentersanddepartmentsofpopulationhealthsciencesatnationallyrecognizedacademicinstitutions.(SeeNationalLandscapesectionandAppendix3formoreinformation.)Tonoteafewexamples,theStanfordCenterforPopulationHealthSciencesresearchfociincludehealthdisparitiesandspecialpopulations,gene-environmentinteractions,learninghealthsystems,andmobilehealth,withmajordataresourcesincludingtheStanfordMilitaryDataRepository,theOptumCommercialDatabase,theWomen’sHealthInitiativedatabase,andtheCenterforBirthDefectsResearchandPrevention.TheNewYorkUniversityDepartmentofPopulationHealthpursuesprojectsindecisionscience,medicalethics,behavioraleconomics,andepidemiology/biostatistics,withdataresourcesincludingCMSclaims,theAmericanMedicalAssociation’sphysicianmasterfile,theHealthcareCostandUtilizationProjectdatabase,andUniversityHospitalConsortiumdata,withafocusondisparitiesincareandvulnerablepopulations.TheHarvardDepartmentofPopulationMedicineconductsresearchinproductsafety,decisionscience,maternal/childhealth,electronichealthrecorddataforresearch,andcancerscreening/prevention,withspecificprogramsinaging,pediatrichealthcare,precisionmedicine,obesityprevention,anddrugpolicy.Whileeachoftheseinstitutionscomprisesnationalleadersinpopulationhealthresearch,DukeinvestigatorsaresimilarlyatthecenterofmultiplenationalprojectssuchastheFDA’sSentinelInitiative;PCORI’snationalclinicalresearchnetwork(PCORnet);theNIH’sHealthcareSystemCollaboratory;theAgencyforHealthcareResearchandQuality’sEvidence-BasedPracticeprogram,andtheVeteransAdministration’sevaluationoftheVALungCancerScreeningDemonstrationprojectrequestedbytheVAUnderSecretaryforHealth(USH)tobetterunderstandhowtheVAmaybeabletoimplementlow-doseCTlungcancerscreening.Additionally,DukeinvestigatorsarecentraltotheVACaregiverSupportProgram,whichseekstosupporttheneedsofinformalcaregiversofVeteransfacingsignificanthealthchallenges.CreationofaDepartmentofPopulationHealthScienceswillprovidetheinfrastructureforbettercollaborationamongDukeinvestigatorsleadingtheseexistingeffortsaswell

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asopportunitiestopursueadditionallargescaleprojectsthatrequireengagementofamultidisciplinaryresearchteam.

AreasforDevelopment

Forthedepartmenttoachievenationalstaturewithin5years,strategicinvestmentswillberequiredinfacultyandtheresearchresourcesonwhichtheyrely.BasedonourreviewofDuke’sextantstrengthsandopportunities,wehaveidentifiedthreesignatureinitiativestobedeveloped:measurementscience,implementationscience,andscientificengagementwiththehealthsystemaroundstrategicpriorities.Theseinitiativesleverageexisting,butunderdevelopedDukestrengths,areatthefoundationofpopulationhealthimprovement,andaregeneralizablebeyondDuke.Todeveloptheseareas,weproposetosupporteffortforcurrentDukefacultytoleadeachinitiative,newfacultyhirestoincreaseourcapacityforworkintheseareas,andspecializedresearchstaffwhowillformthecoresrequiredtoconducttheresearch.Toincreasethelikelihoodofexternalfundingtosupporttheseinitiatives,wehaveallocatedfundstosupportthenecessarypreparatorywork.MeasurementScience.Interestinfindingbetterwaystomeasurehealthandchangesinhealthhasbeenincreasingrecentlyinseveralways:(1)growingconsensusaroundtheimperativetomeasureoutcomesthatmattertoallstakeholders,includingpatients,caregivers,providers,andpayers;(2)increasingemphasisonpatient-andcaregiver-reportedoutcomestounderstandhowdiseasesandtheirtreatmentsaffectday-to-dayliving;(3)improvementsinmobilehealthtechnologythatallowmoreintensive,real-timeassessments;and(4)risinginterestamongregulators(e.g.,theFDA)insystematicallyassessingpatientpreferencestoinformpolicydecisions.Theseencouragingdevelopmentsrequireasoundintellectualfoundationtorealizetheirpotentialforimprovingpopulationhealth.WithinDuke,thereisalsoaneedforgreatercapacitytorespondtofundingopportunitiesfrompublicandprivatesponsorsthatrequireastrongmeasurementcomponent.Thus,akeydepartmentalinitiativewillbetodevelopaHealthMeasurementCore.Healthmeasurescouldincludebiologicalparameters,symptoms,functionalstatus,generalhealthperceptions,health-relatedpreferences,andsatisfactionwithcare.ThevisionfortheHealthMeasurementCoreistopromotebetterclinicalcareandclinicalresearchthroughadvancingthescienceofhealthmeasurement.ThemissionoftheCorewillbetodesignandconductresearchstudiesoncriticalmethodologicalissuesrelatedtomeasurement,andtoserveasaresourceforotherdepartmentsandcentersacrossDukethathaveneedformeasurementexpertise.TheHealthMeasurementCorewillbedirectedbyKevinWeinfurt,Ph.D.Weanticipatehiringtwoadditionalfaculty(onesenior,onerelativelyjunior),2post-doctoralfellows,aswellascorestaffneededforthevarioustypesofprojects.Theinitialstaffwouldincludeasenior-levelprojectleaderwithbroadexperienceinhealthmeasurement,amasters-levelexpertinqualitativemethods(e.g.,amedicalanthropologist),twosenior-levelstaffstatisticians(includingonewithexpertiseinpsychometrics),andabachelor’s-levelresearchassistant.WeenvisionthisCoregrowingasfundedprojectsarebroughtintotheCore.ThecapabilitiesoftheCore’sfacultyandstaffwouldincludethefollowing:(1)identificationandselectionofhealthmeasures;(2)creationofnewhealthmeasures;(3)coordinationofculturaladaptations/translationsofmeasures;(4)integrationofmeasuresintoprocessesofcareandresearch;(5)statisticalanalysesofpatient-,clinician-,andobserver-reported

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outcomesinclinicalresearch;and(6)designandanalysisofpatientpreferencestudies(e.g.,discretechoiceexperiments).ImplementationScience.Onaverage,ittakes17yearstoturnasmallfractionoforiginalresearchfindingstothebenefitofpatientcare,andpatientsonlyreceiveabouthalfofrecommendedevidence-basedcareforpreventionandchronicillnesscare.Moreover,thevastmajorityoforganizationaleffortstoimplementchangefail,andsustainabilityisdifficulttoachieve.Thescienceofdisseminationandimplementationisthesystematicstudyofprocessesandfactorsthatleadtowidespreaduseofanevidence-basedinterventionbythetargetpopulation.Themethodologicalfoundationisbroadandincludesevidencesynthesisandmeta-analysis,evaluationandqualityimprovement,practice-basedclinicalresearch,pragmatictrialdesign,qualitativeandmixedmethods,modelsimulation,andstatedpreferenceresearch.Accordingly,thecontentanddisciplinaryexpertiserequiredisbroadandincludesbehavioralintervention;sharedandinformeddecisionmaking;qualityimprovementandevaluation;stakeholderengagement,community-basedparticipatoryresearch;healthpolicyanalysis;andmHealth.ThevisionfortheDisseminationandImplementationCoreistoacceleratetheuptakeofevidence-basedinterventionsbyadvancingthescienceofdisseminationandimplementation.ThemissionoftheCorewillbetodesignandconductresearchstudiesoncriticalmethodologicalissuesrelatedtodisseminationandimplementation,andtoserveasaresourceforotherdepartmentsandcentersacrossDukethathaveneedfordisseminationandimplementationexpertise.TheDisseminationandImplementationCorewillbedirectedbyHaydenBosworth,PhD.Weanticipatehiringtwoadditionalfacultyandcorestafftosupporttheinitiative.Initially,theteamwillincludeasenior-levelprojectleaderwithexperienceindisseminationandimplementationandstatisticalprogrammingsupport.TheCorewillgrowasfundedprojectsaccumulate.CapabilitieswithintheCoreinclude:(1)Studydesignsupport(e.g.,designingfordissemination,balancingfidelityandadaptation,quasi-experimentaldesign,participatoryapproaches,policyapplications)and(2)methodologicalsupport(e.g.,measurementandevaluation,pragmatictrials,rapidlearning,systemdynamictools,comparativeeffectivenessresearch,informatics).ScientificEngagementwiththeHealthSystem.TheDepartmentwilldevelopauniquepartnershipwiththeDukeUniversityHealthSystem(DUHS)aroundsignificantareasthatareofacademicinteresttotheDepartmentandadvanceDUHS’sstrategicprioritiesregardingthehealthofthepopulation.ThissynergybetweenacademicinterestandhealthsystemprioritiesisahighpriorityforChancellorWashingtonasnotedinthelaunchoftheDukeHealthStrategicFramework(DukeHealth,2016).Examplesofmutualinterestsincludeprospectivelyidentifyinghigh-riskpopulationsanddesigningmulti-facetedinterventionstoimprovehealth,examiningandinterveninguponwaystodeliverhealthcare,developingandevaluatingnewpaymentmodelstoincentivizeclinicalapproachesassociatedwithimprovedhealth,andassessingandinterveningupondeterminantsofavoidableemergencyroomusage,hospitalization,andreadmission.DepartmentfacultywillworkwithDUHStoidentifythemostcompellingquestionsandpopulationhealthchallengestoaddressandthenleveragetheinvestigativepowerintheDepartmenttodesign,implement,andevaluatesolutionsthatcouldbepublishedintop-tierjournalsinthefield.

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EducationTheInstituteofMedicinehighlightedtheneedfortrainingininterdisciplinaryhealthscienceandrecommendedthedevelopmentof“avisionfortheproductionofoutstandingscientistswhocanintegrateknowledge,theory,andmethodsfromdiversedisciplinesandparticipateeffectivelyininterdisciplinaryteamstoaddresscomplexpopulationhealthissues.”(IOM,2015)TheeducationalprogramsoftheDepartmentofPopulationHealthScienceswillrespondtothiscallbypreparingthenextgenerationofscientistsandhealthpractitionerstoadvancethehealthofpopulationsthroughthediscoveryandtranslationofknowledgeintopolicyandpractice.Specifically,theprogramswilltrainandpreparestudentsto:

• Integratepopulation-levelthinkinginunderstandingandaddressinghealthanddisease• Criticallyevaluatescientificevidenceandevaluateitspotentialimpactonpopulations• Applypopulation-levelstrategiesinclinicalcare,research,teaching,andhealthpolicyefforts• Conductresearchaccordingtothehighestscientificallyrigorousandethicalstandardsandto

servetheneeds/valuesofthepopulationswithwhichtheyinteract.Populationhealthscienceisnotitsowndiscipline–itisaninterdisciplinaryfieldthatseekstointegrateknowledge,theory,andtoolsfrommultipledisciplinestodevelopabroadunderstandingofthemulti-factorialpathwaysthatproducehealthandhealthdisparitiessothatmoreeffectivesolutionscanbefound.Whileacknowledgingarelationshiptopublichealth,populationhealthscienceseekstoextendtraditionalscholarshipandtraininginpublichealthtoincorporatethefullrangeofdisciplinesthatcontributetopopulationhealth.Thisimpliesadeepcommitmenttointer-and/ortrans-disciplinaryscience,definedassciencethatcombinesdiscipline-basedtheories,methods,andknowledgetosolvescientificquestions(IOM,2015).Discussionoftheeducationalprograms,forthisfieldingeneralandforthenewDepartmentinparticular,hasconsideredpotentialdegreeandnon-degreeofferings,corecompetenciesassociatedwiththoseofferings,andthepotentialimpactoftheDepartment’seducationalprogramsonotherprogramsatDuke.AssessmentoftheeducationallandscapeincludedareviewofcurrentmastersprogramsatDukeaswellasprogramsinpopulationhealthsciencesbroadlyelsewhere,bothwithinNC(UNC,WakeForest)andbeyond:YaleUniversity,UniversityofToronto,andJohnsHopkinsUniversity,NewYorkUniversity,andUniversityofWisconsin.Whilemanyoftheseeducationalprogramsarebasedinmedicalschools,themajorityarebasedinschoolsofpublichealth.MostofferMastersofPublicHealth,MastersofScience,andPhDdegrees.(SeeNationalLandscapesectionandAppendix3formoreinformation.)Detailedplanningaroundtheacademicprogramsiswellunderway,ledbyanacademicprogramsteamthatischargedwithrefiningthestrategyandoperationalproposalforthenewDepartment’seducationalprograms.Whenapproved,weanticipatethattheDepartmentwillproposeaMasterofScienceandDoctorofPhilosophyforconsiderationbytheDukeUniversitySchoolofGraduateStudies.ThegroupconsideredtheMastersofPublicHealth(MPH),awell-recognizedprofessionaldegree,andconcludedthatamorerigorousresearchorientationofaMasterofSciencedegreewouldalignbetterwiththeDepartment’seducationalgoals.CorecompetenciesforaMasterofScienceinPopulationHealthSciencesshouldincludemasteryofstudydesignandepidemiologicmethods,quantitative

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methodsinpopulationhealth,andkeyperspectivesonpopulationhealth,rangingfromsocialandbehavioraldeterminantsofhealthtohealtheconomics,healthservicesresearch,andanunderstandingofhealthfromapopulationperspective.Additionally,studentswillparticipateinprofessionaldevelopmentseminarsandexperientialprojects(i.e.,practicums)withDukeHealth,otherhealthcareorganizations,communityagencies,payers,governmentagencies,andthebiomedicalindustry.ThePhDprogramwillbuildupontheMaster’sprogramandofferconcentrationsinEpidemiology,HealthServicesResearchandPolicy,andSocialandBehavioralDeterminantsofHealth.Graduateswillbepreparedtoconductresearchanalyzingthedistributionanddeterminantsofhealthanddiseaseandtodevelop,implementandevaluatehealthpoliciesandhealthcaredeliverysystemstoimprovethehealthandqualityoflifeofpopulations.Additionaleducationalofferingswillincludeapopulationhealthsciencestrackfor3rdyearmedicalstudentsandpost-graduatecertificateprogramsgearedtowardcurrentandemerginghealthcareleaders.Theseprogramswilleducateparticipantsaboutthesystemsandtoolsrequiredtounderstandthechangingmarketplace,developandevaluatenewmodelsofcaredelivery,andengagepatientsandproviders.Inaddition,baseduponfeedbackfromkeyleadersandstakeholdersaroundtheUniversityandbeyond,thereisastronginterestinprovidingaprofessionaldegree/certificateinpopulationhealthdirectedspecificallytohealthcareadministrators.TheeducationalprogramswillleveragetheteachingandmentorshipexpertiseoftheDepartment’sproposedfaculty.Facultyrequireprotectedtimetodevelopandteachclassesandwehavereflectedthoserequirementsinourbudget.Morethantwo-thirdsofproposedfacultyhaveteachingexperienceincoursesandtopicsincludinghealtheconomics,surveydesignandinstrumentdevelopment,infectiousdiseaseepidemiology,epidemiologicmethods,healthpolicyandmanagement,cost-effectivenessanalysis,theUShealthcaresystem,anddecisionmodeling.Additionally,manyhavementoredorarementoringearlycareerfacultyandpre-andpost-doctoralstudents.WewillworkwithAnnBrown,MD,MHS,ViceDeanforFacultyintheSchoolofMedicine,andMarkDewhirst,DVM,PhD,AssociateDeanforFacultyMentoring,to(1)ensurethatourfacultyreceivetrainingintheNationalResearchMentoringNetwork(NRMN)curriculumthatDukehasadoptedand(2)developincentivesforseniorfacultytoserveascommittedmentors.Areasofexcellence

Coreareasofexcellencewillincludeepidemiology,healthservicesresearch,experimentalandquasi-experimentalstudydesigns,measurementscience,anddisseminationandimplementation.Theeducationalprogramswillhaveunique,distinguishingcharacteristicsincluding:

• Expert,multidisciplinaryfaculty• Fundedfieldworkopportunities• Flexible,tailoredcurriculum• Focusonapplied,relevantresearchandskills• Diversecohortofstudents• Professionaldevelopmentsupport

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LandscapeforPartnershipsInternalAfterextensivediscussionwithvariousstakeholdersandleadersatDuke,wehaveconcludedthatadequatelyresourcededucationalprogramswithintheDepartmentofPopulationHealthScienceswillsupportstronguniversity-widepartnerships,particularlywiththeDukeGlobalHealthInstitute,theDukeClinicalResearchInstitute,theSchoolofNursing,theDukeMargolisCenterforHealthPolicy,theDukeSocialScienceResearchInstitute,theDukeInitiativeinScienceandSocietyaswellaswithotherdepartmentsintheSchoolofMedicine.Thesepartnershipscouldincludeco-listingofcoursesandjointpredoctoralandpost-doctoralfellowships.Althoughanewmaster’sdegreeinPopulationHealthScienceshaspotentialtoexpandthecourseofferingsavailabletostudentsinexistingprograms,concernshavearisen,however,aboutthepotentialforcompetitionoverstudents,teachingfaculty,andtuitionrevenueflows.DevelopmentoftheeducationalprogramandproposalwillcontinueoverthecomingmonthswithengagementfromtheDukeGlobalHealthInstituteandBiostatistics&Bioinformatics,amongothers.OpportunitiesforpartnershipmayalsoexistwiththeDataScienceMaster’sprogram,anewinterdisciplinarydegreeproposedbytheDukeSocialScienceResearchInstituteandtheInformationInitiativeatDuke(iiD),aswellastheBioethicsMaster’sProgramrunbytheDukeInitiativeinScienceandSociety.ExternalTherearealimitednumberofdepartmentsofpopulationheathintheUnitedStatesasindicatedbyarecentInstituteofMedicinereport.However,thecommitteereviewedcurrentmastersprogramsatDukeaswellasprogramsinpopulationhealthsciencesbroadlyelsewhere,bothwithinNC(UNC,WakeForest)andbeyond:YaleUniversity,UniversityofToronto,andJohnsHopkinsUniversity,NewYorkUniversity,andUniversityofWisconsin.Giventhegrowthintheareaandclearneedforaprogram,wedonotanticipateatthistimeahighlevelofcompetitionwithothermedicalschools.However,manyrelatedprograms(includingMScepidemiology,MSchealthservicesresearch,MPH,Mastersinhealthmanagement,andHealthpolicydegrees)arebasedinschoolsofpublichealthanditisimportanttodifferentiateanynewprogramsormodificationsofexistingprogramsfromthese,especiallythosethatexistwithintheUNCsystem.Service

Historically,accesstoelectronichealthdataatDukeforresearchpurposeshasbeeninefficientduetothesiloednatureofdataandrelevantexpertise.ThereisinterestacrosstheUniversitytoprovideasharedresourcetoeasilyaccesselectronicdata(inparticular,MedicareclaimsdataandDukeHealthelectronichealthrecorddata)inasecure,robustenvironmentwithuniformapproachestogovernanceandregulatoryrequirements.TheDepartmentproposesanelectronichealthdatacoretobehousedinPACE(ProtectedAnalyticComputingEnvironment),anenvironmentoperatedbyDukeHealthTechnologySolutionsandtheOfficeofResearchInformatics.ThecorewillprovideauthenticateduserswithaccesstoMedicareclaimsandDukeHealthelectronichealthrecorddataforthepurposeofconductinghealthservices

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researchandqualityimprovement.WeinitiallyproposetoplacetheexistingMedicareallclaims5%sample(1991-2013),theMedicareinpatientclaims100%sample(2000-2014),andspecialcohortscreatedinconjunctionwiththeDuke-MargolisCenterforHealthPolicy,theDukeClinicalResearchInstitute,andtheDukeInstituteforHealthcareInnovationinthisenvironment.ThesedatarepresentahighlyuniqueresourceavailableinonlyafeworganizationsintheU.S.;thepresentvalueofthedataaloneexceed$2M.Duringthisstart-upphase,wewillenrichavailabledatabyrefreshingthesedatasetsandpurchasingnewclaimsdatatobematchedwithDukeelectronichealthrecorddata.Thiscorewillprovide:1. Accesstoelectronichealthdata(MedicareclaimsandDukeelectronichealthrecorddata)viaPACE;2. accesstoeducationandregulatorysupporttorequestuseofthedatafromtheCenterfor

MedicareandMedicaidServices(MedicareClaimsData)andDukeHealthTechnologySolutions(Dukeelectronichealthrecorddata);

3. processingandintegrationintoappropriatedatasetsbyaninformaticsanalyst;and4. analyticalsupportandtroubleshootingfromexperiencedanalystsanddatascientists.LandscapeforPartnershipsThereistremendousinterestacrosstheUniversityinthecreationofthePHSelectronichealthdatacore,theabilitytoleverageinstitutionalinvestmentsinexistingdata,andtheabilitytoextendthecorewithnewdatasources.WehaveexistingpartnershipswiththeDukeClinicalResearchInstitute,theDukeCancerInstitute,andtheDukeMargolisCenterforHealthPolicy,andaredevelopingsimilarpartnershipswithSCORESandtheSchoolofNursing.Additionally,wehavepresentedthevisionforthecoreattheDukeData&MedicineColloquium,jointlysponsoredbySSRIandtheCenter,andmanycampus-basedinvestigatorsarekeenlyinterested.WehavemetwiththeoperationalteamatSSRItodiscussourplansandhaveidentifiedopportunitiestojointlydevelopandshareresourcesrelatedtoMedicaredatagovernanceandmanagement.Althoughourinitialfocusisoninternalpartnerships,wewillcultivateexternalpartnershipsaswellgiventheuniquenessoftheresourceinthestateandregion.Toacceleratepartnershipsandexpandtheanalyticworkforce,theCenterforPopulationHealthSciencesishostingtheCenterforMedicaidandMedicareServices’ResearchDataAssistanceCenter(ResDAC)fora2.5-daytrainingworkshopinlateFebruary,2017.Theworkshop,“CMS101:IntroductiontotheUseofMedicareDataforResearch,”isopentothepublicbut25seatshavebeenreservedforDukedesignees.ThetrainingworkshopsaretypicallyofferedannuallyattheUniversityofMinnesota,theinstitutionalhomeofResDAC.TheFebruaryworkshopwasfullysubscribedwithinhoursofdistributingtheannouncement.ImpactAnticipatedbenefitstotheUniversity,School,andmemberfacultyIntegrationofexpertiseanddevelopmentofinfrastructurewithinasingledepartmentwillacceleratecollaboration,createefficiencies,andgeneratenewsourcesofresearchandeducationfunding.Inthe

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long-term,theDepartmentwillattractfacultyfromotherinstitutionsandsuccessfullyretainpromisinginvestigators,therebygrowingtheresearchportfolio,increasingNIHrevenuesfortheSchoolofMedicine,andexpandingthebandwidthtopartnerwithclinicaldepartmentsaroundpopulationhealthscience.Theproposedcollaborativemodelwillenableclinicaldepartmentstoexpandtheirresearchportfoliosaswell.Forproposedfaculty,theprovisionofatenure-ableacademichomefornon-clinicalfaculty,theco-locationoffacultyworkinginrelatedareas,andamorecohesiveframeworkforfacultymentoringwillbringsignificantadvantages.PotentialunintendedconsequencesforotherDepartments,Centers,andInstitutesFromareputationalandfinancialperspective,however,thecreationofanewdepartmentcouldnegativelyimpactexistingdepartmentsandinstitutesintheshortterm,asfacultyandtheirfundedportfoliosareconsolidatedintothenewDepartment.Toassessthispotentialnegativereputationalandfinancialimpactonexistingdepartments,wesummarizedcurrentannualNIHfundingforproposedfaculty,summarizedfundingbycurrentdepartmentalhome,andcalculatedtheproportionoftotalNIHfundingaccountedforbythosefaculty.WeestimatedpotentialchangetoNIHrankingbysubtractingtheestimatedNIHfundingforthosefacultyfrom2014NIHfundingfortheircurrentdepartment,andassessedhowtherankingwouldhavechanged.Table4:PotentialimpactofconsolidatingfacultyandtheirfundedportfoliosintothenewdepartmentEntity Federalfunding

FY16(in$mill)FederalfundingofDPHSfaculty(in

$mill,%ofdepartmentFY16)NIHranking4 Potentialchange

torankingMedicine $158.9 $5.7(3.6) 7 -1Psychiatry 37.2 0.4(1.1) 10 -1CFM 4.4 1.7(38.1) 36 -5AsshowninTable2,theanticipatedimpactontheDepartmentsofMedicineandPsychiatryislikelytobemodest.Inthisworst-casescenarioanalysis,moreover,weassumethatthecreationofthenewdepartmentdoesnotgeneratebenefittocurrentdepartments.Inreality,weexpectthatthenewDepartmentwillcreatesynergiesandcollaborationsthatwillhelpbringadditionalfundingtocurrentdepartments.ThepotentialimpactontheDepartmentofCommunityandFamilyMedicinemaybemoresubstantial,andoptionstomitigatethepotentialnegativeimpactshouldbeexplored.Thescenariopresentedaboveisveryconservative.Becauseoneofthedeterminantsofrankingsisfundingperfaculty,thetransitionoffacultyintothenewdepartmentmighthaveapositiveimpactondepartmentrankings.Additionally,clinicaldepartmentsmaychoosetobringinnewfacultywhoseresearchfundingcouldoffsetsomeoftheimpactfacultytransitionsthenewdepartmentUsingthesamecohortfaculty,wealsoestimatedthepotentialimpactontheSchoolofMedicineoftheincreasedrateofindirectreturnassociatedwithmovingthosefacultymembersfromaclinicaldepartmenttoabasicsciencedepartment.Fortheanalysis,weassumedthatfederalfundingsupportsapproximately70%offullyloadedsalariesforthoseindividuals(20%commercial,10%

4Basedon2014data

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unfunded)andthattheindirectreturnratewouldincreasefrom40%to72%.TheannualcosttotheSchoolofMedicineofthechangeinindirectreturnratebasedonretainingongoingstudiesintheirowningdepartments,wouldbeapproximately$217,000inyear1.Thisestimateincreasesto$507,000byyear2whenallnewstudieswillbeunderDepartmentofPopulationHealthSciences.WeexpectthatfacultyaffiliatedwiththeDukeClinicalResearchInstitute,theDukeCancerInstitute,theDukeGlobalHealthInstitute,andotherswillcontinuethoseaffiliationsandthatprojectsthatbenefitfromthoseinfrastructureswouldstaywiththoseorganizations.AfterextensivediscussionwithvariousstakeholdersandleadersatDuke,weexpectthattheDepartmentofPopulationHealthSciencesislikelytohavestronguniversity-widepartnerships,particularlywiththeDepartmentofBiostatisticsandBioinformaticsandclinicaldepartmentsintheSchoolofMedicine,DukeSchoolofNursing,DukeGlobalHealthInstitute,DukeClinicalResearchInstitute,andtheDukeMargolisCenterforHealthPolicyamongothers.Thesepartnershipscouldincludepotentialjointhires,co-listingofcoursesandtraining,andmultidisciplinaryresearchopportunities.Wewillalsoworktoestablishandenhancepartnershipswithotherbasicsciencedepartments.TheapplicationsofthenewDepartment’sresearchandaspectsoftheeducationprogramsmayappeartobemorecloselyalignedwiththeinterestsofclinicaldepartmentsthanthoseofbasicsciencedepartments.However,atafundamentallevel,thenewDepartmentshareswithitsfellowbasicsciencedepartmentsacommitmenttounderstandingbasicmechanisms,developingnewscientificmethodsandtools,andgrowingthenextgenerationofscientistsdevotedtotheprincipledstudyofnature.Inadditiontoestablishingpartnershipswithotherbasicsciencedepartments,webelievethenewDepartmentwillservetoreinforcethevalueandidentityofthebasicsciencesinSchoolofMedicineandthehealthsystemingeneral.AlthoughBiostatistics&Bioinformaticshasadistinctdisciplinaryfocusfromthenewdepartment,weanticipaterobustcollaborationsaroundeducationandfacultyrecruitment.SteveGrambow,PhD,ViceChairofEducationandDirectoroftheClinicalResearchTrainingPrograminB&B,isamemberoftheworkinggrouptaskedwithdevelopingthemastersandPhDeducationalprograms.Withrespecttofacultyrecruitment,weexpecttosharerecruitmentofmethodologicallyorientedpopulationhealthscientistsandbiostatisticiansandbioinformaticistsdeeppopulationhealthinterests.LettersofsupportfromDrs.Boulware,Merson,andMcClellanareincludedinAppendix5,andlettersfromMichenerandDelongareforthcoming.PlanformovingfacultyandapproachtomitigatingunintendedconsequencesforexistingdepartmentsOverthenext15months,weintendtotransitionfacultyandfundedprojectsinameasuredfashionsoasnottopullresourcesabruptlyawayfromclinicaldepartments.WiththeDepartmentofMedicine,wehavereachedagreementabouttheflowofindirectreturnsforgrantsheldbyfacultywhowilltransitionfromMedicinetoPopulationHealthSciences.Specifically,indirectsongrantsthatendinFY18willremainwiththedepartmentandfundedgrantswithmorethanayearoffundingwill

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transitiontothenewDepartmentoveraone-yearperiodthatbeginsJuly1,2017.NewgrantswillbesubmittedthroughtheDepartmentandmanagementresponsibilitiesforthosegrantswillrestwiththenewDepartment.Memorandaofunderstandingbetweencenters,institutes,anddepartmentsthatdescribeinstitutionalcommitmentstoindividualfacultywillbeestablishedbetweenthoseentitiesandthenewdepartment.Wearecommittedtosolutionsthatcreatesynergiesandfostercollaborationsandwilloperationalizethatcommitmentthroughopendialogue,transparency,anddirectengagementofentitieswithsharedinterests.IndicatorsofsuccessWehaveidentifiedapreliminarysetof7indicatorsofsuccessfortheproposeddepartment:

1. recruitmentandretentionofadiverse,productive,renownedfaculty;2. researchfundingandquality;3. successfulcreationofhigh-qualityacademicprogramsandproducts;4. abilitytoserveasaportalforhealth-relatedcollaborationsforscholarsandresearchersacross

theUniversity;5. operationofasustainableinfrastructurethatsupportssecureaccesstoresearch-identifiable

electronichealthdata6. operationofasustainablehealthmeasurementcorethatservesasaresourceacrossthe

Universityforselection,creation,andanalysisofhealthmeasures;and7. educationalproducts/programsandqualityoftheprograms.

Overthecomingmonths,wewillengageDepartmentfacultyandpartnersacrosstheinstitutiontovettheseindicatorsanddevelopspecificmetrics.AdministrativeSupportandSpaceIntheconversionfromCentertoDepartment,PopulationHealthScienceswillneedavarietyofadministrativeservices,whichitwillbuildin-houseandsharewithotherbasicsciencedepartmentsandinstitutes.Thesewillinclude:proposaldevelopment&grantsadministration,populationresearchadministration,HR/Visa/Effortreporting,finance,educationalprogramcoordination,IT,marketingandcommunications,andbusinessandfinancialmanagement.ThemanagingdirectoroftheCenteriscurrentlymeetingwithallpotentialfacultytoassesswhatinfrastructureisneededtomaximizeresearchproductivity.

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AproposedorganizationalstructureforthenewDepartmentisshownbelow:

WehaveworkedwithMoriaMontalbano,AssociateDeanforAdministration,toidentifyshort-termspaceinErwinSquarethatwillhouseapproximately60%ofthefaculty,newrecruits,andoperational/administrativestafftomanagetheresearchandservicemissionsoftheDepartmentforthefirst24months.VAandsomeDCRIfacultywillremainintheircurrentofficespaceuntilapermanentlocationhasbeenidentified.Within24months,permanentspacewillhousetheentiredepartment(includingamajorityoffaculty),accommodatingallmissionsofthedepartment,includingspaceforstudentsandteaching.

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AllMissionsBudget

FinancialsupportfortheDepartmentwillbereceivedfromtheDeanoftheSchoolofMedicine,theChancelloroftheDukeHealthSystem,researchawards,indirectcostrecovery,andtuitionrevenuefromtheeducationalprograms.Asdescribedabove,anequitableandtransparentapproachtotransitioningfacultyandtheirfundedprojectsisbeingdevelopedwithcurrentchairs.IftheDepartment’seducationalprogramsshareteachingresponsibilitieswithotherDukedegreeprograms,thentheChair,theleaderoftheotherDukedegreeprogram,theDeanoftheSchoolofMedicine,andtheProvostmustnegotiateatuition-sharingformula.Basedoncurrentprojectionsandconservativeassumptions,theall-missionsbudgetsuggeststhataninvestmentofapproximately$8.25millionover4yearswillberequiredtoestablishanoperationaldepartment.Althoughthebudgetrepresentsourbestestimatebasedoncurrentinformation,uncertaintyexistswithrespectaroundthetimingoffacultytransitionsandtheirresearchportfolios,thespeedoffacultyrecruitmentwhichwouldappropriatelydelayinitiationofresearchprogram,andthetimingoftheapprovalofthemaster’sprogram.Astheseuncertaintiesarereduced,thebudgetwillbeupdatedaccordingly;wewillbeiteratingthebudgetandoperatingmodelcloselywithSchoolofMedicineFinanceleadershiptooptimizeanddevelopriskmitigationplans.

Duke Health - Department of Population Health Sciences P&Lver:2016 12 20vsb033

Sponsored Research Revenue ModelFY-18 FY-19 FY-20 FY-21 FY-22 FY-23

Net Program SourcesSponsored Research $8,564,372 $9,678,542 $10,909,609 $11,955,619 $13,279,194 $13,614,456Education Programs $0 $401,490 $1,447,371 $2,342,674 $2,851,673 $3,163,164Other

Total Net Program Sources $8,564,372 $10,080,032 $12,356,980 $14,298,293 $16,130,867 $16,777,620

ExpensesFaculty

Administrative $103,261 $105,842 $108,488 $111,201 $113,981 $116,830Education $157,340 $481,353 $493,387 $505,722 $518,365 $531,324Research Studies $5,863,049 $6,160,681 $7,084,522 $7,878,722 $8,892,365 $9,114,674Data Core $104,360 $106,969 $109,643 $112,384 $115,194 $118,074Unallocated $512,080 $599,153 $400,635 $366,322 $418,463 $428,925

StaffTotal staff costs $2,834,256 $2,837,422 $2,886,126 $2,948,784 $3,022,504 $3,098,067

Total Labor $9,574,346 $10,291,421 $11,082,802 $11,923,136 $13,080,872 $13,407,894

Other Expenses $1,825,133 $2,750,406 $2,937,126 $3,161,027 $3,389,868 $3,588,325

Total Expenses $11,399,479 $13,041,827 $14,019,928 $15,084,163 $16,470,740 $16,996,219

Program Surplus/Deficit (2,835,107) (2,961,795) (1,662,948) (785,870) (339,874) (218,599)

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Appendix1 PopulationHealthSciencesNewDepartmentWorkingGroupMembership

TheodorePappas,MDDistinguishedProfessorandViceChairmanforAdministration,DepartmentofSurgeryViceDeanforMedicalAffairs,SOMLesleyCurtis,PhDProfessorinMedicineDukeClinicalResearchInstituteGeneralInternalMedicine,SOMCynthiaGordon,RNAdminDirector,PatientSafetyOffice,DUHSOfficeofViceDeanofMedicalAffairsWORKINGGROUPMEMBERSSureshBalu,MBADirector,Strategy&InnovationandProgramDirector,DukeInstituteforHealthInnovationDukeTranslationalMedicineInstituteJohnA.Bartlett,MDProfessor,MedicineandGlobalHealthCo-Director,DukeUniversityCenterforAIDSResearchAssociateDirectorforResearch,DGHIInfectiousDiseases,SOMHaydenBosworth,PhDProfessorinMedicineProfessorinPsychiatryandBehavioralSciencesSeniorFellowintheCenterforStudyofAgingGeneralInternalMedicine,SOML.EbonyBoulware,MDProfessorofMedicineProfessor,DeptofCommunityandFamilyMedChief,DivisionofGeneralInternalMedicineAssociateDeanforClinicalandTranslationalScience;Director,DukeClinicalandTranslationalScienceAward

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DennisClements,MD,PhDProfessor,Pediatrics,CommunityandFamilyMedicine,GlobalHealthSeniorAdvisor,DirectorofGlobalHealthThirdYearStudyProgramandDirectorofMedicalSchoolPrograms,DukeGlobalHealthInstituteAdrianHernandez,MDProfessorofMedicineAssociateDirector,DukeClinicalResearchInstituteCardiology,SOMEmilyO’Brien,PhDAssistantProfessorinMedicineDukeClinicalResearchInstituteClinicalPharmacology,SOMTrulsØstbye,MD,MPH,MBA,PhD,FFPH(UK)ProfessorinCommunityandFamilyMedicineDirectorofGlobalHealthinCommunityandFamilyMedicineProfessorinHealthServicesResearchDuke-NUSSingaporeKathryn(Kath)Pollak,PhDProfessorinCommunityandFamilyMedicineDukeCancerInstituteCommunityandFamilyMedicine,SOMSudhaRaman,PhDPostdoctoralFellowDukeClinicalResearchInstituteJulieAnnSosa,MDProfessorofSurgeryProfessorofMedicineChief,SectionofEndocrineSurgeryLeader,EndocrineNeoplasiaDiseasesGroup,DukeCancerCenterDirector,HealthServicesResearch,DeptofSurgeryDivisionofAdvancedOncologicandGISurgeryKevinSowers,RN,MSNPresident,DukeUniversityHospital

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DonaldH.(Don)Taylor,PhDProfessor,SanfordSchoolofPublicPolicyAssociateProfessor,SchoolofNursingAssistantProfessorofCommunityandFamilyMedicineAffiliate,DukeInitiativeforScience&SocietyVirginiaWang,PhDAssistantProfessorinMedicineGeneralInternalMedicine,SOMKevinWeinfurt,PhDProfessorofPsychiatryandBehavioralSciencesProfessorofDeptofPsychologyandNeuroscience

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Appendix2DukeUniversityStakeholdersStakeholders Representative WorkingGroup

(WG)ContactIn-personmeetingwithWG

DukeMedicine Washington Curtis YesDIHI Balu YesPDC MarkNewman Pappas DukeConnectedCare DevSangvai Balu

SoM Andrews Pappas YesMedicine Klotman Curtis Yes

MMcI Schulman Curtis Surgery Kirk Sosa YesPsychiatry Lisanby Weinfurt CommunityandFamilyMedicine Michener Curtis YesB&B Delong Curtis Yes

ClinicalResearchTrainingProgram Grambow Weinfurt DurhamVAHSR&D Oddone Bosworth CenterforCommunityandPopulationHealthImprovement

Boulware Curtis

DukeCancerInstitute Patierno Pollack DukeClinicalResearchInstitute Peterson Hernandez SOMFinance BillyNewton Curtis ViceDeanforBasicSciences RaphaelVildavia Curtis

SchoolofNursing Broome Sowers YesDukeGlobalHealthInstitute Merson Bartlett YesMargolisCenterforHealthPolicy McClellan Curtis YesSanfordSchool Brownell Taylor ViceProvostforResearch Carin Curtis YesDuke-NUS Coffman Curtis Specificquestionsposedtostakeholders:

• Whatdoyouseeasthepotentialopportunitiesforthedepartment?HowcouldthedepartmentaddvaluetotheSchoolofMedicineandUniversity?

• Whatarethepotentialchallengesforthedepartment?AretherepotentialriskstotheSchoolandUniversity?

• Howcouldthedepartmentaddvalueto(yourcenter/department/institute)?• Whatconcernsdoyouhaveaboutthepotentialimpactofthedepartmenton(your

center/department/institute’)researchandeducationprograms?

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Appendix3NationalLandscapeAssessment

Background

Anassessmentofthenationallandscapeofuniversity-basedpublicandpopulationhealthentitieswasundertakentoinformtheworkinggroup’sgoal:todevelopanacademicresourceatDuketoaddressthechallengeofimprovingpopulationhealth.Particularfocuswasgiventotheexploringhowthepublicandpopulationhealthentities(forexample,school,department,instituteorcenter)arestructuredwithintheuniversityand/ortheschoolofmedicine,howtheentitiesweresubdivided,andhoweachentityaddressednovelandemergingareasofpopulationhealthresearch,especiallywithrespecttothelinkbetweenpopulationhealthsciencesandtheclinicalhealthcaresystems.Objective

Tounderstandthenationallandscapebasedonthecharacteristicsofthetop-rankeduniversitybasedpublicorpopulationhealthsciencesdepartments,withparticularfocusonuniversitieswithapopulationheathentitywithinaschoolofmedicine(SOM)ascomparedtoawell-established,freestandingschoolofpublichealth(SPH)andwithstrongeducationandresearchprograms.

Methods

i. Todevelopalistofuniversity-basedpopulationhealthacademicentitiestostudyfurther,wecompiledalistoftoprankedmedicalschoolsandschoolsofpublichealthwithintheUS(basedontheUSNewsandWorldReport2015,usingthetop20academicmedicalschools,Researchcategory(http://grad-schools.usnews.rankingsandreviews.com/best-graduate-schools/top-medical-schools/research-rankings)andaddingadditionalschoolsfromthe20toprankedSchoolofPublicHealth(SPH)).

ii. Additionalschoolswithhealthcare/clinicalresearchfocus(UniversityofWisconsin–Madison,DartmouthCollege),arecentlyformedschoolofmedicine(UniversityofTexasAustin)andadditionalinternationalandlocalprogramswithrelevancewereadded.

iii. Publicallyavailableinformationwascompiledfortheaboveuniversities.iv. Characteristicsnotedincludedrank(asperUSNewsandWorldReport)ofacademicSOM,

entities’locationwithinand/oroutsideoftheSOM,rankofSPHifpresent,startyear,graduatedegreeprogramsanddivisions.

Results

TheprogramcharacteristicsandaredetailedinTableA.Weprofiled20universitiesbasedonrankings.Additionalschoolswereincluded:3wereaddedduetoexpertiseinpopulationhealthorclinicalresearch,6schoolswithinNCorSCforregionalcomparison,and2schoolsoutsidetheUSwereincludedforinternationalcontext.

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OverallObservations:

• Locationofentitywithinuniversity–OftheUSNewsandWorldReport2015rankingofthetop20schoolsofmedicine(SOM)(researchcategory),18universitieshadeitheraschoolofpublichealth(SPH),department,oruniversitywideinstitutefocusedonpublichealthorpopulationhealthscience.EightuniversitieshadaSPH,5universitieshadauniversity-wideinstituteorcenterofpublicorpopulationhealthscience.OftheremaininguniversitieswithoutanSPHorsimilarentity,5housedadepartmentofpublichealthorpopulationhealthscienceswithintheSOM(includingCornellUniversity’sDepartmentofHealthcarePolicyandResearchwithintheSOMthatwasformerlytheDepartmentofPublicHealth).Theremaininguniversity,otherthanDuke,wasUC–SanDiego;theUC-SDSOMhousesaDivisionofGlobalPublicHealthwithintheDepartmentofMedicine.Afterevaluatingthepopulationandpublichealthactivitiesofseveraladditionalinstitutions,eightuniversitieswereidentifiedasbeingnationallycomparablepeerinstitutionstoDuke,basedonthepresenceofapublicorpopulationhealthdepartmentwithintheSOM:HarvardUniversity,UniversityofChicago,CornellUniversity,NewYorkUniversity,NorthwesternUniversity,IcahnUniversity,UniversityofWisconsin-Madison,andtheUniversityofTexas–Austin.WithintheSOMateachschool,almostalluniversitieswithandwithoutaSPHhadanon-clinicaldepartmentorsubdivisionthatfocusedonepidemiology,biostatisticsorclinical/translationalresearch.

• Size–Forschoolsthatindicatedthenumberofprimaryfacultyinthepopulationhealthentity,thesizeofthefacultygrouprangedfromasfewas8primaryfacultytoover100+(datanotshown).

• History-Manyoftheschoolsofpublichealthwereestablishedmorethan50yearsago.Newerschools,institutesandcentersestablishedinthelast10yearsreflectnewterminology,usingpopulationhealthratherthanpublichealth.

• Education–Intermsofdegreeprograms,mostpopulationorpublichealthentitiesofferedanMPH,MS,PhDattheminimum,with<5alsoofferingvariousotherdegreesincludingresearchandappliedmastersinhealthcaremanagement,healthadministrationandclinicalresearchdegreesintendedforphysicians,aswellasdoctoratesinpublichealth.

• Research–Asreflectedinthesubdivisionswithineachdepartment,schoolorinstitutes,theresearchfocus,mosthadbetween5-8subdivisions.Themostcommonwereepidemiology,biostatistics,healthpolicy,behavioralhealth,environmentalhealth.Institutes,centersanddepartmentsformedinthelast10yearsincludedemergingfieldssuchasimplementationanddecisionscience,comparativeeffectivenessresearch,medicalbioethicsandmentalhealth.ThefulllistofsubdivisionsareincludedinTableB.Eachschoolhadmultitudesofsmallerorganizationalunits(suchascenters)thatfocusedonspecificmethodsordiseasetopics.

• Programswithestablishedlinkstoclinicalresearchwith/withinahealthsystem–Manyschoolshadactiveandveryvisibleresearchprogramsthatevaluatedthehealthcaresystem,oftenfocusingonnationalorstatehealthcaredata(e.g.includeDartmouth’sInstituteforHealthPolicyandClinicalPractice),howeverfindingastrongexampleofa

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symbioticrelationshipbetweenapopulationhealthresearchandeducationentityoftheuniversityandahealthcaresystemwasdifficult.

• Localfindings–OftheNCuniversitieswithpublicorpopulationhealthentities,UNCisthemostwellestablished,withlargedepartmentswithintheSPH,aswellaspopulationhealthtracksintheSOMandtheSchoolofPharmacyandtheCecilG.ShepsCenterforHealthServicesResearch(aunitoftheUniversityofNorthCarolinaDivisionofHealthAffairs).NotableeducationalofferingatotherstateuniversitiesincludedWakeForestUniversity’sClinicalandPopulationTranslationalSciences(CPTS)program(grantingdegrees(MS)orcertificates)andUNCCharlotte’sPhDinhealthservicesresearch(established2005)withintheDepartmentofPublicHealthSciences.

• Internationalfindings–NotablefeaturesoftheLondonSchoolofHygieneandTropicalMedicine(UK)wereitswell-developeddistancelearningandcontinuedprofessionaldevelopmentforpublichealthprofessionals.NotablefeaturesoftheentitiesattheUniversityofToronto(Canada)wereitsestablished,largehealthpolicy,managementandevaluationdepartment/institute,includingclinicalepidemiologyeducationandresearchprograms,aswellasarelativelynewSPH.Populationandclinicalsciencesarewellrepresentedintheinstitutesdivisions(forexample:clinicalepidemiology,healthservicesresearch,qualityimprovementandpatientsafety).

Conclusions

Publicandpopulationhealthentitiesarebroadcrossuniversityendeavors.

a. EightuniversitieswereidentifiedasbeingnationallycomparablepeerinstitutionstoDuke:HarvardUniversity,UniversityofChicago,CornellUniversity,NewYorkUniversity,NorthwesternUniversity,IcahnUniversity,UniversityofWisconsin-Madison,andtheUniversityofTexas–Austin.Theseuniversitiesallfocusedpublicandpopulationhealthscienceresearchandeducationalactivitieswithinadepartmentwithintheschoolofmedicine.

b. Examiningrecentlyestablishedpopulationandpublichealthentitiesmaygiveabetterindicationofthecurrenttrendsinstructureandacademicfocus.Entitieswereoftenbroadcross-cuttinguniversityendeavorsdrawingfrommultipledisciplines,whetherhousedinaSOMorSPH.Anotablefunctionofthenewerentitieswastolinkpreexistingnumerousinstitutesandcenterswhowereengagedinthistypeofresearch.

Publicandpopulationhealthresearchisincreasinglyfocusingonappliedmethodsandapproaches

c. Sub-divisionswithinanewdepartmentreflectbothestablishedperspectivesandtechniquesofscientificinquiryaswellasemergingmethodologicalapproaches.Withinmorerecentlyestablishedentities,subdivisionswerefocusedonappliedmethodsandapproachestohealthresearch(e.g.implementationanddecisionscience,comparativeeffectivenessresearch)andlessoftenonspecificdiseasegroupsorpopulations(suchasmentalhealth).

Opportunitiesexisttomaximizethelinkbetweenhealthcaresystemandacademicpopulationhealthactivities.

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d. Thoughrelationshipsbetweenapopulationhealthresearchandeducationentityoftheuniversityandhealthcaresystemexistatmanyschools,buildingasymbioticrelationshipbetweenapopulationhealthresearchandeducationentityoftheuniversityandahealthcaresystemwouldbeanareathatanewDepartmentofPopulationHealthSciencesdepartmentwouldexcel.

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Appendix3:TableANationalLandscapeassessment–Results–(peerinstitutionsinbold)SchoolofMedicine

(SOM)1SPH2 Other

entity3SOM-

departmentStartyr5

Graduatedegreesgranted FormalsubdivisionswithinSPHorentity

SOMrank

SPH

rank Pop/PH

Other4

MPH MS PhD DrPH MHA Bios Epi HP SB GH HSR Other

1 Harvard • 2 • 1913 • • • • • •(SPH) • • • • • •2 Stanford • • 2012 • • • • • 3 JohnsHopkins • 1 • 1916 • • • • • • • • • •3 Universityof

California–SF • • 2006 • • •

(SOM)•

(SOM) • •

5 UniversityofPennsylvania

• • 1993 • • • •

6 WashingtonUniversityatStLouis

• • • • • • • •

7 Yale • 14 • 1915 • • • •(SPH) • • • •8 Columbia • 5 • 1922 • • • • • • •8 Duke • •

(GH)•

(Bios) •

(SOM) •

10 UniversityofChicago

• 1993 • • •(SOM)

•(SOM)

•(SOM)

10 UniversityofMichiganAnnArbor

• 4 • 1941 • • • • • • • • •

10 UniversityofWashington

• 6 • 1970 • • • • • • • • •

13 UC–LA • 10 1961 • • • • • • • •14 NewYork

University 6 • 2012 • • • • • • • •

14 VanderbiltUniversity

• • • •(Inst)

•(Inst)

16 UniversityofPittsburg

• 13 • 1948 • • • • • • • •

17 UC-SanDiego •7 • • • • 18 Cornell

University •8 1927 • •

(SOM) •

(SOM)•

(SOM) •

(SOM)•

(SOM)19 Northwestern • • • • • •20 Icahn • • • • • • •

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Appendix3:TableANationalLandscapeassessment-Results–(peerinstitutionsinbold)(page2) SPH2 Other

entitySOM-

departmentStartyr3

Graduatedegreesgranted FormalsubdivisionswithinSPHorentity

Other SPH

rank Pop/PH

Other4

MPH MS PhD DrPH MHA Bios

Epi HP SB GH HSR Other

UniversityofWisconsin–Madison

• • 1984 • • • • • • •

DartmouthCollege

• 1988 • • • • • • •

UniversityofTexas-Austin

• 2012 • • •

Local Universityof

NorthCarolina-ChapelHill

• 2 • 1940 • • • • • • • • • • •

NCState • 1999 • • WakeForest • 2007 • • • • • EastCarolina • • UNCCharlotte • 2002 • • • • • Medical

UniversitySouthCarolina

• • • •

International LondonSchool

ofHygieneandTropicalMedicine

• 1890 • • • • • • • • •

UniversityofToronto

• • 2008 • • • • • • • • • • •

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Appendix3TableAFootnotes1SOMRanking–source-http://grad-schools.usnews.rankingsandreviews.com/best-graduate-schools/top-medical-schools/research-rankings2SPHRanking–source-http://grad-schools.usnews.rankingsandreviews.com/best-graduate-schools/top-health-schools/public-health-rankings3Suchasacenterorinstitute4DepartmentswithinaSOMsuchasEpidemiology,BiostatisticsorHealthServicesResearch5Startyearofprimarypublicorpopulationhealthentity6NYU’sCollegeofGlobalPublicHealthisauniversity-wideentity.7UC-SD’sDivisionofGlobalPublicHealthiswithintheDepartmentofMedicineintheSOM

8CornellUniversity’sDepartmentofHealthcarePolicyandResearchwasformerlytheDepartmentofPublicHealth

Abbreviations Bios–Biostatisticsand/orBioinformatics MPH-mastersinpublichealth PH-publichealthCER-Comparativeeffectivenessresearch MS-mastersofscience Pop-PopulationGH-Globalhealth/internationalhealth PhD-doctorofphilosophy Epi–Epidemiology(alltypes) DrPH-doctorateinpublichealth HP-Healthpolicy MHA-mastersinhealthadministration HP-Healthpolicyandmanagement HSR-Healthservicesresearch,comparativeeffectivenessresearch,healthcaredeliveryresearch

SB–Social/behavioralresearch

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TableB–Subdivisionswithinpopulationandpublichealthentitiesbioinformaticsbiostatisticschronicdiseaseepidemiologyclinicalepidemiologycommunityhealthcomparativeeffectivenessresearchdecisionsciencedeliveryscienceenvironmentalhealthepidemiologyglobalhealth/internationalhealthhealthbehaviorhealthcareanalyticshealthcareredesignandresearchhealthcommunicationhealthpolicyhealthpolicyandmanagementhealthservicesresearchhumangeneticsinfectiousdiseasematernalandchildhealthmedicalethicsmentalhealthnutritionoccupationalhealthprimarycare

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References:

1. DukeHealth.(2016,February01).AdvancingHealthTogether-DukeHealth2016-2020StrategicPlanningFramework.RetrievedFebruary23,2016,fromhttps://www.dukehealthstrategy.duke.edu/sites/www.dukehealthstrategy.duke.edu/files/advancing_health_together.pdf

2. BachrachC,RobertS,ThomasY.(2015,August01).TraininginInterdisciplinaryHealthScience:CurrentSuccessesandFutureNeeds.CommissionedbytheInstituteofMedicineRoundtableonPopulationHealthImprovementAugust2015⋅availableathttp://iom.nationalacademies.org/pophealthrt

3. Kindig,D.(2015,April6).WhatAreWeTalkingAboutWhenWeTalkAboutPopulationHealth?RetrievedFebruary22,2016,fromhttp://healthaffairs.org/blog/2015/04/06/what-are-we-talking-about-when-we-talk-about-population-health/

4. Kindig,D.,&Stoddart,G.(2003).WhatIsPopulationHealth?AmericanJournalofPublicHealth,93(3),380–383.