AcademyHealth’s Delivery System Science Fellowship: training embedded researchers to design, implement, and evaluate new models of care
AcademyHealth’s Delivery System Science Fellowship (DSSF) provides a paid postdoctoral pragmatic learning experience to build capacity within learning healthcare systems to conduct research in applied settings. The fellowship provides hands-on training and professional leadership opportunities for researchers. Since its inception in 2012, the program has grown rapidly, with 16 health systems participating in the DSSF to date. In addition to specific projects conducted within health systems (and numerous publications associated with those initiatives), the DSSF has made several broader contributions to the field, including defining delivery system science, identifying a set of training objectives for researchers working in delivery systems, and developing a national collaborative network of care delivery organizations, operational leaders, and trainees. The DSSF is one promising approach to support higher-value care by promoting continuous learning and improvement in health systems. Journal of Hospital Medicine 2017;12:570-574. © 2017 Society of Hospital Medicine
© 2017 Society of Hospital Medicine
Sixteen delivery systems have participated in the DSSF program over the course of 5 years. These organizations represent a diverse group of innovative, high-performing systems that serve populations across the rural-urban continuum. Host site preceptors are nationally recognized experts in areas such as health economics, comparative effectiveness, pragmatic trials, clinical decision support, and implementation science. The fellowship is guided by an advisory committee that provides strategic direction and plays a key role in selecting fellows. AcademyHealth partners with 8 to 10 health systems annually, accepting new partnerships as interest and availability allows. The Figure summarizes program inputs, elements, antecedents, outputs, and intended outcomes. As a relatively new and evolving program, the DSSF is using a disciplined approach to assess both mid- and long-term outcomes. The Table is a comparative matrix that depicts the range in areas of investment offered by a sample of host sites during the fellowship program. Complementing development of the common core competencies and exposures presented in the Table, specific project choice at a host site is mutually determined according to system needs and the fellow’s interests.
To apply for DSSF, researchers must hold a doctoral degree in any relevant aspect of clinical medicine, HSR, or a related field. The review committee evaluates applicants based on their qualifications, a clear statement of professional goals, appropriateness for placement, the quality of a writing sample, and letters of recommendation. Host sites select a fellow based on their individual preferences and recommendations from the review committee. The minimum duration of the fellowship is 1 year, during which the fellow works full time at the host site. Host sites provide the fellows’ salary and benefits, financial support to attend AcademyHealth’s Annual Research Meeting, and mentorship and/or training. To ensure general continuity across sites, each fellow’s work focuses on “delivery system science (DSS),” with a significant part of the work intended for public dissemination (eg, a conference presentation) or publication in a peer-reviewed journal.
Host sites additionally provide AcademyHealth financial support to manage the process of recruiting promising candidates. AcademyHealth manages and convenes the advisory committee proceedings, facilitates the application cycle (including peer review of applicants), markets the fellowship, guides the interview and match process, and promotes placement of fellows upon program completion. AcademyHealth also convenes active and graduate fellows to foster engagement and professional development.
To date, 118 individuals have applied to the program and 25 fellows have been accepted. Nineteen have completed the fellowship, 2 are continuing as second-year fellows, and 4 started their fellowship in the fall of 2016. Fellows have a wide range of expertise in areas such as epidemiology, exercise physiology, health psychology, anthropology, clinical medicine, qualitative methods, organizational behavior, and systems engineering. Once individuals complete their fellowship, they become DSSF “alumni” and remain involved in program activities and as peer mentors.
EARLY EXPERIENCE WITH OUTCOMES
Program Level
AcademyHealth administers an annual evaluation to assess the program, understand impact on the fellow’s professional development and growth, track publications, and inform programmatic goals. To date, we have identified over 50 peer-reviewed publications resulting from work conducted through the fellowship (visit https://www.academyhealth.org/dssfpublications for a full listing of publications stemming from the DSSF program). As an example of continuous program improvement, this year staff implemented a fellow-led monthly call in response to requests to connect fellows. This has proven to be a useful response for fellows to understand how to enhance their own experience by learning from fellows in other systems to incorporate focused areas of development via cross-system sharing. As an indicator of continued value, of the 16 sites that have participated to date, 10 have participated in the DSSF for more than 1 cycle; 3 are new host sites currently participating in their first year of the program; and 3 host sites participated for 1 year. The 3 inaugural host sites that helped launch the DSSF continue to serve as host sites to date.
As a marker of longitudinal success, staff will continue to follow up with preceptors and fellows to understand fellows’ contributions to the host site and the field, as well as impact on the fellow career trajectory. Of the 19 fellow alumni to date, 8 have moved on to academic or research positions, and 11 have remained in care delivery systems to provide local expertise in study design, execution, and evidence uptake.
The program has also made some general contributions to advance the discipline of delivery system science, including:
1. Defining DSS and clarifying training needs for “embedded researchers” and health system analysts. To characterize the fellowship, AcademyHealth and the program advisory committee jointly developed the following definition for delivery system science (DSS):
“DSS includes research that seeks to understand how delivery systems operate, influence, change, and respond to external stimulus, among other topics. DSS may include efforts to examine how and under what circumstances interventions work and how delivery systems effectively implement evidence-based innovations. For the DSSF, DSS is conducted by researchers who are ‘embedded’ in delivery systems and respond to the decision-making needs of those systems.”
Additionally, closer connections with DSS leaders have led to a better understanding of challenges, opportunities, and needs of delivery systems.10,11
2. Cultivating a network of delivery systems and system leaders interested in expanding the cadre of embedded researchers, and trainees who intend to build careers in DSS. The DSSF also aims to enhance fellows’ skills and knowledge base, career opportunities, and professional network. To extend these relationships and support delivery system analytics, AcademyHealth worked with preceptors and fellows to inform creation of a new Community of Practice supported by AcademyHealth’s EDM Forum and guide planning for AcademyHealth’s Concordium conference to provide a national meeting to showcase DSS.
3. Strategic planning to ensure sustainable support for embedded research within delivery systems. Substantial interest in the program developed quickly, with rapid learning over the first few cycles to refine the program to meet host sites’ and fellows’ needs. Both efforts were critical to demonstrate that the DSSF fulfills an important need for our health system partners and members. As indicated previously, strong, sustained interest from prospective host sites and applicants demonstrates the program has created a win-win to jointly assess fit while building skills and supporting continuous learning.
Likewise, Lisa Simpson, President and CEO of AcademyHealth, and Lucy Savitz, DSSF host site preceptor at Intermountain Healthcare, participated in the Canadian Institutes of Health Research (CIHR) Invitational Workshop, “Modernizing Health Services and Policy Research Training in Canada” in March 2016. Shared learning largely informed by the DSSF led to CIHR creating a similar fellowship program with initial awards to be made in 2017 (see https://www.researchnet-recherchenet.ca/rnr16/vwOpprtntyDtls.do?prog=2540&view=browseActive&sponsor=CIHR-8&type=EXACT&resultCount=25 for more information). We are working to thread these efforts together in a way to leverage our learning community of government agencies, academia, and employers as a long-term funding stream for training in delivery science.
