As if there weren't enough scholarly articles being published about our fractured healthcare delivery system already, a new journal with a different approach will launch soon. It is geared toward those who actually deliver care rather than toward the policy wonks who think and write about healthcare, often without benefit of direct clinical experience.
The new journal's editors expect the new journal will help fill a widening gap, and expand knowledge about the "how" of care delivery at a critical time in this era of reform.
Healthcare: the Journal of Delivery Science and Innovation, due in June, will be published quarterly at first. Its scientific, peer-reviewed papers will be published online and in print at no charge for the first year. The first four issues will each have a theme, such as payment innovation, patient-centered clinical innovation, quality and process improvement, and applied health information technology.
"There are plenty of terrific journals out there," including the Journal of the American Medical Association family and Health Affairs, acknowledges Ashish Jha, MD, a practicing Harvard internist and associate professor in the Department of Health Policy and Management. Jha is one of the new journal's three senior editors.
But this one, Jha says, will be less focused on policy, and more centered on what happens at the patient bedside.
"We are not looking to be Health Affairs-lite or to compete with Health Affairs," Jha says. "Our primary focus is not going to be on policy; our primary focus is going to be on delivery and the science of healthcare innovation. That's not the Health Affairs sweet spot... These journals are going to be complementary. And for most readers like me, we will want to read both."
In a blog post last month, Jha noted that in 2012, healthcare cost $2.8 trillion, money spent on decisions "in the context of a broader healthcare delivery system that is mindboggling diverse, complex, and fundamentally broken.
Despite all the attention on healthcare we still don't know how to make the system work better." Though many smart people are working on the problem, "we need a venue to see bright ideas about policy efforts that might make a difference."
The lineup of HJDSI editors or members of its editorial board boasts some big names:
- David Blumenthal, MD, former National Coordinator for Health Information and Technology
- Maureen Bisognano, president and CEO of the Institute for Healthcare Improvement,
- Christine Cassel, MD, incoming National Quality Forum president;
- Patrick Conway, MD, Centers for Medicare & Medicaid Services' Chief Medical Officer
- Arnold Milstein, MD, Professor of Medicine and Director of the Stanford Clinical Excellence Research Center
- Wil Yu, MPH, Director of Innovation for the Office of National Coordinator for Health Information Technology
- John Iglehart, New England Journal of Medicine founder and national correspondent
Others to appear on the masthead are providers on the front lines, including Henry Ford Health System's Executive Vice President and Chief Medical Officer Mark Kelly, MD. Executives from ThedaCare, Academy Health, Harvard Vanguard Medical Associates, and the Philadelphia VA Medical Center.
Two Harvard clinicians, Sachin H. Jain, MD and Amol S. Navathe, MD, serve as the editors-in-chief.
Asked for examples of upcoming articles, Navathe says one should think about "the how" of healthcare. One paper might be a report on the use of an information technology tool focused on discharge planning or medication reconciliation "that produces measureable, improved outcomes, be they readmissions, cost of care or patient reported outcomes."
Navathe adds that another candidate for publication might be a paper describing a health information technology technique that an accountable care organization has successfully employed to identify patients likely to be high utilizers, or high cost patients, or which are likely to have poor outcomes, and point to resources that, were they to be used sooner, might delay or otherwise alter the progression of disease.
Asked what she thought of the new effort, Susan Dentzer, editor in chief of Health Affairs, replied by e-mail, "We warmly welcome this exciting new journal to the delivery system innovation 'space'."
Even as many publications are cutting back, it occurs to me that there is a need for such a journal, one whose pages aren't taken up with clinical trial results about new medications or stent devices, but which illustrates the fundamental goal of healthcare: care of the patient.
During interviews with at least four published authors about their papers dealing with how we measure safety and quality in recent weeks, I asked them why their papers were so short, and left so many questions hanging.
On background, they all confided the same lament. They'd submitted lengthy manuscripts intended as original contributions or featured pieces, only to see them delayed for years, and/or cut to a fraction of their original length, and/or relegated to a lesser status, for example as "research letters" of barely one page.
Jha says some of the new journal articles will be validated hospital or health system case studies that prove empirical evidence of successful strategies from which other hospitals and healthcare leaders may learn.
"The problem is that often, single-institution studies get looked down upon by other journals, and there's worry about issues of generalizability," Jha says. "We will too, but we will push the authors to tell us what the details of the intervention were, to see if that knowledge is much more transferable," he says.
"The simple view is, if I can figure out a best practice at my hospital, everyone should just replicate it and get similar results. But we know now that's not true," Jha says. The challenge is to figure out what needs to change at other institutions. The core concept may be the same; a hospital may realize it does three of four things really well, but not the fourth, he explains.
"So a big part of our goal is to help understand what is generalizable knowledge, and what is particular to an individual institution."