GLOBAL HEALTH & SOCIAL MEDICINE
The research arm of our team, the Healthcare Systems Design Group, conducts implementation research studies through pragmatic study designs. In brief, our implementation research approach is as follows. It starts with the basic tenant that Possible as a healthcare company has decided to invest heavily in data. That's because we believe that intrinsic to delivering effective, patient-centered healthcare is using quantitative analytics to drive decision-making.
Throughout our team, managers daily, monthly, quarterly, annually, have to make decisions across a wide-range of challenges:
Particularly as healthcare companies scale, it is critical to have a single, unified electronic medical record to which the staff throughout the organization can turn for metrics. Ours, built with partners from Ministry of Health of Nepal, includes the following components:
A frequently overlooked aspect of technology solutions is the management system of the healthcare providers who are delivering care and using the technology. In our system, we have developed a professional cadre of community-based healthcare providers, Community Healthcare Workers (CHWs) who undertake three core functions:
They are women who are recruited from the catchment area under service, receive full-time salary and benefits, and are supervised by a Community Healthcare Nurse. The same metrics backbone is used for scientific studies, quality improvement initiatives, and strategic planning and donor reporting. We must create a data and analytics platform to meet the needs to be rigorous for scientific evaluation, clear and simple for strategic planning, and real-time for quality improvement. The scale and design of interventions within delivering healthcare in our public-private partnership goes hand-in-hand with scientific evaluation. We cannot design interventions that cannot be rigorously evaluated; we cannot place perceived scientific rigor over the pragmatic concerns of healthcare delivery.
The evaluation design approaches need to be both rigorous and pragmatic. As such, we deploy the following primary prospective study design strategies:
Regardless of which design strategy, we utilize implementation research mixed methods (quantitative plus qualitative) to understand mechanism, causality, feasibility, and scalability.
Duncan Maru, MD, PHD is an epidemiologist and physician trained in internal medicine and pediatrics who conducts implementation science research on strategies to improve the delivery of evidence-based healthcare interventions in settings of extreme poverty. He is an Assistant Professor at Harvard Medical School and the Brigham and Women’s Division of Global Health Equity. The focus of his research is in rural Nepal. Over the last seven years, a non-profit healthcare provider he co-founded, Possible, has developed a unique public-private partnership with the Nepali government. Within this arrangement, Possible manages an integrated healthcare system in two of Nepal's most remote areas, and the government provides medicines, facilities, and financing. Presently, Possible cares for 150,000 patients per year via over 300 full time employees and an annual budget of $8 million. He also practices part-time as a pediatrician on the Complex Care Service at Boston Children’s Hospital. Duncan graduated from Harvard College, received his MD/PhD from Yale University, and completed the Harvard Combined Internal Medicine-Pediatrics Program and the Brigham and Women’s Global Health Equity Residence Program. Duncan’s work as a physician researcher and epidemiologist has generated over 50 peer-reviewed articles. He is a recipient of the NIH's High Risk, High Reward Early Independence Award, Canada Grand Challenges Stars in Global Health Award, and is a World Economic Forum and Schwab Foundation Social Entrepreneur.
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