When was the last time you looked at Wikipedia?  Chances are, if you're a blog reader, you probably read it last week, if not more recently. Many of us could write or edit something related to health policy on Wikipedia, but probably not on astrophysics.  But if we have a question on astrophysics, we know where to look.  It is a collaboration, or network, of experts and learners.

The current issue of JAMA has an important commentary that describes how primary health care innovation networks can be funded, operated, and used to disseminate best practice information.  As the article states:

Organized innovation and learning networks provide a systematic way of sharing, learning, and development -- turning variation and local context into an asset rather than a liability -- to identify innovations that result in better performance. Networks take advantage of individuals' motivation to contribute their knowledge and experience to enable sharing the "how to" knowledge required to make ideas work in situ for widespread application. They provide common, transparent metrics that enable peers to evaluate each others' approaches to determine what works and what does not.

The authors point out that we already have isolated networks that disseminate innovation: Kaiser Permanente, the VA, and of course the authors' home institution.  The last of these may be the most interesting: Cincinnati Children's Physician-Hospital Organization (PHO) is "a network of 40 independently owned and operated practices that have developed a shared infrastructure led by a board of practice leaders."  The PHO "provides centralized technical support for quality improvement and a shared registry for population management."

This is an important point: large numbers of physicians (many would say a majority of doctors, although I think it's too hard to pin down because it's a nuanced issue and rapidly evolving) do not wish to become employees of hospitals or health systems.  Two-thirds currently are not, according to the JAMA essay. The question then becomes what arrangements can be created to allow for 1) increased coordination of care and 2) sharing of successes and failures to facilitate learning and quality improvement.   

The answer to number 1 will be largely influenced by payers in the coming years.  The different health reform bills before Congress have various iterations of Accountable Care Organizations, which we have written about numerous times.  Providers of all stripes will be encouraged financially to form relationships with each other to encourage production of health, not health care services.  These need not be employment relationships; they can revolve around the patient and care coordination.  Another model to consider is the independent practice association (IPA) model, which we highlighted this past March with our Hill Physicians case study.  A synopsis of the IPA model can be found in a blog post here. 

Number 2, though, is quite important as well, and has not received the attention it deserves in the national reform conversation.  The Institute for Healthcare Improvement (IHI) collaboratives and the Agency for Healthcare Research and Quality's primary care practice-based research networks continue to educate and facilitate quality improvement.  Both allow for the sharing of successes and failures so that professionals can learn what is and is not working when and where. 

The reason this JAMA commentary is newsworthy is that the authors recently received an $8.3 million grant from the NIH to examine if these networks can improve the care for Crohn's disease and ulcerative colitis, which 100,000 minors suffer from in the U.S.  As the news release informs us:

These (two conditions) were chosen because they have so much to gain from the collaborative: rare enough that patients do not have access to a large peer group and clinicians must collaborate across treatment centers to achieve the numbers they require for study; they primarily affect children in early adolescence, a perfect age to engage in Web-enabled innovation; and because they are uncommon, there are few financial incentives for the pharmaceutical industry to conduct studies with the group.

This is not the first time we've highlighted Cincinnati Children's.  Last year we wrote about an initiative they started to reduce shootings in their city, by focusing on fully prosecuting offenders and supporting job training programs.  As a result, residents are healthier.  Additionally, Atul Gawande wrote about their cystic fibrosis program in his book Better.  The CF program at Children's was an average performer as measured by patient life expectancy, but they worked to improve by benchmarking the best programs in the country.

Primary health care innovation networks are an efficient way to use the Internet to easily share information.  We should continue to think about ways to support these organizations and encourage physicians and other providers to participate.