Healthcare Policy Research

 

Both as the Mary and Deryl Hart Professor of Surgery and Chief Medical Officer of Duke University Medical Center, a major interest of Robert H. Jones is in enhancing value of healthcare. Value implies best quality for least cost. Understanding quality requires measurement of important outcomes, processes, and structure of healthcare delivery. Costs of concern relate both to resource consumption and negative outcomes of treatment.

 

Prior work with the Duke Cardiovascular Database has addressed specific healthcare issues in patients with coronary artery disease. These issues involve defining best strategies for recognition and management of this common disorder. Participation in multicenter randomized trials addressing specific therapeutic questions for patients with coronary artery disease also has provided a resource to intercompare outcomes in large cardiovascular databases and in randomized trials. The similarity of prognostic weight of clinical variables has been intercompared among a number of large databases of patients undergoing coronary artery bypass grafting.

 

Dr. Jones led the group responsible for creation of the NHLBI/AHCPR guideline, Unstable Angina: Diagnosis and Management. This document has been recognized as a prototype for the future development of other clinical practice guidelines. Clinical evaluation instruments have been derived from this guideline to assess the quality of care of patients with unstable angina.

 

Future work will be directed at incorporating guidelines and care plans into a hospital-based electronic medical record. The objective of this work is to facilitate real-time accumulation of clinical and resource information in a way that is fully integrated with healthcare delivery. This information is envisioned to be useful for individual patient decisions and for developing aggregate information to understand changes in healthcare delivery like to enhance value for a number of common medical and surgical disorders.

 

Research Projects