By: Shayna Henry, Ph.D.
2014 Delivery System Science Fellow
A little over a year ago, I was delighted to learn that I had been selected as the 2014 AcademyHealth Delivery Systems Science Fellow (DSSF) by the Kaiser Permanente Southern California Department of Research & Evaluation host site. When I first learned about the program, I was excited about the possibility of working within a health care system to learn more about care delivery and implementation science, particularly in my area of interest – managing care for patients with chronic kidney diseases – and the DSSF program seemed like an excellent segue from academic work in disease management to more translational research. Having trained as a social scientist, it seemed like a long shot. However, I felt certain this would be a productive avenue for my work, and just over a year into my fellowship, I have been afforded innumerable opportunities for independent and collaborative research that would be available at few, if any, other training sites.
Kaiser Permanente Southern California (KPSC) is unique in many ways – its fully-integrated care delivery program, supported by one of the most sophisticated electronic health record systems in the US, means that members receive comprehensive care, and also makes KPSC the ideal “laboratory” to study any number of complex questions in health services research – I cannot think of a better place to develop an expertise in delivery system science. It was important to me, in seeking out postdoctoral training opportunities that I focus on those where I could expand my skills in genuinely applied research. Compared to many other training programs I considered, the DSSF program is special in that Fellows are placed in real, living health care delivery systems where the work they are aligned with has an impact on patient care and health system operations in a practical, visible way.
Now, I work closely with a special research group – the Care Improvement Research Team – on projects that align closely both with our areas of interest as well as the priority areas of our operational leaders. Unlike many postdocs, I was not brought on to work on a specific study, but rather to develop my own program of research in care improvement. To that end, I have formed relationships with several of our clinical partners in nephrology, as well as with our Regional Renal Business Group, an administrative group dedicated to managing the care for all kidney patients throughout Southern California. Some of my projects have included an assessment of hemodialysis patients’ self-reported reasons medication non-adherence, an exploration of rapid mortality among elderly patients initiating dialysis, and physical activity patterns among patients with end-stage renal disease. Along with my clinical partners and collaborators, we are also planning several upcoming studies, including a study of an educational program to increase knowledge about living-donor kidney transplantation, and an evaluation of multi-level facilitators and barriers to the successful implementation of planned dialysis starts.
In my short time as a DSS Fellow, I have learned so much – really, an unbelievable amount – about working within in a learning health care system, and about developing meaningful, patient- and system-oriented research projects. I have been so pleased and honored to be able to work closely with providers and to be able to contribute to the improvement of the care we provide through these research partnerships. Thanks to my mentors here, I have also had the opportunity to meet with delivery system and dissemination and implementation researchers from other local institutions, including the University of Southern California, the University of California at Los Angeles, and the Cedars-Sinai Medical Center, and have been fortunate to have developed collaborations with some of these scientists. I was also selected to participate in the National Institutes of Health Training Institute in Dissemination and Implementation Research in Health this past summer, an opportunity I would never have had had it not been for my involvement with the DSSF program and my colleagues here at KPSC.
In writing for the blog about my experiences, I asked my primary mentor, Dr. Michael Gould, Director of Health Services Research & Implementation Science at KPSC, to describe his experience with the DSSF program – I am the second Fellow to come to our department under his preceptorship. He had this to say:
"The AcademyHealth fellowship in Delivery System Science has enabled us to extend the reach of our research-operations partnership and open up new lines of investigation in cancer survivorship and chronic kidney disease. It has also helped us to recruit outstanding new investigators into our research department."
I feel like this nicely sums up my experience as a Fellow working in our system – even in our “special” status as junior investigators, we are true colleagues with the freedom and flexibility to establish ourselves as independent researchers. I believe that my participation in the program has opened a huge number of doors to moving my work forward. To those considering applying to the DSSF program – a true understanding of how research and care delivery function together can really only be learned in a delivery system, and the DSS Fellowship provides and unmatched opportunity to do just that.