The Palo Alto Medical Foundation (PAMF) is a large not-for-profit delivery system (about 1,400 physicians) with over 17 clinic sites in four San Francisco Bay Area counties. It cares for roughly 950,000 patients a year, about 650,000 of whom have a primary care physician at PAMF. Roughly a fifth of the patients are covered through health maintenance organizations (HMOs), and the rest have a wide variety of fee-for-service plans, including some accountable care organization (ACO)-like shared savings arrangements with commercial payers. The patient population is highly diverse in terms of race/ethnicity, and the comprehensive electronic health record system has excellent capture of self-reported race, ancestry, ethnicity, and language. PAMF is implementing Lean as its operating system, resulting in substantial changes in how care is organized and delivered.  Lean focuses on constant enhancement of patient-perceived value and a reduction in waste—that is, anything not providing value to the patient.

The Palo Alto Medical Foundation Research Institute (PAMFRI) was founded in 1950 and has a strong history of investigator-initiated research. PAMFRI is a Clinical and Translational Science Award partner of both Stanford and the University of California, San Francisco (UCSF) and is a member of the Health Care System Research Network. Its faculty and staff of about 70 are engaged in a wide variety of ongoing research activities, leveraging its close relationship to PAMF, access to the EHR, and engagement with PAMF physicians and leadership. The natural variability arising from multiple payers, incentive systems, geography, and organizational history facilitates certain types of studies, but controlled trials have also been undertaken to explore certain care delivery questions. PAMFRI has developed research approval and support processes to speed internal review board (IRB) reviews and access to de-identified data. Our investigators work closely with PAMF’s operational leadership on various projects, such as a large-scale evaluation of Lean, which facilitates access for other studies. PAMFRI is also active in post-doctoral training, using both internal and external sources of support. 

PAMF is part of the Sutter Health system, which treats over 3 million patients across Northern California, in urban and rural settings, safety net facilities and major teaching hospitals.  During 2017-18 research across the Sutter system will be re-organized and much of the PAMFRI research team, along with colleagues at other sites, will be expanding their focus to leverage system-wide data resources to study the full range of care and delivery sites.  As the Sutter system integrates care within major service lines such as cancer and cardiovascular care there will be new opportunities for research on improved care delivery.

PAMFRI has sponsored 7 AcademyHealth DSSF Fellows (4 in 2013, 2 in 2015, 1 in 2016). Postdocs typically join an ongoing project with a faculty mentor, allowing a rapid start, leveraging of staff resources, and a high probability of completing multiple products. Various projects are underway (and others are likely to be beginning in mid-2018) that could engage a DSSF Fellow with skills ranging from economics and epidemiology to anthropology and implementation science. We have a particular interest in potential Fellows with expertise in patient reported measures and in cancer care.