LDI's Pilot Grants: An Academic Version of Venture Funding
Each year, the more than 200 senior fellows connected to the University of Pennsylvania's Leonard Davis Institute of Health Economics (LDI) work on more than 600 research projects funded with $100 million in external grants from government agencies and private foundations.
Additionally, LDI annually puts aside $150,000 in internal funding for "pilot grants" that work something like startup venture funds in Silicon Valley. The money enables academic investigators to pursue the research of promising concepts that aren't sufficiently developed or verified to qualify for funding from the National Institutes of Health or other external sources.
Telesurgery to e-cigarettes
These pilot grants are awarded in sums of about $20,000 and currently, LDI researchers are using them to investigate everything from telesurgical consultation and cancer patient referral patterns to the lure of e-cigarettes and the economics of retainer-based medicine.
The thirteen projects selected in the 2013 funding cycle span a wide range of topics within health care organization, financing, delivery, and policy.
|Rachel Kelz, MD, MSCE|
Several of the pilot projects examine patient experience. Rachel Kelz, MD, MSCE, an Assistant Professor of Surgery at the Perelman School of Medicine, is leading a project that traces referral patterns among cancer patients in order to better understand clinical best practices.
"From the perspective of a surgeon, we often notice that patients are referred to us at different states of the disease," Kelz said. "Everyone is looking at how we can improve surgical outcomes from the point of surgery on, but very few are looking at what can be done to maximize outcomes before they get here."
Kelz, and co-investigator Rebecca Hoffman, will use a number of data sets to track the different pathways patients take before they reach a surgeon.
Understanding best practices
"It's helping us understand best practices," Kelz said. "The ultimate goal would be to use the information we learn to help patients figure out what to be thinking about when they get a diagnosis."
|Julia Lynch, PhD|
Julia Lynch, PhD, an Associate Professor of Political Science at Penn's School of Arts and Sciences, is likewise looking at patient experience, this time from a public opinion perspective. Lynch and her co-investigators want to understand whether people find it acceptable for different levels of insurance coverage to correspond with different levels of access to physician versus non-physician providers.
This sort of tiered access has become an issue as insurers look to reduce cost and meet increasing demand for primary care.
"The big question we are trying to answer is this: do Americans believe that those with serious medical conditions have an unequivocal right to be seen by a medical doctor?" Lynch said. "Do those who pay more for their care have that right? Or is limiting access to physician providers generally appropriate when there are NPs or PAs who are qualified to provide care?"
|Daniel Holena, MD, FACS|
Limited access to care is similarly at the root of surgeon Daniel Holena's pilot project. Because the availability of specialists is limited in some geographic areas, many hospitals are unable to have enough surgeons on staff to meet demand. One proposed solution has been increased use of telemedicine to allow outside surgeons to consult remotely, which would reduce the number of patients who need to be transferred to larger hospitals to receive care.
Holena, MD, FACS and an Assistant Professor of Surgery at Penn's Perelman School of Medicine, is examining the pros and cons of telesurgical consultation and assess, and the feasibility and safety of using telemedicine in high acuity situations.
Guy David, PhD, an Associate Professor of Health Care Management at the Wharton School and Adam Leive, a third-year doctoral student there, are studying the changing structure of primary care. Specifically, the two are researching the emergence of retainer-based medicine, a system in which patients pay a member fee that grants them increased access to their physician. As a result, retainer-based practices have far fewer patients on their rosters than a traditional practice, at the same time as the Affordable Care Act is creating extra demand for physicians.
|Guy David, PhD|
Often portrayed by the media as a service for the rich, little research has been done on retainer-based medicine; David and Leive are building a theoretical model to study the motivations that lead physicians to enter into retained-based practice.
Another health care development that has garnered media attention is the e-cigarette, which has been touted as boon for smoking cessation, yet there has been little research to date to back up that claim. Pulmonologist Frank Leone, MD, an Associate Professor of Medicine at Perelman, is leading an investigation into consumer decision-making surrounding e-cigarettes. He hopes to learn why people have such a "hopeful, positive, and curious disposition" toward the devices, despite the lack of scientific evidence as to their efficacy.
Working with Wharton marketing professor Barbara Kahn, PhD, MBA, Leone hopes to gain an understanding of the emotion involved in consumer attitudes toward e-cigarettes.
Lure of the e-cigarette
"We want to know what's going on not so much in their minds but in their hearts when they engage with the idea of the e-cigarette," Leone said.
|Barbara Kahn, PhD, MBA|
While nearly all of the pilot projects feature interdisciplinary collaboration, only Evan Fieldston's is focused specifically on it. Fieldston, MD, MBA, a Professor at the Perelman School of Medicine, secured a pilot grant to develop a plan to coordinate quality improvement research and training between the different schools and hospitals.
"Penn has fantastic resources, and a little more organization and logistical thoughtfulness would really help us make substantial improvements in patient care and faculty engagement in quality improvement work," Fieldston said. "We want a more coherent internal strategy as we reach out beyond the walls."
Other 2013 research projects include Robert Wood Johnson Clinical Scholar Pooja Mehta's investigation into overuse of emergency obstetric care by women of low socioeconomic status, Wharton PhD student Boris Vabson's study of Medicare and Medicaid dual eligibles, and Professor of Emergency Medicine Raina Merchant's extraction of data patterns from social media streams to test their potential ability to predict health status and health care utilization.
The full list of LDI-funded pilot projects can be found here.