October 21, 2008 — Shinyi Wu, an assistant professor at the Daniel Epstein Department of Industrial and Systems Engineering, has been working for two years developing and testing a new system for chronic illness care in safety net clinics.
Shinyi Wu: Engineering better healthcare delivery. (Newly Paul photo)
Such clinics, for poor and indigent patients, are set up for emergency care, but have increasingly needed to deal with chronic conditions. Ultimately, Wu hopes to create a better system, the Chronic Care Model (CCM) to deal with these needs that can be efficiently disseminated and will be financially sustainable at such institutions.
The CCM project started in September 2006. Wu, who joined Viterbi in January this year, is project director and principal investigator working in collaboration with RAND, the MacColl Institute at Group Health Cooperative and the Safety Net Institute.
Initiated by the MacColl Institute, the CCM summarizes six basic elements of interventions intended to improve care for patients with chronic illnesses.
"We have developed a toolkit containing an implementation guideline and various tools for changing care for chronic illnesses and related business practices. We are currently testing the toolkit using a practice coaching approach in two primary care clinics in two California public hospital systems," said Wu.
The evaluation examines the extent to which the toolkit is implemented, the effectiveness of the tools and their effects on quality and efficiency of care. Wu hopes to have results next year.
"From our preliminary experiences in the project, we learned that practice coaching is critical in deploying the toolkit. So a secondary aim of the project is to develop a practice coaching manual based on our intervention and lessons learned from the literature and quality improvement practitioners," she said.
|• 45 million people (15%) uninsured
• 44,000 to 98,000 died of medical errors
• Only 55% meeting quality of care indicators
• Expensive, complicated, and lack of coordination
• Low penetration of health information technology and information exchange
• Underprepared for the 21st century (in prevention, children health development, chronic illness care, and primary care)
• Poor performance in international comparisons (spending, mortality, quality, and access)
She added: "We anticipate that this work would be linked with the toolkit, but the utility of the manual would go beyond how to execute the toolkit itself, and extend to coaching in the service of implementing and spreading clinical improvements more generally."
Another project that Wu is directing is to do with improving care at night. Again working with RAND and the University HealthSystem Consortium Wu is helping to design a modification of work processes re-deployment of workforce resources.
In fall 2009, the Wu will be heading a new course on health services engineering. Students will get a M.S. in Health Systems Management Engineering or a Ph.D. in Industrial and Systems Engineering with a health systems specialization.
The course will teach application of industrial engineering principles at the individual and micro-system levels and economic and public policy levels in healthcare. In the former, says Wu, it can be used for technology adoption, workforce and workload models and for the latter for technology assessment and for disease progression and impact modeling.
According to Wu, the suboptimal performance of healthcare is due to the fragmented nature of the healthcare industry in US, its complex set up, the lack of accountability, a misaligned reward structure and lack of product/process specifications.
The new course will fulfill the need for the development of health services research, which is influenced by the enhancing role of the federal government and the rapid increase of health care expenditure. At a recent presentation titled "At the interface of Industrial Engineering and Health Services Research," Wu pointed out the importance of such a course keeping in mind the current healthcare crisis. She cited data from HSR findings to prove that US healthcare needs to improve fast. (see box)
"Prof. Wu has hit the ground running," said James E. Moore, chair of the Epstein Department. "We are used to hiring productive
scholars, but she is raising the bar. Shinyi Wu is proving to be a unique resource for both USC and for the RAND Corporation. Her focus joins Epstein ISE researchers and programs with like-minded investigators at RAND, helping both organizations complete more effectively for research funds, and connects us with faculty supporting other programs in USC, such as the School of Policy, Planning, and Development's Master of Health Administration Program, and the Keck School's Master of Public Health Program."
“Health services research has many opportunities today," said Wu, keeping in mind an aging and growing population, the growing complexity of science and technology and growing cost pressures.”