From left: C4HDS team members Danielle Isaman, Niteesh Choudhry, Namita Mohta, Kyle Morawski, Roya Ghazinouri, Julianne McDonough, Julie Lauffenburger and Alexis Krumme

Many highly effective health interventions are never widely adopted into routine care—sometimes because patients do not follow through on what has been recommended or because providers do not practice as the evidence would indicate they should.

For example, only about 40 percent of adults receive a flu vaccine and only half of patients who have had a heart attack continue to take their cardiac medications over the long term. Overcoming these gaps in health care implementation requires patients and providers to be more actively involved in health care delivery.

The Center for Healthcare Delivery Sciences (C4HDS), a newly created research center within the Department of Medicine, is working to address this problem by design, implementation and rigorous evaluation of novel ways to engage patients and providers in care delivery.

Under the leadership of hospitalist Niteesh Choudhry, MD, PhD, of the Division of Pharmacoepidemiology and Pharmacoeconomics, the C4HDS team focuses on interventions that have the potential to be scaled across settings and could help address engagement problems, including medication adherence, smoking cessation and narcotic misuse.

Studies currently underway at the center include randomized evaluations of the impact of text messaging to increase medication adherence; written commitment devices and “nudges” to increase influenza vaccination rates among Medicare beneficiaries; electronic medical record-based tools to prevent opioid over-prescribing; and others.

Choudhry said C4HDS wants the studies to be undertaken in the same conditions—with the same distractions, impediments and pitfalls—as physicians and patients would experience.

“The ultimate goal for the studies initiated by C4HDS is to create effective, simple and easily scalable interventions,” said Choudhry. “In addition, wherever possible, we want those interventions to address vital challenges: behaviors that can simultaneously address related problems, such as extended disability and hospital readmission.”

Additionally, the center’s two-year fellowship program in implementation research trains the next generation of delivery science academics and researchers.

“The center is a unique place for those interested in improving health care quality to gain the expertise and knowledge to conduct pragmatic clinical trials and evaluate novel strategies in a rigorous manner,” said Roya Ghazinouri, DPT, a physical therapist with extensive expertise in quality improvement, who directs operations at the center.

To learn more about C4HDS and ways to collaborate with the center, email rghazinouri@bwh.harvard.edu.