In search of . . . affordable, effective interventions: Barry Saver, MD, MPH Each Tuesday, the Daily Voice features a first-person narrative from a researcher explaining the science behind a recent grant, and the inspiration or impetus behind becoming a scientist at UMass Medical School. If you know of a researcher you’d like to see profiled, send an email to UMMScommunications@umassmed.edu.
As a family physician and health services researcher, I am interested in improving access to and quality of care, particularly for vulnerable populations. This has led me to doing research in a wide variety of areas, including policy-driven analyses of national survey data and health claims data, qualitative studies seeking to understand patients’ experiences and needs, and intervention trials. Given the runaway health care costs and relatively poor outcomes in the United States, I am particularly interested in sustainable—meaning inexpensive or even cost-saving—ways to improve the quality of care for common health conditions seen in primary care. In the CONDUIT: HID project, we are developing and testing a low-cost approach to using health information technology and home monitoring to improve control of high blood pressure among persons with diabetes. As part of this project, we are learning about acceptance of and barriers to use of some basic health information technology—uploading readings from an automated home blood pressure monitor through a personal health record. We chose improving high blood pressure control in diabetes because it is one of the most cost-effective health care interventions, estimated by the CDC as actually cost-saving in direct health care dollars. In the CONDUIT study, we hope to demonstrate the effectiveness of a low-cost intervention that we designed so it can be adopted in a wide variety of settings, even practices without an electronic health record, and that can easily be adapted to other conditions amenable to home monitoring and creating a data feedback loop between patients and providers. We are giving patients tools to monitor their health conditions and information and support to manage them. Health information technology can potentially play a large role in facilitating patient-centered, affordable care, but it also runs the risk of making medicine more depersonalized and excluding vulnerable groups. More generally, one of the things I have been learning from my qualitative research with patients and my clinical work as a family physician is that there is a huge range of patient understanding, priorities and preferences for roles in medical decision making. I hope to use these insights to continue to develop affordable, effective interventions that enable patients to take greater roles in their health care and are more responsive to their personal needs and priorities, while at the same time based on the best information we have. As a child, I always thought I would be a scientist, though not as a physician. I was in graduate school doing obscure enzyme kinetics experiments and grew frustrated that it seemed completely unrelated to my interests in social justice. So I decided to go to medical school to become a family doctor working with the poor, with no intention of ever doing research again. However, when I was in my first job after residency, working in a community health center, I became frustrated with the senseless and unjust barriers to obtaining care faced by my patients—financial barriers faced not only by those with no insurance, but also many with Medicaid, plus cultural and linguistic barriers. I foolishly thought that at least the first set could easily be rectified by a little research showing the problems and pointing out the solutions, so I applied for a research fellowship. While I eventually learned that these were primarily political, not scientific, issues, I found that I enjoyed the intellectual challenge of doing research based on issues I encountered in practice and my desires to effect change through my work. The Department of Family Medicine & Community Health has a core mission to address the needs of vulnerable populations, including training and practice sites in community health centers, a strong core of researchers, and just generally a great group of people. Despite my primary role being as a researcher, the ability to practice and teach in a safety net setting was critical for me in deciding to come here—that’s why I went into medicine and I have never seriously considered a position where that was not possible. As a generalist, I love the variety of things I get to do—research, teach medical students and residents, and provide high quality care to patients from all over the world who may have few other options for care. The opportunity to do a number of different interesting and challenging things with great colleagues is a real privilege.