Placement: Stanford University and the University of California, San Francisco
Mentors: Arnold Milstein, M.D., M.P.H (Professor of Medicine and Director, Clinical Excellence Research Center, Stanford University)
Laura Gottlieb, M.D., M.P.H. (Director, Social Interventions Research and Evaluation Network and Associate Professor of Family and Community Medicine, University of California, San Francisco)
Project: The Role of the Healthcare System in Addressing the Social Determinants of Health: Identifying Bright Spots in Care for High Need, High Cost Patients
Andrew Old, M.B.Ch.B., M.P.H. (Hons), FNZMA, FAFPHM, is a 2018–19 New Zealand Harkness Fellow in Health Care Policy and Practice. He is a Public Health Physician and the Chief of Strategy, Participation & Improvement for the Auckland District Health Board. His work focuses on how the health system can achieve the best, most equitable health outcomes for the populations its serves, by providing integrated services, co-designed in partnership with patients, whanau (families) and communities. Old is interested in the role of design in health and was instrumental in developing a world first in-hospital design lab at Auckland City Hospital, in partnership with Auckland University of Technology. He is also trained in improvement science and has led numerous projects to improve the value of care. Old has published on the role of design in health, and the place of co-design, and was recently awarded a grant to investigate people’s experiences with end of life care. He is a past Board member of the New Zealand Medical Association (NZMA) and was Chair of the NZMA’s Doctors-in-Training Council from 2005 to 2008. Old received his medical and public health degrees from the University of Auckland and is a Fellow of both the Australasian Faculty of Public Health Medicine (AFPHM), of the Royal Australasian College of Physicians (RACP), and of the New Zealand College of Public Health Medicine (NZCPHM). He was awarded a Fellowship of the NZMA in 2011 for services to the profession and the New Zealand public, and is an Honorary Senior Lecturer in the Department of Medicine at the University of Auckland.
Project Abstract: Improving care outcomes for people with complex health and social needs is a focus for health systems around the world. There is a strong desire to improve outcomes for groups not traditionally well served by existing health systems, and to do this at lower overall system cost. This project will expand upon an ongoing Stanford University-based study of potentially scalable attributes of primary care sites that attain exceptional value in caring for high need, high cost patients – defined as patients whose self-management of illness is complicated by illness severity, poverty and or mental illness.
Previously published quantitative methods will be applied to rank U.S. primary care sites on measures of value. This will be followed by a survey of high and median ranking sites using a validated survey instrument, designed, in part, to establish what focus high performers place on patients’ social context, and what actions (if any) they take, either directly or through partners, to help address the identified needs. A sample of sites will then be selected for visits to examine the processes and mechanisms that enable fulfillment of the care delivery attributes that the survey found to distinguish high value from middle-ranking sites.
The goal of this body of work is to develop approaches that can be spread and scaled to other systems to improve overall health outcomes.
Career Activity Since Fellowship
- Chief of Strategy, Participation & Improvement, Auckland District Health Board
- Clinical Director, Health Gain, Planning, Funding & Outcomes Unit, Waitematā District Health Boards
- Associate Chief Medical Office, Waitematā District Health Board