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Ten major, non-profit managed care organizations that are members of the HMO Research Network will participate in the project, known as the Cancer Research Network. They are: Group Health Cooperative (Seattle), Fallon Healthcare System, represented by the Meyers Primary Care Institute (Worcester, Mass.), Harvard-Pilgrim Health Care (Boston), HealthPartners Research Foundation (Minneapolis), Henry Ford Health System/Health Alliance Plan (Detroit), and five Kaiser Permanente divisions, in Hawaii (Honolulu), Northern California (Oakland), Northwest (Portland, Ore.), Rocky Mountain (Denver), and Southern California (Pasadena). The project will be based at Group Health Cooperative's Center for Health Studies in Seattle.
Each HMO has a research organization that conducts high-quality research in the public interest. This research is peer-reviewed, published, and non-proprietary. Most members are long-standing organizations with a stable presence in their communities. Common to all of the research programs is a fundamental mission to contribute both to scientific knowledge and to the quality of health care for their HMO members.
The HMO Research Network was created in 1996 to encourage and coordinate research activities among the HMO-affiliated researchers. The HMO Research Network works toward this end by sponsoring conferences and meetings in collaboration with various National Institutes of Health institutes, the Agency for Health Care Policy and Research, the Centers for Disease Control and Prevention, and the American Association of Health Plans.
A key goal of the Cancer Research Network project is identifying the patient, treatment and delivery system factors that may make a difference in health outcomes for cancer. By combining the data capacities of these large integrated health systems, researchers will be able to study health care patterns among millions of patients who mirror the diversity of the nation in terms of age, gender, income, education, cultural background and location.
The awarding of the four-year, $16 million project to the HMO consortium follows a competitive review process, which occurred in 1998. The network will establish an administrative infrastructure and launch three research projects.
"The collaborative spirit represented by the commitment of these HMOs exemplifies a new paradigm for cancer research that will pave the way for greater progress in preventing disease," said Barbara K. Rimer, Ph.D., director of NCI's Division of Cancer Control and Population Sciences.
The program will be directed by Edward H. Wagner, M.D., MPH, director of Group Health Cooperative's W.A. (Sandy) MacColl Institute at the Center for Health Studies. He will provide administrative and scientific guidance as chair of the Steering Committee, which will guide the overall direction of the network. The Steering Committee is comprised of the co-principal investigators from each of the participating organizations, and the NCI program director, Martin Brown, Ph.D., Applied Research Branch. In addition, an external advisory committee of collaborators from 10 academic institutions will review and advise the network.
"The network will put together the large populations, excellent researchers and superb data capabilities of these organizations to provide a rich resource for studying important questions in the prevention and care of cancer," Wagner said.
Participating HMO research organizations include the Center for Health Studies (Group Health Cooperative), Center for Health Research (Kaiser Permanente Northwest), Center for Health Research (Kaiser Permanente Hawaii), Clinical Research Unit (Kaiser Permanente Rocky Mountain), Division of Research (Kaiser Permanente Northern California), Research and Evaluation Department (Kaiser Permanente Southern California), Josephine Ford Cancer Center (Henry Ford Health System/Health Alliance Plan), Meyers Primary Care Institute (Fallon Healthcare System/University of Massachusetts Medical School), HealthPartners Research Foundation (HealthPartners), and the Department of Ambulatory Care and Prevention (Harvard Pilgrim Health Care).
The Cancer Research Network's goal is to develop an efficient, high quality population laboratory by blending large enrollee populations, databases and research resources. The network also will develop research tools to promote future studies of effective cancer control interventions that span the natural history of major cancers among diverse populations in various health care systems. Standardized data collection instruments, surveys and analytical methods will foster uniform databases and other research materials that can be shared across network institutions.
The administrative infrastructure will include the steering committee, a data coordinating center, expert teams, and administrative subcommittees. An integral aspect, the Data Coordinating Center, led by Mark Hornbrook, Ph.D., of Kaiser Permanente Northwest, is responsible for developing coordinated and efficient methods of handling data and facilitating understanding of members' data systems.
An essential function of the Cancer Research Network's infrastructure is to further cancer research in the participating HMOs. This structure capitalizes on the rich resources of the HMOs and utilizes the knowledge of the expert teams, which will assure attention to rigorous research methods and important directions in cancer control. New research studies will be encouraged to enhance the value and resources of the Cancer Research Network, and to take advantage of the infrastructure and shared databases.
One of the network's three research projects will study the effectiveness of smoking cessation activities in HMOs. Led by Victor Stevens, Ph.D., at Kaiser Permanente Northwest, the effort will examine characteristics of smoking cessation programs and how such programs impact health care costs.
A second research project will examine late-stage breast and cervical cancer occurrence to uncover factors, such as screening activities, that help prevent advanced disease. The study also will seek to determine the reasons that advanced breast and cervical cancer occur in health care delivery systems that promote and provide regular screening. Stephen Taplin, M.D., MPH, at Group Health Cooperative will provide overall leadership for this study.
The third project will study the efficacy of preventive strategies, such as mammography and prophylactic mastectomy, for women with a personal or family history of breast cancer. It will address whether prophylactic mastectomy or earlier screening mammography prevents fatal breast cancer for these high-risk women. This project is led by Suzanne Fletcher, M.D., MSc, of Harvard Pilgrim Health Care.
An evaluation of the network's activities will focus on the extent of collaboration and quality of communication, and provide ongoing feedback to the network's sites. The performance of the research projects, scientific productivity and the impact on member organizations will be measured.
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