1. The Challenges and Opportunities of AHSCs King’s College London March 6, 2009
Victor J Dzau, MD
James B Duke Professor of Medicine
Chancellor for Health Affairs, Duke University
President and CEO, Duke University Health System

2. Healthcare & medicine needs transformation
Heath inequalities - local & global
Rising cost of healthcare & poor access
Emphasis on late stage disease
Increasingly difficult to develop novel therapies
Begin with patient example – Willa
Uninsured population – 45M in the US without insurance with 8M children
Rising costs – 16% of GDP spent on health care with 20% of GDP in 2015
Per capita spending was $5670 or 1.7trillion in 2003
Drivers of costs – demand for services, aging population, increased utilization, lack of evidence based medicine and focus on late stage disease
Fragmented health care delivery and financing system with misaligned incentives for providers, insurers, regulators and industry
Innovation engines are incented to develop products targeted for late disease and at a high price.
Global health inequalities – 5 billion of the world’s 6 billion citizens experience disproportionate disease burden and a shortened life expectancy caused by poor environment, poor hygiene, poor access to health care and poor economy.
Global health issues impact all of us as evidenced by avian flu and SARS.
Health disparities may be the result of poverty, social factors and political instability and poor health may cause poverty and political instability, creating an endless cycle of disadvantage and widening the gap between those with and without resources

3. Innovation gap is widening
Pharma
Innovation
Gap
Spending is in $ billions US; this rose to $58.8 B in Source: Burrill & Company

4. Fragmented Healthcare delivery system
Primary care to secondary and tertiary care (multiple handoffs)
Misaligned payment & reporting system
Accountability of outcomes & health status
Prevention & Public Health
Electronic health record and information technology
Competition of missions & priorities

5. Innovation Discontinuum: A fragmented system of silos, barriers
Discovery
Clinical Research
Translation
and Adoption
Global
Health
Translation
Basic
Discovery
Proof of
Concept
in Man
Clinical
Development
Phase II, III
FDA Approval
Evidence
Based
Medicine
Preclinical
Research;
In Vivo
Analysis
PK,PD,
Toxicology
Practice
Adoption,
Guidelines,
Cost Effective
Community
Assessment
Care delivery
Outcomes
Economics
Improve
Community
Health
Status
Global
Health:
Service/
Research,
Population/
Publication
Entities
AHS/Industry/
Biotech
Industry/Biotech
Clinical Research
Organizations/AHS
HCS/Hospitals/
Practices/FQHC/AHS
Public Health/Government/
NGOs
The fragmentation of the current biomedical and health care industry is problematic for innovation to have a transformative impact as each sector of the innovation and care systems function as independent silos:
Research and development
Commercialization
Clinical care delivery/patient care
Community and public health
Policy
Insurers/payers
Each of these sectors exist in separate entities (University, industry, CRO, medical centers, hospitals, etc). With its own incentives that are often misaligned with one another, resulting in highly inefficient research, health care delivery and financing.
Silos in Care Processes
- Hospital/ Inpatient vs Ambulatory/Outpatient
- Specialized Medical Center vs Community Care
- Clinical Research vs Patient Care
Silos in Discovery to translation
- Academic Discovery
- Industry Research & Development
- CRO
- Medical Center Clinical Research
- Specialty Care
- Community Practice
- Epidemiology cohorts
- Public health
Timeline
15-20 years ?

6. Example: milestones in ACE inhibition
Captopril receives
FDA Approval for
Severe HT
Discovery of
Captopril
HOPE Trial in
High Risk Patients
Published
Snake Venom
Identified as
ACE Inhibitor
1st Study in
CHF Begins
Captopril receives
FDA Approval for
Mild-to-Moderate HT
Captopril receives
FDA Approval
for CHF
ACE Enzyme
Discovered
Captopril Patent
Issued
CMS Metric for Post MI RX
Synthetic ACE
Inhibitor Developed
1st CHF Study
Published in
NEJM
SAVE Trial in
Post-MI
Published

7. A review of UK health research: Sir David Cooksey
( December 2006) 7

8. Traditional View of Translation: Two Blocks/Gaps
Bench
Patients
Population
First block:
Translation from concept into first human studies
Second block:
Translation from clinical trials into practice

9. A vision for transformation: what must be done?
Extensive reform of healthcare financing
Effective care delivery systems with quality & safe clinical outcomes
Global coverage, affordability & access
Prevention, health & wellness; personalized health
Innovation that leads to transformative/disruptive technologies and approaches; appropriate business models
Creating a seamless continuum from basic discoveries to translational human application
Health care can be transformed through 1.) national mandate and reformation of the delivery system and/or 2) innovation that leads to transformative technology and approaches.
Irrespective of how we pay for new approaches, we must make the health care system much better by bold changes in the way we organize and delivery care to address the unmet needs of our global health and well-being.
Must reconfigure the system such that we optimize the translation of novel biomedical and clinical discoveries and develop technologies that can change the way doctors and providers practice.
Technologies must be:
Practical
Translatable/adaptable
Measurable
Affordable
Cost effective
I will propose an approach to aligning discovery and translational research to sustainable care delivery in the community-whether local or global-by describing several initiatives we are undertaking at DUMC.
We must create a seamless continuum across discovery, translation, adoption, community implementation and global extension through major organizational restructuring, alignment of incentives and public/private partnerships.
Academic health systems are obvious forums for these transformative initiatives to start.
AHS have an opportunity to change this fragmentation and lead the transformation to a seamless continuum given the full spectrum of research and care delivery structures within the AHS.

10. AHSC as driver of transformation
Source of innovation, discoveries, and disruptive thinking
Can identify unmet medical needs
Not constrained by “targets” and “markets”; able to create own “value network”?
Have patient population, biological materials, and database capabilities
Can develop new models of care delivery
Can effect patient outcomes & quality

11. Academic vs Clinical Mission
Organizational misalignment of missions & priorities: Whose responsibility?
Academic vs Clinical Mission
Basic vs Clinical and Translational Research
Clinical Care vs Health Services Research
School of Medicine vs Health System
Public vs Private Interests

12. Academic Health Systems as a leader in transformation
Reorganization of biomedical research and health delivery systems into a seamless continuum from innovation to clinical delivery to community health.
“Bench to Bedside to Population”
Integrated model of innovation-care continuum
Shift in institutional research priorities
Effective utilization of information + investment in IT
Efficient care delivery
Improved health outcomes
AHS are uniquely positioned to lead as models of translational medicine whereby new discoveries, devices, practices and/or drugs are rapidly and efficiently introduced into clinical application and can be expertly translated and adapted to the local and global community with demonstrable benefit to the community health status.
For AHS to act as leaders in transforming health care through innovation and translational medicine, AHS themselves need to change dramatically in the way they conduct research, clinical care and their engagement with the local and global communities.
To transform health care, AHS must:
Create a bold, seamless, facilitated and integrated model that quickly moves innovative discoveries to clinical research to adopted standards of practice to application in the local population and eventually to the global population
Insist on major changes in our research priorities, mandating the development of early-stage technologies (ranging from biomarkers to diagnostic imaging to devices and surgery to information technology) that are value-added, cheaper, faster and adoptable in lieu of continued investment in highly reimbursed, late disease technologies.
Enable more effective utilization of information turning “a deluge of raw and turbulent information streams into much cleaner fonts of decision wisdom.” To really transform health care, raw clinical and biomedical data must be available to and be assimilated by health care professionals and health care systems in manner transparently understood and supported by the global community. We’ll talk about the importance of technology a little later.
Create a more efficient care continuum including risk assessment, prevention strategies, diagnostic capabilities and treatment modalities

13. Lord Darzi “High Quality Care For All” June 2008
We intend to foster Academic Health Science Centres (AHSCs) to bring together a small number of health and academic partners to focus on world-class research, teaching and patient care. Their purpose is to take new discoveries and promote their application in the NHS and across the world.
The best and most successful AHSCs will have the concentration of expertise and excellence that enables them to compete internationally.
The potential of AHSCs to deliver research excellence and improve patient care and professional education is tremendous. Clear governance arrangements with academe, which ensure this works for both patients and the NHS, will be very important.

14. Definition of an Academic Health Center
From the Association of Academic Health Centers (AAHC):
“Academic health centers are accredited, degree granting institutions of higher education and consist of an allopathic or osteopathic medical school, at least one other health professions school or program (such as allied health, dentistry, graduate studies, nursing, pharmacy, psychology, public health veterinary medicine) and one or more owned or affiliated teaching hospitals, health systems or other organized health care services.”

15. Definition of an Academic Health Sciences Center?
Put simply, they are healthcare entities whose
missions are aligned:
Research
Education
Clinical Care

16. Definition of an Academic Health Sciences Center?
Put simply, they are healthcare entities whose
missions are aligned & that aspire to:
Research  Translation
Education  Future Providers & Leaders
Clinical Care  Improved Health & Eliminate Disparities

17. What is the current US landscape?
In 2005, the AAHC conducted a survey of member academic health centers.*
78% of AHCs leaders had direct and sole authority over their hospital.
If they resided within a health system, 73% had direct control over the entire health system.
Only 14% had direct control over both the academic mission and the hospital/health system.
The study also noted that the structure of many AHCs underwent changes in response to managed care pressures.
*Source: Wartman, SA. “The Academic Health Center: Evolving Organizational Models,” Association of Academic Health Centers.

18. What is the UK Landscape?
NHS Trusts and Foundation Trusts
Primary Care Trusts
General Practitioners
Universities
Schools of Medicine, Public Health, Nursing & Allied Health
Government
Communities

19. How can transformation be achieved?
New Organizational Models
New Partnerships
New Research Priorities
Investments in Information Processing + Dissemination
New Models of Care Delivery
Global Health Research and Service Delivery

20. Governance & Culture
Integrated vs Federated Models
Single vs dual boards
Centers/ CAG/ Service lines vs Departments
Single vs matrix responsibilities for all 3 missions
Incentives & Rewards
Common Vision & Values
Teamwork & Culture

21. Academic Hospital Model (not integrated with medical school) Partners Healthcare System:MGH & BWH

22. 22 Chancellor for Health Affairs President/CEO (Dzau) DUHS
Exec. Vice Dean (Gibson)
Vice/Assoc Deans
Education(UME,CME
MSTP, MSC, PHD)
(Buckley)
Basic Sciences
(Kornbluth)
Clinical Research (Oddone)
Faculty Development (Grant)
Finance & Administration(Newton)
Dept. Chairs
Center Directors
DCRI PA PT
Associate Deans
Research Affairs
Administration and Finance
Academic Affairs
ABSN Program
MSN Program
PhD Program
Exec Dir., Development, Alumni & Community Affairs
Dir., Office of Global and Community Health Initiatives
Duke University Hospital
Durham Regional Hospital
Duke Raleigh Hospital
Clinical Centers and Service Lines
DUH Service Chiefs
Quality/Safety/ Outcomes
Duke University Affiliated Physicians
Entity chief medical officers
GME
Duke Outpatient Clinics
Outreach & Community Programs
Duke Home Care and Hospice
Center for Living
Acute Care Services
Medical Affairs (Cuffe)
Ambulatory Care Services (Newman)
DUHS Administration (Brown)
Strategic Planning, Business Development and Marketing (O’Neill)
Corporate Finance (Morris)
Information Technology (Ahmad)
Human Resources (Smith)
Compliance (Shannon & Tyson)
Legal (Gustafson)
Chief of Staff
Celeste Castillo Lee
Duke School of Medicine
Dean
(Nancy Andrews)
Duke University Health System
Senior Vice President, Clinical Affairs
(William Fulkerson)
Duke School of Nursing
Dean & Vice Chancellor, Nursing Affairs (Catherine Gilliss)
Chancellor for Health Affairs
President/CEO (Dzau)
Schools of Medicine
Senior Vice Chancellor, Academic Affairs (RS Williams)
Vice/Assoc
Deans
Education
Research
Clinical & Faculty Affairs
Finance & Administration
Learning Technologies
Duke NUS GMS
(Ranga Krishnan)
Institute Genomic
Sciences (Willard)
Translational and Clinical Research Institute (Califf)
Global Health Institute (Merson)
NC Research
Campus –Kannapolis
(Williams)
Academic Vice Chancellors
Corporate and Venture Development (Taber)
Development and Alumni Affairs (Morsberger)
Government Relations (Vick)
Community Relations (Black)
Communications (Stokke)
DUHS
Duke University 22

23. What is Duke Medicine’s mission?
“As a world-class academic & healthcare system, Duke Medicine strives to transform medicine and health locally and globally through innovative scientific research, rapid translation of breakthrough discoveries, educating future scientific and clinical leaders, advocating and practicing evidence-based medicine to improve community health and leading efforts to eliminate health inequalities.”
Transition out of this slide:
Over the past two years we have been positioning Duke Medicine to pursue this mission vigorously, to really be able to have an impact on health here in Durham and elsewhere.

24. What could AHSCs of the future look like?
Vertically integrated care delivery
Tertiary/quaternary referral hospital(s)
Community/general hospital(s)
Multispecialty clinics
A primary care network
including school-based clinics, clinics for underserved
Support services
cardiac rehab, hospice, home health, etc.
Community-based resources for health
2. Well-developed horizontal integration, too
A seamless continuum: from scientific discoveries to translation to care delivery to global health
Future: Academic Health Sciences System

25. Duke Translational Medicine Institute (DTMI)
Duke Model of Bench to Bedside to Population: Interlocking, Signature Initiatives
Duke Translational Medicine Institute (DTMI)
- Duke Translational Research Institute (DTRI)
- Duke Clinical Research Institute (DCRI)
- Duke Center for Community Research (DCCR)
Global Health Institute (GHI)
- Research
- Education
- Service (Delivery)
- Policy
To lead the transformation of health care efforts, we at Duke are developing the infrastructure and support systems as well as the cultural, academic and clinical alignment needed to move technological and scientific discoveries through the pipeline to clinical delivery in local and global populations.
To be useful globally, we must also ensure that translation occurs successfully across different cultures, countries and contexts. To this end, we have established two interrelated, system-wide interdisciplinary institutes: TCRI and GHI.
TCRI and GHI were both established to minimize the internal fragmentation at Duke, bringing together researchers and clinicians from a variety of fields to facilitate interdisciplinary collaboration among investigators and more efficient utilization of common resources.
TCRI and GHI overlap with common dialogues, programs, faculty and students. In this context, GHI is really part of TCRI and TCRI is part of GHI, making them highly interrelated.

26. Seamless integration: Innovation-Care Continuum
Clinical Research
Translation
and Adoption
Global
Health
Discovery
Translation
AHS,
Industry,
Biotech
Industry,
Biotech
Clinical Research
Organizations,
AHS
HCS, Hospitals,
Practices, FQHC,
AHS
Government,
NGOs
CURRENT
Current Timeline: years?
Right now it takes all these different organizations up to or even longer than 20 or 25 years to see a discovery to market. But if all of Duke Medicine is working together, we could shorten that to perhaps 7 to 10 years. Think of the impact.
Now, this transformation involves the entire institution – it touches basic and clinical research, it requires enhanced translational research to fill the traditional gaps in academia. It involves our ties to the communities we serve. And individuals may not see anything particularly noteworthy change where they are – the scientist is still working at the bench, the student is still learning in the classroom and in the clinic, our employees are still making sure rooms are ready for patients, that our facilities are working and safe. But at the same time, there’s a student who adds to her education by taking a global perspective and participates in service learning through the GHI or GMS. And a researcher who thinks their discovery might help save lives is aided in connecting with the people who can find out. And the nurse who sees a better way of handling catheters to reduce infection rates is helped in making sure that information gets out to others. It’s about a shift to
Duke Medicine (DUHS, SOM, SON)
Basic &
Clinical
Science
Duke Translational
Research Institute
Duke Clinical
Research Institute
Duke Center for
Community Research
Global
Health
Institute
DUKE
New Timeline: years?

27. Pre-clinical Development
DTMI: Structure
DTMI Administration
Education & Training
Ethics
Pediatrics
Biomedical Informatics
Biostatistics
Core Laboratories
Regulatory Affairs
Project Leaders and the Portal Office
DTRI
DCRI
DCCR
Duke as Site
DCRU
New Molecule
Pre-clinical Development
First in Human
Phase II/III
Application in the Community

28. Duke Translational Research Institute (DTRI)
Victor Dzau, MD
LLP
Director, DTMI
Robert Califf, MD
DTRI
Advisory Board
Director, Research, CTSI
Bruce Sullenger, PhD
Board of Directors
Duke Translational Development, Inc.
Associate Director, Clinical Sciences TBD
President and CEO
Associate Director, Basic Sciences TBD
Vice President
Business Development
Associate Director, Biomedical Engineering TBD
Vice President
Pre-clinical Development
Associate Director, Arts and Sciences TBD
Vice President
Early Stage Clinical Trials
Project Leaders
Project Leaders
Scientific
Commercial

29. DTRI: Toolbox In-house capabilities Model systems Chemistry
Molecular imaging
Cell processing & banking
Vaccine production
Institute for Genome Science and Policy (IGSP)
Pratt School of Engineering
Duke Clinical Research Institute (DCRI)
Center for Entrepreneurship and Research Commercialization (CERC)
Outsourced to preferred providers (‘partners’)
Pharmacology & metabolism
Toxicology (esp. large animals)
Formulation
Manufacturing
Prototyping
Key Decisions
Buy vs. outsource
Partnerships
- RTP
- Kannapolis (NCRC)

30. DTRI: Integrated Teams
Clinical Development
Intellectual Property
Regulatory
Business Development/
Commercial
Molecular Medicine/
Biomarkers
Inventors/
Investigators
Project Team
Project Leadership

31. Pilot projects to support promising T1 translation
$ 1 million RFA for pilot projects released Summer 2007, 2008.
Requirements:
Promising early stage
Towards Proof of Concept in Humans
Effective use of resources & facilites
Potential for project management
Business Plans (NIH or Commercial)

32. DTRI is a bridge in the process
Duke Labs
DTRI
DCRI
Small Molecule
Proof of Concept
Venture investors prefer more developed technologies!

33. DTRI: Summary DTRI is fundamentally an accelerator
DTRI provides investigators w/ an extensive toolbox
“One-stop shop ”
Provides resources (skills/facilities/guidance/ support) to help faculty develop ideas from the basic laboratory into the clinical realm
DTRI helps manage what is a very complex process
DTRI faculty are also conducting research on improving this translational process

34. What is DCRI?
The DCRI is the largest academic clinical research organization (ARO) in the world
A global coordinating center for multi-center clinical trials that integrates medical expertise of Duke Medicine with operational capabilities of full-service CRO
>500K patients enrolled in studies
~5,000 peer-reviewed publications
Revenues of over $100M in FY2006
>950 employees

35. A roadmap to the future: Optimizing clinical research, and drug & technology evaluation
Integrated multidisciplinary disease programs
Genotyping – Phenotyping (Physiological/functional genomics & disease subclassification)
Functional, molecular & genetic imaging
Clinical discovery ‘cores’ DCRU, Imaging Facility
Research patient database & registry
DNA, cell & tissue repositories
Translational (‘bridging’) researchers

37. Duke Center for Community Research (DCCR)
Engagement of community in research design
Community/Research interface
Establish treatment algorithms and standards of care
Bidirectional communication
Unified, research-friendly electronic health record system
Developed by McKesson and DHTS
Common Data Repository (CDR)
Decision Support Repository (DSR)
Follow community health trends and clinical outcomes
Rapid-turnaround intervention studies
Given the challenges of translating new clinical discoveries into the community, we have established the Duke Center for Community Research to begin addressing some of these serious challenges.

38. Durham County as a Model
Community based research—CFM, SON
Key construct is participation of residents in planning and interpretation of research
Electronic health record—DUHS
Strategic planning based on measurement—DHS, Center for Geospatial Mapping, HSR
Community relations—Community Affairs
Communication
Keeping the focus on the health of the people of Durham County

39. Demonstration Projects
Pilot projects to see if teams of community groups, clinicians, and researchers can improve health
$ 1 million for planning RFA for pilot projects released Summer 2008.
Requirements:
Input, support, and commitment from community
Well-integrated design for prevention/care
Budget that demonstrates effective use of resources
Evaluation plan that establishes measurable markers

40. New models of healthcare delivery
Develop truly integrated care delivery from medical center to community
“High Tech & High Touch” care delivered in state-of-the-art facilities through specialized centers of excellence
Community care with novel models of care provider teams (physician assistants, nurse practitioners, registered nurses, plus laypersons; technology-enabled care management and self-management)
Use of innovative IT for clinical information capture, connectivity, remote monitoring and decision support

41. Outcomes-based clinical care
Quality & Safety
Clinical Outcomes Metrics
Performance Measurements
Patient Satisfaction
Staff/Physician Satisfaction
Community Relations
Community Health Statistics

42. An integrated approach to health and prevention
Prospective Health
Personalized Medicine
Integrative Medicine
Biomarkers
Genomics, metabolomics, proteomics
Risk assessment
Information technology
→ Driven by Innovation

43. Future: Accountable Care Organizations
Responsible for the health of community
Able to redistribute resources for early detection, tx, f/up, patient self-management
With infrastructure for partnering w/ communities to reduce disparities 43 43

44. Education & training IOM : Learning Healthcare System
Physician scientists
Translational scientists
Prepare trainees for future medicine
Multidisciplinary team training- physicians, nurses, NP, PA, pharmacists, social workers etc
New methodologies- simulation, problem solving
Leadership & management
Global Health
Innovation

45. Leadership & Management
Management Meets Medicine in a New Pathway for Residents at Duke University
DURHAM, N.C. – Duke Medicine has launched a first-of-its-kind management pathway for residents from any of Duke’s residency programs who have also completed a graduate management degree. The program, The Duke Medicine Management and Leadership Pathway for Residents (MLP-R), is designed to provide doctors with the practical operational skills and experiences – touching all three missions of an academic health system, i.e., clinical care, research, and education – necessary for a career as a physician executive, and to serve as a launching pad for the next generation of leaders in healthcare.
Institute of Health Innovation, Strategy, Leadership & Policy

46. Formulae for Success
Culture, identity & brand
Common goals and vision
Decision making & governance
Alignment of missions
Integrated business plan with common bottom line
Leadership
Communication

47. Role of the Academic Health System in Global Health
Conduct innovative research and develop new research technologies
Coordinating multi-disciplinary experts
Create new care delivery models
Translate models from one population to another if appropriate
Train future leaders in a variety of disciplines who understand the problems, their context, and their impact on the larger global society
Examples: Division of Social Medicine at BWH with Paul Farmer, Duke Global Health Institute

48. Local to Global Health Translation to global application
Bidirectional learning & collaboration
A multidisciplinary approach

49. Duke Global Health Institute (DGHI)
DGHI is a University-wide signature initiative to address health inequalities from a multidisciplinary perspective (e.g., environment, engineering, law, policy, medicine, etc).
Built on four pillars:
Research
Education (for undergrads, graduate students, medical students, housestaff)
Service (delivery)
Policy
At Duke, we believe the opportunities offered by our involvement in global health are significant. We want to do the right thing to address global health and disparities.
The collaboration efforts of engineering, biomedical and other sciences will find faster, cheaper solutions. DTRI, DCRI and DCCR will work with these programs to develop, transfer and implement knowledge, discoveries and clinical delivery to developing communities.
We will educate future leaders of any discipline on global health to achieve broad global health literacy.

50. Duke Global Health Institute (DGHI) in action
Undergraduate Focus Cluster
GH Certificate
M.Sc. In GH
Doctoral Program
Postdoctoral Program
GH Residency Program
Signature Research Initiatives
Obesity and CVD
Global Aging
Global Environmental Health
Gender, Poverty, Health
Emerging Infectious Diseases
Health Systems
DGHI
Education
Policy
Research
Service
Domestic and int’l
fieldwork opportunities
Int’l sites for research, education
GH P.L.U.S. program
(surplus medical equipment)
Center for Health Policy
Monitoring & Evaluation Unit
Policy Unit to support decision-making related to GH

51. Duke Global Health Institute: Operational Programs
Country    
Program Area
Tanzania
HIV/AIDS and tuberculosis 
Uganda
Neurosurgical training
Kenya
Secondary school for girls
Malawi
Orphans and vulnerable children
Ghana
Maternal and Child Health 
South Africa
HIV/AIDS 
India
Micro financing and HIV prevention 
China
Duke/PKU Certificate in Global Health
Vietnam
Emerging infections surveillance
Cambodia
Singapore
Emerging Infections
Honduras
Pediatric care
Haiti
Cervical cancer 
Costa Rica
Freshman Focus educational program 
Russia
HIV infection in injecting drug users

52. Costa Rica, Mexico, China, India etc
CHAVI: Building research infrastructure in Zambia, Tanzania, South Africa, Malawi, and Gambia * * * *
DGHI: Service with Research & Education in Tanzania, Uganda, Kenya, Haiti,
Costa Rica, Mexico, China, India etc
CHAVI Member Institutions

53. How are AHSC engaging the globe: How is Duke getting engaged?
Addressing Global Health disparities
Ex. DGHI’s service pillar
Ex. DukeEngage (undergrad service learning program)
Globalization of AHSS Missions
Research
Education
Clinical Care
Global Franchising of Clinical Services
Consulting

54. Global Medicine: Beyond Addressing Health Inequalities
AHSs must consider their future in a global context
Barriers between countries are coming down:
Information technology (spread of new ideas);
Common standards (??decreased perceived quality differences?);
Rapid travel & transmission (increased spread of diseases- SARS);
A single global healthcare marketplace is developing.
Great Universities and Academic Health Centers MUST develop an international presence to be leaders in the global medicine

55. Duke’s global footprint: Duke Global Medicine
DGHI
Singapore
Duke-NUS GMS
SCRI
Duke Med Global
India
Medi-City
Care Group
China
Duke-PKUHSC partnership
Dubai
Health & Wellness

56. Trials conducted in 63 countries
DCRI’s global reach
Iceland
Norway
Finland
Russia
Estonia
Canada
U.K.
Denmark
Latvia
Ireland
Netherlands
Lithuania
Germany
Poland
Belgium
China
Austria
Czech Rep.
Slovenia
Ukraine
France
Switz.
Hungary
Romania
Georgia
Spain
Italy
Bulgaria
United States
Portugal
Greece
Turkey
Japan
Israel
Mexico
United Arab Emirates
Taiwan
Dominica
India
Hong Kong
Guatemala
Panama
Thailand
El Salvador
Venezuela
Malaysia
Columbia
Singapore
Brazil
Indonesia
Paraguay
Australia
Chile
South Africa
Uruguay
Argentina
New Zealand
Trials conducted in 63 countries

57. Duke-NUS GMS: An example of Public Private Partnership (PPP)
History of Duke-NUS GMS
Beginnings traced to 2000
Singapore launched its ambitious Biomedical Sciences Initiative ($10B) designed to make the country the biomedical hub of Asia and attract both research and health sector manufacturing capabilities.
But Singapore needed a school to train a new generation of physician-scientists.
Vision for the GMS
Duke-quality medical school in Asia, drawing students from the region and globally
Train physician scientists for Singapore; develop high quality faculty
Establish world-wide leadership in biomedical research and medical education

58. Singapore: Duke-NUS GMS, AMC, SCRI China: Peking University India
Duke Medicine Asia
Singapore: Duke-NUS GMS, AMC, SCRI
China: Peking University
India
Medical Education
Clinical & Translational Research
Health Sector Management
Disease Programs
Global Health

59. Going Global: Risks and Early Lessons Learned
Develop Public-Private Partnerships
Conduct a Gap Analysis on the “Innovation-Care Continuum”
- Explore the needs of the partner communities
- Determine whether those needs are your strengths
Leverage strengths of partners (government, university, hospital, industry) while filling gaps with your strengths.
Develop long term strategic partners
Dzau VJ: “Innovation in Healthcare in Emerging Nations”
World Economic Forum, Davos, Switzerland; Jan 2008.

60. New Models in Global Healthcare Delivery
Victor J Dzau
Healthcare Industry Meeting Thursday 29 January 2:15-3:30 PM
Centralsport Hotel
Davos, Switzerland
LATEST DRAFT: v2.4 ( )
Beginning of a journey …
Greetings on behalf of Victor Dzau, President and CEO of Duke Medicine, Chancellor for Health Affairs for Duke University; he thanks you all for coming, and regrets he was not able to be here today. [He had to attend the executive session of the University Board of Trustees, as well as deliver one of the major addresses at the annual meeting of the American Heart Association, but would have loved to be here with all of you.] Thank you to our hosts, the World Economic Forum, and particularly to Michael Seo, Associate Director of the Healthcare Industries group. And thank you to Chris Gray, our partner at Pfizer; to Drs. N. Krishna Reddy and Balaji Utla, who you’ll be hearing from later. My name is Bob Taber, and I am excited …
So why are we here? Briefly, and we’ll get into this more in a minute, we are hoping to launch, together with Pfizer, and no doubt with the involvement of some of you here today, a World Economic Forum project focusing on how global firms and in-country innovators in developing countries can come together to build innovative healthcare delivery systems based on new paradigms. Systems that deliver healthcare to the proverbial bottom of the pyramid, contributing to indigenous economic development and the growth of new markets, and even teach developed countries a thing or two about achieving faster, better, cheaper in healthcare.

61. What will future “ideal” AHSS look like?
Bench to Bedside to Population
Seamless Innovation-Care Continuum
Translational/
Clinical Research
Clinical
Delivery
Models
Integrating Discovery Translation and Health Delivery
Fundamental Discoveries
Education and
Adoption
Outcomes
Next Steps: Model Adaptations
Multiple AHSS Models
National AHSS Collaboration
Public-Private Partnerships