Division of Biostatistics, Mayo Clinic Cancer Center, Mayo Clinic, Rochester, MN

摘要

AllegoricaUy, American healthcare and research landscapes are fields of silos, often failing to cultivate products which adequately serve patients or fulfill the potential to advance human biologic science. Interactions, or lack thereof, among the component entities have not resulted in a whole greater than the sum of their parts. Yet, perturbations within one component can reverberate across systems with unintended consequences, or, perhaps more typically, with ignorance of consequences. Indeed, the American health care enterprise is an astounding array of disunited factors and forces including diverse populations, geography, economics, government, the private sector, healthcare providers, researchers, hospital and outpatient systems, and universities, often forced into unequal and haphazard partnerships. Clinical research is a particularly fragile network of silos. It is becoming increasingly more vulnerable because of mounting pressures within the healthcare industry and research community, including reimbursement, regulatory policies, stagnation (or worse) of the federal budget, allocation of physician time and resources, and impending shortage of healthcare personnel#