The Wonderfully Messy Reality of Natural Experiments

Image of headshot of Kurt C. Stange

Shift Happens is my favorite bumper sticker. I love the genuineness of natural experiments, when shifts in policy, practice or environment stimulate changes.  As a scientist, I’m supposed to value the controlled experiment.  But manipulating the conditions of what happens in the laboratory, and then trying to extrapolate that to the real world, just doesn’t feel as interesting as being in the wonderfully messy reality to begin with.

The three articles in this issue of the CHI Center newsletter feature natural experiments and highlight the courageous people trying to make sense of these perturbations of the environments in which we live.

The recent inaugural Wisdom of Practice endowed lecture by Larry Casalino, MD, PhD, brings to light how the ongoing natural experiment of the corporatization of healthcare and the growing influence of venture capital are affecting the professionalism of the workforce and the options available to patients.  To this work Dr. Casalino brings 20 years of experience as a family physician in private practice and an equal number of years as a PhD health systems investigator.

In partnership with OCHIN, a national network of information technology-enabled community health centers, the CHI Center is conducting the PIE and CAKE studies, which provide a taste of what is possible to improve the equity and quality of care by learning from the natural experiment of practice changes resulting from the COVID-19 pandemic. The PIE study provides particular insights into the care of people living with multiple chronic conditions, while the CAKE study examines the entire primary care patient population and workforce viability in the wake of telehealth and other practice changes.

Prakash Ganesh strives to understand and improve public health and clinical systems needed to prevent and treat infectious diseases, people, and communities.  As a resident in family and preventive medicine at University Hospitals Cleveland Medical Center, and then for four years in Malawi, he helped to establish and provide care in systems for blood banking and control of HIV and hepatitis C. Now as a CHI Center faculty member, Medical Director of the Cuyahoga County Board of Health, and a clinician at Neighborhood Family Practice, Dr. Ganesh is developing and evaluating similar systems for COVID-19, mpox, HIV, and hepatitis C.

I hope these examples inspire you, as they do me, to work across boundaries to learn from the many ongoing changes in healthcare and health and to use that learning to make things better.

-Kurt Stange