They said research that does not address organizational priorities amplifies the challenge of translating evidence into practice. They said research is “out of sync” with delivery systems because:
Research evidence is not generated fast enough. Results can be outdated by the time they are published because of advances in technologies, workflows or procedures.Putting research evidence into daily clinical practice requires an additional work commitment. Studies often are not designed so that research results are ready to use in new settings. The workshop and survey uncovered an additional barrier: competing research interests within health systems. Specifically, clinicians look to randomized clinical trial results to guide patient care, while quality-improvement staff need reports on whether changes they are making are leading to improvement. Executives want information on interventions that control costs while improving care.
Nonetheless, the healthcare executives who completed the survey stated that integrating research with care delivery could have multiple benefits, such as supporting organizational performance goals; using data to drive decisionmaking; and enhancing delivery-system reputation and national and community connections. Seamlessly integrating research and clinical care in a cycle of continuous improvement is the goal of learning healthcare systems, which can achieve high-quality, patient-centered care at a reasonable cost.
To achieve this goal, we call on healthcare researchers to draw on insights from dissemination and implementation science and practice-based research networks to identify clinically relevant study questions. The IOM workshop noted that including patient perspectives in all aspects of clinical studies—the PCORI model—is breaking down silos in healthcare research. The same commitment to engaging healthcare leaders, clinicians, clinical staff and payers as research partners could align projects with clinical priorities and meet the diverse needs of all partners.
We encourage leaders to consider participating in these opportunities:
Pragmatic clinical trials. These studies are conducted as partnerships between healthcare systems and researchers to address problems that are a priority for clinicians, patients, payers and delivery system leaders. Unlike many traditional clinical trials, pragmatic trials are conducted as part of everyday care, so the results reflect real-world implementation. Both PCORI and the NIH HCS Research Collaboratory are sponsoring pragmatic clinical trials.“Big data” networks. These are expanding significantly with the growing use of electronic health records. Delivery systems increasingly have rich data on care processes and outcomes. National activities including PCORnet, the Food and Drug Administration's Sentinel Initiative, awards from the NIH National Center for Advancing Translational Sciences and the NIH Big Data to Knowledge initiative (BD2K) are building data infrastructure to help patients make better-informed decisions.Collaborations among executives, policymakers, clinicians, patients and researchers could reduce the disconnect between current healthcare research and delivery system demands. Combining our perspectives, expertise and data resources could create learning healthcare systems that control costs, reduce waste, and improve the experience of clinical personnel and patients.
Dr. Eric Larson is vice president for research at Group Health Cooperative in Seattle and executive director of the Group Health Research Institute. Karin Johnson, PH.D., is a research associate in the MacColl Center for Health Care Innovation at the institute.
