Accelerating implementation of research in Learning Health Systems: Lessons learned from VA Health Services Research and NCATS Clinical Science Translation Award programs.

Amy M Kilbourne,Patricia L Jones,David Atkins

doi:10.1017/cts.2020.25

Abstract

Translation of research to practice is challenging. In addition to the scientific challenges, there are additional hurdles in navigating the rapidly changing US health care system. There is a need for innovative health interventions that can be adopted in "real-world" settings. Barriers to translation involve misaligned timing of research funding and health system decision-making, lack of research questions aligned with health system and community priorities, and limited incentives in academia for health system and community-based research. We describe new programs from the US Department of Veterans Affairs Health Services Research and Development (HSR&D) and the National Center for Advancing Translational Sciences (NCATS) Clinical and Translational Science Award (CTSA) Programs that are building capacity for Learning Health System research. These programs help to incentivize adopting and adapting Learning Health System principles to ensure that, primarily in implementation science within academic/veterans affairs health systems, there is alignment of the research with the health system and community needs. Both HSR&D and NCATS CTSA Program encourage researchers to develop problem-focused research innovations in partnership with health systems and communities to ultimately facilitate design treatments that are feasible in "real-world" practice.

Highlights

The US health care system is complex and rapidly changing
In a landmark report on the Future of Health Services Research [1], the National Academy of Medicine (NAM) recommends that health care research initiatives: (1) promote more rapid and timely research that directly informs treatment implementation; (2) address priorities of health systems; (3) involve patients, clinicians, their communities, and other stakeholders; and (4) build capacity within the scientific workforce that leads to more relevant research
Learning Health Systems [5] ensure continuous improvement of health outcomes through alignment of clinical informatics and organizational culture that promote scientific innovations that lead to the implementation of effective treatments [6]

Summary

Introduction

The US health care system is complex and rapidly changing. These changes entail the needs and expectations of patients, as well as the increased demand on the clinicians, health systems, and communities who care for them. CEnR-Nav program Community Engagement Studios solicits perspectives about a scientific topic from community stakeholders Translational Research Studios: health system provider input on new discoveries or treatments for “real-world” use COREs: access, suicide prevention, opioid/pain, virtual care Implementation plan requirement addressing stakeholders, strategy, and sustainment issues of investigator-initiated research project QUERI partnered evaluations: Mechanisms co-funded by VA operations leaders focused on rigorous implementation evaluation of national program or policy. HSR&D research priorities updated to include cross-cutting health services research methods: informatics/data science, complexity science/ health systems engineering, and implementation science Career Development Awards and implementation science training (QUERI Center for Evaluation and Implementation Resources, NIMH Implementation Research Institute – VA sponsorship) funding and scientific publications, not the kind of work of building partnerships with health system leaders to develop pathways to sustain innovations These activities may demand significant time without generating funding or publications. Using a streamlined application and review process (three page applications, assessed on only two criteria: innovation and potential clinical impact), the initiative elicited a wide range of applications that proposed innovative tests of policy, data collaborations, or new partnerships to tackle five VA priority areas including suicide and opioid misuse

Discussion

Institute of Medicine