How Can Health Services Research Become More Relevant?
A new report on the state of health services research notes some irony in the fact that while the “appreciation has never been higher for both the need and potential from health services research, the political and financial support for sustenance and growth appear to be weakening.” For instance, members of Congress have repeatedly threatened to defund the Agency for Healthcare Research and Quality (AHRQ). So what is to be done?
The National Academy of Medicine recently convened experts to write a publication to identify the range of issues that health services research must address and overcome to transform the field to meet the needs of a 21st century healthcare system.
Participants in writing the report suggested a call to action for the field to mobilize sustained initiatives, including:
• identify the tools and strategies—available and emerging—to refine and deploy in the change process;
• steward the societal-wide advancement of a culture of continuous learning and sharing throughout the system;
• foster the development of the data infrastructure and research teams required for real-time insights and feedback in the virtuous cycle of continuous learning;
• create a working network of stakeholders, including patients as partners in research, for expedited coordination, collaboration, and, as required, governance;
• establish shared network-wide goals and a process for tracking and adapting strategies; and
• characterize the anticipated and actual results for improvement, in qualitative and quantitative personal, societal, and economic terms.
In a webinar panel asked to respond to the paper, Joe Selby, M.D., executive director of the Patient-Centered Outcomes Research Institute, stressed the importance of engaging patients and systems leaders in research to make sure you are getting the questions right. “Consider the entire spectrum of research from clinical on the one hand to epidemiology and public health, involving the community and studying the social determinants as major parts of the clinical services milieu, and the importance of data now that we have so much of it, as well as artificial intelligence and machine learning and the role it is going to play in healthcare, and hopefully addressing disparities along the way.”
As important as it is to engage patients in health services research, Selby said it is at least as important and maybe more challenging to engage front-line clinicians in health services research. “In most settings, it is difficult to get their attention because nurses, pharmacists, physicians or others are under intense time pressures, yet it is so essential to getting the questions right and getting the results listened to and implemented,” he said. “My theory it is important for addressing workforce burnout, on the part of the clinicians too. I would say from the perspective of health service researchers, thinking about getting clinicians involved in your research is critically important."
Selby said funding organizations such as PCORI can foster this effort by requiring clinician engagement in funding opportunities. For instance, PCORI and AHRQ have co-sponsored grants to train system-based clinicians as researchers. “In turn, I would hope that these trainees would take up the challenge of getting their colleagues in healthcare systems involved in asking and answering questions,” he said. “We can define the learning health systems a little more precisely as just those systems that make time to engage clinicians in relevant research. We can work with professional organizations to elevate the role of research among their front-line members.”
Fellow panelist Timothy Ferris, M.D., M.P.H., CEO of the Massachusetts General Physicians Organization, reflected on strengths and weaknesses of health services research historically and gave it a mixed report card.
He gave health services research an A grade on its ability to give point estimates on deficiencies in the delivery of healthcare. Ferris said the many studies that have provided concrete information about deficiencies have been remarkably important for changing policies and addressing issues and have been instrumental in major changes in the system.
He gave it more of a B grade in terms of policy development from evidence. “It is challenging to translate evidence into policy. There is room to do a better job there,” Ferris said. “I would say particularly as a manager in a delivery system, I would give HSR a C or maybe even a D on usefulness to the delivery system of what is mostly being produced in health services research.”
Ferris pointed to a few issues that are substantial barriers to getting useful information out of health services research for managers. He noted that it is difficult to assign causality to a particular intervention when in real life in the delivery of healthcare there are a lot of variables changing at once. “There is criticism of clinical trials because they are not generalizable to the real world, I would say the same holds true in much health services research. We need to address that.”
Ferris also called problematic the time frame over which results are often published. “I get that there is a push to publish early results, but making changes in the delivery of services is a multi-year process,” he said. “We have seen press coverage of early results that actually does a disservice to the efforts of change when in fact the time frame over which real change occurs hasn’t been allowed to play out. That tension is an issue to managers of deliveries systems. We have to overcome these challenges, and I look forward to next generation of health services research finding ways to overcome them.”
