Review: Integrating Research and Practice 2/2

25. october 2015 at 8:00 | Veronika Valdova, ARETE-ZOE |  Medicine & Pharmacy

Institutional governance of continuous learning activities that can accelerate progress and sustainability was the focus of a panel of brief presentations by James Rohack (Baylor Scott & White Health), Mary Brainerd (HealthPartners), and John Steiner (Institute for Health Research at Kaiser Permanente Colorado) (p 86).

John Steiner (Kaiser Permanente National Research Council and the HMO Research Network governing board) noted that transformation of research can only occur through transformation of governance. Research studies, he said, need to be larger, of higher quality, using trustworthy, high-quality data and better analytic methods while achieving or maintaining regulatory and fiscal compliance. He also stressed that research needs to be faster, in terms of initiating studies, organizing the contractual relationship between collaborators, and getting studies approved by IRBs; less expensive and more engaging, and has to rely on data collected during the course of routine care (p 92).

In section Fostering the well-prepared stakeholder culture Peter Knox presented Bellin Health's high-performance health care model. This framework holds that for an organization to execute effectively it must think about six dimensions: strategic position (understanding the market, the value proposition, and focus on patients' important priorities); production system or organizational structure that delivers on the specifications; and a system of measurement that provides insights into how the system is performing. Only then is it time to create a system of improvement, marketing the product, that is to give individual patients diagnosis-to-treatment options within 3days, and finally a high-performance culture that supports creating value at speed (p 98).

According to Patrick Conway, sustainability requires that learning become part of the fabric of care and that health care organizations embrace infrastructure support as essential to their survival. Additionally, infrastructure needs to become part of the financial model in a way that enables investments in the research infrastructure that will drive continuous learning to improve population health and the efficiency of care delivery (p 109).

Scott Armstrong stressed that an organization can foster a culture in which its leadership team and medical professionals work together consistently to create a virtuous cycle between research and operations to create value at speed (p 109). John Warner added that PCORnet represents an opportunity to build the infrastructure needed to maximize return on the huge investment that health systems have made in EHRs (p 109).

As Jonathan Perlin said, there is a strong business case for health care systems that have already made significant investments in information technologies to support research networks. These networks allow the systems to leverage their investments by investigating questions that can be best addressed using data from multiple organizations. Raymond Baxter added that because organizations have a limited supply of intellectual capital, it should be spent on research that produces change for patients; and that the barometer for success is the speed at which research results produce changes in care and outcome (p 119).

According to David Labby, there is a concern about the biases inherent in using observational data and about the generalizability and scalability of results. Steven Corwin said that

"Taking cost out of the system will not happen without moving toward population health and providing value, and both of those steps require knowledge of the sort that a learning health system can produce. In the absence of knowledge to refine the blunt measurement of cost and utilization, the health care system will bifurcate into one that has hospitals that treat the "haves" and hospitals that treat the "have nots," which would be problematic for the country as a whole. Privacy and security issues need to be addressed in a way that balances the need for transparency with the concerns of liability" (p 120).

From the presented materials it is apparent that there is a strong business case for the utilization of various tools which facilitate learning of healthcare organizations toward improvement of patient outcomes. Tendency toward observational research within real-life context is becoming a trend that may substantially transform clinical research toward greater integration with care. The workshop summary is an essential resource for those who need to stay on top of the latest trends in clinical research.

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