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

Abstract

<jats:title>Abstract</jats:title><jats:p>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&amp;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&amp;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.</jats:p>

Learning health systems: Driving real‐world impact in mental health and substance use disorder research

“…Key ingredients to the VA LHS included a national electronic health record, funding or protected time for researchers, and a health system with a commitment from operational leaders to participate in research or evaluation. U.S. organizations that have these include the Health Care Systems Research Network, 16 which is a consortium of health care systems that share common electronic data elements and an infrastructure to conduct research. Increasingly, federal research funding agencies have also funded health systems and academic health centers to support LHS components.…”

“…Current research funding mechanisms do not generally provide sustained support -for both resources and protected time -to successfully build and support the partnerships, data infrastructure, and rapid evaluations of current best practices needed to ensure an efficient and responsive research enterprise that results in meaningful impacts in clinical outcomes and care delivery (16). This paper describes the Office of Research Development's (ORD's) efforts in the U.S. Department of Veterans Affairs (VA) to build an LHS, particularly in the areas of mental health and substance use disorder treatment, through funding mechanisms that align researcher and operations partner priorities and infrastructure needs.…”

“…For these research‐operations partnerships to successfully address health care priorities related to NCDs, incentives, timing, and agendas of researchers and health system leaders need to be aligned. Current research funding mechanisms do not generally provide sustained support – for both resources and protected time – to successfully build and support the partnerships, data infrastructure, and rapid evaluations of current best practices needed to ensure an efficient and responsive research enterprise that results in meaningful impacts in clinical outcomes and care delivery 16 …”

“…Key ingredients to the VA LHS included a national electronic health record, funding or protected time for researchers, and a health system with a commitment from operational leaders to participate in research or evaluation. U.S. organizations that have these include the Health Care Systems Research Network(51), which is a consortium of health care systems that share common electronic data elements and an infrastructure to conduct research.Increasingly, federal research funding agencies have also funded health systems and academic health centers to support LHS components. For example, the U.S. National Institutes of Health's National Cancer Institute and National Center for Advancing Translational Sciences explore the role of implementation science, building capacity in supporting and complementing LHS in precision medicine approaches to transforming patient care (16, 52).Examples of health systems implementing these LHS core elements include New York University's Langone Health system, which employs rigorous, rapid-cycle randomized testing of existing system wide initiatives to close ineffective programs and optimize valuable programs for consumers, clinicians, and support staff(53).…”

Introduction to the JCTS special issue on Dissemination and Implementation Sciences

“…7 Aarons et al 8 and Dolor et al 9 examined opinions of D&I researchers and CTSA leaders to identify strategies that could promote team science and improve population health. The importance of partnerships between academic and public health systems and organizations is examined by both Kilbourne et al 10 and Towfighi et al 11 This is further explored in terms of a broader engagement of specific participants, including stakeholder and workforce related issues. Quanbeck et al 12 and Meissner et al 13 discuss the vital role of stakeholder engagement.…”