Health and Disease Management Within an Academic Health System

Bernard, David B.; Coburn, Kenneth D.; Miani, Mark

doi:10.2165/00115677-200007010-00004

Cited by 6 publications

(3 citation statements)

References 20 publications

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“…Disaggregating how the various mechanisms through which research engagement improves performance operate in complex healthcare systems and factoring the role of ‘organisational form’ into all this 41 is also not straightforward. 40 49–51 Both the focused and the wider reviews identified situations in which impacts seemed less likely to arise from research engagement, and in which the operation of networks and schemes aimed at involving clinicians more fully in research faced difficulties in making progress, particularly when there were not changes at the organisational level to support these initiatives. 36 52 This suggests that, if we are to understand better why “…healthcare institutions or service providers who are active in research deliver better care and outcomes than those who do not participate in clinical research?”, 4 more work is needed to encourage engagement both in and with research in order to identify the organisational determinants of implementation effectiveness and thereby improve healthcare performance.…”

Section: Discussionmentioning

confidence: 99%

Does the engagement of clinicians and organisations in research improve healthcare performance: a three-stage review

et al. 2015

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ObjectiveThere is a widely held assumption that engagement by clinicians and healthcare organisations in research improves healthcare performance at various levels, but little direct empirical evidence has previously been collated. The objective of this study was to address the question: Does research engagement (by clinicians and organisations) improve healthcare performance?MethodsAn hourglass-shaped review was developed, consisting of three stages: (1) a planning and mapping stage; (2) a focused review concentrating on the core question of whether or not research engagement improves healthcare performance; and (3) a wider (but less systematic) review of papers identified during the two earlier stages, focusing on mechanisms.ResultsOf the 33 papers included in the focused review, 28 identified improvements in health services performance. Seven out of these papers reported some improvement in health outcomes, with others reporting improved processes of care. The wider review demonstrated that mechanisms such as collaborative and action research can encourage some progress along the pathway from research engagement towards improved healthcare performance. Organisations that have deliberately integrated the research function into organisational structures demonstrate how research engagement can, among other factors, contribute to improved healthcare performance.ConclusionsCurrent evidence suggests that there is an association between the engagement of individuals and healthcare organisations in research and improvements in healthcare performance. The mechanisms through which research engagement might improve healthcare performance overlap and rarely act in isolation, and their effectiveness often depends on the context in which they operate.

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Section: Discussionmentioning

confidence: 99%

Does the engagement of clinicians and organisations in research improve healthcare performance: a three-stage review

et al. 2015

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“…Many other organisational structures have been designed to support ongoing partnerships between researchers and users of research in health-care organisations in the USA and elsewhere. In the USA, in addition to the VHA (and its QUERI) and Kaiser Permanente, these include the University of Pennsylvania Health System, 197 the United Healthcare Corporation's Center for Health Care Policy and Evaluation, 198 and the Agency for Healthcare Research and Quality's (AHRQ) Integrated Delivery Systems Research Network (IDSRN). 173 In the UK, there are now Biomedical Research Centres and Units, Academic Health Science Centres, and the CLAHRCs.…”

Section: The Complexity Of Health-care Organisationsmentioning

confidence: 99%

“…They also point out that in recent years things have changed: a more centralist approach is being taken in the VHA and this has undermined the flexibility to tailor local improvement strategies. 196 In a similar vein, another US study, by Bernard et al,197 emphasises the importance of a comprehensive and inclusive approach in which all of the health-care team are involved at all stages in decision-making in a way that gives them ownership of health and disease management programmes in an academic health system. In the UK, the way in which the CLAHRCs have been developed as local collaboratives that involve local communities of practice also reflects this thinking.…”

Section: The Use Of Organisational Mechanismsmentioning

confidence: 99%

Engagement in research: an innovative three-stage review of the benefits for health-care performance

Hanney

Boaz

Jones

et al. 2013

Health Services and Delivery Research

106

160

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BackgroundThere is a widely held assumption that research engagement improves health-care performance at various levels, but little direct empirical evidence.ObjectivesTo conduct a theoretically and empirically grounded synthesis to map and explore plausible mechanisms through which research engagement might improve health services performance. A review of the effects on patients of their health-care practitioner's or institution's participation in clinical trials was published after submission of the proposal for this review. It identified only 13 relevant papers and, overall, suggested that the evidence that research engagement improves health-care performance was less strong than some thought. We aimed to meet the need for a wider review.MethodsAn hourglass review was developed, consisting of three stages: (1) a planning and mapping stage; (2) a focused review concentrating on the core question of whether or not research engagement improves health care; and (3) a wider (but less systematic) review of papers identified during the two earlier stages. Studies were included inthe focused review if the concept of ‘engagementinresearch’ was an input and some measure of ‘performance’ an output. The search strategy covered the period 1990 to March 2012. MEDLINE, EMBASE, PsycINFO, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science and other relevant databases were searched. A total of 10,239 papers were identified through the database searches, and 159 from other sources. A further relevance and quality check on 473 papers was undertaken, and identified 33 papers for inclusion in the review. A standard meta-analysis was not possible on the heterogeneous mix of papers in the focused review. Therefore an explanatory matrix was developed to help characterise the circumstances in which research engagement might improve health-care performance and the mechanisms that might be at work, identifying two main dimensions along which to categorise the studies:the degree of intentionalityandthe scope of the impact.ResultsOf the 33 papers in the focused review, 28 were positive (of which six were positive/mixed) in relation to the question of whether or not research engagement improves health-care performance. Five papers were negative (of which two were negative/mixed). Seven out of 28 positive papers reported some improvement in health outcomes. For the rest, the improved care took the form of improved processes of care. Nine positive papers were at a clinician level and 19 at an institutional level. The wider review demonstrated, for example, how collaborative and action research can encourage some progress along the pathway from research engagement towards improved health-care performance. There is also evidence that organisations in which the research function is fully integrated into the organisational structure out-perform other organisations that pay less formal heed to research and its outputs. The focused and wider reviews identified the diversity in the mechanisms through which research engagement might improve health care: there are many circumstances and mechanisms at work, more than one mechanism is often operative, and the evidence available for each one is limited.LimitationsTo address the complexities of this evidence synthesis of research we needed to spend significant time mapping the literature, and narrowed the research question to make it feasible. We excluded many potentially relevant papers (though we partially addressed this by conducting a wider additional synthesis). Studies assessing the impact made on clinician behaviour by small, locally conducted pieces of research could be difficult to interpret without full knowledge of the context.ConclusionsDrawing on the focused and wider reviews, it is suggested that when clinicians and health-care organisations engage in research there is the likelihood of a positive impact on health-care performance. Organisations that have deliberately integrated the research function into organisational structures demonstrate how research engagement can, among other factors, contribute to improved health-care performance. Further explorations are required of research networks and schemes to promote the engagement of clinicians and managers in research. Detailed observational research focusing on research engagement within organisations would build up an understanding of mechanisms.Study registrationPROSPERO: CRD42012001990.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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A Knowledge Based Search Tool for Performance Measures in Health Care Systems

Beyan

Baykal

2010

J Med Syst

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Health and Disease Management Within an Academic Health System

Cited by 6 publications

References 20 publications

Does the engagement of clinicians and organisations in research improve healthcare performance: a three-stage review

Does the engagement of clinicians and organisations in research improve healthcare performance: a three-stage review

Engagement in research: an innovative three-stage review of the benefits for health-care performance

A Knowledge Based Search Tool for Performance Measures in Health Care Systems

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