Overcoming Challenges to Evidence‐Based Policy Development in a Large, Integrated Delivery System

Frakt, Austin B.; Prentice, Julia C.; Pizer, Steven D.; Elwy, A. Rani; Garrido, Melissa M.; Kilbourne, Amy M.; Atkins, David C.

doi:10.1111/1475-6773.12986

Cited by 23 publications

(17 citation statements)

References 26 publications

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“…Another VHA initiative called Quality Enhancement Research Initiative (QUERI) is an internally-funded program to help the VHA translate research into practice more quickly and efficiently than traditional knowledge translation [ 45 , 47 , 48 ]. Four priority research projects were: 1) home- and community-based care for Veterans at risk of nursing home placement, 2) risk mitigation for patients receiving opioid prescriptions, 3) targeting care for patients at high risk for suicide, and 4) a telehealth tool to improve access to dermatology services.…”

Section: Resultsmentioning

confidence: 99%

Learning health systems in primary care: a systematic scoping review

et al. 2021

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Background Learning health systems have been gaining traction over the past decade. The purpose of this study was to understand the spread of learning health systems in primary care, including where they have been implemented, how they are operating, and potential challenges and solutions. Methods We completed a scoping review by systematically searching OVID Medline®, Embase®, IEEE Xplore®, and reviewing specific journals from 2007 to 2020. We also completed a Google search to identify gray literature. Results We reviewed 1924 articles through our database search and 51 articles from other sources, from which we identified 21 unique learning health systems based on 62 data sources. Only one of these learning health systems was implemented exclusively in a primary care setting, where all others were integrated health systems or networks that also included other care settings. Eighteen of the 21 were in the United States. Examples of how these learning health systems were being used included real-time clinical surveillance, quality improvement initiatives, pragmatic trials at the point of care, and decision support. Many challenges and potential solutions were identified regarding data, sustainability, promoting a learning culture, prioritization processes, involvement of community, and balancing quality improvement versus research. Conclusions We identified 21 learning health systems, which all appear at an early stage of development, and only one was primary care only. We summarized and provided examples of integrated health systems and data networks that can be considered early models in the growing global movement to advance learning health systems in primary care.

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Section: Resultsmentioning

confidence: 99%

Learning health systems in primary care: a systematic scoping review

et al. 2021

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“…Sustainment also includes prioritizing national budgets to support effective programs/policies derived from interventions. For example, the QUERI Partnered Evidence-based Policy Resource Center (PEPReC)27 informs national policies in the US Department of Veterans Affairs through rigorous evaluation of intervention sustainability. PEPReC is also helping VHA operationalize the Foundations for Evidence-based Policymaking Act,28 which requires all Cabinet-level agencies to have a plan to evaluate the level of evidence of their programs and policies, and use research to generate rigorous evidence to inform budget decisions.…”

Section: Resultsmentioning

confidence: 99%

Research Lifecycle to Increase the Substantial Real-world Impact of Research

et al. 2019

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Background: US health care systems face a growing demand to incorporate innovations that improve patient outcomes at a lower cost. Funding agencies increasingly must demonstrate the impact of research investments on public health. The Learning Health System promotes continuous institutional innovation, yet specific processes to develop innovations for further research and implementation into real-world health care settings to maximize health impacts have not been specified. Objective: We describe the Research Lifecycle and how it leverages institutional priorities to support the translation of research discoveries to clinical application, serving as a broader operational approach to enhance the Learning Health System. Methods: Developed by the US Department of Veterans Affairs Office of Research and Development Research-to-Real-World Workgroup, the Research Lifecycle incorporates frameworks from product development, translational science, and implementation science methods. The Lifecycle is based on Workgroup recommendations to overcome barriers to more direct translation of innovations to clinical application and support practice implementation and sustainability. Results: The Research Lifecycle posits 5 phases which support a seamless pathway from discovery to implementation: prioritization (leadership priority alignment), discovery (innovation development), validation (clinical, operational feasibility), scale-up and spread (implementation strategies, performance monitoring), and sustainability (business case, workforce training). An example of how the Research Lifecycle has been applied within a health system is provided. Conclusions: The Research Lifecycle aligns research and health system investments to maximize real-world practice impact via a feasible pathway, where priority-driven innovations are adapted for effective clinical use and supported through implementation strategies, leading to continuous improvement in real-world health care.

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“…Displaying As IDSs in the United States are usually the product of the corporate strategies of parent companies, research on the implementation of IDSs tends to focus on corporate organizational strategies [16]. Corporate leadership is identified as the most important factor in implementation [17,18], and research excludes the role of local governments, focusing on the health insurance coverage [19]. In China, most of the literature focuses on the "vertical" model, which was adopted to reform the hospital-centric and fragmented delivery system [20], and to "gatekeep" for health care service and health insurance [21][22][23].…”

Section: Inter-local Government Levelmentioning

confidence: 99%

“…Res. Public Health 2021, 18, 9176 2 of 14 focus on the lack of financial support from the government to covering the expanded insurance coverage and training of more health care professionals. The other group looks at inter-hospital conflicts such as administrative disorganization and difficulties in digitizing and sharing patient case files among hospitals.…”

Section: Introductionmentioning

confidence: 99%

Reshaping the Regional Order of Health Care Resources in China: The Institutional Participants in an Inter-City Integrated Delivery System

Nie

Fan

2021

IJERPH

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Over the past decades, pro-growth policies in China led to rapid economic development but overlooked the provision of health care services. Recently, increasing attention is paid to the emergence of integrated delivery systems (IDS) in China, which is envisioned to consolidate regional health care resources more effectively by facilitating patient referral among hospitals. IDS at an inter-city scale is particularly interesting because it involves both the local governments and the hospitals. Incentives among them will affect the development of an inter-city IDS. This paper thereby builds an economic model to examine both the inter-local government and inter-hospital incentives when participating in an inter-city IDS in China. The findings suggest that while inter-hospital incentives matter, inter-local government incentives should also be considered because the missing incentives at the local government level may oppose the development of inter-city IDSs.

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Overcoming Challenges to Evidence‐Based Policy Development in a Large, Integrated Delivery System

Abstract: Successful program implementation and rigorous evaluation require resources, specialized expertise, and careful planning. If the learning health system model is to be sustained, organizations will need dedicated programs to prioritize resources and continuously adapt evaluation designs.

Cited by 23 publications

References 26 publications

Learning health systems in primary care: a systematic scoping review

Learning health systems in primary care: a systematic scoping review

Research Lifecycle to Increase the Substantial Real-world Impact of Research

Reshaping the Regional Order of Health Care Resources in China: The Institutional Participants in an Inter-City Integrated Delivery System

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