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

Abstract

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.

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

“…Table 2 provides examples of CTSA and VA programs that focus on Learning Health System capacity building [30]. Current efforts to measure impacts of these programs are underway [8,24].…”

“…The VA's HSR&D program and the NCATS's CTSA Program have developed capacity building initiatives that overcome the disincentives of translational science from innovation to implementation in "real-world" health systems. In doing so, they build upon the VA's Research-to-"Real-World" Lifecycle [24] and the CTSA Dissemination and Implementation Science Workgroup findings [2], which outline how implementation science in particular can be applied to speed the deployment of research-to-"real-world" settings across the translational spectrum. As defined by NCATS and VA, implementation science involves the study of specific strategies (e.g., user-centered design, clinical tools, organizational methods, and public policies) derived from different scientific disciplines to promote the uptake of innovative treatments in "real-world" settings [7,8].…”

Integrating Health System Data With Systematic Reviews: A Framework for When and How Unpublished Health System Data Can Be Used With Systematic Reviews

“…In response to a request to examine pharmacogenomic strategies to inform antidepressant selection, the VA ESP conducted a rapid evidence synthesis that identified specific gaps in evidence. 25 This report informed a request for proposals for studies of pharmacogenomic testing in veterans, and there is currently a funded multisite study underway. In another example, in response to a request from the VA's Office of Health Equity to help identify research priority areas, the VA ESP developed an evidence map to graphically illustrate major evidence gaps in VA health disparities research.…”

Early Intervention in Psychosis: Effectiveness and Implementation of a Combined Exercise and Health Behavior Intervention Within Routine Care

“…Deenik et al (29) highlighted a need for effective physical health intervention studies with SMI to be translated into real-world settings, suggesting that research on program implementation in standard care practice is an essential step to translate effective health behavior interventions into routine mental health care. Unfortunately, there remains a "research to real-world" gap where research innovations are rarely effectively adopted and implemented in real-world health care settings (93), Both studies highlighted barriers to effective implementation including poor alignment between researchers, health care systems, and providers. They argued that moving research "from innovation to application" requires local input, using local options, and developed using a sustainable approach that enables frontline workers to continue implementation and delivery.…”