Integrating Research and Practice: Health System Leaders Working Toward High-Value Care: Workshop Summary, by IOM Roundtable on Value & Science-Driven Care, Institute of Medicine
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Integrating Research and Practice: Health System Leaders Working Toward High-Value Care: Workshop Summary, by IOM Roundtable on Value & Science-Driven Care, Institute of Medicine
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Health care has been called one of the most complex sectors of the U.S. economy. Driven largely by robust innovation in treatments and interventions, this complexity has created an increased need for evidence about what works best for whom in order to inform decisions that lead to safe, efficient, effective, and affordable care. As health care becomes more digital, clinical datasets are becoming larger and more numerous. By realizing the potential of knowledge generation that is more closely integrated with the practice of care, it should be possible not only to produce more usable evidence to inform decisions, but also to increase the efficiency and decrease the costs of doing clinical research.
Patient-Centered Clinical Research Network, or PCORnet, is a nation-wide patient-centered clinical research network intended to form a resource of clinical, administrative, and patient data that can be used to carry out observational and interventional research studies and enhance the use of clinical data to advance the learning health care system. The primary goal of the first phase of PCORnet will be to establish the data infrastructure necessary to do such research.
In April and June 2014 the Institute of Medicine's Roundtable on Value and Science-Driven Health Care convened two workshops aimed at accelerating progress toward real-time knowledge generation through the seamless integration of clinical practice and research, one of the fundamental concepts of a continuously learning health system, centered on the development of the PCORnet. The first workshop brought together health care system leaders, both administrative and clinical, and researchers to consider issues and strategic priorities for building a successful and durable clinical research network and facilitate progress toward a continuously learning health care system more broadly, including issues related to science, technology, ethics, business, regulatory oversight, sustainability, and governance. The second workshop focused on implementation approaches. Health system CEOs convened to consider strategic priorities and explore approaches to implementation. These workshops will inform the decisions of field leaders moving forward, including PCORI, the PCORnet steering committee, and PCORnet grantees. Integrating Research and Practice is the summary of the presentations and discussions of the workshops.
Integrating Research and Practice: Health System Leaders Working Toward High-Value Care: Workshop Summary, by IOM Roundtable on Value & Science-Driven Care, Institute of Medicine - Amazon Sales Rank: #2755930 in Books
- Published on: 2015-04-04
- Original language: English
- Number of items: 1
- Dimensions: 8.90" h x .80" w x 6.00" l, .0 pounds
- Binding: Paperback
- 226 pages
Integrating Research and Practice: Health System Leaders Working Toward High-Value Care: Workshop Summary, by IOM Roundtable on Value & Science-Driven Care, Institute of Medicine
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Integrating Research and Care By Arete-Zoe Review: Integrating Research and Practice: Health System Leaders Working Toward High-Value Care: Workshop Summary (2015)The Institute of Medicine Roundtable on Value & Science-Driven Health Care introduced an intriguing vision of“a continuously learning health system in which science, informatics, incentives, and culture are aligned for continuous improvement and innovation, with best practices seamlessly embedded in the care process, patients and families active participants in all elements, and new knowledge captured as an integral by-product of the care experience” (p xi).The authors argue that care is often not relevant due to failure to apply the evidence about treatment efficacy as a result of lack of knowledge, accountability, coordination support or insurance, or as the result of misplaced patient expectations (p xi), and that datasets generated through the normal course of health care offer great potential for achieving the “triple aim”—improved care, better health for populations, and reduced health care costs (p 1).The main topics discussed in the book are: Continuous learning and improvement in healthcare, integration of clinical research and practice, sustainability, regulatory oversight and its challenges, and stakeholder culture which accommodates culture of learning and patient and clinician engagement. Continuous learning of organizations is then seen as the utmost priority.Efforts to share information across systems are designed to compare data for quality improvement, benchmarking, for public health and drug safety surveillance (e.g. Mini-Sentinel), for the conduct of pragmatic clinical trials, or comparative effectiveness research (CER) through PCORnet (p 3).In another workshop, Raymond Baxter and Elizabeth McGlynn described the PORTAL network developed by Kaiser Permanente which sees research as a critical part of its strategy (p 21).“PORTAL’s contract with PCORnet focuses its efforts on three specific groups of its 11 million patients: colorectal cancer patients, with an emphasis on treatment and how patients navigate survivorship; 330 adolescents and adults with severe congenital heart disease; and obesity in adults” (p 24).In workshops relating to the integration of clinical research and practice the speakers introduced among other projects REDUCE MRSA trial (p 46), Improve Care Now Network created to transform care for children with inflammatory bowel disease (p 48), and embedding research into clinical care at Group Health, a nonprofit health system with about 600,000 members in Washington State (p 50).In a discussion on learning healthcare systems, Brent James recommended Realistic Evaluation, material that that proposes an alternative to the randomized clinical trial that may be useful for evaluating context-specific interventions, and Meta-Analysis by the Confidence Profile Method, that describes methods that could be used to construct more appropriate designs for testing complex interventions (p58).In section on sustainability, Brent James introduced Intermountain knowledge management system that, according to his experience, saves lives. In addition, the experience suggests that better care is almost always less expensive (p 60).Concerning business imperatives, Thomas Garthwaite said there are a number of factors that can contribute to sustainability: good quality care is the most effective and efficient care, with reduced variable cost, reduced complications, shorter lengths of stay, and engaged nurses who feel more valued and proud of their efforts. Improved staff retention and morale and reputation enhancement are another benefits that can help grow market share (p 63).In section Regulatory oversight, Nancy Kass proposed a new way of thinking about ethics and human research, from the current regulatory definition, to a “learning health care system paradigm” in which research and care are integrated (p 72). The most controversial of the obligations, based on feedback Kass received holds that patients have an obligation to participate in the enterprise of learning (p 75).James Weinstein in his contribution compared RCT and observational trials on spine outcomes. Weinstein and his colleagues found that the RCT was not much better than the observational trial, and that patients had a great deal of decisional regret if they were not involved in the decision-making process. He said that rather than have the process be one of informed consent, it should be one of informed choice, with the patient actively involved in the decision-making process (p 79).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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Integrating Research and Practice: Health System Leaders Working Toward High-Value Care: Workshop Summary, by IOM Roundtable on Value & Science-Driven Care, Institute of Medicine
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Integrating Research and Practice: Health System Leaders Working Toward High-Value Care: Workshop Summary, by IOM Roundtable on Value & Science-Driven Care, Institute of Medicine
Integrating Research and Practice: Health System Leaders Working Toward High-Value Care: Workshop Summary, by IOM Roundtable on Value & Science-Driven Care, Institute of Medicine
