Laura J Damschroder1, Andrew J Knighton2, Emily Griese3, Sarah M Greene4, Paula Lozano5, Amy M Kilbourne6, Diana S M Buist7, Karen Crotty8, A Rani Elwy9, Lee A Fleisher10, Ralph Gonzales11, Amy G Huebschmann12, Heather M Limper13, NithyaPriya S Ramalingam14, Katherine Wilemon15, P Michael Ho16, Christian D Helfrichfcr17. 1. VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2800 Plymouth Rd. Building 16, Floor 3, (152), Ann Arbor, MI, 48105, USA. Electronic address: laura.damschroder@va.gov. 2. Healthcare Delivery Institute, Intermountain Healthcare, 5026 South State Street, 3rd Floor, Murray, UT, 84107, USA. Electronic address: Andrew.knighton@imail.org. 3. Sanford Research, Sanford Health, 2301 E 60th Street, N Sioux Falls, SD, 57106, USA. Electronic address: Emily.griese@sanfordhealth.org. 4. Health Care Systems Research Network, 1249 NE 89th Street, Seattle, WA, 98115, USA. Electronic address: smgreene27@outlook.com. 5. Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue, Suite 1600, Seattle, WA, 98101, USA. Electronic address: Paula.Lozano@kp.org. 6. Quality Enhancement Research Initiative (QUERI), U.S. Dept of Veterans Affairs, 810 N Vermont Avenue (10X2), Washington, DC, 20420, USA; Learning Health Science, University of Michigan Medical School, North Campus Research Complex, 2800 Plymouth Road, Bldg 16 Ann Arbor, MI, 48198, USA. Electronic address: Amy.Kilbourne@va.gov. 7. Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue, Suite 1600, Seattle, WA, 98101, USA. Electronic address: Diana.S.Buist@kp.org. 8. RTI International, 3040 E. Cornwallis Road, Hobbs 139 P.O. Box 12194, Durham, NC, 27709, USA. Electronic address: kcrotty@rti.org. 9. VA Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, 200 Springs Road (152), Bedford, MA, 01730, USA; Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Box G-BH, Providence, RI, 02912, USA. Electronic address: Rani.Elwy@va.gov. 10. Department of Anesthesiology and Critical Care, Leonard Davis Institute of Health Economics, University of Pennsylvania, 3400 Spruce Street, Dulles 680, Philadelphia, PA, 19104, USA. Electronic address: Lee.fleisher@pennmedicine.upenn.edu. 11. Division of General Internal Medicine, Department of Medicine, UCSF, 350 Parnassus Avenue, Box 0361, San Francisco, CA, 94117-0361, USA. Electronic address: ralph.gonzales@ucsf.edu. 12. University of Colorado (CU) School of Medicine, Department of Medicine, Division of General Internal Medicine, 12631 E. 17th Ave., Mailstop, B180, Aurora, CO, 80045, USA. Electronic address: amy.huebschmann@cuanschutz.edu. 13. Vanderbilt University Medical Center, 2525 West End Ave, Nashville, TN, 37203, USA. Electronic address: Heather.m.limper@vumc.org. 14. Department of Family Medicine, Oregon Health & Science University, 3181 Sam Jackson Park Rd, Portland, 97239, USA. Electronic address: ramalinn@ohsu.edu. 15. 680 East Colorado Boulevard, Suite #180, Pasadena, CA 91101-6144, USA. Electronic address: kw@thefhfoundation.org. 16. Cardiology Section, Rocky Mountain Regional VA Medical Center, 1700 N. Wheeling St, Aurora, CO 80045, USA. Electronic address: Michael.ho@ucdenver.edu. 17. Seattle-Denver Center of Innovation for Veteran-Centered Value-Driven Care, 1660 South Columbian Way, S-152, Seattle, WA, 98108, USA. Electronic address: christian.helfrich@va.gov.
Abstract
BACKGROUND: Traditional research approaches do not promote timely implementation of evidence-based innovations (EBIs) to benefit patients. Embedding research within health systems can accelerate EBI implementation by blending rigorous methods with practical considerations in real-world settings. A state-of-the-art (SOTA) conference was convened in February 2019 with five workgroups that addressed five facets of embedded research and its potential to impact healthcare. This article reports on results from the workgroup focused on how embedded research programs can be implemented into heath systems for greatest impact. METHODS: Based on a pre-conference survey, participants indicating interest in accelerating implementation were invited to participate in the SOTA workgroup. Workgroup participants (N = 26) developed recommendations using consensus-building methods. Ideas were grouped by thematic clusters and voted on to identify top recommendations. A summary was presented to the full SOTA membership. Following the conference, the workgroup facilitators (LJD, CDH, NR) summarized workgroup findings, member-checked with workgroup members, and were used to develop recommendations. RESULTS: The workgroup developed 12 recommendations to optimize impact of embedded researchers within health systems. The group highlighted the tension between "ROI vs. R01" goals-where health systems focus on achieving return on their investments (ROI) while embedded researchers focus on obtaining research funding (R01). Recommendations are targeted to three key stakeholder groups: researchers, funders, and health systems. Consensus for an ideal foundation to support optimal embedded research is one that (1) maximizes learning; (2) aligns goals across all 3 stakeholders; and (3) implements EBIs in a consistent and timely fashion. CONCLUSIONS: Four cases illustrate a variety of ways that embedded research can be structured and conducted within systems, by demonstrating key embedded research values to enable collaborations with academic affiliates to generate actionable knowledge and meaningfully accelerate implementation of EBIs to benefit patients. IMPLICATIONS: Embedded research approaches have potential for transforming health systems and impacting patient health. Accelerating embedded research should be a focused priority for funding agencies to maximize a collective return on investment. Published by Elsevier Inc.
BACKGROUND: Traditional research approaches do not promote timely implementation of evidence-based innovations (EBIs) to benefit patients. Embedding research within health systems can accelerate EBI implementation by blending rigorous methods with practical considerations in real-world settings. A state-of-the-art (SOTA) conference was convened in February 2019 with five workgroups that addressed five facets of embedded research and its potential to impact healthcare. This article reports on results from the workgroup focused on how embedded research programs can be implemented into heath systems for greatest impact. METHODS: Based on a pre-conference survey, participants indicating interest in accelerating implementation were invited to participate in the SOTA workgroup. Workgroup participants (N = 26) developed recommendations using consensus-building methods. Ideas were grouped by thematic clusters and voted on to identify top recommendations. A summary was presented to the full SOTA membership. Following the conference, the workgroup facilitators (LJD, CDH, NR) summarized workgroup findings, member-checked with workgroup members, and were used to develop recommendations. RESULTS: The workgroup developed 12 recommendations to optimize impact of embedded researchers within health systems. The group highlighted the tension between "ROI vs. R01" goals-where health systems focus on achieving return on their investments (ROI) while embedded researchers focus on obtaining research funding (R01). Recommendations are targeted to three key stakeholder groups: researchers, funders, and health systems. Consensus for an ideal foundation to support optimal embedded research is one that (1) maximizes learning; (2) aligns goals across all 3 stakeholders; and (3) implements EBIs in a consistent and timely fashion. CONCLUSIONS: Four cases illustrate a variety of ways that embedded research can be structured and conducted within systems, by demonstrating key embedded research values to enable collaborations with academic affiliates to generate actionable knowledge and meaningfully accelerate implementation of EBIs to benefit patients. IMPLICATIONS: Embedded research approaches have potential for transforming health systems and impacting patient health. Accelerating embedded research should be a focused priority for funding agencies to maximize a collective return on investment. Published by Elsevier Inc.
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