1056 — VHA Research and Policymaking: VA ESP Efforts to Build Bridges

Floyd N, VA Portland Health System; Helfand M, VA Portland Health System; Kansagara D, VA Portland Health System; Wilt T, Minneapolis VAMC; Williams J, Durham VAMC; Shekelle PG, Los Angeles VAMC;

Objectives:
Health care policy and decision-makers need research evidence that is methodologically rigorous, applicable, and timely. Within VHA, as in other health care systems, policy makers need to respond to change and make decisions on timeframes that often outpace the ability of traditional health services research to produce timely evidence, forcing policy makers to make decisions with imperfect evidence. The VHA Evidence-based Synthesis Program (ESP) is fulfilling part of this knowledge gap through evidence briefs and systematic reviews conducted in direct partnership with VHA Program Offices. Our innovative approach to engaging clinical operational partners throughout the evidence synthesis process"”from project conception to dissemination"” has created products that are specifically tailored to improve health system decision-making and to increase the use of evidence in VHA policymaking. Examples highlight how evidence synthesis reports were scoped and the methods applied to address operational partner needs in the complex VHA system of care. We demonstrate how these collaborations have resulted in reports that answer key policy questions and provide policymakers' perspectives on use and impact of evidence.

Methods:
Provide brief overview of ESP Program, including program structure, operations-driven topic nomination process, rigorous editorial review, and comprehensive dissemination approach. Describe innovations to increase evidence utility in VHA, including approaches used to ensure high relevance, methods for developing products that meet the needs of VHA operations by providing evidence in an accessible format for a variety of audiences and meeting the time constraints of policymakers, e.g., standard systematic reviews, rapid reviews and evidence maps.

Results:
Roundtable Discussion: VHA leadership to share their experiences using evidence syntheses to shape VHA policy and practice. Focus will be on cases presented by ESP Center Directors in which there was a controversy either between stakeholders, contestation regarding level of evidence included, known challenges of implementing review findings into policy.

Implications:
Collaborations between research and operations have resulted in evdience synthesis reports that answer key policy questions and provide policymakers' perspectives on use and impact of evidence. Future directions for continued innovation include developing methods for understanding program impact; piloting the use of narratives to make evidence reviews more relevant, accessible, and transparent to veteran as well as clinician audiences; and partnering with primary researchers to validate or supplement findings of systematic reviews.

Impacts:
Our presentation describes the involvement of health care management and policy makers throughout the evidence synthesis process in order to ensure the utility of evidence synthesis for decision-making, an area not well-addressed in the current literature.