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Director's Letter: Health Services Research Must Prove Its Value Now

Health care issues facing the VA are similar to those facing the nation: dramatic increases in health care cost, health care of modest quality, wide practice variation and inequities, and overutilization. The coming health care budget squeeze and the competitive challenge resulting from expanded health care benefits for the Veteran and his/her family under the Affordable Care Act require that VA provide health care of unequaled QUALITY and VALUE. The time is now for health services researchers to unequivocally demonstrate the importance of our contributions to Veterans' health. To facilitate success, attention to six areas is required.

• Expand the Concept of the Research Team. The concepts of program/operations and patient stakeholder engagement in research, as embodied in the CREATE and COIN programs, must be extended to all research efforts.
• Speed Research. Stakeholders must be engaged at the outset of research to ensure speedy implementation of products, and experienced investigators must direct the IRB process. For critical, nearly-fundable projects, HSR&D will substitute the rapid SDR (Service Directed Research) revise-and-review approach for the semi-annual 'revise and resubmit' process.
• Ensure Focused Research Objectives. Research can no longer be undertaken simply because data is handy and the research questions 'interesting.' Projects must be undertaken within the scope of a broader vision that emphasizes generalizable principles, models, and acquisition of new knowledge that moves the field measurably forward.
• Adopt Health Care Informatics Technologies. Investigators must gain a working knowledge of VINCI's data and data sharing, applications, and computational abilities. Because informatics will be a core component of health services research, every investigator must become familiar with natural language processing (NLP) and understand the concepts and applications of 'big data.'
• Share Methodology and Outcomes Knowledge. Investigators must routinely share their research methodology (e.g., statistical code, tools) and products (e.g., data, registries) with colleagues under guidelines that respect individual efforts and intellectual property.
• Intensify Mentoring. Mentoring is the responsibility and requirement of every investigator.

Our research environment is stronger than ever. We have VA leadership support, a substantial budget, a vast health care database, a strong informatics program, outstanding investigators, the freedom to transparently study issues, and the ability to implement evidence based results. We must now demonstrate that we can contribute value to Veterans' health.