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Special Medical Care Supplement Features VA/HSR&D Research on Evidence Synthesis in a Learning Healthcare System


BACKGROUND:
Titled 'Evidence Synthesis in a Learning Health Care System,' this Medical Care supplement includes 14 original articles that present new insights and perspectives from HSR&D’s Evidence Synthesis Program (ESP). The ESP is dedicated to making high-quality evidence syntheses available to clinicians, managers, and policymakers as they work to improve the health and healthcare of Veterans. In this way, the ESP also helps VA function as a continuously “learning healthcare system.” Thus, this special supplement features articles that discuss optimal evidence synthesis methods and applications in a learning healthcare system; some articles target the effect in one area (i.e., mental health, primary care), while others discuss a broader, system-wide effect.

Articles in this supplement include, but are not limited to: 

  • Bauer and colleagues outline the multistage process – from evidence synthesis, to testing in a formal implementation trial, to policy impact, to scale-up and spread – by which the Collaborative Chronic Care Model (CCM) was implemented for managing mental health conditions in Veterans.
  • Christensen and colleagues conducted interviews with VA leadership to assess facilitators and barriers to using evidence synthesis products in decision-making. Factors that fostered the use of evidence included timeliness, lack of bias, and flexible approaches. Barriers included lack of information on how to translate evidence into practice, and resistance to change among stakeholders.
  • Gierisch and colleagues explore engaging patients as advisors in synthesizing the evidence, co-building the science to enhance its impact. They also outline emerging practices that other evidence synthesis programs should consider, i.e., the careful selection of stakeholders, co-developed expectations and goals, and adequate training and appropriate resources for meaningful engagement.
  • Kaboli and colleagues examine an evidence-based approach to managing access to primary care in the VA healthcare system. They also describe how VA adopted a more sophisticated vision as a learning healthcare system to address the complex and persistent issues around access that aligns science, informatics, incentives, and culture toward continuous improvement and innovation.
  • Kilbourne and colleagues describe the Research Lifecycle – developed by VA’s Office of Research and Development (ORD) – and how it leverages institutional priorities to support the translation of research discoveries to clinical applications, thereby maximizing real-world practice impact and continuous improvement in real-world healthcare.
  • Kilbourne and colleagues describe the QUERI Implementation Roadmap, which systematically guides identification, implementation, and sustainment of evidence-based practices (EBPs). QUERI (Quality Enhancement Research Initiative) was created by VA/HSR&D more than two decades ago to accelerate the adoption of EBPs, thus making QUERI a leader in the field of implementation science.

IMPLICATIONS:

  • Guest Editors, Mark Helfand, MD, MS, MPH, and Nicole Floyd, MPH, who lead the ESP, and Amy M. Kilbourne, PhD, MPH, Director of QUERI, write in their editorial: "The articles in this series demonstrate what can be accomplished when research synthesis is integrated with qualitative information from health system personnel and patients and quantitative data from health systems in the context of an overarching framework for health system learning."


Evidence Synthesis in a Learning Health Care System. Medical Care October 2019;57:S203-S293.

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What are HSR&D Publication Briefs?

HSR&D requires notification by HSR&D-funded investigators about all articles accepted for publication. These journal articles are reviewed by HSR&D and publication briefs or summaries are written for a select number of articles that are then forwarded to VHA Central Office leadership to keep them informed about important findings or information. Articles to be summarized are selected by HSR&D based on timeliness of the findings, interest of leadership, or potential impact on the organization. Publication briefs are written for only a small number of HSR&D published articles. Visit the HSR&D citations database for a complete listing of HSR&D articles and presentations.