The Role of VA Research in a Learning Healthcare System
The VA healthcare system provides care for more than six million Veterans annually and conducts more than $1 billion of research each year. Recent research suggests that on most measures, VA continues to provide care comparable to – or better than – the quality of private sector care; however, these same reports indicate wide variation in practices across VA medical centers, which suggests systematic issues that affect organization and management, including delays in providing care. As VA continues to address these challenges, research will help fulfill the vision of a learning healthcare system as outlined by the Institute of Medicine. As one of its core missions (along with clinical care and education), VA's research program enables investigators embedded in the VA healthcare system to conduct scientific studies on health issues uniquely affecting Veterans, while benefiting from partnerships with VA's clinical programs and academic affiliates. This overview discusses the ways in which VA research has contributed to improvements in care and health outcomes, reflects on ongoing challenges in getting new evidence taken up quickly in a diverse healthcare system, and offers suggestions about different roles for research in a learning healthcare system.
- VA has a robust history of practice-based research that can inform future research in a learning healthcare system, creating a culture of quality and innovation. VA is the only organization that conducts research specific to the unique health issues affecting Veterans, through an extensive network of partnerships and clinical investigators embedded in its facilities.
- Major VA research initiatives in mental health, homelessness, primary care, women's health, implementation science, and health information technology have impacted health care delivery.
- Lessons learned include the need for researchers to augment "big data" (large, diverse data sets) with deep data (i.e., both quantitative and qualitative) to generate more patient- and provider-centered metrics, and the value of rigorous top-down and bottom-up implementation strategies that will support the spread of effective practices and strengthen effective research and practice collaboration.
- The lessons learned in VA are increasingly relevant to other healthcare systems, as the issues confronting VA – the need to provide timely access, coordination of care, and consistent high quality across a diverse system – mirror those of the larger U.S. healthcare system.
- A robust research program can support health care systems such as VA achieve learning healthcare system goals.
This work was funded by HSR&D. Dr. Atkins is Director of HSR&D; Dr. Kilbourne is Director of VA HSR&D's Quality Enhancement Research Initiative (QUERI), and Dr. Shulkin is Secretary of Veterans Affairs – all based in Washington, DC.
Atkins D, Kilbourne A, and Shulkin D. Moving from Discovery to System-Wide Change: The Role of Research in a Learning Health Care System: Experience from Three Decades of Health Systems Research in the Veterans Health Administration. Annual Review of Public Health. March 20, 2017;38:467-487.