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Demand-driven research yields greater benefits
Push toward practical uses
Current health care research and service development all too often misses the target, according to presenters during the "Translating Research Into Practice: Advancing Excellence from Discovery to Delivery," conference held in Washington, DC, in July.
Sponsored by the Agency for Healthcare Research and Quality (AHRQ; Rockville, MD), the event brings together clinicians, researchers and business leaders to focus on more efficient and productive ways to deliver health care and related services to the end-user patient, which is the backbone of the agency’s Translating Research Into Practice (TRIP) program.
"We have done our best to turn this [traditional research methods] on its head and create demand-driven types of research," said Cynthia Palmer, program officer of AHRQ’s Integrated Delivery System Research Network, told conference participants. "We need to get away from helping other researchers do more research and help the decision makers and the end users that are out there looking for the solutions."
She said the move from purely academic types of research to more practical applied approaches is a shift in mindset for many, but it must happen because current research efforts often take too much time to reach the benefit of patient care.
"By focusing on topics that are actionable," Palmer said, "we are fostering research that builds the collaboration and a dialog between the people that produce the findings and the people that we hope to use the findings."
The way to build what Palmer and others at the conference called "demand-driven research," is to begin creating collaborations and dialog with decision makers and researchers. This helps both sides by revealing expectations and creating understanding.
"If you define evidence as decision makers do, they are more inclined to understand and use that information," she explained.
"What is really needed across the country are targeted tools that inform decision making to guide rational resource allocation," said Lucy Savitz, PhD, senior health services researcher for RTI International based in Research Triangle Park, NC.
Savitz said practice change is best accomplished through knowledge utilization. She explained that research is not a one-way flow of communication but rather that there is a bidirectional flow of shared learning between research and practice — or there should be.
When this doesn’t happen, research results don’t translate to practice and you get under-used vehicles. That was the term used to describe electronic medical records and clinical reminder systems in one of the TRIP breakout sessions.
"In 1977, we completed a study that said that the electronic medical record would be in wide-spread use in 15 years, and that statement is as true today as it was 20 years ago," said Peter Goldschmidt, president of Bethesda, MD-based World Development Group, a health care business development and consulting company specializing in quality management and decision support technology. He previously served as director of the Health Services Research and Development Service of the Department of Veterans Affairs.
"In all seriousness, the electronic medical record has enormous potential to improve the quality of care," he said.
One of the electronic technologies being used and discussed at TRIP sessions is Microsoft Windows-based Logician software from GE Medical Systems, based in Waukesha, WI, used to help with a tobacco cessation program in a primary care setting. The software allowed researchers to track patients through primary care clinics to help physicians with identifying and targeting patients that fit the criteria for smoking cessation programs.
Research showed that this approach was more direct and had a more measurable impact on patients than traditional informational techniques.
It was specifically more measurable because the software is able to maintain a more precise record of the steps taken to flag smoking cessation patients and track them through the process via their health care record. It is intended to put physicians in greater control of the message and the plan of care. It also was cheaper than commonly used mass media or literature-based methods, according to the presentation.