Seismic Changes in Healthcare Research Looming: Are You Ready?

Seismic Changes in Healthcare Research Looming: Are You Ready?

 

Recent signals from prominent corners of the healthcare community indicate dissatisfaction with the direction of healthcare research and big changes ahead. Dr. Gillespie and I recently posted a piece on this blog about the Transparency and Openness Promotion (TOP) guidelines and why adopting these guidelines raises the quality of healthcare research. Since then, physician leaders have published commentaries about the need for better alignment between researchers’ study objectives and their organization’s strategic priorities, and also calling for faster turnaround of reporting results. The combination of these three “pressures” could radically shift our approach to healthcare research – for the better. Let’s take a closer look, starting with perhaps the strongest catalyst – better alignment between health system strategies and researchers’ priorities.

Physician executives at Group Health Cooperative (GHC) recently wrote an essay calling on researchers to figure out how to better align research priorities with care delivery organization priorities. Why Drs. Larson and Johnson believe this is an imperative:  (a) as healthcare continues to move to value-based payment, healthcare executives and researchers must collaborate more closely, and (b) executives have difficulty deciding where and how to fund research because an organization’s strategic priorities and proposed results from researchers often are not aligned. They also call on researchers to provide specifics on how to implement innovations in response to a study’s findings.

Reducing the cycle time between completing a study and publishing results is also a topic of conversation among healthcare leaders. The GHC executives assert that by the time research is published, they’ve moved on to other challenges. In a recent New York Times op-ed, two medical thought leaders want researchers to take advantage of the speed of communication now possible with the Internet to release details of significant new findings before completing the process and formalities of publication in a peer-reviewed journal. Drs. Topol and Krumholz cite greater transparency as a reason for faster disclosure of the details of a study, which brings us back to the TOP guidelines.

Preregistration of studies with an independent registry and transparency of all major elements of high-quality research studies are TOP standards that a researcher can use to his or her advantage in this new environment. By preregistering studies and having mechanisms in place to report a study’s methods and design, materials and data as they become available the cycle time for publishing results can be shortened. This is especially true when the target media has expedited peer review and Web publishing processes, and an open access policy.    

With its focus on developing and supporting scholar-practitioners who excel in their professions, the UOPX School of Advanced Studies (SAS) is well-positioned to get ahead of these looming pressures for change in how research is conducted. We’re immersed every day in the major challenges confronting the healthcare system. As the SAS Center for Healthcare Research embarks on its next stage of growth, a commitment by its scholar-practitioners to align research with health system priorities, adopt the TOP guidelines, and rapidly disseminate study results will certainly get the attention of leaders who hold the purse strings for funding research. Just ask the physician executives named in this piece who felt compelled to articulate their unmet needs. So, as you pursue funds to conduct meaningful research and meet your publishing goals, are you prepared for these potentially transformative changes?

Comments

jjgillespie's picture | November 2, 2015 8:38 am MST

Dr. Solomon, Great commmentary.  Thank you for sharing this thoughtful post and these insights.  It would indeed be terrific for SAS to be a leader in terms of TOP standards.  Why?  Among other reasons, given our scholar-practitioner orientation, we should be particularly attuned to issues such as alignment and transparency. 

Michael R. Solomon's picture Michael R. Solomon | November 4, 2015 12:17 pm MST

Dr. Gillespie, 

I echo your assessment that SAS, with its scholar-practioner message to the health care community has laid a solid foundation to build on and differentiate itself from other academic research entities. Perhaps as the leadership of the three Health Centers for Research craft "what's next" after the hugely successful Knowledge With Boundaries, workshops, "Alignment, adherance to the TOP standards and rapid publishing of research" could be three differentiating planks for a new round of advancement of the Research Centers' growth?  

jjgillespie's picture | November 2, 2015 8:41 am MST

Michael, Transparency is kind of like Mom and apple pie: Most people like both or at least don't generally hate them.  What then do you see as the barriers to greater research transparency?  If we'd all agree that it's a good thing, where do you believe the resistance comes from?  Why?  I look forward to getting your always thoughtful comments on these questions.

Michael R. Solomon's picture Michael R. Solomon | November 4, 2015 12:29 pm MST

Dr, Gillespie,

I like the "Mom and apple pie" analogy; it's so true! In response to your question that gets right to the heart of the challenges, "what [are the] barriers to greater research transparency?" I'll start the conversation by offering three major barriers, and I am certain there are more:

1) Lack of a roadmap for researchers to follow: We now have one with the TOP standards.
2) Lack of guidance on who the "credible" agents are for collecting and maintaining the data and content for the research studies: This is a major challenge in front of us. The TOP standards call for researchers to record the study methods, design, instruments, and data with independent entities, but who do we turn to? 
3) Time and money: We all know most research studies are already under-funded. Researchers budget for the actual study work; who is going to fund the time spent on the activities associated with ensuring complete and clear transparency? 

As I noted at the top of this reply to Dr. Gillespie, there are certainly other barriers. Please join the conversation and share your thoughts on the barriers and what we need to do to achieve greater research transparency. 

 

Ruth Grendell's picture Ruth Grendell | November 2, 2015 2:34 pm MST

Thank you for the post, Dr. Solomon.  I was fortunate to hear Dr. Eric Topal speak at a meeting here, in San Diego.  I highly recommend his book,  The Creative Destruction of Medicine:  How the digital revolution will create better health care.  

Ruth Grendell

Michael R. Solomon's picture Michael R. Solomon | November 4, 2015 12:35 pm MST

Ruth,

Thank you for the recommendation. I believe all of us at the CHR could benefit from Dr. Topal's views on the future of digital medicine. This topic grabs my attention, as my focus of scholarship is health informatics. By the way, Dr. Topal is the featured speaker of a handful of TED sessions, including this one on mobilizing healthcare:

Topol, E. (2009). The wireless future of medicine. Talks | TED Partner Series. Retrieved from: http://www.ted.com/talks/eric_topol_the_wireless_future_of_medicine.html

Ruth Grendell's picture Ruth Grendell | November 2, 2015 2:34 pm MST

Thank you for the post, Dr. Solomon.  I was fortunate to hear Dr. Eric Topal speak at a meeting here, in San Diego.  I highly recommend his book,  The Creative Destruction of Medicine:  How the digital revolution will create better health care.  

Ruth Grendell

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