In June, the Agency for Healthcare Quality and Research’s (AHRQ) National Advisory Council (NAC) met to discuss and identify the most important questions the agency should address in order to promote improvements in the quality, outcomes, and cost-effectiveness of clinical practice. This blog summarizes remarks shared by AcademyHealth’s President and CEO, Aaron Carroll, at the latest NAC meeting on his vision for the future of health services research. These remarks, which have been edited for length and clarity, outline key priorities for health services research that NAC can consider in its recommendations to AHRQ.
Innovation in Methods and Messaging
The future of health services research (HSR) rests on a commitment to innovative methods and action-oriented health system reform. Health services research does an excellent job of conducting observational research but does not focus as much on interventional research as it could. Said another way, the health services research field is very good at pointing out problems with our health system, but is less adept at proposing and implementing solutions. Improving HSR methods can improve our ability to disseminate evidence that leads to impact.
Drawing on lessons from the science communication field, health services researchers also need to better and more meaningfully communicate research outputs. We need to explain clearly what health services research is and how it can be used to improve health and health care for all. By only pointing out how bad the health care system is, we make it difficult to convey the importance and necessity of health services research. One goal for the future of HSR is to train professionals in the field to better articulate the impact of this work. Research findings have limited potential to improve health if they cannot be translated into the real world.
Diversity, Equity and Inclusion in the Health Services Research Workforce
A second area I urge everyone to continue to focus on is operationalizing what it means to advance diversity, equity and inclusion in health services research. There is no shortage of evidence on the continued gaps and challenges in diversity and equity of health care; we publish research all the time on these observations. Again, observational data is needed but we also need to increase focus on how to close these disparities. One area of focus is developing partnerships with historically black colleges and universities (HBCUs) and minority-serving institutions (MSIs).
Structural racism in the grant-making process drives inequitable resource distribution across universities and academic institutions. HBCUs and MSIs universities do not often have the large endowments, massive research capacity, or robust grant writing infrastructure that larger universities have, and which makes it easier for the larger institutions to obtain funding. Faculty at HBCUs and MSIs often have heavier teaching loads, which limits bandwidth and makes it harder to compete for time-sensitive request for proposals (RFPs).
But HBCUs and MSIs also provide incredible advantages that are equally important to focus on, especially as we think about how to equitably improve health services research. These universities have unparalleled expertise and are at the forefront of identifying solutions to make the health system more diverse, equitable, and inclusive. Leaders at these institutions equip their scholars with skills in resilience and persistence. HBCUs and MSIs also often have trusted relationships with local communities, which are essential for community‐based participatory research. Community partnerships are essential for HSR implementation because with better relationships with communities it is easier to implement effective interventions and make actual improvements in the health care system. Because of their community-partnerships and trusted relationships, HBCUs and MSIs are often more equipped to work in under-resourced environments. As we work to curb health care spending, it will be beneficial to learn how we can make more with less.
Finally, it is important to expand mentoring and training opportunities and get new voices involved in health services research. That could include creating new funding areas focused on transdisciplinary HSR topics, establishing new early career fellowships and programs to capture a more diverse workforce, expanding networking opportunities in partnership with HBCUs and MSIs, and broadening these networks beyond academia. Really phenomenal research is happening outside of the academic environment, and it is important to bring those perspectives into the HSR community.
Incentivizing Community and Patient Partnerships
We know there is value in creating community partnerships relevant and responsive to research. In 2004, one of AHRQ's evidence‐based policy centers published one of the first systematic reviews on community‐based participated research (CBPR). The Agency has done significant work in continuing and fostering that in the last twenty years. Although health services researchers all over the country continue CBPR work, it often does not fit into the usual National Institutes of Health (NIH) funding mechanisms. In a standard NIH R01 independent investigator grant, it is very hard to conduct community‐based participatory research. Successful CBPR requires unique skills and competencies not requisite in traditional research, therefore these projects need a different set of evaluation criteria.
Additionally, community perspectives should be incorporated in the grant review process to inform funding decisions. Good CBPR requires legitimate partnerships with power and budget sharing, which is hard to do in the traditional grant-making process. Often study sections do not understand or value the importance of involving community-based organizations. In recent years, AcademyHealth has focused more on challenges in the grant-making process. Our Community Research for Health Equity (CRHE) program supports community‐led research projects and requires that community‐based organizations be either principal investigators (PIs) or an equal co‐PI. Of 10 awarded grants six have gone to community‐based organizations and we assess each of those partnerships for equity.
A lot of these projects are still underway, but our preliminary results show that the grantees report many strengths and few challenges. We have also seen more examples of patient-driven research organizations and advocates serving as PIs or co-PIs and advocacy organizations serving as prime awardees. These examples highlight some of the ways we can translate efficacy into effectiveness. If we involve community‐based organizations, who actually do the work, through all the steps of research, it is much more likely that that research gets used sooner and more effectively. Given how long it takes to translate findings into actual health care interventions, this can only be seen as a positive.
The remainder of Aaron’s remarks will appear in part two of this blog series.