In a recent commentary about enhancing the role of research in health care systems, authors summarized the differences and commonalities of researchers and health care system leaders.
“Leaders of health care organizations and health services researchers too often occupy different worlds, with different cultures, different economies, and a different sense of time. They are united, however, by the need to solve a persistent problem: there isn't enough good research to answer health systems' most pressing problems.”
Health systems’ problems and perspectives were featured at last month’s Annual Research Meeting (ARM) with panels focusing on quality improvement, social determinants, and lessons from COVID-19 as well as presentations on learning health systems. Themes emerged from across health system-related presentations included a focus on equity, the impact of new data sources on decision making and needs to advance the workforce.
Equity Key to Quality Care
Across presentations, speakers agreed that health systems have not made enough progress in eliminating health disparities or providing equitable care.
Mark Smith of the University of California San Francisco noted that while “equitable” is one of the six domains of health care quality, it is not well understood.
“Equitable is least often understood, measured, reported or acted on,” he said during a plenary session on the Quality Chasm Report. “There’s been a renewed focus on equity in the last year and the focus is framed as a social justice issue, but a commitment to equity should not have to depend on a consensus to my understanding of social justice or yours. It should be based on a professional commitment to high quality care.”
Speakers agreed that health equity requires a multipronged and multi-sectoral approach to addressing social determinants of health (SDOH). One breakout session explored the various components of social needs including upstream factors that affect health. Panelists also discussed place-based SDOH assessments and tools as critical aspects to advancing health equity.
In a session on learning health systems, Amy Kilbourne of the U.S. Department of Veterans Affairs agreed that innovation is needed to make progress on equity.
“Innovation and implementation are key tools in addressing health disparities. You can find plenty of studies saying health care inequities exist, but there’s less second-generation work, which is understanding the reasons for those health disparities,” she said. “What we really need is to develop interventions and implementation strategies to reduce or eliminate disparities.”
New Data Sources Support New Opportunities for Improvement
Several discussions across the conference centered on opportunities for health systems to leverage new data sources for better care. In a plenary session on key insights from health services research during the pandemic, panelists highlighted real-world data sources such as routine hospital or doctor visits, patient registries and surveys, claims reports, prescription data, and connected devices.
“We need to pivot fast to new streams of data to draw insights into things we care about in ways we might not have been accustomed to,” plenary panelist Kosali Simon of Indiana University said.
Daniel Dawes of Satcher Health Leadership Institute, Morehouse School of Medicine, agreed and highlighted a need to address gaps in data to improve health equity. He presented the Health Equity Tracker created in 2020 to aggregate up-to-date demographic data from the hardest-hit communities during the pandemic. Dawes noted that the Centers for Disease Control and Prevention dataset only reports 65 percent of COVID-19 cases and race/ethnicity data availability is highly variable across different states, even after a year of collecting data.
Plenary panelist Harlan Krumholz of the Yale School of Medicine agreed that while new data sources are exciting, there is work to do to leverage them effectively.
“What really amazed me was that we couldn’t bring together a large number of health systems in this country to share data, to learn quickly, to be able to provide insights in any sort of coherent way,” he said about the pandemic. “This (COVID) exposed the kind of system we have set up that’s really good at telling people what happened three or five years ago, but isn’t real good about telling us what’s happening today, yesterday and last week.”
Collaboration is Needed Across the Workforce
When it comes to linking research and operational innovations, collaboration across distinct departments is key.
“The challenge is to simultaneously take advantage of the unique perspectives and skill sets of both science and practice, but at the same time find opportunities for overlap and collaboration so that the impact of each can be greater than the sum of its parts,” said George L. Jackson, Durham VA Health Care System.
In a session on learning health systems, he highlighted how the VA is doing this through the Veterans Health Administration Innovation Ecosystem which:
- Imbeds innovation as a core fabric at VHA;
- Delivers repeatable process for scaling innovation;
- Engages external partners to develop solutions for strategic priorities; and
- Fosters collaboration at select, local VA medical centers.
In a session on addressing social determinants of health (SDOH) in the health care system, Brandy Kelly Pryor noted that the field is shifting to move beyond a focus on clinical settings.
“People operate within systems and clinicians are often trained to operate within their specific system of health care. We know the field is widening and those clinicians are needing to grapple with health care happening outside the walls of those spaces in which clinicians operate,” she said.
Experts across the conference agreed that our ability to achieve stronger integration both within and across the health sector will position us to make progress on seemingly intractable issues related to equity, quality, and cost. We also might position ourselves to fair much better when the next pandemic comes along.