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Suggested Citation:"Front Matter." National Academy of Medicine. 2018. The Future of Health Services Research: Advancing Health Systems Research and Practice in the United States. Washington, DC: The National Academies Press. doi: 10.17226/27113.
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A NATIONAL ACADEMY OF MEDICINE
SPECIAL PUBLICATION

THE FUTURE OF HEALTH
SERVICES RESEARCH

ADVANCING HEALTH SYSTEMS RESEARCH
AND PRACTICE IN THE UNITED STATES

Danielle Whicher, Kristin Rosengren, Sameer Siddiqi,
Lisa Simpson, Editors

Image

WASHINGTON, DC
NAM.EDU

Suggested Citation:"Front Matter." National Academy of Medicine. 2018. The Future of Health Services Research: Advancing Health Systems Research and Practice in the United States. Washington, DC: The National Academies Press. doi: 10.17226/27113.
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NATIONAL ACADEMY OF MEDICINE • 500 FIFTH STREET, NW • WASHINGTON, DC 20001

NOTICE: This publication has undergone peer review according to procedures established by the National Academy of Medicine (NAM). Publication by the NAM signifies that it is the product of a carefully considered process and is a contribution worthy of public attention, but it does not constitute endorsement of conclusions and recommendations by the NAM. The views presented in this publication are those of individual contributors and do not represent formal consensus positions of the authors’ organizations; the NAM; or the National Academies of Sciences, Engineering, and Medicine.

Support for this publication was provided by AcademyHealth, American Association of Colleges of Nursing, American Board of Family Medicine, American Society of Anesthesiologists, Association of American Medical Colleges, and the Federation of American Hospitals. Support for this publication was also provided in part by the Robert Wood Johnson Foundation. The views expressed here do not necessarily reflect the views of the Foundation.

Library of Congress Cataloging-in-Publication Data

Names: Building the Evidence Base for Improving Health Care: Contributions, Opportunities, and Priorities (Workshop) (2018 : Washington, D.C.), author. | Whicher, Danielle, editor. | Rosengren, Kristin, editor. | Siddiqi, Sameer, editor. | Simpson, Lisa (Of AcademyHealth), editor.

Title: The future of health services research : advancing health systems research and practice in the United States / Danielle Whicher, Kristin Rosengren, Sameer Siddiqi, Lisa Simpson, editors.

Description: Washington, DC : National Academy of Medicine, [2018] | At head of title: A National Academy of Medicine special publication. | Includes bibliographical references.

Identifiers: LCCN 2018048491 (print) | LCCN 2018049191 (ebook) | ISBN 9781947103153

(E-book) | ISBN 9781947103146 (pbk. : alk. paper)

Subjects: | MESH: Health Services Research--methods | Health Services Research--trends |

Research Design | Health Policy | United States | Congresses

Classification: LCC RA440.85 (ebook) | LCC RA440.85 (print) | NLM W 84.3 | DDC 362.1072--dc23

LC record available at https://lccn.loc.gov/2018048491

Copyright 2018 by the National Academy of Sciences. All rights reserved.

Printed in the United States of America.

Suggested citation: Whicher, D., Rosengren, K., Siddiqi, S., Simpson, L., editors. 2018. The Future of Health Services Research: Advancing Health Systems Research and Practice in the United States. Washington, DC: National Academy of Medicine.

Suggested Citation:"Front Matter." National Academy of Medicine. 2018. The Future of Health Services Research: Advancing Health Systems Research and Practice in the United States. Washington, DC: The National Academies Press. doi: 10.17226/27113.
×

“Knowing is not enough; we must apply.
Willing is not enough; we must do.”

—GOETHE

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Suggested Citation:"Front Matter." National Academy of Medicine. 2018. The Future of Health Services Research: Advancing Health Systems Research and Practice in the United States. Washington, DC: The National Academies Press. doi: 10.17226/27113.
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Suggested Citation:"Front Matter." National Academy of Medicine. 2018. The Future of Health Services Research: Advancing Health Systems Research and Practice in the United States. Washington, DC: The National Academies Press. doi: 10.17226/27113.
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ABOUT THE NATIONAL ACADEMY OF MEDICINE

The National Academy of Medicine is one of three Academies constituting the National Academies of Sciences, Engineering, and Medicine (the National Academies). The National Academies provide independent, objective analysis and advice to the nation and conduct other activities to solve complex problems and inform public policy decisions. The National Academies also encourage education and research, recognize outstanding contributions to knowledge, and increase public understanding in matters of science, engineering, and medicine.

The National Academy of Sciences was established in 1863 by an Act of Congress, signed by President Lincoln, as a private, nongovernmental institution to advise the nation on issues related to science and technology. Members are elected by their peers for outstanding contributions to research. Dr. Marcia McNutt is president.

The National Academy of Engineering was established in 1964 under the charter of the National Academy of Sciences to bring the practices of engineering to advising the nation. Members are elected by their peers for extraordinary contributions to engineering. Dr. C. D. Mote, Jr., is president.

The National Academy of Medicine (formerly the Institute of Medicine) was established in 1970 under the charter of the National Academy of Sciences to advise the nation on issues of health, health care, and biomedical science and technology. Members are elected by their peers for distinguished contributions to medicine and health. Dr. Victor J. Dzau is president.

Learn more about the National Academy of Medicine at NAM.edu.

Suggested Citation:"Front Matter." National Academy of Medicine. 2018. The Future of Health Services Research: Advancing Health Systems Research and Practice in the United States. Washington, DC: The National Academies Press. doi: 10.17226/27113.
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Suggested Citation:"Front Matter." National Academy of Medicine. 2018. The Future of Health Services Research: Advancing Health Systems Research and Practice in the United States. Washington, DC: The National Academies Press. doi: 10.17226/27113.
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PLANNING COMMITTEE ON BUILDING THE EVIDENCE BASE FOR IMPROVING HEALTH CARE

NAM Staff

Development of this publication was facilitated by contributions of the following NAM staff, under the guidance of J. Michael McGinnis, NAM Leonard D. Schaeffer Executive Officer and Executive Director of the Leadership Consortium for a Value & Science-Driven Health System:

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Suggested Citation:"Front Matter." National Academy of Medicine. 2018. The Future of Health Services Research: Advancing Health Systems Research and Practice in the United States. Washington, DC: The National Academies Press. doi: 10.17226/27113.
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AcademyHealth Staff

Consultant

Suggested Citation:"Front Matter." National Academy of Medicine. 2018. The Future of Health Services Research: Advancing Health Systems Research and Practice in the United States. Washington, DC: The National Academies Press. doi: 10.17226/27113.
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REVIEWERS

This publication was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with review procedures established by the NAM. We wish to thank the following individuals for their review of this publication:

Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the content of the publication, nor did they see the final draft before it was published. Review of this publication was overseen by Danielle Whicher, Senior Program Officer, NAM and J. Michael McGinnis, Leonard D. Schaeffer Executive Officer, NAM. Responsibility for the final content of this publication rests entirely with the editors and the NAM.

Suggested Citation:"Front Matter." National Academy of Medicine. 2018. The Future of Health Services Research: Advancing Health Systems Research and Practice in the United States. Washington, DC: The National Academies Press. doi: 10.17226/27113.
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Suggested Citation:"Front Matter." National Academy of Medicine. 2018. The Future of Health Services Research: Advancing Health Systems Research and Practice in the United States. Washington, DC: The National Academies Press. doi: 10.17226/27113.
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FOREWORD

It is evident in multiple dimensions that health and health care in the United States is in a period of unprecedented opportunity, accompanied by very imposing challenges. The promises are clear. The biomedical and social sciences are providing new fundamental insights on sources and courses of disease and infirmity, along with new strategies for prevention, diagnosis, and treatment. Mapping the human genome has opened the door to better targeting of individual and public health interventions. Engineering technologies applicable from the nano- to macro- scale hold prospects for restructuring health and safety as integral products of our physical and biologic environments. Diagnostic and therapeutic interventions previously developed for delivery in sophisticated medical centers now have variations in development for delivery and use in remote settings. Data gathered with greater convenience to patients and families and delivered securely to a skilled site for interpretation and application offer prospects for both accelerated access to effectively tailored interventions and for continuous learning and improvement facilitated by artificial intelligence and machine learning. Advances of these sorts have yielded real gains for Americans: saving lives, extending life spans, and introducing progress against many chronic conditions, infectious diseases, and injuries. Similarly, meaningful contributions have been made to cost sharing, quality improvement, payment models, and patient safety.

Yet significant unmet challenges remain, and some of them are worsening. Health care costs in the United States still rank highest in the world, well above the next most expensive delivery system, now approaching 18% of the US Gross Domestic Product. Despite the magnitude of national spending, unacceptable disparities still exist in the health experiences of different population groups, and, for certain groups, those disparities are increasing to the point that life spans are actually decreasing. These persistent disparities are in part the product of lifelong inequities experienced by some groups, and in part the product of a longstanding divide between the delivery of health services and the access to social services—such as food, housing, and transportation—needed particularly in the context of the health risks in play.

Suggested Citation:"Front Matter." National Academy of Medicine. 2018. The Future of Health Services Research: Advancing Health Systems Research and Practice in the United States. Washington, DC: The National Academies Press. doi: 10.17226/27113.
×

Our payment systems remain substantially focused on rewarding service volume over value or outcomes. Further, the implications of environmental warming trends for treatment and prevention services and programs are poorly understood.

One thing is certainly clear: effective action to take full advantage of opportunities or to counter growing threats requires a timely, reliable, and continuously improving evidence base to guide decisions. Whether those decision-makers are clinicians, patients and families, executives from health care organizations, public health agencies, employers, or health payers or purchasers, they need to know what problems are in play and what works best, for whom, and under what circumstances. In the past, this has underscored the importance of health services research. Yet, ironically, at a time when the need is becoming more complex and more acute, when our realization of the importance of linking what happens inside clinic doors with what happens outside them, the support for health services research is softening. Especially needed at this time is a deepened capacity and commitment with a broader vision—one of a transformed capability for health systems research and practice embedded in health related initiatives throughout the nation.

Against this backdrop, a discussion among leaders and stakeholders in the field of health services research was convened in early 2018 by the National Academy of Medicine, with the partnership, support, and leadership of AcademyHealth, the American Association of Colleges of Nursing, the American Board of Family Medicine, the American Society of Anesthesiologists, the Association of American Medical Colleges, the Federation of American Hospitals, and the Robert Wood Johnson Foundation. It was a meeting planned by a steering group comprised of experts representing those fields, and bringing together many of the individuals and organizations that have helped to create, expand, and lead the field of health services research. Those gathered explored the broad terrain of the field, including its evolution, past accomplishments, emerging issues and tools, priorities for attention, and potential impact on health, health care, health costs, and individual and community engagement.

The discussion identified a number of priority topics, including development of more effective approaches for integrating data on social determinants with other health care data; determining which quality measures and outcomes are critical to improving patient-centered care; embedding research skills and tools in care delivery; developing models of patient and stakeholder engagement throughout the research process; understanding the impact on population health of alternative payment models, of innovative care delivery models, and of artificial intelligence in health care; building upon existing progress in patient safety and

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Suggested Citation:"Front Matter." National Academy of Medicine. 2018. The Future of Health Services Research: Advancing Health Systems Research and Practice in the United States. Washington, DC: The National Academies Press. doi: 10.17226/27113.
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errors, and exploring how to best translate health services research and scale its impact within policy settings and health systems.

In assessing the historical pattern of public and private support for health services research, and the scope, scale, structure, and function of that support, observers suggested that perhaps as important as the topics identified for priority attention are the vision and strategies for engaging key stakeholders. Specifically, success in deepening the commitment and support base for the field will be advanced by the extent to which collaborative efforts using systems perspectives help foster a culture of continuous learning, development of the data infrastructure and research teams for real-time insights, gathering and communicating the contributions in personal, societal, and economic terms, and linking those returns to stakeholder investments.

Both the National Academy of Medicine and the Commonwealth Fund are committed to helping advance, expand, and deepen progress in the research field most central to generating better guidance for progress in the nation’s health and health care. If the promise discussed here is a reliable harbinger of the prospects reported in The Future of Health Services Research: Advancing Health Systems Research and Practice in the United States, and if the requisite commitment is made to a sustained and well-networked public-private resource base for the accelerated health systems research envisioned, then the cost, quality, safety, outcome, and equity shortfalls that have for decades eluded solution, might instead see a quickening pace on the path to better health for all Americans.

J. Michael McGinnis, MD, MPP
Leonard Schaeffer Executive Officer
National Academy of Medicine
David Blumenthal, MD, MPP
President
The Commonwealth Fund
Suggested Citation:"Front Matter." National Academy of Medicine. 2018. The Future of Health Services Research: Advancing Health Systems Research and Practice in the United States. Washington, DC: The National Academies Press. doi: 10.17226/27113.
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Suggested Citation:"Front Matter." National Academy of Medicine. 2018. The Future of Health Services Research: Advancing Health Systems Research and Practice in the United States. Washington, DC: The National Academies Press. doi: 10.17226/27113.
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ACKNOWLEDGMENTS

The NAM would like to acknowledge and express its gratitude to those who participated in planning the symposium and developing this Special Publication.

First, we would like to thank the sponsors of this symposium and Special Publication: AcademyHealth, American Association of Colleges of Nursing, American Board of Family Medicine, American Society of Anesthesiologists, Association of American Medical Colleges, Federation of American Hospitals, and the Robert Wood Johnson Foundation, for their financial support. We would also like to thank members of the planning committee for their contributions in developing the symposium agenda and corresponding Special Publication.

This Special Publication was informed by presentations and discussions at a National Academy of Medicine Symposium on February 26-27, 2018, in Washington, DC, entitled Building the Evidence Base for Improving Health Care: Contributions, Opportunities, and Priorities.

A number of NAM staff played instrumental roles in coordinating the symposium and the preparing of this Special Publication, including Danielle Whicher, Michelle Johnston-Fleece, Henrietta Osei-Anto, Sameer Siddiqi, Gwendolyn Hughes, and Jenna Ogilvie. We would also like to acknowledge AcademyHealth for their participation in preparing this Special Publication, particularly Lisa Simpson and Kristin Rosengren. Additionally, we would like to thank Tammy Chang of the University of Michigan Medical School, Sean Lucan of the Albert Einstein College of Medicine, and Caroline Hagedorn of the National Institutes of Health for their insight and contributions. We would also like to thank Steve Olson for distilling key points from the symposium and assisting in the development of the manuscript. Finally, we would like to acknowledge the guidance and contributions of J. Michael McGinnis, Leonard D. Schaeffer Executive Officer and Executive Director of the Leadership Consortium for a Value & Science-Driven Health System.

Suggested Citation:"Front Matter." National Academy of Medicine. 2018. The Future of Health Services Research: Advancing Health Systems Research and Practice in the United States. Washington, DC: The National Academies Press. doi: 10.17226/27113.
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Suggested Citation:"Front Matter." National Academy of Medicine. 2018. The Future of Health Services Research: Advancing Health Systems Research and Practice in the United States. Washington, DC: The National Academies Press. doi: 10.17226/27113.
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ACRONYMS AND ABBREVIATIONS

AARP American Association of Retired Persons
AHRQ Agency for Healthcare Research and Quality
APCD All Payer Claims Databases
AQC Alternative Quality Contract
CDC United States Centers for Disease Control and Prevention
CMMI Center for Medicare & Medicaid Innovation
CMS Centers for Medicare & Medicaid Services
CPOE Computerized Provider Order Entry
DOD United States Department of Defense
EHR Electronic Health Record
FDA United States Food and Drug Administration
HCCI Health Care Cost Institute
HCUP Healthcare Cost and Utilization Project
HIPAA Health Insurance Portability and Accountability Act
HSR&D Health Services Research and Development Service
IOM Institute of Medicine (now the National Academy of Medicine)
JAMA Journal of the American Medical Association
MCPS Medicare Claims Processing System
MEPS Medical Expenditure Panel Survey
NAM National Academy of Medicine
NHLBI National Heart, Lung, and Blood Institute
NIH National Institutes of Health
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Suggested Citation:"Front Matter." National Academy of Medicine. 2018. The Future of Health Services Research: Advancing Health Systems Research and Practice in the United States. Washington, DC: The National Academies Press. doi: 10.17226/27113.
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OECD Organisation for Economic Co-operation and Development
PCORI Patient-Centered Outcomes Research Institute
PCORnet National Patient-Centered Clinical Research Network
RWJF Robert Wood Johnson Foundation
SES Socioeconomic Status
VA United States Department of Veterans Affairs
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Health services research is "the multidisciplinary field of scientific investigation that studies how social factors, financing systems, organizational structures and processes, health technologies, and personal behaviors affect access to health care and the quality and cost of health care." Since the 1960s, health services research has provided the foundation for progress, effectiveness, and value in health care. Ironically, at a time in which appreciation has never been higher for both the need and potential from health services research, the political and financial support for sustenance and growth appear to be weakening.

With funding support from AcademyHealth, the American Association of Colleges of Nursing, the American Board of Family Medicine, the American Society of Anesthesiologists, the Association of American Medical Colleges, the Federation of American Hospitals, and the Robert Wood Johnson Foundation, this National Academy of Medicine Special Publication identifies the range of issues that health services research must consider, address, and potentially overcome to transform the field to meet the needs of a 21st-century health care system. These issues are broad, multidisciplinary, and will require a coordinated effort to address—as well as dedicated and sustainable funding. Federal support for health services research has never been more critical. Now is a critical time for the field to articulate its priorities, demonstrate its utility, and transform to meet the needs of a 21st-century health care system. The physical and financial health of the nation is at stake.

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