Learning among Leaders: Integrating Effectiveness and Implementation Research into Clinical Care

By Mildred Solomon

What do reducing the bleeding complications of angioplasty, injuries due to shoulder dystocia in newborns, and blood glucose levels for patients with diabetes all have in common?

These diverse improvements in quality of care are three examples of successful outcomes described at a recent meeting co-sponsored by the Association of American Medical Colleges and the Institute of Medicine on February 13 at the IOM’s Keck Center in Washington, DC.

The meeting brought together approximately 60 thought leaders from medical schools and teaching hospitals across the country, who are building their institutions’ capacities in clinical effectiveness and implementation research. Participants included vice presidents for quality and safety from teaching hospitals, as well as deans and research deans from medical schools and other senior leaders. The AAMC identified participants through an extensive exploration and subsequent in-depth interviews. The goal was to identify leaders who see the importance of using research to transform health care and are actively committing financial and human resources to building this end of the research spectrum. Special efforts were made to identify academic medical centers aiming to collect data on their own patients and then design and evaluate new ways of delivering care, based on what they learn in their own institutions.

Participants described three kinds of research being undertaken on their campuses: clinical effectiveness research (discovering what works for whom, when); quality-gap diagnoses (discovering where current knowledge is not being applied in practice and why); and interventional research (designing, implementing, and evaluating interventions to close quality gaps).

Major themes of the day included the critical importance of top-level leadership and their commitment to communicating the importance of this kind of research. Participants also spoke of the need to align research and quality improvement priorities. As one person said, “There are people who know how to do this kind of research who don’t speak ‘clinician-speak.’ And there are clinicians who understand what they need, but don’t speak ‘expert-speak.’ ” Many presentations focused on how to bring experts in research design, biostatistics, and implementation science together with quality improvement leaders, who are often located in different buildings and have different priorities and incentives. Presenters also stressed the importance of building transdisciplinary teams — by tapping expertise that exists in university departments, schools of engineering, nursing, public health, and business — as well as the need to build career pathways for junior faculty who would like to do this kind of research.

The AAMC announced the formation of its new Research on Care Community (ROCC), which will provide opportunities for peer-to-peer learning among the nation’s leaders in academic medicine, who wish to build these important capacities. Interested persons can register at www.aamc.org/rocc.

For more than a decade now, there has been a vision of what the Institute of Medicine has called “learning health systems”: institutions able to collect and use data to ensure performance improvement. The quality improvement field has grown and strides have been made. However, we have not yet harnessed the full power of research to enhance quality, safety, health equity, or system efficiencies. The academic medicine leaders who gathered last week understand this imperative and should be congratulated for the actions they are taking.

—Mildred Solomon, EdD, is senior research director of implementation science at the AAMC. She can be reached at msolomon@aamc.org.

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