What works in research labs often takes decades to make it to doctors’ offices and hospital bedsides, where patients might experience it as “evidence based care.” There are many reasons for this slow progress. For one, most research is done in big-city academic hospitals that are unlike where most Americans receive their health care. That makes it hard to adapt what worked under near-perfect situations into real-life healthcare, which is a lot messier. Researchers are also often on their own, many steps removed from healthcare management and policy decision-making.
Such independence has its advantages, helping create an environment ripe for scientific discovery and innovation. But disconnects from the everyday world of clinicians and their patients can also reduce the meaningfulness and ultimate impact of their work. Striking the right balance and breaking down silos is essential to ensuring our research has the best possible chance of making a difference in the lives of the Veterans we serve.
Dr. Mian Li, a neurologist at the Washington, DC, Medical Center, administers a test to Gulf War Veteran Melanie Yvette Jackson. (Photo by Mitch Mirkin)
The VA Health Services Research & Development (HSR&D) program has been hard at work developing new incentives for doing partnered research. These efforts include the CREATE initiative (for “Collaborative Research to Enhance and Advance Transformation and Excellence”).
CREATEs fundamentally change the equation by making partnerships with VA leaders a requirement of the research process. Partners have to not only be actively involved, but also commit to implementing research findings into new practices and policies. Researchers, in turn, have to design clusters of projects that fit together and work synergistically to help meet high-priority challenges for Veterans and the VA healthcare system.
One of 10 such CREATEs focuses on women’s health. The Women Veterans Healthcare CREATE includes five interrelated projects:
- The first CREATE project looks at factors that contribute to women leaving VA care – is it a bad experience with a doctor? Are they not getting the services they need? Do they not perceive VA as a safe and welcoming place?
- The second project measures the comprehensiveness of care at each VA medical center and will be able to point to the features of care that improve women’s experiences and quality of care.
- The third project tests a quality-improvement approach to tailoring VA primary care to women’s needs – helping clinicians and managers integrate gender-specific care in gender-sensitive environments.
- Now that more women Veterans than ever before get primary care in VA clinics in the community instead of at big VA medical centers, the fourth project is testing a new way to deliver women’s health training and support to VA doctors at smaller clinics through computerized, video and telephone consults and education.
- Finally, the fifth project takes a closer look at what it’s like for women Veterans who use care in the community, evaluating how that care is coordinated and its quality. The initial focus is on breast cancer screening.
It is important to note the research-clinical partnerships that drive the CREATEs are not “shotgun weddings.” Rather, they are the result of years of behind-the-scenes development. The Women’s Health CREATE is a good example. VA research on women Veterans’ health and health care began over 20 years ago, often led by VA clinicians who provided care for women Veterans and designed research to help them.
A linchpin of these efforts has been the VA Women’s Health Research Network (WHRN), designed to increase inclusion of women Veterans in VA research, making sure women equitably benefit from VA’s investment in health care research. WHRN educates researchers about methods for including women, analyzing study results by gender and making it easier to recruit women through the VA Women’s Health Practice Based Research Network. The group has also overseen development of a series of journal supplements focused on women Veterans’ research, harnessing the energy of a growing group of VA investigators with interests in this area. The newest supplement just came out in Medical Care (April 2015) and includes 21 scientific papers, in addition to partner editorials that provide a national VA perspective on the research.
To further this vision for personalized, proactive, patient-driven health care for Veterans, VA will require ongoing clinical innovation, research and education. Practicing partnered research through new approaches like the CREATEs will help transform VA into a next-generation learning healthcare organization.
Dr. Elizabeth Yano is director of the VA HSR&D Center for Healthcare Innovation, Implementation & Policy and Professor of Health Policy & Management at the UCLA Fielding School of Public Health. Her research focuses on improving care for women Veterans and advancing VA’s women’s health research agenda.