Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.
University of Michigan Medical School, Ann Arbor, MI, USA.
J Gen Intern Med. 2023 Jul;38(Suppl 3):923-930. doi: 10.1007/s11606-023-08115-5. Epub 2023 Jun 20.
BACKGROUND/OBJECTIVE: The Veterans Health Administration (VHA) has prioritized timely access to care and has invested substantially in research aimed at optimizing veteran access. However, implementing research into practice remains challenging. Here, we assessed the implementation status of recent VHA access-related research projects and explored factors associated with successful implementation.
We conducted a portfolio review of recent VHA-funded or supported projects (1/2015-7/2020) focused on healthcare access ("Access Portfolio"). We then identified projects with implementable research deliverables by excluding those that (1) were non-research/operational projects; (2) were only recently completed (i.e., completed on or after 1/1/2020, meaning that they were unlikely to have had time to be implemented); and (3) did not propose an implementable deliverable. An electronic survey assessed each project's implementation status and elicited barriers/facilitators to implementing deliverables. Results were analyzed using novel Coincidence Analysis (CNA) methods.
PARTICIPANTS/KEY RESULTS: Among 286 Access Portfolio projects, 36 projects led by 32 investigators across 20 VHA facilities were included. Twenty-nine respondents completed the survey for 32 projects (response rate = 88.9%). Twenty-eight percent of projects reported fully implementing project deliverables, 34% reported partially implementing deliverables, and 37% reported not implementing any deliverables (i.e., resulting tool/intervention not implemented into practice). Of 14 possible barriers/facilitators assessed in the survey, two were identified through CNA as "difference-makers" to partial or full implementation of project deliverables: (1) engagement with national VHA operational leadership; (2) support and commitment from local site operational leadership.
These findings empirically highlight the importance of operational leadership engagement for successful implementation of research deliverables. Efforts to strengthen communication and engagement between the research community and VHA local/national operational leaders should be expanded to ensure VHA's investment in research leads to meaningful improvements in veterans' care. The Veterans Health Administration (VHA) has prioritized timely access to care and has invested substantially in research aimed at optimizing veteran access. However, implementing research findings into clinical practice remains challenging, both within and outside VHA. Here, we assessed the implementation status of recent VHA access-related research projects and explored factors associated with successful implementation. Only two factors were identified as "difference-makers" to adoption of project findings into practice: (1) engagement with national VHA leadership or (2) support and commitment from local site leadership. These findings highlight the importance of leadership engagement for successful implementation of research findings. Efforts to strengthen communication and engagement between the research community and VHA local/national leaders should be expanded to ensure VHA's investment in research leads to meaningful improvements in veterans' care.
背景/目的：退伍军人事务部（VHA）优先考虑及时获得医疗服务，并投入大量资金进行研究，旨在优化退伍军人的就医机会。然而，将研究成果付诸实践仍然具有挑战性。在这里，我们评估了最近与 VHA 获得医疗服务相关的研究项目的实施情况，并探讨了与成功实施相关的因素。
我们对最近的 VHA 资助或支持的项目（2015 年 1 月至 2020 年 7 月）进行了投资组合审查，这些项目侧重于医疗服务的可及性（“可及性投资组合”）。然后，我们通过排除以下项目来确定具有可实施研究成果的项目：（1）非研究/运营项目；（2）最近才完成（即，在 2020 年 1 月 1 日或之后完成，这意味着它们不太可能有时间实施）；（3）未提出可实施的成果。一项电子调查评估了每个项目的实施情况，并征集了实施成果的障碍/促进因素。使用新颖的一致性分析（CNA）方法对结果进行了分析。
参与者/主要结果：在 286 个可及性投资组合项目中，有 286 个项目由 20 个 VHA 设施的 32 名研究人员牵头，共纳入 36 个项目。29 名调查对象完成了 32 个项目的调查（应答率为 88.9%）。28%的项目报告已完全实施项目成果，34%的项目报告部分实施了成果，37%的项目报告未实施任何成果（即，未将相关工具/干预措施实施到实践中）。在调查中评估的 14 个可能的障碍/促进因素中，有两个通过 CNA 被确定为“促成因素”，可促进项目成果的部分或全部实施：（1）与国家 VHA 运营领导层的互动；（2）来自当地站点运营领导层的支持和承诺。
这些发现从实证角度强调了运营领导层参与对于成功实施研究成果的重要性。应扩大努力，加强研究界与 VHA 当地/国家运营领导层之间的沟通和参与，以确保 VHA 在研究方面的投资能够为退伍军人的护理带来有意义的改善。退伍军人事务部（VHA）优先考虑及时获得医疗服务，并投入大量资金进行研究，旨在优化退伍军人的就医机会。然而，将研究发现转化为临床实践仍然具有挑战性，无论是在 VHA 内部还是外部。在这里，我们评估了最近与 VHA 获得医疗服务相关的研究项目的实施情况，并探讨了与成功实施相关的因素。只有两个因素被确定为“促成因素”，可以将项目发现纳入实践：（1）与国家 VHA 领导层的互动或（2）来自当地站点领导层的支持和承诺。这些发现强调了领导层参与对于成功实施研究发现的重要性。应扩大努力，加强研究界与 VHA 当地/国家领导层之间的沟通和参与，以确保 VHA 在研究方面的投资能够为退伍军人的护理带来有意义的改善。
