Policy

Beyond the data governance issues discussed in the previous two sections, there are also implications of this changing landscape for those in a position to help define research priorities, including HSR funders, journals, and professional associations such as AcademyHealth. Themes that emerged from the papers and the Summit deliberations point to the importance of investing in the development of new definitions and measurements in emerging research areas, greater support for implementation research, and incentives to form partnerships between academic researchers and delivery systems to design and analyze data that are generated as a by-product of care.

Iezzoni’s paper brings attention to the measurement challenges associated with the growing prevalence of multiple chronic conditions and disabilities. She describes nascent developments in this area, including the advantages of adopting the ICD-10-CM in 2013 and the contributions of the International Classification of Functioning, Disability and Health. These instruments are key to being able to develop performance measures that take into account this large population, as well as the ability to study the effects of multiple chronic conditions and disabilities on therapeutic effectiveness and the development of appropriate treatment options for this special population. She goes on to suggest, however, that significant incentives and training will be required before these instruments can be programmed into electronic medical records and leveraged for research.

Bilheimer, Keepel, and Klein also focus on the need for better measures and definitions in the area of disparities research. They propose a series of definitions relating to equity, equality, disparities, and burden of disease that they believe could help to clarify measurement challenges. Similarly, Goeschel and Provonost make the case for investing in measurement development in the area of patient safety research.

In their paper on value-based purchasing, McHugh and Joshi explore the critical role of implementation research, that is, research that assesses the process of applying research-based knowledge to policy and practice stress. While academic researchers bear some responsibility for the sparse attention given to this type of research, Summit participants agreed that federal agencies that support HSR, as well as the journals that publish HSR, could play a more active leadership role in expanding the concept of HSR to actively embrace these types of evaluations.