The NIH Pragmatic Trials Collaboratory Heath Care Systems Interactions Core supports and facilitates productive collaboration between researchers, clinicians, and health system leaders to conduct effective, relevant embedded pragmatic clinical research.
Health Care Systems Interactions Core Co-Chairs Dr. Eric B. Larson and Dr. Gregory Simon discussed the Core’s progress over the last 10 years in an interview at the NIH Pragmatic Trials Collaboratory Steering Committee meeting in April.
Over the last 10 years, the Health Care Systems Interactions (HCS) Core has allowed researchers to learn about working with healthcare delivery systems. Knowledge that is now common, was unknown when the Core was started, such as how dynamic healthcare delivery systems are and how the capabilities of and changes to the electronic health record can impact pragmatic clinical trials.
Through this type of discovery, the HCS Core has helped researchers become more sensitive to and aware of the priorities of healthcare delivery systems, resulting in better collaboration.
“The researchers’ priorities are usually not the same as the priorities of the people we are working with, whether they are patients, providers, or delivery systems. You have to know what other people’s purpose and drivers are and find a way to adapt,” said Larson. “We have learned and taken pretty seriously this idea of a learning health system with bidirectional engagement from research and from elements of the delivery system.”
The work of the HCS Core and NIH Pragmatic Trials Collaboratory has created a safe haven where researchers can share experiences and advance the field with common learning.
Simon sees the HCS Core as having internal and external missions. The internal mission is to support NIH Collaboratory Trials and be a community where researchers can come together, share their trials and tribulations, and experts in the Core can help these projects be successful, he described.
The external mission is focused on generalizable knowledge and advocacy. The HCS Core has shared knowledge with the research community and funders through publications and meetings and is advocating for research that includes the healthcare delivery system perspective.
“The discussion we are having is not just how do I work with healthcare systems to do my research, but how do I engage with healthcare systems about what research we should be doing, what are the right questions we should be asking for the studies that will be happening 5 years from now not the studies that are already underway,” Simon said.
Another lesson the HCS Core has learned is the importance of being flexible and adjusting. This lesson has been particularly relevant during the COVID-19 pandemic.
“COVID-19 is an extreme case of health system overwhelm, but I think we need to recognize that if we are going to serve people that have been traditionally not been well-served by the healthcare system, we will often be dealing with health systems that are chronically overwhelmed,” said Simon. “How do we do research in those settings? There are some really interesting challenges to think about.”
The HCS Core is focused on continued engagement between researchers and healthcare delivery systems that results in implementable new knowledge.
“My belief is that if we have the upstream involvement and are engaged in research projects that matter to the delivery system from the patients all the way up to the executives, we have a much better chance that when a result is valuable it becomes implementable and spreads to benefit everybody,” Larson said.
View the full interview.
See the complete materials from the 2022 Steering Committee meeting.