A NATIONAL ACADEMY OF MEDICINE SPECIAL PUBLICATION THE FUTURE OF HEALTH SERVICES RESEARCH Advancing Health Systems Research and Practice in the United States Danielle Whicher, Kristin Rosengren, Sameer Siddiqi, Lisa Simpson, Editors WASHINGTON, DC NAM.EDU NATIONAL ACADEMY OF MEDICINE • 500 FIFTH STREET, NW • WASHINGTON, DC 20001 NOTICE: This publication has undergone peer review according to procedures established by the National Academy of Medicine (NAM). Publication by the NAM signifies that it is the product of a carefully considered process and is a contribution worthy of public attention, but it does not constitute endorsement of conclusions and recommendations by the NAM. The views presented in this publication are those of individual contributors and do not represent formal consensus positions of the authors’ organizations; the NAM; or the National Academies of Sciences, Engineering, and Medicine. Support for this publication was provided by AcademyHealth, American Association of Colleges of Nursing, American Board of Family Medicine, American Society of Anesthesiologists, Association of American Medical Colleges, and the Federation of American Hospitals. Support for this publication was also provided in part by the Robert Wood Johnson Foundation. The views expressed here do not necessarily reflect the views of the Foundation. Library of Congress Cataloging-in-Publication Data Names: Building the Evidence Base for Improving Health Care: Contributions, Opportunities, and Priorities (Workshop) (2018 : Washington, D.C.), author. | Whicher, Danielle, editor. | Rosengren, Kristin, editor. | Siddiqi, Sameer, editor. | Simpson, Lisa (Of AcademyHealth), editor. Title: The future of health services research : advancing health systems research and prac- tice in the United States / Danielle Whicher, Kristin Rosengren, Sameer Siddiqi, Lisa Simpson, editors. Description: Washington, DC : National Academy of Medicine, [2018] | At head of title: A National Academy of Medicine special publication. | Includes bibliographical references. Identifiers: LCCN 2018048491 (print) | LCCN 2018049191 (ebook) | ISBN 9781947103153 (E-book) | ISBN 9781947103146 (pbk. : alk. paper) Subjects: | MESH: Health Services Research--methods | Health Services Research--trends | Research Design | Health Policy | United States | Congresses Classification: LCC RA440.85 (ebook) | LCC RA440.85 (print) | NLM W 84.3 | DDC 362.1072--dc23 LC record available at https://lccn.loc.gov/2018048491 Copyright 2018 by the National Academy of Sciences. All rights reserved. Printed in the United States of America. Suggested citation: Whicher, D., Rosengren, K., Siddiqi, S., Simpson, L., editors. 2018. The Future of Health Services Research: Advancing Health Systems Research and Practice in the United States. Washington, DC: National Academy of Medicine. “Knowing is not enough; we must apply. Willing is not enough; we must do.” —GOETHE LEADERSHIP INNOVATION I M PAC T for a healthier future ABOUT THE NATIONAL ACADEMY OF MEDICINE The National Academy of Medicine is one of three Academies constituting the National Academies of Sciences, Engineering, and Medicine (the National Academies). The National Academies provide independent, objective analysis and advice to the nation and conduct other activities to solve complex problems and inform public policy decisions. The National Academies also encourage education and research, recognize outstanding contributions to knowledge, and increase public understanding in matters of science, engineering, and medicine. The National Academy of Sciences was established in 1863 by an Act of Congress, signed by President Lincoln, as a private, nongovernmental institu- tion to advise the nation on issues related to science and technology. Members are elected by their peers for outstanding contributions to research. Dr. Marcia McNutt is president. The National Academy of Engineering was established in 1964 under the charter of the National Academy of Sciences to bring the practices of engineer- ing to advising the nation. Members are elected by their peers for extraordinary contributions to engineering. Dr. C. D. Mote, Jr., is president. The National Academy of Medicine (formerly the Institute of Medicine) was established in 1970 under the charter of the National Academy of Sciences to advise the nation on issues of health, health care, and biomedical science and technology. Members are elected by their peers for distinguished contributions to medicine and health. Dr. Victor J. Dzau is president. Learn more about the National Academy of Medicine at NAM.edu. v PLANNING COMMITTEE ON BUILDING THE EVIDENCE BASE FOR IMPROVING HEALTH CARE ANDREW BINDMAN, University of California San Francisco CAROLYN CLANCY, US Department of Veterans Affairs ELLIE DEHONEY, Research!America ADAEZE ENEKWECHI, McDermott+Consulting LEE FLEISHER, University of Pennsylvania SHERRY GLIED, New York University ATUL GROVER, Association of American Medical Colleges SANDRA R. HERNÁNDEZ, California Health Care Foundation CHARLES N. KAHN III, Federation of American Hospitals GOPAL KHANNA, Agency for Healthcare Research and Quality SUZANNE MIYAMOTO, American Association of Colleges of Nursing ROBERT PHILLIPS, American Board of Family Medicine ALONZO PLOUGH, Robert Wood Johnson Foundation JOE V. SELBY, Patient Centered Outcomes Research Institute LISA SIMPSON, AcademyHealth NAM Staff Development of this publication was facilitated by contributions of the follow- ing NAM staff, under the guidance of J. Michael McGinnis, NAM Leonard D. Schaeffer Executive Officer and Executive Director of the Leadership Consortium for a Value & Science-Driven Health System: DANIELLE WHICHER, Senior Program Officer MICHELLE JOHNSTON-FLEECE, Senior Program Officer (until September 2018) HENRIETTA OSEI-ANTO, Senior Program Officer SAMEER SIDDIQI, Technical Consultant GWENDOLYN HUGHES, Senior Program Assistant (until July 2018) JENNA OGILVIE, Communications Officer vii viii | The Future of Health Services Research AcademyHealth Staff LISA SIMPSON, President and CEO KRISTIN ROSENGREN, Vice President, Strategic Communications Consultant STEVE OLSON, Science Writer and Rapporteur REVIEWERS This publication was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with review proce- dures established by the NAM. We wish to thank the following individuals for their review of this publication: ALEXANDER OMMAYA, Association of American Medical Colleges ELEANOR M. PERFETTO, National Health Council MEREDITH ROSENTHAL, Harvard T.H. Chan School of Public Health Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the content of the publication, nor did they see the final draft before it was published. Review of this publi- cation was overseen by Danielle Whicher, Senior Program Officer, NAM and J. Michael McGinnis, Leonard D. Schaeffer Executive Officer, NAM. Responsibility for the final content of this publication rests entirely with the editors and the NAM. ix FOREWORD t is evident in multiple dimensions that health and health care in the United IStates is in a period of unprecedented opportunity, accompanied by very imposing challenges. The promises are clear. The biomedical and social sciences are providing new fundamental insights on sources and courses of disease and infirmity, along with new strategies for prevention, diagnosis, and treatment. Mapping the human genome has opened the door to better targeting of indi- vidual and public health interventions. Engineering technologies applicable from the nano- to macro- scale hold prospects for restructuring health and safety as integral products of our physical and biologic environments. Diagnostic and therapeutic interventions previously developed for delivery in sophisticated medical centers now have variations in development for delivery and use in remote settings. Data gathered with greater convenience to patients and families and delivered securely to a skilled site for interpretation and application offer prospects for both accelerated access to effectively tailored interventions and for continuous learning and improvement facilitated by artificial intelligence and machine learning. Advances of these sorts have yielded real gains for Americans: saving lives, extending life spans, and introducing progress against many chronic conditions, infectious diseases, and injuries. Similarly, meaningful contributions have been made to cost sharing, quality improvement, payment models, and patient safety. Yet significant unmet challenges remain, and some of them are worsening. Health care costs in the United States still rank highest in the world, well above the next most expensive delivery system, now approaching 18% of the US Gross Domestic Product. Despite the magnitude of national spend- ing, unacceptable disparities still exist in the health experiences of different population groups, and, for certain groups, those disparities are increasing to the point that life spans are actually decreasing. These persistent disparities are in part the product of lifelong inequities experienced by some groups, and in part the product of a longstanding divide between the delivery of health services and the access to social services—such as food, housing, and transportation—needed particularly in the context of the health risks in play. xi xii | The Future of Health Services Research Our payment systems remain substantially focused on rewarding service