How does engagement in research benefit health services?
Readers of this blog will know that Western Alliance encourages health professionals to participate in research as a way of maintaining interest and engagement in their work. Participating in the discovery of new and useful knowledge is a valuable and stimulating experience, and developing new collaborations and skills is highly beneficial in the context of a health system that is constantly changing and increasingly technically sophisticated.
Western Alliance’s view of research engagement as positive for health professionals’ and health services’ performance is widely shared. However, it is also true that the health services sector is seriously under-researched.
Health services research needs you (or does it?)
At the recent Health Service and Policy Research Conference (Melbourne, 7–9 December 2015), Professor Sherry Glied of New York University noted that an enormous amount of health service information has not yet been analysed, and argued that the supply side of health care is grossly under-studied. She pointed out that most health care policies focus on the service provider, so research should reflect this perspective.
In contrast, most health and medical research funding schemes focus on curing or understanding specific diseases or populations.
Glied encouraged academic researchers to embed themselves in health services so that they might interact directly with health care providers, patients and funders: ‘… when you talk to these people you often realise that you have the data and methods to answer questions they are asking; you just didn’t ever realise that they were questions.’
Her advice to early career researchers was to ‘take a walk around the hospitals, talk to the clinicians and meet with consumers.’
These ideas about the potential for health professionals to partner with academic researchers and the value of doing so are logical and widely held.
But what is the evidence that the engagement of health professionals and health care service providers in research leads to better health care performance? This article briefly examines the literature on this question.
What we know about the value of engaging in research.
There is considerable evidence that engagement in research improves the quality and efficiency of health care.
In a review published in BMJ Open in 2015, Professor Annette Boaz and her colleagues examined the scientific literature to answer the question: Does research engagement (by clinicians and organisations) improve health care performance?
They defined ‘engagement in research’ as:
a deliberate set of intellectual and practical activities undertaken by healthcare staff (including conducting research and playing an active role in the whole research cycle) and organisations (including playing an active role in research networks, partnerships or collaborations and ensuring the research function is fully integrated into organisational structures).
Boaz and colleagues identified 33 relevant, peer-reviewed journal articles from 15 clinical fields, including 10 on cancer and six on cardiovascular research.
The articles report on research from nine countries (15 articles from the United States, five from Canada), and the health services represented include hospitals, drug treatment centres, primary health care centres, elder care centres and a sexual health clinic.
Twenty-eight of the 33 articles (85 per cent) associate improvements in health services performance with their participation in research. Seven of the 28 describe improvements in patient health outcomes, and 21 report improved processes of care, as described below.
What were the mechanisms of improvement?
Boaz and colleagues asserted that ‘collaborative and action research can encourage some progress along the pathway from research engagement towards improved healthcare performance’.
Specifically, they found that staff in research-active health services:
- used the infrastructure created to support clinical trials more widely, or for a longer period, to improve patient care
- engaged in two-way knowledge exchange throughout the research network, ensuring that the research remained relevant to health practitioners
- applied the processes and protocols developed in research to all patients with specific illnesses, irrespective of their involvement in clinical trials
- outperformed organisations that paid less heed to research and its outputs.
How did health outcomes and processes of care actually improve?
Some of the reviewed studies and the improvements they recorded are outlined below.
In the United Kingdom, as far back as 1978, Adler and colleagues conducted a randomised controlled trial of early discharge from hospital after treatment for inguinal hernia and varicose veins. They found a significant reduction in mean length of stay in study area hospitals over the five years covering the three-year trial, but no change in hospitals located in two non-participating, adjacent health districts.
A Melbourne-based study by Morton and colleagues (2006) investigated whether clinician involvement in research improved clinical practice at a sexual health service. They reviewed 100 cases of bacterial vaginosis (BV) treated before and immediately after a cross-sectional study of BV. Significant improvements in the use of Amsel’s diagnostic criteria for BV were detected (only in high-recruiting clinicians), and in the prevalence of treatment with metronidazole or vaginal clindamycin.
Majumdar and colleagues (2008) sought to discover whether hospitals’ participation in clinical trials was related to quality of care and outcomes for patients with high-risk, acute coronary syndrome. They compared 145 hospitals in the United States that had not enrolled patients in trials with 349 hospitals that had enrolled at least one patient (4590, or 2.6 per cent, of all eligible patients were enrolled overall).
The investigators concluded that hospitals that had participated in trials provided better care (based on higher levels of adherence to treatment guidelines), and their patients had significantly lower mortality, than patients treated at non-participating hospitals.
Rhyne and colleagues (2011) studied the short and long-term effects on clinician and patient behaviour of participation in a practice-based research network (PBRN).
Clinicians in two PBRN studies of Acanthosis nigricans (AN – a moderately common skin pigmentation disorder associated with hyperinsulinemia and therefore type II diabetes) were interviewed 3–6 months after one study and 3–5 years after the other to collect data about self-reports of behavioural change in the clinical encounter, the persistence of those changes and their likely causes.
The study showed that involvement in research inspired positive changes in clinicians’ practice. Eighty-six per cent of clinicians in the short-term samples and 79 per cent of those in the long-term samples put more – and more frequent – effort into diagnosing AN following research participation.
They examined patients’ necks for AN and diagnosed AN more often, and spent more time counselling patients with risk factors for diabetes. Sixty-eight per cent and 54 per cent, respectively, reported more frequent preventive counselling after research participation.
Clinicians agreed that the research had improved their knowledge and practice with respect to AN and its association with hyperinsulinemia and diabetes, and that this had led their patients to becoming more receptive to counselling about the risks of diabetes. The investigators concluded that PBRNs were effective vehicles for education, translation and practice change.
Research engagement in the western region.
The literature demonstrates that involvement in research improves health service performance and patient outcomes, but it also has health benefits for health professionals. Engagement in research adds interest and challenge to their everyday tasks, enhancing job satisfaction and reducing burnout and stress.
Western Alliance has an active program designed to develop and enhance the research skills of health professionals in western Victoria and promote partnerships with academic researchers.
Western Alliance is also backing several research projects that bring together leading Australian researchers and health services in western Victoria. One of these projects is described below.
Integrating alcohol and drug prevention and treatment services in western Victoria.
Communities across the western region of Victoria are partnering with experts at Deakin University in initiatives designed to reduce harmful alcohol and drug (AOD) use in the City of Warrnambool and the Shires of Moyne, Glenelg, Southern Grampians, Horsham City and Corangamite.
Harmful AOD use is a regional priority. Compared to Victoria, the western region has higher rates of alcohol-related problems, including assaults, hospitalisations and family incidents.
Professor John Toumbourou, colleagues and collaborators are developing a system enabling the monitoring of trends in AOD use among young people, as well as supply sources, sales of alcohol to underage young people, implementation of screening, early intervention and treatment services, and participation in services.
They are also conducting repeated annual surveys (and, eventually, an intervention) in consultation with primary care and AOD service staff to monitor changes in perceived community support for effective prevention, screening and early intervention services, and implementation of these interventions.
As Dr Nik Zeps and Prof Steve Webb pointed out in their recent article, ‘Embedding research in health care’, health care is – or should be – highly reliant on evidence about the quality of practices. Increasing recognition of the value of evidence is a great incentive to get involved in research that seeks to establish the value of current practices or to test new ways of delivering care.
Most importantly, as the literature demonstrates, engagement in research has many and substantial benefits for health services and their staff.