Journal of Health Organization and Management Guidance for research-practice partnerships (R-PPs) and collaborative research John Ovretveit Susanne Hempel Jennifer L. Magnabosco Brian S. Mittman Lisa V. Rubenstein David A. Ganz
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Guidance for research-practice partnerships (R-PPs) and collaborative research John Ovretveit, Susanne Hempel, Jennifer L. Magnabosco, Brian S. Mittman, Lisa V. Rubenstein and David A. Ganz
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(Affiliations at end of article)
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Abstract Purpose – The purpose of this paper is to provide evidence based guidance to researchers and practice personnel about forming and carrying out effective research partnerships. Design/methodology/approach – A review of the literature, interviews and discussions with colleagues in both research and practice roles, and a review of the authors’ personal experiences as researchers in partnership research. Findings – Partnership research is, in some respects, a distinct “approach” to research, but there are many different versions. An analysis of research publications and of their research experience led the authors to develop a framework for planning and assessing the partnership research process, which includes defining expected outcomes for the partners, their roles, and steps in the research process. Practical implications – This review and analysis provides guidance that may reduce commonly-reported misunderstandings and help to plan more successful partnerships and projects. It also identifies future research which is needed to define more precisely the questions and purposes for which partnership research is most appropriate, and methods and designs for specific types of partnership research. Originality/value – As more research moves towards increased participation of practitioners and patients in the research process, more precise and differentiated understanding of the different partnership approaches is required, and when each is most suitable. This article describes research approaches that have the potential to reduce “the research-practice gap”. It gives evidence- and experience-based guidance for choosing and establishing a partnership research process, so as to improve partnership relationship-building and more actionable research. Keywords Knowledge sharing, Action research, Evidence-based practice, Research methods, Implementation, Research methodology Paper type General review
The authors would like to thank Roberta Shanman, Lopamudra Das, Jodi Lui, and Tanja Perry for assistance with the literature review, and Deborah Delevan for editorial assistance. The authors would also like to thank John Midolo for provision of information on QUERI partnered research evaluation centers, and Amy Kilbourne for her comments on a prior version of this manuscript. This project was funded by the US Department of Veterans Affairs, Veterans Health Administration Quality Enhancement Research Initiative through core funding to the Center for Implementation Practice and Research Support (Project # TRA 08-379). Additional support for investigator time and visiting professorship was provided from the Medical Management Center, Karolinska Institutet, Stockholm, and by a Career Development Award to David Ganz from the US Department of Veterans Affairs, Health Services Research and Development (HSR&D) Service (Project #VA CD2 08-012-1).
Journal of Health Organization and Management Vol. 28 No. 1, 2014 pp. 115-126 q Emerald Group Publishing Limited 1477-7266 DOI 10.1108/JHOM-08-2013-0164
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Introduction It often takes many years for treatments and management interventions that have been found to be more effective to be widely implemented. Interest about, and research into “closing the gap between research and practice” has grown over the last fifteen years. There are a number of explanations for the gap. Research and researchers are sometimes criticized as being “too distant” from real practice in health services (Kessler and Glasgow, 2011; van de Ven and Johnson, 2006). Some practitioners say that the findings of research do not give useful guides to action (Campbell et al., 2009). For their part, researchers point to the apparent disinterest of some practitioners in the findings of research, and to the work pressures that make it difficult for practitioners to give time to changing their practice. Sometimes, researchers also note an unwillingness or inability of practitioners to think through what a particular piece of research might mean for practice in their setting. Whether, when or how researchers should help practitioners interpret research in order to improve care is a question increasingly asked. The view that “research in, and with, practice” might be a more effective way to make better use of researchers and research in implementing or adapting research in practice settings (Green and Ottoson, 2004), has been gathering weight with research funders and government agencies. Some have called for a greater emphasis on “rapid cycle learning” and “fast cycle research” involving closer research-practice collaborations (Gold et al., 2011). Initiatives such as the USA NIH translational research program (National Institute of Health, 2007) have aimed to respond to this call for improvements in closing the research-practice gap. Partnerships between researchers and practitioners have been established with the aim of producing “more relevant” or “more actionable” research (Department of Health, 2007). Another aim of such partnerships has been to enable the implementation of research (Bosworth et al., 2010). The purpose of this article is to give an overview of different approaches to “research-practice partnerships” (R-PPs) and to give research-informed guidance for establishing and developing such partnerships. We define partnered research as “an activity where researchers and practitioners work together, with different roles, to use research both to solve practical problems and to contribute to science”. Throughout this article, the term “practitioner” is used to refer to clinicians and managers alike. The perspective on partnerships given here is based on a synthesis of the literature coupled with our own experience conducting “partnered research”, and also on interviews with individuals in both research and operations roles who have been involved in such partnerships within the US Veterans Health Administration (VA) and in one UK University and National Health Service (NHS) collaborative research program (Øvretveit et al., 2010). More details on one set of partnership research in the VA can be found at VA Health Services Research and Development (2013b). In 2008, the UK NHS started nine “Collaborations for Leadership in Applied Health Research and Care” (CLAHRCs) between University health research centers and NHS service-providing organizations and local communities. The aim is to “stimulate innovation and best practice across local health communities using two-way collaborative learning and delivery pathways” in order to link researchers with research users who include policymakers, managers, front-line clinical professionals, patients and community representatives (“local health community”). More details are given by Baker et al. (2009), Rycroft-Malone et al. (2011) and Øvretveit et al. (2010).
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With this background, our conceptualization of partnerships emphasizes relationships between researchers and practitioners for clinical research and clinical improvement, rather than for policy or population public health practice. Findings from the overview of the literature about research-practice partnerships Our review of the literature identified many different “approaches” to partnership research, which overlap both in concept and application. Broad categories of R-PPs described in the literature include: . Community based participatory research (CBPR): defined in one paper as “conducting research by equitably partnering researchers and those directly affected by and knowledgeable of the local circumstances that impact health” (Horowitz et al., 2009). . Practice-based research networks (PBRN): defined as “a group of clinicians, practices, or institutions that are devoted primarily to the delivery of patient care and are affiliated with each other in order to investigate questions related to community-based practice” (Kutner et al., 2005). . Practice-based quality improvement research (PBQIR): research by practitioners or academic researchers on changes to clinical practice or organization, where the researcher works with practitioners to collect data and sometimes to report data to enable improvement. . Action research (specifically for improving healthcare): defined as “a period of inquiry, which describes, interprets and explains social situations while executing a change intervention aimed at improvement and involvement” (Waterman et al., 2001). . Specially-created health services research-practice partnerships involving universities/academic medical centers: examples are the UK University-NHS CLAHRCs (e.g. Baker et al., 2009) or a US academic medical center community partnership (Yaggy et al., 2006). These are broad-based “umbrellas” for a range of research-practitioner studies and have tended to be university-driven and vehicles for research-into-practice “translational research”. Our review found information lacking about many practical aspects of partnerships including the nature and level of participation of practitioners in different stages of projects, and this made it difficult to assess whether the partnership was in name only or more substantive. In exploring how to define key features of a partnership approach, we assessed a range of studies which did give details. Table I gives a sample of studies showing the different ways that R-PPs can be established and run. We built on this review, our interviews and our varied experience as researchers in the UK, the USA, Europe and Australia to define criteria which differentiate more substantial partnership research and a framework to specify a particular type of partnership (Figure 1). We return to this after noting other observations from the literature review. A second finding from our overview is that investigators showed significantly different understandings of “research” and of the role of practitioners with respect to research. At least three conceptions of research could be identified in the literature: research as knowledge generation, as existing evidence, and research as referring to
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Table I. Examples of research-practice partnership “arrangements”
Nursing Engelke service and and Marshburn research (2006)
East Carolina University School of Nursing, Pitt Country Memorial Hospital
Hospital, nursing
Oklahoma Physicians Resource/ All Research Network, Colorado Research Network, Oregon Rural Practice-Based Research Network; University at Buffalo Family Medicine Research Institute and Upstate New York Practice-based Research Network
Nagykaldi Practice et al. (2006) facilitators
Primary care
Clinical area
AHRQ funded PBRN to complement a community health collaborative of safety net organizations called OCHIN and is based in the Western states of USA
Health care system/context
DeVoe et al. Practice-based (2012) research network (PBRN)
Type
Practice facilitators participate most often in externally funded research projects; clinicians may have an active role in the planning and the completion of these projects but the activities are driven mostly by the study protocols; facilitators act as research assistants, develop relationships, assist clinicians in local research and QI projects initiated by the practices, help with assessment of the practice’s needs and potential to implement interventions, and typically interact with a “champion” physician or practice leader as well as key personnel to ensure communication Collaborative research based on commitment to teamwork, reciprocity, and mutual benefit; research interests need to be aligned; two mechanisms to foster collaboration: collaborative research day (one day) and collaborative research award ($1,000)
OCHIN is a collaborative, member-based organization of federally qualified health centers and similar entities that provides a primary health care “safety net” to vulnerable populations. Using a collaborative learning organization model, OCHIN facilitates its members’ adoption of health information technology to improve patient care quality. To this end, OCHIN maintains one electronic health record (EHR) with a single master patient index linked across all clinic sites. OCHIN is recognized by the Health Resources and Services Administration as a health center-controlled network and now has more than 62 member organizations and over 200 clinics
Partnership operationalization
Commitment to provide funding and support as well as the willingness of the partners to evaluate and revise the program have been critical (continued)
Strategic factors important to the success of a PBRN: (1) shared vision and commitment to a unique patient population; (2) strong leadership, mentorship, collaboration; (3) creative approaches to engaging busy clinicians/bridging the worlds of academia and practice; (4) harnessing electronic health record data, navigating data protection, sharing, ownership Practice facilitators can be a particularly useful resource
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Study
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Rapid Learning Health System (RLHS)
Greene Group health et al. (2012)
Health care system/context University of Hawai’i Rural Health Collaboration (UHRHC)
Type
Helm et al. Health (2010) collaboration
Study
All
Mental health, psychiatric services
Clinical area
(continued)
Community engagement was critical to cultivating referral sources; integrated rather than collocated training and service delivery should be initiated; ethno-cultural and diagnostic diversity should be a top priority; there are critical considerations for research ethics when academic institutions partner with indigenous communities Hallmarks of the RLHS are the vital partnership between research and clinical operations and a shared commitment to leverage scientific knowledge and evaluation for rapid, point-of-care improvements
Established to increase rural access to behavioral health services, primarily via tele-psychiatry through partnerships with community health clinics. Direct patient care is provided either face to face or via videoteleconferencing. UHRHC uses a service-learning approach to workforce development, which allows universities to contribute to improved public health through structured trainee experiences in community settings such as federally qualified health and community health centers The Rapid Learning Health System leverages recent developments in health information technology and a growing health data infrastructure to access and apply evidence in real time, while simultaneously drawing knowledge from real-world care-delivery processes to promote innovation and health system change on the basis of rigorous research. Implementing the RLHS system involves six steps: (1) internal/external scan to identify problems and solutions; (2) designing evidence based care and evaluation; (3) implementing the plan in pilot and control setting; (4) evaluating what works or does not work; (5) adjusting evidence to influence continual improvement; and (6) dissemination of results to improve care for everyone. Model promotes bidirectional discovery and an open mind at the system level, resulting in willingness to make changes on the basis of evidence that is both scientifically sound and practice-based
Lessons learned
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Table I.
Table I.
Solberg (2006)
Kaiser Permanente (KP) Performance Improvement System’s Learning Organization
Health care system/context
HealthPartners Medical groups in Minnesota who were also part of the Minnesota Community Measurement public reporting initiative
Schilling Kaiser et al. (2011) Permanente
Type
Mental health/ primary care
All
Clinical area
Lessons learned
Six “building blocks” were identified to enable KP to make the transition to becoming a learning organization: (1) real-time sharing of meaningful performance data; (2) formal training in problem-solving methodology; (3) workforce engagement and informal knowledge sharing; (4) leadership structures, beliefs, and behaviors; (5) internal and external benchmarking; and (6) technical knowledge sharing
Creating a learning organization required a combination of topdown and bottom- up strategies. The demand for real-time meaningful performance data can conflict with prioritized changes to health information systems. It is an ongoing challenge to teach performance improvement, change management, innovation, and project management to all managers and staff without consuming too much training time. Challenges with workforce engagement include low initial use of tools intended to disseminate information through virtual social networking Describes seven factors affecting recruitment of medical While all studies will not have all of these factors in such good practices in implementation research: (1) relationship of the recruiter with the local medical alignment, attention to them may be important to other efforts to community; add to our knowledge of (2) reputation of the recruiters within the medical implementation science research/QI community; 3) requirements for research participation that do not impose too burden on busy physicians in the group; 4) rewards (not always financial) and recognition for time invested by the participants; 5) reciprocity; 6) resolution to keep trying until you reach the right person to get the job done; and (7) respect of the recruiter for the participant’s contribution, constraints, and time
Partnership operationalization
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Study
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Figure 1. Guide for defining roles and tasks in partnership research projects
researchers, i.e. professionals for whom the main job description is to conduct research (van de Ven and Johnson, 2006). Similarly, reports describe the role of practitioners in the partnership in different ways. Practitioners can be research “clients”, can facilitate research, or can do both. In our research in the VA, we are perhaps most familiar with practitioners as “customers”, who seek to use expertise from researchers to improve practice. In some instances, the partnership with practitioners was primarily established to facilitate research, for example by establishing data agreements, patient confidentiality
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arrangements, or working together to build an information technology platform to facilitate data collection (McDonald and Viehbeck, 2007). Overall, the literature characterized R-PPs mostly in terms of the objectives, function, or the main activities of the partnership (King et al., 2008; Mendel et al., 2009; Mold and Peterson, 2005). R-PPs have also been characterized in terms of the productivity of the partnerships as regards products, tools or deliverables, such as publications or grants (King et al., 2008; Gold and Taylor, 2007), or in terms of impact. For many, a dual objective is to contribute to both resolving practical problems and producing generalizable knowledge. However, there are different conceptions of how to assess the effectiveness and impact of the partnership, and these include lasting change (Waterman et al., 2001), measurable change in clinical practice (process measures, cost savings or other organizational impacts, or improvements in patients’ health), or the degree of spread (Gold and Taylor, 2007). Defining “R-PPs” Drawing on our literature review, interviews and discussions, we propose the following criteria to differentiate R-PPs from other ways of conducting research: . researchers contribute to actions taken by practitioners or community members acting on or at one or more levels of a health system; . studies are intended to produce quickly and directly actionable findings, but also to be published in peer-reviewed scientific journals; . studies involve both researchers and practitioners in defining the research questions and interpreting the findings; . studies involve a “significant” amount of time or other contributions (such as a data gathering system) from both researchers and practitioners; and . a formulated description of the partnership approach has been published, with aims and methods, and there are published empirical studies showing the approach as applied (i.e. not just a conceptual description of a possible approach without examples). A guide that we developed to help future partnership researchers and practitioners define roles at different stages of the project is given in Figure 1. The goal of this guide is to increase the likelihood of those interested creating a substantive R-PP rather than the superficial “involvement” that characterizes many collaborations. The guide has not been formally validated as a tool; it is intended to stimulate discussion among researchers and practitioners before undertaking a project, so that the parties more fully understand what is involved and agree upon roles at different stages of the venture. We are not presenting recommendations about where a partnership should be placed on this matrix, as there is insufficient evidence for this and because it may well depend on the purpose of the partnership and its objectives. Another guide we found useful is CACSH (2013). Implications for research-practice partnership programs As regards VA research or UK CLAHRCs, our overview of the literature did not reveal a partnership typology that adequately characterized or categorized the research we had reviewed or which was useful for the future. In the VA, several partnership approaches have been, or are being, used, including PBRNs (Frayne et al., 2013), practice-based quality
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improvement research (Rubenstein et al., 2010), and action research. Similarly, there are a range of collaborative research approaches used in UK CLAHRCs and elsewhere. Within the VA setting, and as part of an evaluation of the VA Quality Enhancement Research Initiative (QUERI), we are currently assessing the degree to which funded QUERI projects include “partnered work”. Based on the significant conceptual overlap in the various partnership approaches above, our strategy for completing this evaluation will be less concept-driven and more empirical, focusing on characterizing the individuals or organizational entities involved in the partnership, the partnership activities that were proposed compared to what happened, and the various outputs from the partnership. This approach may be suitable for reviewing or evaluating or other partnerships, such as the UK CLAHRCs and/or for planning their future development. Of note, King et al. (2008) provide a categorization of partnerships that could be adapted for use by QUERI and other programs. This categorization includes four partnership types: (1) In King’s “clinician-researcher skill development model”, researchers provide consultation and advice to clinicians who are interested in pursuing research projects. Although not identical to what King describes, QUERI, together with the VA Health Services Research and Development (HSR&D) service, does offer mentored career development awards for nascent clinician researchers as well as PhD-trained non-clinicians seeking careers in health services research (VA Health Services Research and Development, 2013a, c). (2) In the “clinician and researcher program evaluation model,” researchers support clinicians and managers to evaluate specific clinical services. Similarly, QUERI researchers partner with practitioners in certain VA program offices to help evaluate activities within the VA operations. These include advanced disease management, prevention of hospital-acquired pressure ulcers, and “eConsults,”, which allow primary care providers to obtain specialist input on patient management without the specialist seeing the patient face-to-face. (3) In the “researcher-led knowledge generation model”, the focus is on generating new knowledge, but in collaboration with other stakeholders, including clinicians and patients. In the VA, QUERI seeks to fund investigator-initiated interventions, conducted in collaboration with practitioners, that will generate new knowledge about effective implementation strategies. Our evaluation of QUERI will determine to what degree this has been achieved. (4) In the “knowledge conduit model,” the focus is on researchers synthesizing knowledge that can be shared with stakeholders within and outside the organization. Similarly, the HSR&D/QUERI Evidence Synthesis Program synthesizes knowledge in a useful form for practitioners (VA Health Services Research and Development, 2013b). Conclusion Our review of published reports about research-practice partnerships revealed a wide range of understandings and conceptualizations of R-PPs in healthcare. The details about the partnership arrangements were often not described, unlike the intermediate outcomes of partnerships such as scientific publications. It was possible, however, to define a distinct set of approaches with substantive collaboration, which we classify
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here as R-PPs and for which we define criteria so as to distinguish them from many that are only partnerships in name but not in substance. We found the King et al. (2008) categorization a useful starting point for defining different approaches, but this categorization did not describe a number of partnerships reported in research, or which we had observed or experienced in the VA and UK CLAHRCs. To characterize these, we find the guide which we developed and presented in Figure 1 more useful. We offer this guide for others to try when describing to others a particular type of partnership being used, or when choosing an approach. or to help to see how the partnership might be developed and to develop one type into another type of partnership. Ultimately, the impact of the partnership should be assessed, but the most appropriate approach to measurement remains to be shown. An important question for future research is for which objectives R-PPs are more effective than “conventional research” for producing actionable research, or for enabling research to be applied in practice for improvement. References Baker, R., Robertson, N., Rogers, S., Davies, M., Brunskill, N., Khunti, K., Steiner, M., Williams, M. and Sinfield, P. (2009), “The National Institute of Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for Leicestershire, Northamptonshire and Rutland (LNR): a programme protocol”, Implementation Science, Vol. 4, p. 72. Berwick, D. (1998), “Developing and testing changes in delivery of care”, Annals of Internal Medicine, Vol. 128 No. 8, pp. 651-656. Bosworth, H.B., Almirall, D., Weiner, B.J., Maciejewski, M., Kaufman, M.A., Powers, B.J., Oddone, E.Z., Lee, S.Y., Damush, T.M., Smith, V., Olsen, M.K., Anderson, D., Roumie, C.L., Rakley, S., Del Monte, P.S., Bowen, M.E., Kravetz, J.D. and Jackson, G.L. (2010), “The implementation of a translational study involving a primary care based behavioral program to improve blood pressure control: the HTN-IMPROVE study protocol (01295)”, Implementation Science, Vol. 5, p. 54. CACSH (2013), “Partnership self assessment tool”, Center for the Advancement of Collaborative Strategies in Health, available at: www.lmgforhealth.org/node/190 (accessed 6 August 2013). Campbell, D., Redman, S., Jorm, L., Cooke, M., Zwi, A. and Rychetnik, L. (2009), “Increasing the use of evidence in health policy: practice and views of policy makers and researchers”, Australia and New Zealand Health Policy, Vol. 6, p. 21. Department of Health (2007), Report of the High Level Group on Clinical Effectiveness chaired by Professor Sir John Tooke, Department of Health, London. DeVoe, J.E., Likumahuwa, S., Eiff, M.P., Nelson, C.A., Carroll, J.E., Hill, C.N., Gold, R. and Kullberg, P.A. (2012), “Lessons learned and challenges ahead: report from the OCHIN Safety Net West practice-based research network (PBRN)”, Journal of the American Board of Family Medicine, Vol. 25 No. 5, pp. 560-564. Engelke, M.K. and Marshburn, D.M. (2006), “Collaborative strategies to enhance research and evidence-based practice”, Journal of Nursing Administration, Vol. 36 No. 3, pp. 131-135. Frayne, S.M., Carney, D.V., Bastian, L., Bean-Mayberry, B., Sadler, A., Klap, R., Phibbs, C.S., Kimerling, R., Vogt, D., Yee, E.F., Lin, J.Y. and Yano, E.M. (2013), “The VA Women’s Health Practice-Based Research Network: amplifying women veterans’ voices in VA research”, Journal of General Internal Medicine, Vol. 28, Supplement 2, pp. 504-509.
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Gold, M. and Taylor, E.F. (2007), “Moving research into practice: lessons from the US Agency for Healthcare Research and Quality’s IDSRN program”, Implementation Science, Vol. 2, p. 9. Gold, M., Helms, D. and Guterman, S. (2011), Identifying, Monitoring, and Assessing Promising Innovations: Using Evaluation to Support Rapid-Cycle Change, Issue Brief, The Commonwealth Fund, Washington, DC. Green, L.W. and Ottoson, J.M. (2004), “From efficacy to effectiveness to community and back: evidence-based practice vs practice-based evidence”, From Clinical Trials to Community: The Science of Translating Diabetes and Obesity Research, National Institutes of Health, Bethesda, MD. Greene, S.M., Reid, R.J. and Larson, E.B. (2012), “Implementing the learning health system: from concept to action”, Annals of Internal Medicine, Vol. 157 No. 3, pp. 207-210. Helm, S., Koyanagi, C., Else, I., Horton, M. and Fukuda, M. (2010), “Public-academic partnerships: the University of Hawai’i Rural Health Collaboration: partnerships to provide adult telepsychiatry services”, Psychiatric Services, Vol. 61 No. 10, pp. 961-963. Horowitz, C.R., Robinson, M. and Seifer, S. (2009), “Community-based participatory research from the margin to the mainstream: are researchers prepared?”, Circulation, Vol. 119 No. 19, pp. 2633-2642. Kessler, R. and Glasgow, R.E. (2011), “A proposal to speed translation of healthcare research into practice: dramatic change is needed”, American Journal of Preventive Medicine, Vol. 40 No. 6, pp. 637-644. King, G., Currie, M., Smith, L., Servais, M. and McDougall, J. (2008), “A framework of operating models for interdisciplinary research programs in clinical service organizations”, Evaluation and Program Planning, Vol. 31 No. 2, pp. 160-173. Kutner, J.S., Main, D.S., Westfall, J.M. and Pace, W. (2005), “The practice-based research network as a model for end-of-life care research: challenges and opportunities”, Cancer Control, Vol. 12 No. 3, pp. 186-195. McDonald, P.W. and Viehbeck, S. (2007), “From evidence-based practice making to practice-based evidence making: creating communities of (research) and practice”, Health Promotion Practice, Vol. 8 No. 2, pp. 140-144. Mendel, P., Damberg, C.L., Sorbero, M.E., Varda, D.M. and Farley, D.O. (2009), “The growth of partnerships to support patient safety practice adoption”, Health Services Research, Vol. 44 No. 2 Part 2, pp. 717-738. Mold, J.W. and Peterson, K.A. (2005), “Primary care practice-based research networks: working at the interface between research and quality improvement”, Annals of Family Medicine, Vol. 3, Supplement 1, pp. S12-S20. Nagykaldi, Z., Mold, J.W., Robinson, A., Niebauer, L. and Ford, A. (2006), “Practice facilitators and practice-based research networks”, Journal of the American Board of Family Medicine, Vol. 19 No. 5, pp. 506-510. National Institute of Health (2007), “Re-engineering the clinical research enterprise: translational research”, available at: http://nihroadmap.nih.gov/clinicalresearch/overview-translational. asp (accessed June 4, 2013). Øvretveit, J., Lomas, J., Davies, H. and Powell, A. (2010), Evaluation of the LNR CLAHRC: Report to the Management Board, Department of Health Sciences, University of Leicester, Leicester. Rubenstein, L.V., Chaney, E.F., Ober, S., Felker, B., Sherman, S.E., Lanto, A. and Vivell, S. (2010), “Using evidence-based quality improvement methods for translating depression collaborative care research into practice”, Families, Systems, & Health, Vol. 28 No. 2, pp. 91-113.
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Rycroft-Malone, J., Wilkinson, J., Burton, C., Andrews, G., Ariss, S., Baker, R., Dopson, S., Graham, I., Harvey, G., Martin, G., McCormack, B., Staniszewska, S. and Thompson, C. (2011), “Implementing health research through academic and clinical partnerships: a realistic evaluation of the Collaborations for Leadership in Applied Health Research and Care (CLAHRC)”, Implementation Science, Vol. 6 No. 1, p. 74, available at: www. implementationscience.com/content/6/1/74 Schilling, L., Dearing, J.W., Staley, P., Harvey, P., Fahey, L. and Kuruppu, F. (2011), “Kaiser Permanente’s performance improvement system. Part 4: creating a learning organization”, Joint Commission Journal on Quality and Patient Safety, Vol. 37 No. 12, pp. 532-543. Solberg, L.I. (2006), “Recruiting medical groups for research: relationships, reputation, requirements, rewards, reciprocity, resolution, and respect”, Implementation Science, Vol. 1, p. 25. VA Health Services Research and Development (2013a), “Career Development Program”, available at: www.hsrd.research.va.gov/cdp/ (accessed August 5, 2013). VA Health Services Research and Development (2013b), “Evidence-based Synthesis Program”, available at: www.hsrd.research.va.gov/publications/esp/ (accessed August 5, 2013). VA Health Services Research and Development (2013c), “QUERI factsheets”, available at: www.hsrd. research.va.gov/publications/queri_factsheets/#.Uk0Y-mRgboE (accessed October 3, 2013). van de Ven, A.H. and Johnson, P.E. (2006), “Knowledge for theory and practice”, Academy of Management Review, Vol. 31, pp. 802-821. Waterman, H., Tillen, D., Dickson, R. and de Koning, K. (2001), “Action research: a systematic review and guidance for assessment”, Health Technology Assessment, Vol. 5 No. 23. Yaggy, S.D., Michener, J.L., Yaggy, D., Champagne, M.T., Silberberg, M., Lyn, M., Johnson, F. and Yarnall, K.S. (2006), “Just for Us: an academic medical center-community partnership to maintain the health of a frail low-income senior population”, Gerontologist, Vol. 46 No. 2, pp. 271-276. Author affiliations John Ovretveit is at the Medical Management Center (MMC), Karolinska Institutet, Stockholm, Sweden. Susanne Hempel is at the RAND Corporation, Santa Monica, California, USA. Jennifer L. Magnabosco is at the VA QUERI California Mental Health Services Authority, Los Angeles, California, USA and Yo San University of Traditional Chinese Medicine, Los Angeles, California, USA. Brian S. Mittman is at the VA Greater Los Angeles Healthcare System, Los Angeles, California, USA, VA QUERI Center for Implementation Practice and Research Support, Sepulveda, California, USA, and Kaiser Permanente Southern California Department of Research and Evaluation, Oakland, California, USA. Lisa V. Rubenstein and David A. Ganz are at the VA Greater Los Angeles Healthcare System, Los Angeles, California, USA, VA QUERI Center for Implementation Practice and Research Support, Sepulveda, California, USA, David Geffen School of Medicine, University of California Los Angeles, California, Los Angeles, USA and RAND Corporation, Santa Monica, California, USA. Corresponding author John Ovretveit can be contacted at: [email protected]
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1. Huw TO Davies, Alison E Powell, Sandra M Nutley. 2015. Mobilising knowledge to improve UK health care: learning from other countries and other sectors – a multimethod mapping study. Health Services and Delivery Research 3, 1-190. [CrossRef] 2. Elizabeth M. Yano. 2015. A Partnered Research Initiative to Accelerate Implementation of Comprehensive Care for Women Veterans. Medical Care 53, S10. [CrossRef] 3. Amy M. Kilbourne, David Atkins. 2014. Partner or Perish: VA Health Services and the Emerging BiDirectional Paradigm. Journal of General Internal Medicine 29, 817-819. [CrossRef] 4. Martin P Charns, Leonard E Egede, John S Rumsfeld, Geraldine C McGlynn, Elizabeth M. Yano. 2014. Advancing Partnered Research in the VA Healthcare System: The Pursuit of Increased Research Engagement, Responsiveness, and Impact. Journal of General Internal Medicine 29, 811-813. [CrossRef]
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Guidance for research-practice partnerships (R-PPs) and collaborative research John Ovretveit, Susanne Hempel, Jennifer L. Magnabosco, Brian S. Mittman, Lisa V. Rubenstein and David A. Ganz
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(Affiliations at end of article)
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Abstract Purpose – The purpose of this paper is to provide evidence based guidance to researchers and practice personnel about forming and carrying out effective research partnerships. Design/methodology/approach – A review of the literature, interviews and discussions with colleagues in both research and practice roles, and a review of the authors’ personal experiences as researchers in partnership research. Findings – Partnership research is, in some respects, a distinct “approach” to research, but there are many different versions. An analysis of research publications and of their research experience led the authors to develop a framework for planning and assessing the partnership research process, which includes defining expected outcomes for the partners, their roles, and steps in the research process. Practical implications – This review and analysis provides guidance that may reduce commonly-reported misunderstandings and help to plan more successful partnerships and projects. It also identifies future research which is needed to define more precisely the questions and purposes for which partnership research is most appropriate, and methods and designs for specific types of partnership research. Originality/value – As more research moves towards increased participation of practitioners and patients in the research process, more precise and differentiated understanding of the different partnership approaches is required, and when each is most suitable. This article describes research approaches that have the potential to reduce “the research-practice gap”. It gives evidence- and experience-based guidance for choosing and establishing a partnership research process, so as to improve partnership relationship-building and more actionable research. Keywords Knowledge sharing, Action research, Evidence-based practice, Research methods, Implementation, Research methodology Paper type General review
The authors would like to thank Roberta Shanman, Lopamudra Das, Jodi Lui, and Tanja Perry for assistance with the literature review, and Deborah Delevan for editorial assistance. The authors would also like to thank John Midolo for provision of information on QUERI partnered research evaluation centers, and Amy Kilbourne for her comments on a prior version of this manuscript. This project was funded by the US Department of Veterans Affairs, Veterans Health Administration Quality Enhancement Research Initiative through core funding to the Center for Implementation Practice and Research Support (Project # TRA 08-379). Additional support for investigator time and visiting professorship was provided from the Medical Management Center, Karolinska Institutet, Stockholm, and by a Career Development Award to David Ganz from the US Department of Veterans Affairs, Health Services Research and Development (HSR&D) Service (Project #VA CD2 08-012-1).
Journal of Health Organization and Management Vol. 28 No. 1, 2014 pp. 115-126 q Emerald Group Publishing Limited 1477-7266 DOI 10.1108/JHOM-08-2013-0164
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Introduction It often takes many years for treatments and management interventions that have been found to be more effective to be widely implemented. Interest about, and research into “closing the gap between research and practice” has grown over the last fifteen years. There are a number of explanations for the gap. Research and researchers are sometimes criticized as being “too distant” from real practice in health services (Kessler and Glasgow, 2011; van de Ven and Johnson, 2006). Some practitioners say that the findings of research do not give useful guides to action (Campbell et al., 2009). For their part, researchers point to the apparent disinterest of some practitioners in the findings of research, and to the work pressures that make it difficult for practitioners to give time to changing their practice. Sometimes, researchers also note an unwillingness or inability of practitioners to think through what a particular piece of research might mean for practice in their setting. Whether, when or how researchers should help practitioners interpret research in order to improve care is a question increasingly asked. The view that “research in, and with, practice” might be a more effective way to make better use of researchers and research in implementing or adapting research in practice settings (Green and Ottoson, 2004), has been gathering weight with research funders and government agencies. Some have called for a greater emphasis on “rapid cycle learning” and “fast cycle research” involving closer research-practice collaborations (Gold et al., 2011). Initiatives such as the USA NIH translational research program (National Institute of Health, 2007) have aimed to respond to this call for improvements in closing the research-practice gap. Partnerships between researchers and practitioners have been established with the aim of producing “more relevant” or “more actionable” research (Department of Health, 2007). Another aim of such partnerships has been to enable the implementation of research (Bosworth et al., 2010). The purpose of this article is to give an overview of different approaches to “research-practice partnerships” (R-PPs) and to give research-informed guidance for establishing and developing such partnerships. We define partnered research as “an activity where researchers and practitioners work together, with different roles, to use research both to solve practical problems and to contribute to science”. Throughout this article, the term “practitioner” is used to refer to clinicians and managers alike. The perspective on partnerships given here is based on a synthesis of the literature coupled with our own experience conducting “partnered research”, and also on interviews with individuals in both research and operations roles who have been involved in such partnerships within the US Veterans Health Administration (VA) and in one UK University and National Health Service (NHS) collaborative research program (Øvretveit et al., 2010). More details on one set of partnership research in the VA can be found at VA Health Services Research and Development (2013b). In 2008, the UK NHS started nine “Collaborations for Leadership in Applied Health Research and Care” (CLAHRCs) between University health research centers and NHS service-providing organizations and local communities. The aim is to “stimulate innovation and best practice across local health communities using two-way collaborative learning and delivery pathways” in order to link researchers with research users who include policymakers, managers, front-line clinical professionals, patients and community representatives (“local health community”). More details are given by Baker et al. (2009), Rycroft-Malone et al. (2011) and Øvretveit et al. (2010).
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With this background, our conceptualization of partnerships emphasizes relationships between researchers and practitioners for clinical research and clinical improvement, rather than for policy or population public health practice. Findings from the overview of the literature about research-practice partnerships Our review of the literature identified many different “approaches” to partnership research, which overlap both in concept and application. Broad categories of R-PPs described in the literature include: . Community based participatory research (CBPR): defined in one paper as “conducting research by equitably partnering researchers and those directly affected by and knowledgeable of the local circumstances that impact health” (Horowitz et al., 2009). . Practice-based research networks (PBRN): defined as “a group of clinicians, practices, or institutions that are devoted primarily to the delivery of patient care and are affiliated with each other in order to investigate questions related to community-based practice” (Kutner et al., 2005). . Practice-based quality improvement research (PBQIR): research by practitioners or academic researchers on changes to clinical practice or organization, where the researcher works with practitioners to collect data and sometimes to report data to enable improvement. . Action research (specifically for improving healthcare): defined as “a period of inquiry, which describes, interprets and explains social situations while executing a change intervention aimed at improvement and involvement” (Waterman et al., 2001). . Specially-created health services research-practice partnerships involving universities/academic medical centers: examples are the UK University-NHS CLAHRCs (e.g. Baker et al., 2009) or a US academic medical center community partnership (Yaggy et al., 2006). These are broad-based “umbrellas” for a range of research-practitioner studies and have tended to be university-driven and vehicles for research-into-practice “translational research”. Our review found information lacking about many practical aspects of partnerships including the nature and level of participation of practitioners in different stages of projects, and this made it difficult to assess whether the partnership was in name only or more substantive. In exploring how to define key features of a partnership approach, we assessed a range of studies which did give details. Table I gives a sample of studies showing the different ways that R-PPs can be established and run. We built on this review, our interviews and our varied experience as researchers in the UK, the USA, Europe and Australia to define criteria which differentiate more substantial partnership research and a framework to specify a particular type of partnership (Figure 1). We return to this after noting other observations from the literature review. A second finding from our overview is that investigators showed significantly different understandings of “research” and of the role of practitioners with respect to research. At least three conceptions of research could be identified in the literature: research as knowledge generation, as existing evidence, and research as referring to
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Table I. Examples of research-practice partnership “arrangements”
Nursing Engelke service and and Marshburn research (2006)
East Carolina University School of Nursing, Pitt Country Memorial Hospital
Hospital, nursing
Oklahoma Physicians Resource/ All Research Network, Colorado Research Network, Oregon Rural Practice-Based Research Network; University at Buffalo Family Medicine Research Institute and Upstate New York Practice-based Research Network
Nagykaldi Practice et al. (2006) facilitators
Primary care
Clinical area
AHRQ funded PBRN to complement a community health collaborative of safety net organizations called OCHIN and is based in the Western states of USA
Health care system/context
DeVoe et al. Practice-based (2012) research network (PBRN)
Type
Practice facilitators participate most often in externally funded research projects; clinicians may have an active role in the planning and the completion of these projects but the activities are driven mostly by the study protocols; facilitators act as research assistants, develop relationships, assist clinicians in local research and QI projects initiated by the practices, help with assessment of the practice’s needs and potential to implement interventions, and typically interact with a “champion” physician or practice leader as well as key personnel to ensure communication Collaborative research based on commitment to teamwork, reciprocity, and mutual benefit; research interests need to be aligned; two mechanisms to foster collaboration: collaborative research day (one day) and collaborative research award ($1,000)
OCHIN is a collaborative, member-based organization of federally qualified health centers and similar entities that provides a primary health care “safety net” to vulnerable populations. Using a collaborative learning organization model, OCHIN facilitates its members’ adoption of health information technology to improve patient care quality. To this end, OCHIN maintains one electronic health record (EHR) with a single master patient index linked across all clinic sites. OCHIN is recognized by the Health Resources and Services Administration as a health center-controlled network and now has more than 62 member organizations and over 200 clinics
Partnership operationalization
Commitment to provide funding and support as well as the willingness of the partners to evaluate and revise the program have been critical (continued)
Strategic factors important to the success of a PBRN: (1) shared vision and commitment to a unique patient population; (2) strong leadership, mentorship, collaboration; (3) creative approaches to engaging busy clinicians/bridging the worlds of academia and practice; (4) harnessing electronic health record data, navigating data protection, sharing, ownership Practice facilitators can be a particularly useful resource
Lessons learned
118
Study
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Rapid Learning Health System (RLHS)
Greene Group health et al. (2012)
Health care system/context University of Hawai’i Rural Health Collaboration (UHRHC)
Type
Helm et al. Health (2010) collaboration
Study
All
Mental health, psychiatric services
Clinical area
(continued)
Community engagement was critical to cultivating referral sources; integrated rather than collocated training and service delivery should be initiated; ethno-cultural and diagnostic diversity should be a top priority; there are critical considerations for research ethics when academic institutions partner with indigenous communities Hallmarks of the RLHS are the vital partnership between research and clinical operations and a shared commitment to leverage scientific knowledge and evaluation for rapid, point-of-care improvements
Established to increase rural access to behavioral health services, primarily via tele-psychiatry through partnerships with community health clinics. Direct patient care is provided either face to face or via videoteleconferencing. UHRHC uses a service-learning approach to workforce development, which allows universities to contribute to improved public health through structured trainee experiences in community settings such as federally qualified health and community health centers The Rapid Learning Health System leverages recent developments in health information technology and a growing health data infrastructure to access and apply evidence in real time, while simultaneously drawing knowledge from real-world care-delivery processes to promote innovation and health system change on the basis of rigorous research. Implementing the RLHS system involves six steps: (1) internal/external scan to identify problems and solutions; (2) designing evidence based care and evaluation; (3) implementing the plan in pilot and control setting; (4) evaluating what works or does not work; (5) adjusting evidence to influence continual improvement; and (6) dissemination of results to improve care for everyone. Model promotes bidirectional discovery and an open mind at the system level, resulting in willingness to make changes on the basis of evidence that is both scientifically sound and practice-based
Lessons learned
Partnership operationalization
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Table I.
Table I.
Solberg (2006)
Kaiser Permanente (KP) Performance Improvement System’s Learning Organization
Health care system/context
HealthPartners Medical groups in Minnesota who were also part of the Minnesota Community Measurement public reporting initiative
Schilling Kaiser et al. (2011) Permanente
Type
Mental health/ primary care
All
Clinical area
Lessons learned
Six “building blocks” were identified to enable KP to make the transition to becoming a learning organization: (1) real-time sharing of meaningful performance data; (2) formal training in problem-solving methodology; (3) workforce engagement and informal knowledge sharing; (4) leadership structures, beliefs, and behaviors; (5) internal and external benchmarking; and (6) technical knowledge sharing
Creating a learning organization required a combination of topdown and bottom- up strategies. The demand for real-time meaningful performance data can conflict with prioritized changes to health information systems. It is an ongoing challenge to teach performance improvement, change management, innovation, and project management to all managers and staff without consuming too much training time. Challenges with workforce engagement include low initial use of tools intended to disseminate information through virtual social networking Describes seven factors affecting recruitment of medical While all studies will not have all of these factors in such good practices in implementation research: (1) relationship of the recruiter with the local medical alignment, attention to them may be important to other efforts to community; add to our knowledge of (2) reputation of the recruiters within the medical implementation science research/QI community; 3) requirements for research participation that do not impose too burden on busy physicians in the group; 4) rewards (not always financial) and recognition for time invested by the participants; 5) reciprocity; 6) resolution to keep trying until you reach the right person to get the job done; and (7) respect of the recruiter for the participant’s contribution, constraints, and time
Partnership operationalization
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Study
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Figure 1. Guide for defining roles and tasks in partnership research projects
researchers, i.e. professionals for whom the main job description is to conduct research (van de Ven and Johnson, 2006). Similarly, reports describe the role of practitioners in the partnership in different ways. Practitioners can be research “clients”, can facilitate research, or can do both. In our research in the VA, we are perhaps most familiar with practitioners as “customers”, who seek to use expertise from researchers to improve practice. In some instances, the partnership with practitioners was primarily established to facilitate research, for example by establishing data agreements, patient confidentiality
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arrangements, or working together to build an information technology platform to facilitate data collection (McDonald and Viehbeck, 2007). Overall, the literature characterized R-PPs mostly in terms of the objectives, function, or the main activities of the partnership (King et al., 2008; Mendel et al., 2009; Mold and Peterson, 2005). R-PPs have also been characterized in terms of the productivity of the partnerships as regards products, tools or deliverables, such as publications or grants (King et al., 2008; Gold and Taylor, 2007), or in terms of impact. For many, a dual objective is to contribute to both resolving practical problems and producing generalizable knowledge. However, there are different conceptions of how to assess the effectiveness and impact of the partnership, and these include lasting change (Waterman et al., 2001), measurable change in clinical practice (process measures, cost savings or other organizational impacts, or improvements in patients’ health), or the degree of spread (Gold and Taylor, 2007). Defining “R-PPs” Drawing on our literature review, interviews and discussions, we propose the following criteria to differentiate R-PPs from other ways of conducting research: . researchers contribute to actions taken by practitioners or community members acting on or at one or more levels of a health system; . studies are intended to produce quickly and directly actionable findings, but also to be published in peer-reviewed scientific journals; . studies involve both researchers and practitioners in defining the research questions and interpreting the findings; . studies involve a “significant” amount of time or other contributions (such as a data gathering system) from both researchers and practitioners; and . a formulated description of the partnership approach has been published, with aims and methods, and there are published empirical studies showing the approach as applied (i.e. not just a conceptual description of a possible approach without examples). A guide that we developed to help future partnership researchers and practitioners define roles at different stages of the project is given in Figure 1. The goal of this guide is to increase the likelihood of those interested creating a substantive R-PP rather than the superficial “involvement” that characterizes many collaborations. The guide has not been formally validated as a tool; it is intended to stimulate discussion among researchers and practitioners before undertaking a project, so that the parties more fully understand what is involved and agree upon roles at different stages of the venture. We are not presenting recommendations about where a partnership should be placed on this matrix, as there is insufficient evidence for this and because it may well depend on the purpose of the partnership and its objectives. Another guide we found useful is CACSH (2013). Implications for research-practice partnership programs As regards VA research or UK CLAHRCs, our overview of the literature did not reveal a partnership typology that adequately characterized or categorized the research we had reviewed or which was useful for the future. In the VA, several partnership approaches have been, or are being, used, including PBRNs (Frayne et al., 2013), practice-based quality
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improvement research (Rubenstein et al., 2010), and action research. Similarly, there are a range of collaborative research approaches used in UK CLAHRCs and elsewhere. Within the VA setting, and as part of an evaluation of the VA Quality Enhancement Research Initiative (QUERI), we are currently assessing the degree to which funded QUERI projects include “partnered work”. Based on the significant conceptual overlap in the various partnership approaches above, our strategy for completing this evaluation will be less concept-driven and more empirical, focusing on characterizing the individuals or organizational entities involved in the partnership, the partnership activities that were proposed compared to what happened, and the various outputs from the partnership. This approach may be suitable for reviewing or evaluating or other partnerships, such as the UK CLAHRCs and/or for planning their future development. Of note, King et al. (2008) provide a categorization of partnerships that could be adapted for use by QUERI and other programs. This categorization includes four partnership types: (1) In King’s “clinician-researcher skill development model”, researchers provide consultation and advice to clinicians who are interested in pursuing research projects. Although not identical to what King describes, QUERI, together with the VA Health Services Research and Development (HSR&D) service, does offer mentored career development awards for nascent clinician researchers as well as PhD-trained non-clinicians seeking careers in health services research (VA Health Services Research and Development, 2013a, c). (2) In the “clinician and researcher program evaluation model,” researchers support clinicians and managers to evaluate specific clinical services. Similarly, QUERI researchers partner with practitioners in certain VA program offices to help evaluate activities within the VA operations. These include advanced disease management, prevention of hospital-acquired pressure ulcers, and “eConsults,”, which allow primary care providers to obtain specialist input on patient management without the specialist seeing the patient face-to-face. (3) In the “researcher-led knowledge generation model”, the focus is on generating new knowledge, but in collaboration with other stakeholders, including clinicians and patients. In the VA, QUERI seeks to fund investigator-initiated interventions, conducted in collaboration with practitioners, that will generate new knowledge about effective implementation strategies. Our evaluation of QUERI will determine to what degree this has been achieved. (4) In the “knowledge conduit model,” the focus is on researchers synthesizing knowledge that can be shared with stakeholders within and outside the organization. Similarly, the HSR&D/QUERI Evidence Synthesis Program synthesizes knowledge in a useful form for practitioners (VA Health Services Research and Development, 2013b). Conclusion Our review of published reports about research-practice partnerships revealed a wide range of understandings and conceptualizations of R-PPs in healthcare. The details about the partnership arrangements were often not described, unlike the intermediate outcomes of partnerships such as scientific publications. It was possible, however, to define a distinct set of approaches with substantive collaboration, which we classify
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here as R-PPs and for which we define criteria so as to distinguish them from many that are only partnerships in name but not in substance. We found the King et al. (2008) categorization a useful starting point for defining different approaches, but this categorization did not describe a number of partnerships reported in research, or which we had observed or experienced in the VA and UK CLAHRCs. To characterize these, we find the guide which we developed and presented in Figure 1 more useful. We offer this guide for others to try when describing to others a particular type of partnership being used, or when choosing an approach. or to help to see how the partnership might be developed and to develop one type into another type of partnership. Ultimately, the impact of the partnership should be assessed, but the most appropriate approach to measurement remains to be shown. An important question for future research is for which objectives R-PPs are more effective than “conventional research” for producing actionable research, or for enabling research to be applied in practice for improvement. References Baker, R., Robertson, N., Rogers, S., Davies, M., Brunskill, N., Khunti, K., Steiner, M., Williams, M. and Sinfield, P. (2009), “The National Institute of Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for Leicestershire, Northamptonshire and Rutland (LNR): a programme protocol”, Implementation Science, Vol. 4, p. 72. Berwick, D. (1998), “Developing and testing changes in delivery of care”, Annals of Internal Medicine, Vol. 128 No. 8, pp. 651-656. Bosworth, H.B., Almirall, D., Weiner, B.J., Maciejewski, M., Kaufman, M.A., Powers, B.J., Oddone, E.Z., Lee, S.Y., Damush, T.M., Smith, V., Olsen, M.K., Anderson, D., Roumie, C.L., Rakley, S., Del Monte, P.S., Bowen, M.E., Kravetz, J.D. and Jackson, G.L. (2010), “The implementation of a translational study involving a primary care based behavioral program to improve blood pressure control: the HTN-IMPROVE study protocol (01295)”, Implementation Science, Vol. 5, p. 54. CACSH (2013), “Partnership self assessment tool”, Center for the Advancement of Collaborative Strategies in Health, available at: www.lmgforhealth.org/node/190 (accessed 6 August 2013). Campbell, D., Redman, S., Jorm, L., Cooke, M., Zwi, A. and Rychetnik, L. (2009), “Increasing the use of evidence in health policy: practice and views of policy makers and researchers”, Australia and New Zealand Health Policy, Vol. 6, p. 21. Department of Health (2007), Report of the High Level Group on Clinical Effectiveness chaired by Professor Sir John Tooke, Department of Health, London. DeVoe, J.E., Likumahuwa, S., Eiff, M.P., Nelson, C.A., Carroll, J.E., Hill, C.N., Gold, R. and Kullberg, P.A. (2012), “Lessons learned and challenges ahead: report from the OCHIN Safety Net West practice-based research network (PBRN)”, Journal of the American Board of Family Medicine, Vol. 25 No. 5, pp. 560-564. Engelke, M.K. and Marshburn, D.M. (2006), “Collaborative strategies to enhance research and evidence-based practice”, Journal of Nursing Administration, Vol. 36 No. 3, pp. 131-135. Frayne, S.M., Carney, D.V., Bastian, L., Bean-Mayberry, B., Sadler, A., Klap, R., Phibbs, C.S., Kimerling, R., Vogt, D., Yee, E.F., Lin, J.Y. and Yano, E.M. (2013), “The VA Women’s Health Practice-Based Research Network: amplifying women veterans’ voices in VA research”, Journal of General Internal Medicine, Vol. 28, Supplement 2, pp. 504-509.
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Gold, M. and Taylor, E.F. (2007), “Moving research into practice: lessons from the US Agency for Healthcare Research and Quality’s IDSRN program”, Implementation Science, Vol. 2, p. 9. Gold, M., Helms, D. and Guterman, S. (2011), Identifying, Monitoring, and Assessing Promising Innovations: Using Evaluation to Support Rapid-Cycle Change, Issue Brief, The Commonwealth Fund, Washington, DC. Green, L.W. and Ottoson, J.M. (2004), “From efficacy to effectiveness to community and back: evidence-based practice vs practice-based evidence”, From Clinical Trials to Community: The Science of Translating Diabetes and Obesity Research, National Institutes of Health, Bethesda, MD. Greene, S.M., Reid, R.J. and Larson, E.B. (2012), “Implementing the learning health system: from concept to action”, Annals of Internal Medicine, Vol. 157 No. 3, pp. 207-210. Helm, S., Koyanagi, C., Else, I., Horton, M. and Fukuda, M. (2010), “Public-academic partnerships: the University of Hawai’i Rural Health Collaboration: partnerships to provide adult telepsychiatry services”, Psychiatric Services, Vol. 61 No. 10, pp. 961-963. Horowitz, C.R., Robinson, M. and Seifer, S. (2009), “Community-based participatory research from the margin to the mainstream: are researchers prepared?”, Circulation, Vol. 119 No. 19, pp. 2633-2642. Kessler, R. and Glasgow, R.E. (2011), “A proposal to speed translation of healthcare research into practice: dramatic change is needed”, American Journal of Preventive Medicine, Vol. 40 No. 6, pp. 637-644. King, G., Currie, M., Smith, L., Servais, M. and McDougall, J. (2008), “A framework of operating models for interdisciplinary research programs in clinical service organizations”, Evaluation and Program Planning, Vol. 31 No. 2, pp. 160-173. Kutner, J.S., Main, D.S., Westfall, J.M. and Pace, W. (2005), “The practice-based research network as a model for end-of-life care research: challenges and opportunities”, Cancer Control, Vol. 12 No. 3, pp. 186-195. McDonald, P.W. and Viehbeck, S. (2007), “From evidence-based practice making to practice-based evidence making: creating communities of (research) and practice”, Health Promotion Practice, Vol. 8 No. 2, pp. 140-144. Mendel, P., Damberg, C.L., Sorbero, M.E., Varda, D.M. and Farley, D.O. (2009), “The growth of partnerships to support patient safety practice adoption”, Health Services Research, Vol. 44 No. 2 Part 2, pp. 717-738. Mold, J.W. and Peterson, K.A. (2005), “Primary care practice-based research networks: working at the interface between research and quality improvement”, Annals of Family Medicine, Vol. 3, Supplement 1, pp. S12-S20. Nagykaldi, Z., Mold, J.W., Robinson, A., Niebauer, L. and Ford, A. (2006), “Practice facilitators and practice-based research networks”, Journal of the American Board of Family Medicine, Vol. 19 No. 5, pp. 506-510. National Institute of Health (2007), “Re-engineering the clinical research enterprise: translational research”, available at: http://nihroadmap.nih.gov/clinicalresearch/overview-translational. asp (accessed June 4, 2013). Øvretveit, J., Lomas, J., Davies, H. and Powell, A. (2010), Evaluation of the LNR CLAHRC: Report to the Management Board, Department of Health Sciences, University of Leicester, Leicester. Rubenstein, L.V., Chaney, E.F., Ober, S., Felker, B., Sherman, S.E., Lanto, A. and Vivell, S. (2010), “Using evidence-based quality improvement methods for translating depression collaborative care research into practice”, Families, Systems, & Health, Vol. 28 No. 2, pp. 91-113.
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Rycroft-Malone, J., Wilkinson, J., Burton, C., Andrews, G., Ariss, S., Baker, R., Dopson, S., Graham, I., Harvey, G., Martin, G., McCormack, B., Staniszewska, S. and Thompson, C. (2011), “Implementing health research through academic and clinical partnerships: a realistic evaluation of the Collaborations for Leadership in Applied Health Research and Care (CLAHRC)”, Implementation Science, Vol. 6 No. 1, p. 74, available at: www. implementationscience.com/content/6/1/74 Schilling, L., Dearing, J.W., Staley, P., Harvey, P., Fahey, L. and Kuruppu, F. (2011), “Kaiser Permanente’s performance improvement system. Part 4: creating a learning organization”, Joint Commission Journal on Quality and Patient Safety, Vol. 37 No. 12, pp. 532-543. Solberg, L.I. (2006), “Recruiting medical groups for research: relationships, reputation, requirements, rewards, reciprocity, resolution, and respect”, Implementation Science, Vol. 1, p. 25. VA Health Services Research and Development (2013a), “Career Development Program”, available at: www.hsrd.research.va.gov/cdp/ (accessed August 5, 2013). VA Health Services Research and Development (2013b), “Evidence-based Synthesis Program”, available at: www.hsrd.research.va.gov/publications/esp/ (accessed August 5, 2013). VA Health Services Research and Development (2013c), “QUERI factsheets”, available at: www.hsrd. research.va.gov/publications/queri_factsheets/#.Uk0Y-mRgboE (accessed October 3, 2013). van de Ven, A.H. and Johnson, P.E. (2006), “Knowledge for theory and practice”, Academy of Management Review, Vol. 31, pp. 802-821. Waterman, H., Tillen, D., Dickson, R. and de Koning, K. (2001), “Action research: a systematic review and guidance for assessment”, Health Technology Assessment, Vol. 5 No. 23. Yaggy, S.D., Michener, J.L., Yaggy, D., Champagne, M.T., Silberberg, M., Lyn, M., Johnson, F. and Yarnall, K.S. (2006), “Just for Us: an academic medical center-community partnership to maintain the health of a frail low-income senior population”, Gerontologist, Vol. 46 No. 2, pp. 271-276. Author affiliations John Ovretveit is at the Medical Management Center (MMC), Karolinska Institutet, Stockholm, Sweden. Susanne Hempel is at the RAND Corporation, Santa Monica, California, USA. Jennifer L. Magnabosco is at the VA QUERI California Mental Health Services Authority, Los Angeles, California, USA and Yo San University of Traditional Chinese Medicine, Los Angeles, California, USA. Brian S. Mittman is at the VA Greater Los Angeles Healthcare System, Los Angeles, California, USA, VA QUERI Center for Implementation Practice and Research Support, Sepulveda, California, USA, and Kaiser Permanente Southern California Department of Research and Evaluation, Oakland, California, USA. Lisa V. Rubenstein and David A. Ganz are at the VA Greater Los Angeles Healthcare System, Los Angeles, California, USA, VA QUERI Center for Implementation Practice and Research Support, Sepulveda, California, USA, David Geffen School of Medicine, University of California Los Angeles, California, Los Angeles, USA and RAND Corporation, Santa Monica, California, USA. Corresponding author John Ovretveit can be contacted at: [email protected]
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