As an implementation scientist attending my first AcademyHealth National Health Policy Conference, I was struck by the event's intense focus on the promise of implementation but surprised by the fact that implementation science was left out of the discussions that packed the Washington Grand Hyatt with health researchers and government policy executives for two days.
Every session that I attended mentioned the word implementation multiple times. In her keynote speech, U.S. Department of
Rinad Beidas, PhD, is an Assistant Professor of Psychology in Psychiatry at Penn's Perelman School of Medicine and specializes in the study of the dissemination and implementation of evidence-based practices.
Health and Human Services Secretary Kathleen Sebelius made implicit reference to the importance of implementation science when she urged conference attendees to "help us speed up the rate of change in our providers."
Other plenary discussions also referenced implementation, including the implementation of the HITECH Act to achieve massive expansion of health information technology, implementation of the Affordable Care Act (ACA), and implementation of health care delivery innovation and Medicaid expansion.
Largely absent But interestingly, I found discussion of the science of implementation to be largely absent. Given the many opportunities put forth that would be prime for implementation research, I found this disappointing. For example, a number of research questions could be formulated including: What are barriers and facilitators of implementation of HITECH? Does implementation of the ACA change provider behavior? Who are the individuals or groups who use uncommon but innovative strategies to solve problems of delivery innovation in Medicaid? For example, conference attendees heard how Hennepin County in Minnesota is investing in its system by experimenting with a number of uncommon strategies to address the needs of top Medicaid utilizers with behavioral and addiction problems. It now offers same-day dental and primary care services in the Emergency Department. The move is credited with improving outcomes and reducing costs. Without studying such natural experiments, we suffer missed opportunities that could help us understand implementation better in the future.
Another topic area largely absent from the conference was a discussion of the interface between health and mental health. As many wise individuals have suggested, "there is no health without mental health." During the
Photo: Hoag Levins
U.S. Department of Health and Human Services Secretary Kathleen Sebelius: 'help us speed up the rate of change.'
Congressional plenary, Dr. Jenelle Krishnamoorthy, Health Policy Director of the Senate Health, Education, Labor and Pensions Committee, noted the importance of mental health and the potential opportunity for revamping the U.S. mental health system in the wake of recent tragedies. However, she was one of the only people to reference mental health policy throughout the conference, and that is expected given her background as a clinical psychologist. I was disappointed to see mental health given short shrift, particularly given the established links between health and mental health. I hope that future conferences include a more prominent mental health perspective.
Unusual experience Overall, the AcademyHealth gathering was unlike research conferences that I typically attend in its emphasis on presenting the viewpoints of multiple stakeholders. Usually, I go to conferences where researchers present to other researchers and data is the currency. At this one, there was an amalgamation of health service researchers, policy makers, lobbyists, and representatives of various stakeholder groups (e.g., patients). As a result, a number of perspectives were both represented and emphasized, and seemed to be the currency of the conference.
For example, when I attended a breakout session titled, "Stirring It Up: Putting Patients in the Middle," I had the opportunity to hear from Harvard Medical School's Tom Delbanco, MD, who investigated the impact of providing patients with the notes from their medical records via OpenNotes, Charles Ornstein of the ProPublica journalism site that is making the records of pharmaceutical industry payments to doctors freely available to the public, Patrick McCabe of the GYMR Public Relations Firm discussing how the "Choosing Wisely" campaign was informed by focus groups, and Jessie Gruman, PhD, President of the
Photo: Hoag Levins
Dr. Jenelle Krishnamoorthy, Health Policy Director of the Senate Health, Education, Labor and Pensions Committee, was one of the only ones to mention mental health treatment.
Center for Advancing Health (and a cancer patient herself) discussing the potential and perils of integrating mobile applications into patient care practices.
Many different lenses This wide array of perspectives allowed me to look at the issue of patient centered healthcare through many different lenses and gave me with a more nuanced understanding.
I feel energized by attending this conference. One point it made clearer for me was that as a researcher, I need to be more effective in communicating the importance of research to policy makers in "policy time," not "academic time."
In her opening remarks, Secretary Sebelius emphasized that the timeline of academia often does not match up with the timeline of policy making. She noted how it is not possible for policy makers to wait five years to find out whether or not accountable care organizations are effective -- they need to know NOW. It is incumbent upon us researchers to figure out how to present our findings in easily digestible and timely units that enable policy makers to make decisions based on the evidence.
Contracting the timespan One example of such an endeavor comes from Dr. Catherine Gallagher's work to shorten the time associated with conducting systematic reviews that provide answers to policy makers within 4-6 weeks. Of course, tension exists, given the reluctance of researchers to draw conclusions prior to study completion. However, as one conference attendee noted most eloquently, "It is time to pass the large psychological kidney stone of change."
If we, as researchers, want to impact policy and translate our research into practice, then the time is ripe to begin passing that kidney stone.
