8

STRATEGIC PRIORITIES FOR THE FIELD

Given the scope of the issues in the domains considered in the Priorities on the Health Horizon meetings—emerging technologies, social and environmental factors, optimizing value, infrastructure, and the resultant cross-cutting themes—a formidable set of pressing health and health care research needs was identified and discussed. In addition, three fundamental strategic priorities emerged as basic and critical to progress in the field: (1) the need to reorient research perspectives and activities to patient and family priorities and values, in particular, those conditions that drive inequities; (2) the need to foster strategic learning partnerships across groups, organizations, and sectors; and (3) the need to build the continuous learning infrastructure to produce new insights at the pace and scale necessary for improving health and health care.

The first of these is directly linked to PCORI’s origins: the search for better evidence on what works best, for whom, and under what unique circumstances for each individual. It has become clear that this means factoring in a much broader characterization of individual perspectives and conditions at work to determine individual receptivity, responses, and opportunities for interventions. In some respects, it means developing a strategy in which new technologies, new conceptualizations about health and health care, and new connections between health care needs and social factors are embraced, depending on individual circumstances. The recognition that this includes economic circumstances is now embedded in PCORI’s expanded mandate to embrace financial realities as part of its remit. It also means using research strategies that accommodate and facilitate stronger relationships between the health care and social care systems that are beneficial to patients and families. From a research funder’s perspective, it can mean attracting and funding applications from diverse organizations that, while close to daily lives of patients and families, may seem afield from more familiar

research entities. Some studies mobilized during the COVID-19 pandemic used nontraditional lenses, which enhanced the understanding of problems and solutions for people, families, caregivers, and health workers on the front lines.

The importance of ensuring that research design accommodates an appropriate range of the factors shaping health prospects—and responses to interventions—requires forging learning partnerships across groups, organizations, and sectors. At the most basic level, this means dedicated attention to ensure that there is strong strategic interplay and synergy among traditional funders of effectiveness research, like the National Institutes of Health, the Agency for Healthcare Research and Quality, the Centers for Disease Control and Prevention, the Health Resources and Services Administration, the Centers for Medicare & Medicaid Services, and the Food and Drug Administration, and certain voluntary organizations and philanthropies. But the importance of dedicated partnerships extends into other organizations, public and private, social and corporate, quantitative and qualitative, all of which are, at some level, important stakeholders in the applicability of research results. In principle, this can appear to add substantial complexity to an already complex challenge of reckoning with the multiple variables that influence health status and outcomes. But, in practice, enlisting and engaging these partnerships that add value to the generalizability and reach of discovery also builds stakeholders in the dissemination and use of results. A co-learning process, whether with patients and families or with multiple stakeholder organizations, adds and invests them naturally and additively in the process of dissemination and use. In addition, the forging of novel partnerships may help loosen the occasionally binding and self-perpetuating forces sometimes at play in more traditional academic research environments.

This raises the third strategic priority discussed: building a research infrastructure that is more seamlessly blended with routine care and even daily life. The aim of a continuously learning health system is to take better advantage of the digital environment now constantly generating structured and unstructured data from our experiences, introducing selective variability capture and analytic capacity, generating and testing insights, and accelerating the introduction of improved and tailored interventions accordingly. The infrastructure required has technical, economic, professional, cultural, and personal components, and its effectiveness depends on multisystem interoperability, synergy, and incentives. Although still relatively early in its development, the PCORnet^® infrastructure has helped to demonstrate the potential to use diverse real-world data in the conduct of pragmatic trials and observational research. That the build-out of the basic infrastructure components envisions operation across health care facilities of multiple sizes, interfaces with organizations in multiple sectors, while anchoring on the

needs and preferences of individuals, underscores the need for stewardship of the connector and governance dimensions that represent common ground. Without a strongly committed steward, common ground can too easily become abandoned turf. The promise of the learning health system is profound in its technical achievability and, hence, its potential to accelerate progress toward a health system that is more effective, more efficient, more equitable, and more personal. Achieving that potential depends on careful attention to weaving together the multifaceted elements of the infrastructure.

This page intentionally left blank.