Publication to Practice: How Research Drives Clinical Action to Improve Patient Care

Technology is changing faster than ever before. When Uber launched in 2009, it took nearly 6 years for the app to reach 100 million users. ChatGPT reached that same milestone in only 2 months.

Medicine is no exception in this age of transformation. However, the stakes couldn’t be higher when it comes to using technology to improve healthcare so as innovators, we need to balance speed with accuracy (and safety!)  How can we accelerate health care innovations faster without compromising accuracy and safety, not to mention accessibility, equity and affordability?     The answer lies within academic health systems, like MedStar Health, that bring together the best minds of academic medicine into a real world healthcare environment. 

At MedStar Health Research Institute, we don’t do research for the sake of research. Instead, we’re focused on studies that directly impact our role caring for our patients, our communities, and the people who will need care tomorrow. To achieve this, we leverage the benefits of being a large learning health system (LHS), in which we embed clinicians and researchers together, working side-by-side, and view every collaboration and initiative through the twin lenses of implementation science and health equity. 

The sum of these parts is that we can fast-track the application of new knowledge and processes at the bedside.

Twin lenses for success: Implementation and equity.

As a young academic cardiologist, I thought there were only two areas of research: New drugs and new devices. I was really excited about the discovery part of the process, but figured the dissemination part was best left to others. 

Over time, I came to understand that discoveries are meaningless unless that knowledge is shared effectively and broadly to impact the most people. At MedStar Health, we achieve this by positioning our work through the lens of implementation science and health equity.

For the last 50 years, the classic approach to applying research into new drugs, devices, and diagnostic techniques hasn’t changed much. Research is completed, the study is analyzed, and conclusions are drawn. A paper is written, peer-reviewed, and published. Then the information is spread through lectures, courses, grand rounds, and scientific conferences. Eventually, implementation begins.  

If we are going to accelerate the process for broader and faster adoption, we need to disseminate high-quality research results quickly and in a manner that are directly applicable to vast majority of clinical settings, so decision makers in all healthcare settings have access to timely, relevant information. It’s a real-time “bench to bedside to community” innovation.

From the patient’s perspective, an LHS like MedStar Health offers major advantages, including:

• System-wide dissemination of research. What’s learned in one center can be quickly distributed across the entire system. For us, that’s more than 300 locations, including 10 hospitals and 33 urgent care clinics, where new knowledge can immediately benefit patients. Our providers hold doctor-to-doctor telehealth consultations regularly, so a front-line provider could reach out to a neurosurgeon for an expert perspective.
• Focus on patient-centered research. We have active trials on quality, safety, accessibility, affordability, and equity. When our studies demonstrate a better way, we implement that knowledge to improve care, creating new models other health systems can follow.

Implementation

At MedStar Health Research Institute, researcher scientists Hannah Arem, PhD and Karey Sutton, PhD lead our research efforts in implementation science and health equity, respectively. These experts and other researchers embedded throughout the operational, administrative, and clinical levels of our health system function like internal consultants.

Working closely with experts who know what questions to ask, researchers become leaders and trusted advisors. Their perspective is valued as they partner with leadership to understand the questions and seek out impactful answers, and uncover gaps or new opportunities to improve our patient care.

For instance, our National Center for Human Factors in Healthcare team works to help analyze the root causes of serious safety events. Working closely with the MedStar Institute for Quality and Safety, these experts help us improve the patient experience using rigorous research methods that reveal opportunities for improvement.

This practice of internal consultancy is one powerful example of how integrating research and clinical practice creates a culture of inquiry and mutual respect that pays dividends for our patients by speeding dissemination and improving equity in care. 

Equity

The MedStar Center for Health Equity Research helps us work toward developing evidence-based ways to close gaps and ensure everyone has equal access to high-quality healthcare.

Our research initiatives investigate health disparities, structural inequities, and social determinants of health. Our team is particularly well-positioned to explore these topics because of the size, scale and most importantly diversity of care environments and patient population. Our region covers major metropolitan areas like Washington, D.C. and Baltimore, suburban hubs like northern Virginia and Montgomery and Prince George Counties in Maryland, rural communities in Southern Maryland, and everything in between. Because of that, we have the tremendous privilege and responsibility to advance the health of communities that include people across diverse demographics, 

A large LHS like ours enables researchers to work in a real-world environment with a wide array of patients. The more diverse our research participants, the closer we can get to our goal of creating knowledge that can be applied across settings and geographies and inform practices to improve care for everyone. 

Embedding equity-focused researchers and research priorities throughout the system raises the profile of this important work to advance health equity by exploring factors like bias that can inform policies and programs, while collaborating with community partners to advance health. 

Related reading: Health Systems and Researchers Can, and Must, Work to Advance Community Health and Equitable Access.

Embedded research leads to care-enhancing programs.

Thanks to the insight and dedication of countless clinicians and researchers, there are many examples of collaborative efforts improving care for patients throughout the MedStar Health system. One of my favorites is the MedStar Diabetes Pathway, or Diabetes Boot Camp.

The program started in the Emergency Department at MedStar Washington Hospital Center. There, clinicians saw first-hand the personal health impact of diabetes on our patients. 

Working together, clinicians and researchers developed a 12-week program. Patients with type 2 diabetes and an A1C of 9% or higher receive one-on-one intervention and education, followed by virtual visits that support a personalized plan of lifestyle modifications and medical therapy.

Our research demonstrated the program’s success. On average, participants lower their A1C by 3%. When we implemented the program in the emergency departments of our hospitals in Baltimore, it worked there too. So we asked ourselves, why wait until it’s an emergency? Now, the Diabetes Boot Camp program is making a difference for MedStar Health patients, emergency or not. And we won’t stop there.

Other examples of our research-backed clinical initiatives include:

• Creating positive, sustainable change in maternal health with D.C. Safe Babies Safe Moms Program: A partnership between MedStar Health and community organizations like Mamatoto Village and Community of Hope, Safe Babies Safe Moms works to improve the health and well-being of mothers and infants. Our approach combines evidence-backed strategies with MedStar Health’s expertise and community-centric support services.
• Reducing patient harm through the MedStar Center for Diagnostic Systems Safety: A new collaboration between MedStar Health Research Institute and the MedStar Institute for Quality and Safety, the Diagnostic Safety Center is co-chaired by a PhD researcher and an MD clinician. Their systematic approach helps us identify gaps in the diagnostic process and implement improvements.
• Tracking cardiovascular risk with Million Hearts risk calculator: Working with electronic health record (EHR) vendors, a patient advocate, and MedStar Health clinicians, the National Center for Human Factors in Healthcare team developed an application within the EHR that can quickly and accurately help a clinician—and the patient—understand each patient’s risk for heart attack and stroke.
• Exploring the future of telehealth with Connected CARE – Care Access, Research, Equity & Safey Consortium: The effort examines and enhances the impact of telehealth technology on U.S. health care access, safety, and health equity—especially for patients with chronic conditions and other vulnerable populations.
• Designing a safe and efficient workflow at a high-capacity community vaccination site: We applied the HRO principles of Deference to Expertise and Preoccupation with Failure when multiple disciplines worked together to design a workflow that managed patient throughput, vaccine preparation, and administration of over 15,000 doses of two different COVID-19 vaccines simultaneously and safely.
  
  

Working together to improve patient care.

When you have successes like these, it becomes easier to get buy-in and build momentum for making real, positive, patient-centered change. Embedding research in clinical spaces and speeding dissemination are ideas that have been discussed in academic medical circles for decades. We’re doing something about it. 

What’s more, we’re making a difference for our patients and our communities. By building clinical and research collaborations throughout our learning health system, we’re fast-tracking changes in care that result in real-world care improvements for our patients.