Integrating research, practice, and policy to create a virtuous cycle of continuous improvement

12.18.2017
Commentary
Philadephia mural Mapping Courage

To advance a Culture of Health in our country, we must engage all sectors to work collaboratively. At the core of this effort should be a commitment to rigorous, engaged research that reflects people’s true conditions and realities, generates quick feedback on what is working and what is not, and feeds into policy and practice to drive continuous real-time improvements. 

We’re not there yet. But we are taking bigger and bigger steps along this journey—steps that will ultimately bridge the gap between research, practice, and policy. 

At P4A, we’re seeing just how much potential these principles have in elevating our own work and advancing the field more broadly.   

Working hand-in-hand with communities

► In 2015, Feeding America launched its “Feeding America Intervention Trial for Health-Diabetes Mellitus (FAITH-DM)” to test the effects of providing diabetic food pantry clients with a diabetes-appropriate food box, glucose monitoring, self-management classes, and referrals to primary care. 

Building on early findings about the intervention’s positive health impacts, experts at the Urban Institute joined forces with Feeding America, the University of California-San Francisco and three participating food banks in a randomized controlled trial investigating whether those improvements were sustained after an individual completed the program; if a modified or scaled-down intervention could be sufficient; and if the intervention influences health care utilization. This collaborative endeavor is accelerating insights on evidence-based, cost-effective strategies to help food-insecure populations managing chronic disease.

► In 2016, the Chicago Police Department launched a pilot project to redirect low-level drug offenders to treatment, rather than jail and prosecution. Using Seattle’s “Law Enforcement Assisted Diversion” program as a model, they carefully adapted the approach to serve the unique needs of underserved neighborhoods in Chicago’s west side. 

Dr. Harold Pollack and the University of Chicago Urban Labs are currently evaluating the expansion of the strategy, exploring its impact on various health outcomes, testing whether diversion is more cost-effective than incarceration, and exploring how lessons learned from this program can help other city leaders implement similar policies and improve health equity on a larger scale.

Deploying data to drive policy

Academic institutions—with their broad scope, diverse community of scholars, and strong local networks—can be ideal settings for engaged research. For example, the P4A Research Hub at the NYU Wagner Graduate School of Public Service, led by Dr. Sherry Glied, is developing partnerships across the university and with New York City agencies to more deeply understand the impact of social services on health. The Hub’s portfolio of projects hinges on the researchers’ nearly unprecedented access to more than 10 years of New York State Medicaid claims data—truly a gold mine of health and demographic information on low-income populations.

While sharing her findings on the health impacts of New York City’s new Pre-K for All program at a P4A event this summer, Dr. Glied described how the Hub’s symbiotic approach to research was changing the mindsets of both her fellow academics and city leadership: 

“We were trying to figure out what kind of candy we could offer researchers and New York policymakers to make them come to us and have us do some analysis for them. And it turned out that having these data was the most wonderful candy. If we could explain to them that we could find answers to questions that they really cared about using our data, they were really interested in coming to us. 

But in order to do that, we had to amass a set of skills that are pretty broad. So for this particular study, we worked with our child development group. We also have a person who’s a machine-learning expert, because we’re doing a bunch of work on housing. And then the criminal justice people really just came to us because they heard we were doing the work.”

Dr. Glied described the exhilaration felt by the faculty that had been encouraged to apply their own unique research questions to the dataset. Most importantly, she talked about the positive energy being kindled among local advocates and policymakers who could see the potential of these data to propel policies forward. She noted, “we have these opportunities to deploy data and analytic techniques that really can support policymaking and support policymakers. Having the evidence does give the people who want to push the policy forward some momentum.”

Accelerating innovation along the way

Though none of these efforts are yet fulfilling all the elements of engaged research, they are helping to challenge the ingrained perspectives and siloed approaches that hold back progress. And on the horizon, we’re starting to see yet other innovative models and approaches that may accelerate continuous improvement, and that we can all learn from:

► Collaborative learning networks can be understood as “living laboratories” in which data and quality-improvement approaches are broadly—and quickly—shared among a diverse group of stakeholders. Patients and families, teams of clinicians and staff, scientists and communities—they all play an equal role in these networks. The model can be applied to a diverse spectrum of individual and population health issues. Examples of these networks are slowly emerging across the country. 

► Adaptive policies are predicated on the idea that policies and programs can be crafted, by design, to adapt to varying contexts. They perform well under a range of circumstances and conditions, and include mechanisms to accommodate unexpected changes, ensuring that fundamental goals and objectives are still met even when underlying conditions change. We have yet to see much of this work in the US, but international partners studying health equity have observed a few promising policies in areas like nutrition and education

Connecting the cycle of engaged research

As 2017 winds down, and we launch into our third year of the Policies for Action program, I hope to see the practice of engaged research being more fully embraced. If the goal of research is to improve real-world policy and practice, the research itself must reflect real-world insights and experience. 

What models or approaches around bridging the gap between research, practice, and policy most excite you? How can we learn from them to enhance research and cross-sector collaboration?

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