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"Implementation Is so Difficult": Survey of National Learning Health System Decision-makers Identifies Need For
Nicole Floyd1, Kimberly Peterson, Vivian Christensen
1Evidence Synthesis Program Coordinating Center, Portland VA Medical Center, Portland, OR.
Medical Care
|September 14, 2019
Summary
The Veterans Affairs Evidence Synthesis Program (ESP) reports are widely used by healthcare decision-makers, primarily for clinical guidance and policy development. Users need more implementation support to maximize evidence uptake in learning health systems.
Area of Science:
- Health Services Research
- Evidence-Based Practice
- Healthcare Management
Background:
- The Veterans Affairs Evidence Synthesis Program (ESP) supports the Veterans Health Administration (VHA) learning health care system.
- ESP has been surveying users since 2016 to improve its evidence synthesis services.
Purpose of the Study:
- To assess end-user decision-making needs and report utilization patterns.
- To identify how ESP reports inform VHA clinical guidance, research, and implementation strategies.
- To understand the timing and purpose of evidence use within the VHA.
Main Methods:
- Survey data from ESP end-users between September 2016 and June 2019.
- Assessment of decision-making needs, report-driven actions, implementation timelines, and content perception.
- Analysis of feedback from 66 operational partners who requested ESP products.
Main Results:
- ESP reports frequently informed clinical guidance (58%), identified research needs (58%), and VHA implementation strategies (47%).
- 91% of respondents used reports, with 82% utilizing them within 3 months.
- Key uses included informing VHA policy/guidance (26%), adoption decisions (23%), and procurement (21%).
- 53% of users desired more implementation guidance within ESP reports.
Conclusions:
- Survey data reveals patterns and timing of evidence use by VHA decision-makers.
- Findings support strengthening partnerships between health systems and evidence producers.
- Key needs for enhancing evidence uptake in health systems were identified.