Embedded Research in a Learning Health System: How a Research-Operations Partnership Informed the Development,...

Embedded research partnerships can advance the implementation of evidence-based policies and practices, including those aligned with person-centered care. Care delivery model transformations, such as the VA's person-centered Whole Health System (WHS), can benefit from an ongoing cycle of program implementation and their evaluation to inform future evolution. This paper describes how embedded researchers partnered with policy makers leading VA's WHS transformation to support its development, implementation, and scaling to illustrate lessons learned for embedded research.

Fifty-eight embedded research projects were conducted from FY2013 to FY2024.

We recorded each project's scope, methodology, results, products, and impact. Through a group reflection process, we identified common cross-project lessons that fostered this successful embedded research partnership. Finally, we mapped projects to phases of Kilbourne's Knowledge to Action Framework (Pre-Implementation, Implementation, and Sustainment) to demonstrate how embedded researchers defined evaluation questions, evaluated WHS transformation, and assessed outcomes to inform the implementation and sustainment of VA's WHS transformation.

Projects used multiple qualitative, survey, and large database methods.

Across 58 projects, 380 discrete products were used by our operational partner to refine the WHS model, improve implementation support, scale effective practices, inform new policy, and sustain transformation. Three practices cut across these projects to contribute to our successful embedded research partnership: agility, collaboration, and continuous learning and improvement. Additionally, the purpose, questions, and methods of embedded research projects varied as operational partner activities moved across pre-implementation, implementation, and sustainment phases, iteratively impacting WHS transformation.

Embedded research can transform a healthcare system through the timely translation of data into practice, enabling evidence-based policy and practice decisions. Our embedded research-operations partnership, characterized by trust, respect, and strong communication, ensured that evaluations generated an evidence base to inform both implementation and impact.