Can the research driving healthcare reform be reformed?

Healthcare research unfortunately doesn’t produce the kind of heart-wrenching drama you need to watch TV or viral videos, but it does quietly provide the evidence that can determine where you get medical care, what kind of care you get and what kind of care you receive. How much is it. It is the foundation of any form of healthcare reform.

“Who lives, who dies and who pays” is how one book by a former senior federal official summarized the effort briefly and succinctly. And this research is the foundation of a healthcare system that now consumes one in every seven dollars in our economythat Aaron Carroll wants to change.

Carroll, an academic pediatrician, is the new president of Academy Healththe professional association of healthcare researchers.

“We have a real opportunity to focus on data and evidence to improve health and healthcare for all,” Carroll told a meeting of the National Advisory Council of the Agency for Healthcare Research and Quality (I am a council member), before repeating much the same themes at AcademyHealth’s annual research meeting, held in Baltimore.

Carroll called for studies to be encouraged to move from observational to actionable evidence that has a real impact on people’s health, especially in primary care. He also wants to place less emphasis on studies that demonstrate what is already known in increasingly methodologically elegant ways. “We need to pivot and say how we can make things better,” he said.

HSR isn’t flashy, with “grand slam” successes like curing a disease, Carroll acknowledged. It is more incremental and usually only results in ‘a few individuals’, like vaccination. But “everyday singles is how you win a game, how you win a World Series,” he said.

Still, Carroll added, “we need to communicate much better. We are not very good at talking about what HSR is and why it is important.”

As someone who transitioned from journalism to the world of health policy and research, and as a former board member of AcademyHealth’s predecessor group, I have my fingers crossed for Carroll’s success in his shake-up. He brings one impressive background to the task. In addition to a long record of service at Indiana University as a respected researcher in health outcomes, decision analysis, cost-effectiveness, and other important policy areas, Carroll has also regularly contributed to the New York Times opinion section; is a book author and co-author; and is co-editor of the blog The Incidental Economist.

Carroll even has his own YouTube channel, Triage in healthcare, whose viewing history illustrates the challenge he faces. If the benchmark for a video going viral is 1 million to 5 million views in a week (estimates vary), Carroll can boast a video has racked up almost a million views (789,000 to be exact) – but unfortunately, more than 10 years, befitting a compelling seven and a half minute explanation about ‘The United States health care system.” Meanwhile, Carroll’s diagnosis of the profession’s communication disorder confirmed his video titled “Dissemination: Get out there and strut your stuff!” spread with only 10,000 views in 5 years.

Carroll also signaled his intention to break down old silos and bring new voices to the table. That means reaching private sector groups; researchers with ties to minority communities, even if they are not part of academic institutions; patient-driven research efforts; and journalists.

Both Carroll and I served for many years as judges at an annual journalism competition sponsored by the National Institute for Health Care Management. We’ve seen how the best of healthcare journalism is often carefully executed. HSR is then presented to tell a compelling story, rather than being confined to the stylistic straitjacket of an academic journal.

However, the bottom line of efforts to drive change is still the economic bottom line. The kind of long-term research needed to provide solid evidence that doing something different in health care (also called “reform”) has a real economic or clinical impact requires flexible and reliable funding. However, HSR financing is usually ‘one-off’.

“We need new ways to think about important work,” Carroll said.