AcademyHealth’s Delivery System Science Fellowship: training embedded researchers to design, implement, and evaluate new models of care

For over 3 decades, AcademyHealth and its predecessor organizations and members have been studying how the healthcare system works and ways to improve health outcomes. The value of health services research (HSR) training programs that emphasize learning opportunities in delivery system settings was initially articulated at the 2009 AcademyHealth Summit on the Future of HSR Data and Methods.¹ Two years later, the need for such programs was reiterated as a priority for AcademyHealth’s HSR Learning Consortium in their strategic plan.² While HSR methods have become increasingly sophisticated, historical approaches largely relied on extant (usually academic-based) researchers.

To realize the goal of building learning health systems (considered here to be entities where applied, operationally relevant research is systematically designed, generated, and translated into high-quality care delivery), many healthcare organizations have begun to use researchers as an internal resource to inform and support higher quality and more efficient care delivery operations. However, there is a current dearth of scientists trained in research disciplines (eg, comparative effectiveness research, patient-centered outcomes research, implementation science) more directly applicable to operational settings.^3,4 Conducting research within these “real-world” environments is challenging for a variety of well-documented reasons,^5,6 and many important questions cannot be answered using traditional study designs and/or methodologies. Until more researchers are trained in research approaches that align better with care delivery needs, the field will continue to fall short of addressing topics identified by the National Academy of Medicine (NAM; formerly the Institute of Medicine) as priorities for real system improvement.

While researchers in academic and consulting settings play critical roles in knowledge generation, a substantial area for expansion is support for “embedded researchers” who work more directly with operational leaders and understand local context, data, and organizational-level goals of delivery systems. AcademyHealth’s Delivery System Science Fellowship (DSSF) was developed to forge a stronger link between rigorous research practice and pragmatic aspects of care delivery.

Since inception of the DSSF, national attention has further emphasized the need for specialized, experiential learning with specific competencies that extend formal HSR training. The Agency for Healthcare Research and Quality (AHRQ) is currently convening a Technical Expert Panel to guide Training the Next Generation of Learning Health System Researchers as part of its larger effort to provide support for evidence generation and uptake in these applied settings (see https://www.ahrq.gov/news/blog/ahrqviews/supporting-learning-health-systems.html for more information). This work is reinforced by an ongoing project at AcademyHealth focused on Understanding the Current Health Services Research Workforce and Maximizing Its Future,⁷ partially sponsored by AHRQ. These efforts aim to inform AHRQ-funded career and training program requirements in order to build a workforce in partnership with academia and delivery organizations in support of developing high-functioning researchers directly positioned to drive progress toward learning healthcare systems.

The AcademyHealth DSSF Program is a pioneering effort designed to meet the needs of learning healthcare systems for a human capital resource capable of generating insights from operational data and deploying this knowledge effectively. Established in 2012 in partnership with 3 initial host sites, the DSSF provides a paid, postdoctoral training opportunity to help highly qualified, early-career researchers gain applied experience in delivery system settings.⁸ The goal is to provide hands-on experience and professional leadership opportunities to enhance the array of skills needed to generate and apply evidence in delivery systems. The long-term program objective is for graduates to employ the methods and training garnered during the DSSF to produce new, practical insights required to transform healthcare delivery and achieve the “Triple Aim.”⁹