Blueprints for military research portfolios

Julie Babyar

Our Health Comes First

发布日期: 2021年2月8日

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Originally published January 2021 on https://broadcastedge.blogspot.com/

Unique opportunities. They appear in all sorts of categories between military health and researchers. Department of Defense (DoD) funded inquiries into a health topic may be met with academic medicine or expert organization partnership. Congressional concerns may mandate scientific analyses. The Veteran’s Health Administration (VHA) may work with the Office of Inspector General or partner federal health agencies for research and analytical support.

Unique opportunities in an anticipated health system should not be so isolated. Experts should not have to recall the studies and professional colleagues that may or may not have insight into some aspects of care. Rather, research opportunities should be developed with blueprints already established for major military and veteran health concerns. These blueprints should be the responsibility of a designated entity. Subsets of excellence and/or task forces already address some health aspects, by a military branch or federal agency. Centers of excellence and research portfolio blueprints are not standard.

We never know when military and veteran research will reveal something never before considered. We do know that collaborative, efficient research portfolios create a system of better anticipation. Standard and consistent centers of excellence or expert research offices should be formal, with research portfolio blueprint design of similar structure.

Major military and veteran analyses, literature reviews, systematic reviews and meta-analyses should be the groundwork for designated excellence areas. The strategic advancement of research should be an inter-agency mission, with budgeting for multiple federal organization partnerships. Expert leadership should develop short and long term goals, and each avenue should be required to report regularly on progress. Evaluation metrics should include intervention and policy developments resulting from the portfolios. International partnership could begin and build with these excellence areas.

A. Standardize current excellence and blueprints. Already established centers of excellence should assist in development of accessible literature portfolios as well as key metrics. In example, a research report on the now-dissolved Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCoE) suggests that the new expertise involved in DCoE health should begin outcome and impact metrics. Streamlined reporting and analytics have been advised (1). Coordination of research strategies, research needs and the agencies involved could be identified and outlined. Coordination should assist with the financial security of the research portfolio. Any area that speaks across a military branch, or even international community, could be identified.

B. Identify and initiate blueprints and excellence centers for health areas, based on priority and feasibility. Areas of military and veteran health care without major centers of excellence or blueprinting should be identified and initiated, with consideration given to funding. Research funding is not unlimited and, for maximum impact, areas without major federal coordination should seek formal strategic planning. There are several immediate blueprint and excellence centers that could begin without delay. Examples include family and caregiver health, health technology and health information exchange, mental health and substance abuse, and social partnerships in healthcare.

*A blueprint for family and caregiver health research has been published. This blueprint recommended that caregiving, the effects of caregiving and family health, caregiving impact, program assessment and evaluation, and multi-cultural considerations should all be advanced with research (2) . Veteran caregiver studies are abundant and without strategic plans. A strategic caregiving research portfolio could be completed beyond just DoD or VHA, and the research portfolio could be a professional track managed by experts. Caregiver analytics (3, 4, 5, 6, 7), cost effectiveness, offsets (8) and caregiver support could be addressed with strategic research priority assigned. Additionally, reports that identify the major needs for military family and child health research, including adherence to evidence-based rigor and need for quality of life assessment, should be a foundation for broad excellence. As opposed to research under the Army silo (9), the work could inspire an expanded military and veteran family health blueprint. Components of studies such as the Active Duty Spouse Study should also be evaluated for addition (10). Initiatives that seek to partner with the population, such as REACH and accessible databases of military family research (11), should be incorporated into these blueprints. Questions such as how are military families using the databases, is there a way to translate expert language and is there room for satisfaction improvement could be posed. International research interest into service person caregiving and family health is strong and should be advanced.

*Military and veteran health technology and health information exchange (HIE) continues to be suboptimal (12). The IT issues for these populations continue to be a barrier to seamless care. A blueprint for excellence in research could seek to better understand cost and utilization analysis of military and veteran HIE(13, 14). Concepts such as return on investment for HIE (15) could be funded. Success and strategic planning around military and veteran HIE (16, 17) should be developed under systemic review or meta-analyses build. A blueprint for HIE and health information technology could include departments, such as VHIE (18), to ensure that grants are tied to the blueprint priorities.

*Mental health and substance abuse receives significant attention of research around military and veteran populations (19, 20, 21). There is great reliance on third-party expert analysts to develop recommendations for research, quality to the research, interventions and guidance for healthcare (22, 23). Many mental health and substance abuse reports are funded by DoD or VHA, yet there appears to be no singular blueprint or center of excellence devoted to follow up. Having one responsible entity for research advancement assures both the public and invested analytical organizations that the departments are committed to report recommendations.

*Social partnerships should be an active and immediate priority in military and veteran healthcare research, and this prioritization should be developed with a blueprint and excellence center. The assurance that military members and veterans receive needs through charitable donation or other nonprofit avenues is a social partnership. A country’s public is a part of this contract, as is the federal government. The receipt of charitable services often includes mental health support (24), durable medical equipment and wheelchairs, respite care, access to food or access to social services, and these aspects of healthcare delivery are an overlooked yet important metric. Everything from specialty of service to demographics of the service person should be understood, and the barriers to formal receipt under federal government care should also be measured. Unfortunately, there is little to no data on healthcare support provided by informal or charitable means. Research should liaison with all major military and veteran charities (25) , should standardize data, should drive change at the federal government level and should be accountable to strategic plans. Formalizing a blueprint and excellence to research and interventions with social partnerships should be a priority for active duty and veteran healthcare.

C. Develop specific standards for quality assurance of research. Standards for publication quality, limitation avoidance, study design and high quality analytics (26) should accompany each center of excellence or blueprint. These standards should be evaluated at minimum on an annual basis, and reports should be transparent to the public. Additionally, broad research improvements, such as the military Institutional Review Board (IRB) quality improvement (27), centralized research administration or other avenues of QA/QI should also be reported on.

Let’s not regret not having done something about the disarray of military and veteran health research portfolios. These portfolios represent incredible talent, numerous experts, valued research partnerships and commitment to active duty and veteran individuals. The research on health issues are disorganized, fragmented and slightly all over the place. Let’s polish the portfolios for the respect deserved; let’s move beyond memory recall and into formal architectural plans.

Success is about making military and veteran research a special version of coordination; excellence that is not unique to one study. We should fund and expect professionalism in return.

Traveling with the refs:

1. https://www.rand.org/pubs/research_reports/RR2370.html

2. https://www.rand.org/pubs/research_reports/RR1873.html

3. https://journals.sagepub.com/doi/full/10.1177/1077558717697015

4. https://agsjournals.onlinelibrary.wiley.com/doi/abs/10.1111/jgs.16767

5. https://www.frontiersin.org/articles/10.3389/fpubh.2019.00122/full

6. https://eprints.lse.ac.uk/90188/

7. https://onlinelibrary.wiley.com/doi/abs/10.1111/1475-6773.13312

8. https://onlinelibrary.wiley.com/doi/abs/10.1111/1475-6773.13312 9.https://www.rand.org/pubs/technical_reports/TR1256.html ,

10.https://download.militaryonesource.mil/12038/MOS/Reports/MFLP-Longitudinal-Analyses-Report.pdf

11. https://www.militaryonesource.mil/data-research-and-statistics/research-partners/

12. https://www.va.gov/oig/pubs/VAOIG-20-01129-220.pdf