title: Moving From Discovery to System-Wide Change: The Role of Research in a Learning Health Care System: Experience from Three Decades of Health Systems Research in the Veterans Health Administration.
abstract: The Veterans Health Administration is unique, functioning as an integrated health care system that provides care to more than six million veterans annually and as a home to an established scientific enterprise that conducts more than $1 billion of research each year. The presence of research, spanning the continuum from basic health services to translational research, has helped the Department of Veterans Affairs (VA) realize the potential of a learning health care system and has contributed to significant improvements in clinical quality over the past two decades. It has also illustrated distinct pathways by which research influences clinical care and policy and has provided lessons on challenges in translating research into practice on a national scale. These lessons are increasingly relevant to other health care systems, as the issues confronting the VA-the need to provide timely access, coordination of care, and consistent high quality across a diverse system-mirror those of the larger US health care system.
authors.affiliation: Veterans Health Administration, US Department of Veterans Affairs, Washington, DC 20420; emails: David.Atkins@va.gov , Amy.Kilbourne@va.gov , David.Shulkin@va.gov.
authors.forename: David
authors.initials: D
authors.lastname: Atkins
authors.affiliation: Veterans Health Administration, US Department of Veterans Affairs, Washington, DC 20420; emails: David.Atkins@va.gov , Amy.Kilbourne@va.gov , David.Shulkin@va.gov.|Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan 48109-5624.
authors.forename: Amy M
authors.initials: AM
authors.lastname: Kilbourne
authors.affiliation: Veterans Health Administration, US Department of Veterans Affairs, Washington, DC 20420; emails: David.Atkins@va.gov , Amy.Kilbourne@va.gov , David.Shulkin@va.gov.
authors.forename: David
authors.initials: D
authors.lastname: Shulkin
mesh_terms: D003695:Delivery of Health Care; D006801:Humans; D012106:Research; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans; D058014:Veterans Health
keywords: VA/military health; access; best practices; implementation; learning health care system; quality of care