The 5 R's: An Emerging Bold Standard for Conducting Relevant Research in a Changing World

Abstract

Research often fails to find its way into practice or policy in a timely way, if at all. Given the current pressure and pace of health care change, many authors have recommended different approaches to make health care research more relevant and rapid. An emerging standard for research, the "5 R's" is a synthesis of recommendations for care delivery research that (1) is relevant to stakeholders; (2) is rapid and recursive in application; (3) redefines rigor; (4) reports on resources required; and (5) is replicable. Relevance flows from substantive ongoing participation by stakeholders. Rapidity and recursiveness occur through accelerated design and peer reviews followed by short learning/implementation cycles through which questions and answers evolve over time. Rigor is the disciplined conduct of shared learning within the specific changing situations in diverse settings. Resource reporting includes costs of interventions. Replicability involves designing for the factors that may affect subsequent implementation of an intervention or program in different contexts. These R's of the research process are mutually reinforcing and can be supported by training that fosters collaborative and reciprocal relationships among researchers, implementers, and other stakeholders. In sum, a standard is emerging for research that is both rigorous and relevant. Consistent and bold application will increase the value, timeliness, and applicability of the research enterprise. THE NEED FOR RELEVANT RESEARCH IN A RAPIDLY CHANGING HEALTH CARE WORLDA ccelerated pressure for change in health care creates an exploding need for relevant and rapidly generated new information. A growing volume of care delivery experiments around the country pose questions that research can help answer: Which interventions or system changes improve care, access, safety, or quality-and for which populations, under what conditions? Which system changes reduce underuse, overuse, or misuse? Which approaches are implementable and engaging to clinicians and patients-and can be done at reasonable cost? 1,2 Evolving clinical, organizational, and business models for health care, such as patient-centered medical homes 3 and accountable care organizations 4 need rapidly generated research evidence in real-world experiments for multiple stakeholders: implementers who want to improve their practices; purchasers who want to pay for value; health plans that administer benefits and take risks for care provided; policy makers who are being asked to change "the rules of the game" to support new approaches; patients who wish to know their care is effective, safe, and worth their effort and money; and public health, community groups, and agencies who wish to see improved health at a societal level. 5,6 The current research approach is not up to this challenge. Most recent research is slow to influence practice, does so only in pockets, or does not address practical needs for decision making. [7][8][9] Innovative ideas to remedy this situation have been proposed and so...

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