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Appendix D. List of Other Research Gaps Identified by Study Participants

Health Services and Primary Care Research Study: Comprehensive Report
Primary Research Domain of Gap Other Related Research Domain(s) of Gap Specific Gap Description
Organization of Care Care Delivery Process
  • The impact of the changing health care system on care
  • There needs to be a better understanding of how changes to the health care system, including increased consolidation in the health care marketplace and other health reforms, are impacting the care delivered to patients.
Organization of Care Financing Mechanisms
  • The impact of payment policies on outcomes
  • There is a lack of understanding of the general effect of current and new payment policies on patient outcomes. As value-based care is becoming a more common policy tool, there needs to be a better understanding of how those policies impact care.
Organization of Care Quality of Care
  • The impact of the complexity of the health care system on patient outcome
  • The health care system is complex, and new models and reforms are making it increasingly complex. There needs to be more attention paid to how the complexity of the health care system impacts patient care and outcomes.
Organization of Care Quality of Care
  • Care Coordination
  • More research is needed on effective strategies for care coordination in the health care system, including within a single practice and between practices.
Care Delivery Organization of Care
  • Nonopioid substance use disorder and mental health research
  • There needs to be a better understanding of what substance abuse mental health treatments work the best, particularly as it relates to nonopioid substance use, and how to tackle suicides in the primary care system.
Care Delivery  
  • Specialized care models
  • There needs to be more research on models of care for specialty care that are integrated into the larger health care system. One example of this is the treatment of end-stage renal disease.
Care Delivery  
  • Private payer models
  • There are new models of care being developed for the delivery of health care services. More attention needs to be paid to how these models affect the delivery of health care, especially models being developed by the private sector.
Care Delivery  
  • Care transitions in peds
  • There needs to be more research on the gaps in care from children transitioning from the pediatric to the adult health care system, especially those children with chronic conditions.
Care Delivery  
  • Multiple comorbidities for elderly
  • There needs to be more research on how providers deliver care to older patients with multiple chronic conditions and multiple problems per visit.
Care Delivery  
  • Opioid addiction  treatment in primary care
  • There is an understanding that primary care practices are not prescribing medication-assisted therapy. More research and tools are needed to promote prescriptions in primary care practices.
Personal Behaviors and Preferences  
  • Patient understanding of consent
  • There is a lack of research into whether patients actually understand consent forms and what they are consenting to in those forms.
Personal Behaviors and Preferences  
  • Biometrics on patient engagement
  • There is an increased use of biometrics in the health care system (i.e., the use of fingerprints or face scans). There is little research on how patients react to biometrics being used in the health care system.
Organization of Care Quality of Care
  • Coordination between public and private payers
  • The federal government and private payers work in tandem to provide health care and health insurance to patients. Little is known about what methods are best to coordinate the efforts of CMS (and other health agencies) and private payers in improving health outcomes.
Health outcomes  
  • Lack of outcome-based measures
  • In general, there are a lot of health outcomes measures, and especially few for behavioral health.
Equity and disparities Cost and Utilization
  • Impact of cost on personal behaviors
  • There is little research done on the impact of increased costs through cost sharing and higher insurance premiums on patient behaviors and disparities in outcomes from these increased costs.
Equity and disparities  
  • Root cause of disparities in utilization
  • More research is needed on understanding the root causes of disparities caused by the health care system, including whether provider bias is leading to inequities in treatment.
Equity and disparities  
  • Understanding full spectrum of disparities
  • More research is needed to better capture the full spectrum of equity and disparities in the health care system. This is more than just looking at the impact of poverty or social disadvantages on health care outcomes.
Policy Organization of Care
  • Unintended consequences
  • More research is needed on the unintended consequences of policy changes on the health care system.
Policy Organization of Care
  • Impact of big policy changes
  • There is not enough definitive research done on the impacts of big policy changes on the health care system (i.e., the impact of the ACA on primary care, or the potential impact of a single-payer system on health care).
Policy Research Methods and Tools
  • Testing policies before legislation
  • There needs to be more research done on policies before they are passed and implemented on the ground.
Research Methods and Tools  
  • Use of systems thinking in HSR and PCR
  • There needs to be more research using a broader lens, for example:
    • One that encompasses the larger end-to-end patient experience (e.g., from one treatment change to how that treatment interacts over time with the other treatments patients are receiving). 
    • One that encompasses the larger health care delivery system (e.g., from the care coordination intervention, to how that intervention interacts with other aspects of care coordination already present).
Research Methods and Tools  
  • Use of system dynamics modeling in HSR and PCR
  • There needs to be more research into understanding hypotheses and testing alternative hypotheses for the mechanisms involved (e.g., for linking inputs with outputs).
Research Methods and Tools  
  • Use of probabilistic methods
  • There needs to be more research using probabilistic methods that can communicate more than “Did it work to a statistically significant degree?” Delivery leaders and other stakeholders can then use these results in combination with their own risk tolerance to make choices.
Research Methods and Tools  
  • Taking advantage of natural experiments
  • Natural experiments are taking place inside health care organizations, but they are not being evaluated, and lessons learned are not being disseminated beyond the organization. Obtaining funding in time to evaluate a natural experiment is especially challenging.
Research Methods and Tools Care Delivery Process
  • Use of RCTs in real-world settings
  • There needs to be more RCTs and other causal research in the primary care setting. For example, real-world RCTs need to be done to better understand how to make the correct diagnosis for patient conditions, especially for those with multiple comorbidities.
Research Methods and Tools Cost and Utilization
  • Economic impact analysis as HSR
  • There needs to be more research on the economic impacts of various trends in the health care system, including the impact of incentives on patient and provider behavior and the impact of market consolidation on patient care.
Research Methods and Tools  
  • Issues around data access and privacy
  • As more sophisticated research methods are developed and researchers have access to more powerful analytic tools, there is a need for access to data at a more granular level. More research needs to be done to understand the impacts of these new tools and greater access to data on privacy, especially for information on behavioral health and substance abuse, and the role of big data and artificial intelligence in HSR. Particular attention needs to be paid to make sure data for research is not abused.

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Page last reviewed June 2020
Page originally created June 2020

Internet Citation: Appendix D. List of Other Research Gaps Identified by Study Participants. Content last reviewed June 2020. Agency for Healthcare Research and Quality, Rockville, MD.
https://www.ahrq.gov/healthsystemsresearch/hspc-research-study/appendix-d.html

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