will be the important variable some time, but at other times it may not be as important.

Amy Wilson-Stronks, roundtable member from the Joint Commission, suggested articulating the research in terms of what it means for practice. There are some practices that are known to improve outcomes, such as access to language services, but despite the evidence, these practices are not implemented.

Isham ended the discussion session by asking whether researchers tend to cluster their studies in some areas more than in others because those areas are easier to study or better thought through. Is the research portfolio distributed appropriately? Do researchers intend to produce practical knowledge that people can do something about in the short run? Would there be value in prioritizing areas and taking on some tough questions? It seems that the complexity of the health care interface is less well understood as a contextual factor, but it provides a real opportunity for some interventions, for example, mammography rates among vulnerable populations may go up by having same-day mammography available at the clinic. Are the questions being studied prioritized by the likelihood of producing something that can be acted upon?

Schillinger replied that Isham’s approach is an evidence-based and rational approach to inquiry. Yet research is more opportunistic, based on the principal investigator’s expertise. Those with a background in communication will study literacy. There may be opportunities for professional development there, said Paasche-Orlow, adding that funding sources set the agenda as well. Setting priorities is a good idea, Cooper added, but it must be done within the broader setting including environmental issues. Other disciplines and expertise need to be at the table. Schillinger pointed to Michael Wolf’s work on the complexity of the pill bottle; it involved basic science all the way to policy change.



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