This paper examines how user interest in health services research is shaped by the following factors: the current health care policy environment, the organizations and institutional mechanisms available to advance the movement of health services research into policy and practice, and emerging innovative models. The paper also considers the implications of these factors for health services research. It builds on earlier work defining pathways that support the translation of research (evidence) and policy (action). It is one of a series of papers commissioned by AcademyHealth to help identify strategies that the field can use to enhance the impact of health services research.