Changing Practice Through Research: Role of the CTSA

Initiative

Changing Practice Through Research: Role of the CTSA

Initiative

David O. Warner, M.D.Associate Director and co-PI,

Mayo Clinic CTSA,

Professor of Anesthesiology

Dougherty, D. et al. JAMA 2008;299:2319-2321.

Current resource allocation

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Dougherty, D. et al. JAMA 2008;299:2319-2321.

Future resource allocation?

CTSA – Approaches to Practice ResearchCTSA – Approaches to Practice Research

• Perform research in community settings (T2) Community-Based Participatory Research Practice-Based Research Networks

• Identify problems• Effectiveness and sustainability• Laboratory for testing system improvements

Community practices as clinical research sites (NCRA model)

Example of Mayo CTSA approach…Example of Mayo CTSA approach…

• Creation of PBRN within local health system

• Creation of Knowledge Transfer Research Unit “incubator” for T2/T3

• Development of T2/T3 curriculum

• Extend Rochester Epidemiology Project (“T4”)

Mayo Health System PBRNMayo Health System PBRN

MHS PBRN Construction…MHS PBRN Construction…

• Planning process 3 Workgroups with full MHS participation

• Business plan formulated and approved Creation of network infrastructure Significant intramural funding

• Planning grants for initial projects Led by MHS clinicians, with Mayo Rochester partners

CTSA – Approaches to Practice Research (2) CTSA – Approaches to Practice Research (2)

Determine how to produce sustainable changes in clinical practice (T3)

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Example of Mayo CTSA approach…Example of Mayo CTSA approach…

• Creation of PBRN within local health system

• Creation of Knowledge Transfer Research Unit “incubator” for T2/T3

• Development of T2/T3 curriculum

• Extend Rochester Epidemiology Project (“T4”)

Olmsted Countyrecords-linkage system

Minnesota

Iowa

Wisconsin

• Total = 127,277• Women = 51% (63,199)• ≥ 65 = 11% (13,392)

“Toolkit” to Support T2/T3“Toolkit” to Support T2/T3

evidencesynthesis

economicsand finance organization

theory

qualitativeresearchdesigns

systemsengineering

informaticspublicpolicy

communications

behavioralscience

CTSA – Key functions that can support T2/T3CTSA – Key functions that can support T2/T3

• Development of Novel Clinical and Translational Methodologies • Pilot and Collaborative Translational and Clinical Studies • Biomedical Informatics • Research Design, Epidemiology, Biostatistics and Clinical

Research Ethics • Regulatory Knowledge and Support • Community Engagement and Research • Translational Technologies and Resources • Research Education, Training and Career Development

Bringing together disciplines important to T2/T3….Bringing together disciplines important to T2/T3….

CTSA?

epidemiology

sociology

political science

psychologyeconomics

communications

social marketing

IT

biomedical sciences

Challenges to T2/T3 in CTSAsChallenges to T2/T3 in CTSAs

• CTSA leadership may or may not value T2/T3 Politics may be complicated Educational efforts needed

• Resources are limited Internal competition from T1 and other needs

• Will funding from NIH and others keep pace with expanded capacity to perform T2/T3?

How to take advantage of the CTSAs…How to take advantage of the CTSAs…

• Get to know what is available locally• Lobby your CTSA leadership regarding the

importance of T2/T3 Emphasize “transformation” Emphasize need to demonstrate actual changes in actual

people’s lives Emphasize that NCRR really, really wants to hear good

stories of successful translation and transformation

• Take advantage of the emerging consortium

Changing Practice Through Research: Role of the CTSA

Initiative

Changing Practice Through Research: Role of the CTSA

Initiative

TRANSFORMATION!

Changing Practice Through Research: Role of the CTSA

Initiative

Changing Practice Through Research: Role of the CTSA

Initiative

TRANSFORMATION!