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!