Module 6:Research to Practice

Developed through the APTR Initiative to Enhance Prevention and Population Health Education in collaboration with the Brody School of Medicine at East Carolina University with funding from the Centers for Disease Control and Prevention

Translating Research into Practice

Acknowledgments

APTR wishes to acknowledge the following individuals who developed this module:

Anh Tran, PhD, MPHDuke University School of Medicine, Department of Community and Family Medicine Duke Center for Community Research

Victoria S. Kaprielian, MD, FAAFP Duke University School of Medicine, Department of Community and Family Medicine

Jennifer Cook, MPH Duke University School of Medicine, Department of Community and Family Medicine

This education module is made possible through the Centers for Disease Control and Prevention (CDC) and the Association for Prevention Teaching and Research (APTR) Cooperative Agreement, No. 5U50CD300860. The module represents the opinions of the author(s) and does not necessarily represent the views of the Centers for Disease Control and Prevention or the Association for Prevention Teaching and Research.

Presentation Objectives

1. List reasons for lag time between scientific discoveries and their application

2. Provide suggestions on how to facilitate translation of research to practice

3. Discuss the value of working with practice based research networks

4. List creative ways to disseminate research findings with and to communities

5. Explain ways to build a pipeline of community engaged researchers

Clinical Translation & Community Engagement

Translation of Research to Outcomes that

Matter!Medicine

Community

Public Health

Research

Lag Time Between Scientific Discovery and Application of It It takes, on average, a decade between a scientific

discovery and the application of that discovery as standard of care.

Example: Tamoxifen

Why Research Takes So Long to Translate to Practice Many patients have co-morbid conditions, which require

complex solutions.

Most studies conducted in academic centers

Results found in academic research journals

Practice patterns difficult to modify

Lack of rewards to influence behavior

Recommendations not always feasible

Translating Research to PracticeCommunity Engagement

Outcomes that matter: Access to safe, quality care Coordination between services Better prevention of disease Improved quality of life Safer, healthier communities

Translating Research to PracticeSystem Level Redesign

Conduct larger population health studies

Organize education efforts to share results

Provide support to change practice patterns

Change reward systems and metrics

What is a PBRN?

PBRNs Value

Practice Based Research Networks are important partners in translational medicine

Practice-based research networks can: help define the research agenda participate in research translate findings quickly into practice

PBRNsExamples

Family Medicine Networks Internal Medicine Networks Mixed Networks Nursing Networks Pediatric Networks Nutritionist/Dietician Networks Networks serving the uninsured or underinsured.

PBRN projects must be a two-way street:Researchers Practicing Clinicians

True success comes only with partnership.

PBRNs

PBRNs in Action

HRSA Collaboratives: http://www.hrsa.gov/healthit/collaboratives.html

OCHIN: http://ochin.org Washington State Practice-Based Research Network:

http://www.kingcounty.gov/healthservices/health/partnerships/pbrn.aspx

The Dental Practice-Based Research Network: http://www.dentalpbrn.org

IN4Kids Project An Example of Translating Research to Practice

Funder: North Carolina Health and Wellness Trust Fund. Primary Grantee: Duke Medicine. Time period: July 2008 – Dec. 2010.

Purpose: Assess the feasibility and effectiveness of integrating registered dietitians (RDs) into primary care practices to address weight problems in overweight or obese children. Study of a model of care.

Design: Half-time RDs placed in 8 practices to provide standard of care. Abstracted data collected for clinical purposes , surveyed practices, conducted RD interviews and practice focus groups.

Findings: RD integration is feasible, but identified modifiable and non-modifiable barriers to reimbursement. Indications of effectiveness for individual patients and impact on practice overall.

IN4Kids Project: An Example of Translating Research to Practice

Translation: Five of eight practices hired the RD after the study ended. Billing guide for RD services hosted on American Dietetic Association website. Approach to financial assessment is being requested by clinicians.

Study characteristics supporting translation: Addressed question of interest to those in practice. An effectiveness study of how the model worked in a real-world setting, not an

efficacy study of how it would work under controlled research conditions. Addressed implementation issues of work flow and cost. Provided practices with individualized implementation data and financial

assessments to support decision-making. Created billing guide to support RD integration.

The Importance of Dissemination

At the beginning of a study, it is crucial to plan for dissemination back to patients and practitioners.

Rarely, however, are researchers encouraged or rewarded for this effort.

Important to consider privacy concerns when planning for dissemination.

Institutional Review Board Considerations

Work with IRBs at the beginning stages of aproject to address dissemination issues such as:

Whether research participants can be directly contacted without their consent.

Ways to encourage more participants to receive information.

DisseminationEvolving Beyond Publishing

Dissemination strategies must go beyond traditional medical journals.

Journal articles do not always trickle down to the community level.

Work with community partners to creatively share information in different ways.

Disseminating to Everyone…In professional

journals, conferences,

abstracts, posters

Back to referring

physicians

Back to participants

Disseminate Research Findings:

To the community through emails,

newsletters, events

Modes of Communication with the Community Universities can engage the community in the

research process through avenues such as:

Regular emails List-servs Newsletters “Open mic” nights Radio/TV coverage Social media marketing campaigns

Do Not Forget Referring Physicians

New Relationships with Data

Old Model: Data is sole property of the

researcher Disseminate through

academic journals Privacy and proprietary

concerns trump sharing

New Model: Data is shared property

with the community Disseminate regardless of

journal-worthy results Privacy is protected,

academic proprietary needs addressed AND data is freely shared.

The importance of building a pipeline of researchers….

Educate the community about research

Inspire pre-college students from underserved communities to explore careers in research

Offer providers and social service professionals in community

setting research methods training

Change the culture of medical academia to appreciate

and reward community engagement

Make community engagement a required competency at all levels of training

Work with Area Health Education Centers (AHEC)

Attracting Partners to the Research EnterpriseOld Model:

Research Subjects from Community

ResearchStudies

New Model:

Research Studies

Expanded & Coordinated

Access to Care

Community Partnerships

Healthier Community

Published Literature

Summary

Health problems exist within context of people’s lives so solutions are context specific as well.

Successful academic-community partnerships can promote greater trust and more impacting research that can influence clinical practice.

Collaborating Institutions

Department of Public HealthBrody School of Medicine at East Carolina University

Center for Public Health Continuing EducationUniversity at Albany School of Public Health

Advisory Committee

Mike Barry, CAELorrie Basnight, MDNancy Bennett, MD, MSRuth Gaare Bernheim, JD, MPHAmber Berrian, MPHJames Cawley, MPH, PA-CJack Dillenberg, DDS, MPHKristine Gebbie, RN, DrPHAsim Jani, MD, MPH, FACP

Denise Koo, MD, MPHSuzanne Lazorick, MD, MPHRika Maeshiro, MD, MPHDan Mareck, MDSteve McCurdy, MD, MPHSusan M. Meyer, PhDSallie Rixey, MD, MEdNawraz Shawir, MBBS

APTR

Sharon Hull, MD, MPHPresident

Allison L. LewisExecutive Director

O. Kent Nordvig, MEdProject Representative