Establishing a Pre-Award Office to Support Research at Intermountain Healthcare“Thank you for your heroic efforts getting us to the finish line, or starting line.”

Brad M. Isaacson, PhD, MBA, MSFResearch Initiatives ManagerOffice of Research

“THE ONLY REAL MISTAKE IS THE ONE FROM WHICH WE LEARN NOTHING.” – HENRY FORD

IDENTIFYING OUR WEAKNESS

BUILDING THE PATH FOR SUCCESSFUL RESEARCH

MINI-ATP

ADJUSTING THE PRE-AWARD WORKFLOW

No oversight

No knowledge

No followup meeting

PROBLEM:Grants were not being submitted on time

ManagementEnvironmentEquipment

“island” not team based

Opinionnot valued

No legacy information

PeopleProcess

No redundancy

One personw/knowledge

No formal process

No history of “prime”

No forms

No intake/kick offNo scientific

expertise

Metrics

No dashboardor tracking

No software for sharing documents

Materials

Computers not adequate for work load

Shauna got a notification

Shauna would see what’s

needed

Subaward

Prime

Admin. Review only

Subaward

Prime

Sent to sponsor

Shaunawould submit

OLD PROCESS

Timelines

Folders (electronic)

Forms

Package for AVP

Direct to team

members

Team plans a “kick off”

NEW PROCESS

OoR receives an email

Team discusses deadline

understands expectations

Project intake planned

Weekly calls planned

Application Submitted

Project manager assigned

15 min. huddles for

updates

When package is complete the

manager reviews

AVP proofs

No mgr. support No PM support No metrics/tracking No Backup or redundancy

No scientific support No “kick off” No package for AVP to proof No Awareness of issues

Issues Corrected

AVP asked to sign

55

85

0

20

40

60

80

100

2015 2016

# of Grants

55% increase in grants submitted since forming the Pre-Award Office

Prior to the Pre-Award Office : 14 +/- 6

After the Pre-Award Office: 21 +/- 2

14

21

7

13

22

19

2321

0

5

10

15

20

25

Q1 2015 Q2 2015 Q3 2015 Q4 2015 Q1 2016 Q2 2016 Q3 2016 Q4 2016

# of Grants for the Pre-Award Office

THE RESULTS

15

35

9

4

10 10

13

16

4

8

13

15

1311

0

5

10

15

20

25

Q1 2015 Q2 2015 Q3 2015 Q4 2015 Q1 2016 Q2 2016 Q3 2016 Q4 2016

Prime vs. Subawards for the Pre-Award Office

Prime Subcontracts

10

15

610

1916

19

14

4

6

1

3

3

3

4

7

0

5

10

15

20

25

Q1 2015 Q2 2015 Q3 2015 Q4 2015 Q1 2016 Q2 2016 Q3 2016 Q4 2016

Federal vs. Private Grants for the Pre-Award Office

Federal Private

A SHIFT TO PRIMESUBMISSIONS

WHO DID WE TARGET?

N=38N=6 N=4

N=8 N=1 N=3

$25,499,185

$7,649,800

$33,148,985

$66,776,041

$24,845,471

$91,621,511

$0

$20,000,000

$40,000,000

$60,000,000

$80,000,000

$100,000,000

Direct Indirect Total

Submissions on Annualized Basis

2015 2016

PRIVATE AND FEDERAL FUNDING WE APPLIED FOR BEFORE AND AFTER THE PRE-AWARD OFFICE ESTABLISHMENT

RESEARCH IS ALIGNING WITH INTERMOUNTAIN’S MISSION AND POPULATION HEALTH

Characterizing and Quantifying Challenges and Opportunities in Outpatient Care that Lead to an Emergency Department (ED) or InstaCare Visit

U.S. emergency departments treat

approximately 136 million patients

annually at a cost of $48.3 billion

Study Aim• Understand the predominant causes and effects

of the challenges and opportunities of outpatient care

• Improve education/training for patients and their providers

• Reduce cost• Decrease unnecessary healthcare utilization• Enhance patient safety and safety initiatives

National Child Traumatic Stress Initiative —Category II Treatment and Service Adaptation (TSA) Centers

Each year in the state of Utah over 50,000 children receive medical care after potentially

traumatic experiences and over 5,000 are evaluated in children’s advocacy centers.

Study Aim• Develop an Evidence-Based Care Process Model (EB-

CPM) and decision support tools for pediatric traumatic stress

• Implement and assess pediatric traumatic stress EB-CPM for frontline healthcare providers in primary care and children’s advocacy centers

• Provide national leadership on the use of care process models in trauma exposed children

ePneumonia: Development of an Electronic Clinical Decision Support System for Community-Onset Pneumonia

Pneumonia acquired in the community is the

eighth leading cause of death in the U.S.,

and accounts for over six million cases and

1.1 million annual hospitalizations.

Study Aim• Develop an electronic clinical decision support

systems (ePneumonia) for portability to the >500 hospitals and healthcare networks (iCentra)

• Evaluate the usability of ePneumonia and impact on clinical, patient-centered, and healthcare resource utilization outcomes

• Develop ePneumonia in a Standards-Based Services platform with interoperability across most EHR and widespread potential scalability

13771515 1471

1583 1589OPEN STUDIES 2012-2016

1 2 3

PI: Julie BradshawTotal Funded: $509,070

PI: Brandon Webb, MDPending: $2,245,581

PI: Todd Allen, MDTotal Funded: $287,000

RESEARCH IMPACT — Study shows that integrating mental and physical health through primary care teams results in better clinical outcomes and lower costs.

Brenda Reiss-Brennan, PhD, APRN, et al. 2016

10-YEAR STUDY 2003-2013

113,452 Unique patients

113 Primary care providers

27 Team-based care (TBC) medical practices

75 Traditional practice management (TPM)medical practices

SCREENED FOR DEPRESSION

TBC TPM

46.1%

24.1%

DOCUMENTEDSELF-CARE PLAN

TBC TPM

48.4%

8.7%

ADHERED TODIABETES PROTOCOL

TBC TPM

24.6%19.5

EMERGENCY ROOM VISITS

Reduced

23%

HOSPITAL ADMISSIONS

Reduced

10.6%

PRIMARY CARE ENCOUNTERS

Reduced

7%

PAYMENTS TO PROVIDERS

Reduced

3.3%

($3,401 for TBC vs. $3,516 for TPM)

Savings of $115.00 Per patient per year (PPYR)

Savings of over $13 Million per year

$

CUSTOMER SERVICE“One good experience is shared with 1-3 people, but a negative experience is typically shared with 10-15.” – Brent James

CUSTOMER SERVICE

Use the Pre-Award Office Again Recommend a Friend

“One good experience is shared with 1-3 people, but a negative experience is typically shared with 10-15.” – Brent James

* Over the past 6 months, our mean customer service scores > 95% and respondents have given us a perfect score > 80% of the time

WHAT IS THE FUTURE OF THE PRE-AWARD OFFICE?

• “Research on a Napkin”

• Subject matter expertise and Research Director support

• Mock study sections

• Targeted solicitations and developing an investigator registry

• Supporting types I-IV research

SPECIAL THANKS TO

• Pre-Award Team

• Research Operational Leadership Team

• Office of Research, Homer Warner Center, Clinical Programs

• Mini-ATP Administration

• And many more….

QUESTIONS?

“Thank you for your heroic efforts getting us to the finish line, or starting line.”

BACKUP SLIDES

Time Period of Engagement with Customers

n=26

Roles of the Customers and Services Utilized in the of Office of Research

(n=5)

(n=2)

(n=11)

(n=8)

(n=12)

(n=5)

(n=19)

(n=12)

Customer Service Data for Mini-ATP (Pre and Post Intervention)

• A two-tailed paired sample’s t-test with an α = 0.05 indicated that all changes pre and post were statistical significant for those that have worked with the Office of Research.

Assessing Statistical Significance with Repeat Customers

Mean N

Std.

Deviation

Std. Error

Mean

Sig. (2

tailed)

PM_Pre 36.7 18 37.9 8.9

PM_Post 79.8 18 21.7 5.1

Transparency_Pre37.4 18 35.2 8.3

Transparency_Post76.0 18 21.9 5.2

Admin_Pre37.2 18 32.1 7.6

Admin_Post76.2 18 24.3 5.7

Editorial_Pre30.2 17 37.9 9.2

Editorial_Post 64.6 17 29.7 7.2

Science_Pre 19.8 17 28.1 6.8

Science_Post 48.6 17 35.2 8.5

Trust_Office_Pre 34.1 18 35.3 8.3

Trust_Office_Post 72.7 18 28.2 6.6

Pair 5

Pair 6

0.000

0.000

0.000

0.001

0.004

0.000

Paired Samples Statistics

Pair 1

Pair 2

Pair 3

Pair 4

Evaluating the Impact of our Change on Roles and Grants Submitted

Dedicated Project

Manager

Transparent Process

General Administrative

Support

Reviewer/Editing Expertise

Staffed Scientist

Trust in the

Process

Trust in the Leadership

Operations/Administrators (n=5) + 49% + 49% + 41% + 42% + 28% + 50% + 61%

Physician Investigators (n=7) + 54% + 40% + 56% + 46% + 29% + 45% + 43%

Non-physician Investigators (n=6) + 31% + 31% + 21% + 12% + 6% + 25% + 34%

The Intermountain Healthcare Customer Service data was further segmented into roles to determine how these groups were effected.

Dedicated Project

Manager

Transparent Process

General Administrative

Support

Reviewer/Editing Expertise

Staffed Scientist

Trust in the

Process

Trust in the Leadership

None, 0 Grants per Year (n=3) + 24% + 24% + 19% + 6% + 7% + 2% + 15%

Low, 1-2 Grants per Year (n=6) + 53% + 42% + 58% + 40% + 42% + 41% + 40%

High, 3-5 Grants per Year (n=6) + 34% + 28% + 28% + 41% + 28% + 45% + 51%

Super, 6-8 Grants per Year (n=1) + 42% + 77% + 76% + 27% + 16% + 57% + 62%

Examining the Profile of the DataTrust in the Office of Research (Prior to the Pre-Award Office)

Trust in the Office of Research (After the Pre-Award Office)

Trust in the Office of Research Leadership (Prior to the Pre-Award Office) Trust in the Office of Research Leadership (After the Pre-Award Office)

Trust in the Process

Trust in the Leadership

Understanding the Impact to Quality

Pearson Correlation Coefficients: Highlighting the Direct Relationships

Trajectory Charts: Going from a 50,000 to a 1,000 Foot View

Increased trajectory for 89% of cases