module 6: research to practice
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Module 6: Research to Practice. Translating Research into Practice. Developed through the APTR Initiative to Enhance Prevention and Population - PowerPoint PPT PresentationTRANSCRIPT
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