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Tools for Building Research Infrastructure at Health Centers

Tools for Building Research Infrastructure at Health Centers. Jonathan N. Tobin, PhD. Clinical Directors Network (CDN) The Rockefeller University Center for Clinical & Translational Science (CCTS) JNTobin@CDNetwork.org www.CDNetwork.org/Rockefeller

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Tools for Building Research Infrastructure at Health Centers

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  1. Tools for Building Research Infrastructure at Health Centers Jonathan N. Tobin, PhD Clinical Directors Network (CDN) The Rockefeller University Center for Clinical & Translational Science (CCTS) JNTobin@CDNetwork.org www.CDNetwork.org/Rockefeller www.Rockefeller.edu/ccts/communityengagement Presented at NACHC – CHI August 22, 2013 Chicago IL

  2. CDN: Past, Present & Future • An informal network of clinical leaders who practice as primary care clinicians in low-income and minority communities • A research and educational organization • A means to translate clinical research into clinical practice Primary Activities • Practice-based Research • Clinical Leadership & Sustained Clinician Engagement • Early & Significant Community Engagement • Education and Training • Quality Improvement • Professional Development • PBRN Research Infrastructure www.CDNetwork.org

  3. Practice-based Research Network (PBRN) Primary Health Care Safety-net Practices& Center of Excellence AHRQ Designated “Center of Excellence” (P30) For Practice-based Research and Learning (2012) US Department of Health & Human Services Regional Health Administrator’s Award “Outstanding Contribution Toward the Elimination of Racial and Ethnic Disparities in Health” (2001) NIHRoadmap Initiative Designated “Best Practice” Clinical Research Network (2006)

  4. Accelerating Research Translation Funded in part by AHRQ Grant #1 P30-HS-021667 NIH-National Center for Advancing Translational Sciences to The Rockefeller University (NIH-NCATS Grant #8 UL1 TR000043) CTSA Administrative Supplement Award (2011) to The Rockefeller University Center for Clinical and Translational Science (CCTS) and Clinical Directors Network (CDN) and by HRSA (CHARN) www.CDNetwork.org

  5. CDN N2-PRN Building a Network of Safety Net PBRNs A collaboration among: Access Community Health Network (ACCESS) Alliance of Chicago (ALLIANCE) Association of Asian Pacific Community Health Organization (AAPCHO) Center for Community Health Education Research and Service (CCHERS) Clinical Directors Network (CDN) Community Health Applied Research Network (CHARN) Fenway Institute (FENWAY) New York City Research and Improvement Group (NYCRING) Oregon Community Health Information Network (OCHIN) Funded by AHRQ Grant: P30 HS 021667 Principal Investigator: Jonathan N. Tobin, PhD Project Officer: Rebecca A. Roper, MS, MPH Director, AHRQ PBRN Initiative

  6. Monthly Webcast Series Review Best Practices PBRN/CRM Innovations Research Methods Trainings Design rapid tests and implement pilots (PDSAs) Evaluate Adopt, Implement, Spread Share Accelerate! N2 Learning Collaborative

  7. TRACKS PBRN Research Management Innovations (for PBRN Senior Staff) PBRN Methods (for PBRN Senior Staff & Academic Collaborators) Introduction to Research (for CHC Nodes Staff & New PBRN Staff) PBRN Study Results (for CHC Nodes, CHC Partners, PBRN Senior Leadership & Staff, Academic Partners) N2 Learning Collaborative 933 online viewers to date Visit: www.CDNetwork.org

  8. Social Determinants of Health: Important Considerations for Medically Underserved Community Health Center Patients Featured PBRN: Association of Asian Pacific Community Health Organizations (AAPCHO) An Update on Community-Based HIV Prevention Research and Applications Featured PBRN: The Fenway Institute, Boston MA Integrating Patient Reported Outcomes into Clinical Care: HIV as a Case Study Featured PBRN: The Fenway Institute, Boston MA Introduction to Collaborative Community-based Research Featured PBRN: National Association of Community Health Centers (NACHC) and Lutheran Family Health Center (Incubator PBRNs) and Clinical Directors Network Inc., (CDN), NY, NY CDN N2-PBRN Learning Collaborative Track:PBRN Introduction to Research Funded by: AHRQ; Grant No. 1 P30-HS-021667

  9. CDN N2-PBRN Learning Collaborative Track:PBRN Study Results Stakeholder Feedback on Community Engaged Research in the CTSA Program Featured PBRN: Center for Community Health Education, Research and Service (CCHERS) Friday, August 9, 2013, 2:00-3:00pm EDT Young African American Men and HIV: An Interactive Response to a Community Health Issue Featured PBRN: Access Community Health Network, Chicago, IL Thursday, June 27, 2013, 12:00-1:00pm EDT The Bronx Ongoing Pediatric Screening (BOPS) Initiative: Lessons Learned from a Large Scale Initiative to Enhance Screening in Urban Primary Care Featured PBRN: New York City Research and Improvement Group (NYC RING) From Bench to Bedroom: Testing and Translating Behavioral Interventions from Research into Practice Featured PBRN: National Association of Community Health Centers (NACHC) (Incubator PBRN) and Clinical Directors Network Inc., (CDN), NY, NY Funded by: AHRQ; Grant No. 1 P30-HS-021667

  10. CDN N2-PBRN Learning Collaborative Track:Research Methods Patient-Centered Medical Home: Using the EMR to facilitate PCMH Transformation Featured PBRN: Alliance of Chicago Community Health Services Thursday, Sept 12, 2013, 1:00-2:00pm EDT Preparing for Meaningful Use Stage 2 Featured PBRN: Alliance of Chicago Community Health Services Tuesday, July 30, 2013, 2:00-3:00pm EDT The Research Potential of an EHR-Based Network: Lessons from the OCHIN PBRN Featured PBRN: Oregon Community Health Information Network (OCHIN) Funded by: AHRQ; Grant No. 1 P30-HS-021667

  11. CDN N2-PBRN Clinical Directors Network (CDN) Lutheran Family Health Centers (LFHCs) Incubator PBRN Access Community Health Network (ACCESS) South Texas Ambulatory Research Network (STARNet) + + + Park Slope LFHC Family Physician LFHC Kling Adult Medicine Madison Family Health Trevino Family Clinic University Health System Hudson River Health Care Brookdale Family Care Center Open Door Family Health Center Urban Health Plan Manhattan Physician’s Group – 95th Street Manhattan Physician’s Group - 125th Street Community Health Centers Hospitals

  12. N2 Partners: “Incubator PBRN” Lutheran Family Health Center (LFHC) Brooklyn, NY DC Research Collaborative • National Association of • Community Health Centers (NACHC) • Clinical and Translational Science • Institute at Children’s National • George Washington University (GWU) • Clinical Directors Network (CDN) • Alexandria Neighborhood • Health Services • Mission Life Center • Mary's Center for • Maternal and Child Care • Unity Health Care • Research Training for Clinical Leaders • Epidemiology and Statistics • Study Design and Implementation • Grant Writing and IRB • Team Intervention Projects: • Hepatitis C/HIV Screening • Childhood and Teen Obesity • Teen Pregnancy and Contraception • Diabetes Type II

  13. Goals: To enable practicing clinicians to develop their research interests and skills, through didactics on the scientific and statistical aspects of study design (quantitative and qualitative) as well as through hands-on experience in preparing and implementing a research project To provide technical assistance in grant-writing and identifying potential funding sources, including training exercises and assistance in developing budgets, staffing plans, work-scopes, and timelines To develop and provide oral and written research dissemination/presentation skills (scientific, clinical and lay) at local, regional and national forums Co-Directors: NonkulieDladla, MD, MS Lutheran Family HealthCare Jonathan N. Tobin, PhD CDN /The Rockefeller University Center for Clinical & Translational Science Facilitator: Maria Dziok, PhD, Clinical Directors Network, Inc. (CDN) Lutheran Medical CenterClinical Directors Network, Inc.RESEARCH TRAINING FOR CLINICAL LEADERS 2012-2013

  14. Research Training for Clinicians Course Goals • Study Design and Implementation • To enable practicing clinicians to develop their research interests and skills, through didactics on the scientific and statistical aspects of study design as well as through hands-on experience in preparing and implementing a research project • Epidemiology and Biostatistics • To develop and provide oral and written research dissemination/presentation skills at local, regional and national forums • IRB/Human Subjects Protection • IRB Application • Informed Consent • Grant Writing • To provide technical assistance in grant-writing and identifying potential funding sources, including training exercises and assistance in developing budgets, staffing plans, work-scopes, and timelines • 60 CME/CNE/CDE Credits for Participation

  15. Study Design and Implementation • Developing study questions and interventions • Calculating sample size • Identifying dependent and independent variables, and covariates • Patient-centered, clinical, laboratory, public health • Recruiting and retaining patients • Health disparities and cultural competence • Intervention and Fidelity Monitoring • Engaging Stakeholders • Interactive Experiences • Participated in qualitative research/focus groups • Participated in the informed consent process

  16. Epidemiology and Biostatistics • Prevalence and Incidence • Odds Ratio (OR), Relative Risk or Risk Ratio (RR) • Significance Testing, p-values, Confidence Intervals • Validity and Reliability • Bias and Confounding • Types of Analysis • Power, Sample Size, and Effect Size • Sensitivity and Specificity • Using Statistical Software (CDC EpiInfo)

  17. Prevalence/Surveys • Cross-sectional • Retrospective • Case Control • Prospective Cohort • Historical Cohort • Randomized Controlled Trial (RCT) • Site level (Cluster RCT) vs. patient level • Comparative Effectiveness Research (CER) • Patient Centered Outcomes Research (PCOR) • Qualitative/Focus Group • Mixed Methods (Qualitative/Quantitative) A Review of Types of Study Designs

  18. A Review of Study Designs http://sph.bu.edu/otlt/MPH-Modules/EP/EP713_AnalyticOverview/EP713_AnalyticOverview7.html

  19. Biomedical Informatics Biomedical Informatics Methods, Techniques, and Theories Basic Research Applied Research Imaging Informatics Clinical Informatics Public Health Informatics Bioinformatics Molecular and Cellular Processes Tissues and Organs Individuals (Patients) Populations and Society

  20. Human Subjects Protection • & IRBs • Writing an Informed Consent Form • Conducting Informed Consent Interview (role play) • Preparing an IRB Application Grant Writing • Literature searches using PubMed • Patient Centered Outcomes Research Institute (PCORI) • Biosketch development • Drafting Specific Aims, Hypotheses, Analysis Plans • Identifying Funders – Using Foundation Center Resources • Grant development and submission

  21. Recommended Texts Primary Text: SB Hulley, SR Cummings et al., Designing Clinical Research: An Epidemiologic Approach  (NY: Lippincott Williams & Wilkins; 2nd Ed. 2001) Additional/Supplemental Texts & Resources: • Leon Gordis Epidemiology (Philadelphia PA: Saunders Elsevier, 2009 4th Ed) • N Krieger Epidemiology for the People (New York NY: Oxford, 2010) • RS Greenberg, SR Daniels, WD Flanders, JW Eley, JR Boring III Medical Epidemiology (4th Ed) (New York NY: Lange/McGraw Hill, 2005) • RM Merrill Introduction to Epidemiology (Boston MA: Jones and Bartlett, 2010, 5th Ed) • Univ of Pittsburgh - Epidemiology Super Course www.pitt.edu/~super1 • Univ of North Carolina – Epidemiology eText www.epidemiolog.net • CDN Clinical Research Track www.CDNetwork.org • Rockefeller Webcasts www.CDNetwork.org/Rockefeller

  22. Building a Stronger Science of Community Engaged Research Guest Editors: • Milton Eder, PhD (ACCESS Community Health Network) • Michelle Proser, MPP (NACHC) • Peter Shin, PhD (GWU) • Jonathan N. Tobin, PhD (CDN/Rockefeller Univ.) Sponsors: • AHRQ • CDN • GWU • NACHC • RCHN • HENRY SCHEIN http://muse.jhu.edu/journals/progress_in_community_health_partnerships_research_education_and_action/toc/cpr.6.3.html

  23. NATIONAL CENTER FOR HEALTH STATISTICS (NCHS)www.cdc.gov/DataStatisticswww.cdc.gov/nchs/data_access/ftp_data.htmwww.cdc.gov/nchs/dhcs/dhcs_surveys.htm • NATIONAL HOSPITAL DISCHARGE SURVEY (NHDS) www.cdc.gov/nchs/nhds.htm • NATIONAL AMBULATORY MEDICAL CARE SURVEY (NAMCS) www.cdc.gov/nchs/ahcd.htm • NATIONAL HEALTH EXAMINATION & NUTRITION SURVEY (NHANES) www.cdc.gov/nchs/nhanes.htm • NATIONAL HEALTH INTERVIEW SURVEY (NHIS) www.cdc.gov/nchs/nhis.htm • BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM (BRFSS) • YOUTH BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM (YBRFSS) www.cdc.gov/brfss www.CDNetwork.org

  24. www.hrsa.gov/data.htm

  25. http://datawarehouse.hrsa.gov

  26. http://quickfacts.census.gov/qfd/states/00000lk.html

  27. www.CDNetwork.org/ CME accredited through AAFP CDE accredited through AGD

  28. CDN Webcast Series • Health Care Acquired Infection Prevention for Ambulatory Surgical Centers • Train-the-Trainer Workshop in Infection Prevention for Ambulatory Surgical Centers • www.CDNetwork.org/HAI • The Rockefeller University Center for Clinical and Translational Science (CCTS) Series • www.CDNetwork.org/Rockefeller • Howard University College of Medicine AIDS Education and Training Center-National Multicultural Center Cultural Competence Series • www.CDNetwork.org/AETCNMC • RCHN Community Health Foundation • www.CDNetwork.org/RCHN

  29. CDN Resource Libraries & Toolkits • Improving Colorectal Cancer Screening Rates among NYC Russian Speaking Communities • Sponsored by: NYC Dept. of Health and Mental Hygiene • www.CDNetwork.org/RussianCRC • Online Guidelines & Clinical Decision Support Tools • Sponsored by: NYC Dept. of Health and Mental Hygiene • eClinician.org • Research Training Catalog for Federally Qualified Health Centers (FQHCs) • Sponsored by: NACHC, GWU, Children’s CTSI • www.CDNetwork.org/NACHC www.CDNetwork.org

  30. www.CDNetwork.org/NACHC

  31. Step 1: Getting Started www.CDNetwork.org/NACHC

  32. Step 3: Asking the Right Questions www.CDNetwork.org/NACHC

  33. www.CDNetwork.org www.eClinician.org

  34. Types of T2 T3 T4 Research • CER Comparative Effectiveness Research • PCOR Patient Centered Outcomes Research ------------------------------------------------------------------------------------------------------------------------------------------------------------------------- • CEnR Community-Engaged Research • CBPR Community-based Participatory Research ------------------------------------------------------------------------------------------------------------------------------------------------------------------------- • PBRN Practice-based Research Networks

  35. Models of Practice-Based Research Top-Down Researcher-focused Funder-focused Bottom-up Clinician-focused (PBRN) Patient-focused (CBPR) Mixed Model (Bi-directional) Clinician Researcher

  36. A common aim behind Comparative Effectiveness Research (CER) and Practice-based Research Network (PBRN)-conducted research is to produce new evidence-based medical knowledge that fills gaps between primary care practice realities and findings produced by academic/tertiary-care research and clinical trials Less control over Patient characteristics Variability in practice clinical and research capacity Multiple IRBs Significant resource problems that impede research Other challenges include: selecting studies that meet network goals and objectives working within an adequate and sufficient budget developing study teams and agreements among team members training practice staff for participation Challenges for PBRNs

  37. Translational Research & NIH “Blue Highways” T4 Public Health Impact SOURCE: Westfall, et al., “Practice-Based Research—“Blue Highways’ on the NIH Roadmap” JAMA 2007; 297: 403-406

  38. Stages of CBPR vs. Key Steps in PCTs MacPherson H. Pragmatic clinical trials. Complementary Therapies in Medicine. 2004. 12:136-140.

  39. Pragmatic-Explanatory Continuum Indicator Summary (PRECIS) Tool Thorpe KE et al. A pragmatic-explanatory continuum indicator summary tool (PRECIS): a tool to help trial designers. CMAJ 2009; 180(10):E47-57.

  40. Four-Stage Model of Community-Engaged Research 1. Hatch J, Moss N, Saran A et al. Community research: Partnership in Black communities. American Journal of Preventive Medicine. 1993 Nov-Dec;9(6 Suppl):27-31; discussion 32-34.

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