Transforming Healthcare Practice: Role of the CTSA Initiative

1. 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

2. Current resource allocation $$$ Dougherty, D. et al. JAMA 2008;299:2319-2321.

3. Future resource allocation? Dougherty, D. et al. JAMA 2008;299:2319-2321.

4. CTSA – 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)

5. 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”)

6. Mayo Health System PBRN

7. 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

8. CTSA – Approaches to Practice Research (2) Determine how to produce sustainable changes in clinical practice (T3) ???

9. 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”)

10. Wisconsin Minnesota • Total = 127,277 • Women = 51% (63,199) • ≥ 65 = 11% (13,392) Iowa Olmsted County records-linkage system

11. economics and finance evidence synthesis organization theory qualitative research designs communications behavioral science systems engineering public policy informatics “Toolkit” to Support T2/T3

12. CTSA – 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

13. IT epidemiology biomedical sciences sociology social marketing political science communications psychology economics Bringing together disciplines important to T2/T3…. CTSA?

14. Challenges 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?

15. 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

16. Changing Practice Through Research: Role of the CTSA Initiative TRANSFORMATION!

17. Changing Practice Through Research: Role of the CTSA Initiative TRANSFORMATION!