Module 6: Research to Practice

1. Module 6:Research to Practice Translating Research into 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

2. Acknowledgments 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. APTR wishes to acknowledge the following individuals who developed this module: Anh Tran, PhD, MPH Duke 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

3. Presentation Objectives • List reasons for lag time between scientific discoveries and their application • Provide suggestions on how to facilitate translation of research to practice • Discuss the value of working with practice based research networks • List creative ways to disseminate research findings with and to communities • Explain ways to build a pipeline of community engaged researchers

4. Clinical Translation & Community Engagement Community Translation of Research to Outcomes that Matter! Public Health Medicine Research

5. 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

6. 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

7. 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

8. 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

9. What is a PBRN?

10. 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

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

12. PBRNs PBRN projects must be a two-way street: Researchers Practicing Clinicians True success comes only with partnership.

13. 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

14. IN4Kids ProjectAn 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.

15. 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.

16. 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.

17. Institutional Review Board Considerations • Work with IRBs at the beginning stages of a project to address dissemination issues such as: • Whether research participants can be directly contacted without their consent. • Ways to encourage more participants to receive information.

18. 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.

19. Disseminating to Everyone… In professional journals, conferences, abstracts, posters Disseminate Research Findings: Back to referring physicians Back to participants To the community through emails, newsletters, events

20. 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

21. Do Not Forget Referring Physicians

22. 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.

23. 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

24. Work with Area Health Education Centers (AHEC)

25. Attracting Partners to the Research Enterprise Old Model: New Model: Community Partnerships Research Subjects from Community Expanded & Coordinated Access to Care ResearchStudies Research Studies Published Literature Healthier Community

26. 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.

27. Collaborating Institutions Department of Public Health Brody School of Medicine at East Carolina University Center for Public Health Continuing Education University at Albany School of Public Health

28. Advisory Committee Mike Barry, CAE Lorrie Basnight, MD Nancy Bennett, MD, MS Ruth Gaare Bernheim, JD, MPH Amber Berrian, MPH James Cawley, MPH, PA-C Jack Dillenberg, DDS, MPH Kristine Gebbie, RN, DrPH Asim Jani, MD, MPH, FACP Denise Koo, MD, MPH Suzanne Lazorick, MD, MPH Rika Maeshiro, MD, MPH Dan Mareck, MD Steve McCurdy, MD, MPH Susan M. Meyer, PhD Sallie Rixey, MD, MEd Nawraz Shawir, MBBS

29. APTR • Sharon Hull, MD, MPH President • Allison L. Lewis Executive Director • O. Kent Nordvig, MEd Project Representative