Thomas W. Carton, PhD, MS Principal Investigator, Research Action for Health Network (REACHnet) Director of Health Services Research, Louisiana Public Health Institute
Identifying Research Needs on the Ground
Overview of PFA PCORI has provided support to CDRNs to engage health systems
leaders to work jointly to identify and prioritize a set of data-driven research activities of high interest to systems and/or
clinicians within the systems
TOPIC SELECTION GUIDELINES
Rated as priority by the CEOs/
system leaders
Involve iterative
review and discussion between
researchers and health
systems leaders
Of interest and add
value for >2 PCORnet
health systems
Leverage data
resources (PCORnet Common
Data Model) with or without
additional health
system data
Projects should be <= 1 year duration
Overview of REACHnet REACHnet is a network of health systems containing clinical records for more than 3 million patients in Louisiana and Texas, facilitating patient-centered comparative effectiveness research (CER). Partners include:
◦ Ochsner Health System
◦ Tulane University Medical Center
◦ Louisiana State University and Pennington Biomedical Research Center
◦ Baylor Scott & White Health
◦ Partnership for Achieving Total Health (PATH) - network of FQHCs
Topic solicitation, prioritization, and framing the question
Comparators and outcomes, conceptual framework, analysis
plan, and data collection
Reviewing & interpreting results,
translation, and dissemination
REACHnet (and all CDRNs) seek to transform the culture of research by engaging patients, caregivers, and the broader healthcare community throughout the research process.
PCORI research
priorities & funding
opportunities
Researchers
Health systems leaders
Patients Clinicians
Payor groups
Community health
activists & workers
Research Question Formation: A Stakeholder-led Approach
Facilitated by REACHnet Coordinating Center
Stakeholders
Clinical Researcher, 3
Community Health Advisory Board, 11
Health System CEO, 3
Health System CMO, 2 Health System CQO, 1
Medical Student, 1
Patient Representative, 3
Payor, 2
Practicing Clinician & Researcher, 2
REACHnet Coordinating Center, 8
REACHnet Partner Health System VP, 2
REACHnet Health Systems Demonstration Project Participants by Stakeholder Identification (n=38)
June 2015: Engagement
of health system C-
Suite members and initial discussion
7/14/15 [Admin Board]:
Brainstormed general areas
of need for health
systems research
8/25/15 [Dinner #1]: Open round-
table discussion
about topics of
importance
9/30/15 [CHAB]:
Prioritization activity and discussion
10/22/15 [Dinner #2]:
Further refinement
and prioritization
of defined research
questions
12/10/15 [Dinner #3]: Finalization of research
questions to be taken to
DC
Method and Timeline
Generation
• Guided discussion • Study Prioritization Matrix
Prioritization
• Voting activity • HSD Priorities
Scorecard • Guided discussion
Refinement
• Emailed Refinement Survey
• Small-group discussion
Tools Used During the Process Topic Prioritization Matrix (Product of
Dinner 1, CHAB, and Admin Board) Patient-Partner Orientation
Topic Scorecard & Online Survey (During and after Dinner 2)
Lit Review & Discussion Guide (Dinner 3)
Final Topics
Topic Question Sample
1. Effects of end of life care on health outcomes and utilization
Examine patterns of healthcare utilization one year prior to mortality to better understand comparative effects of advanced illness management/end-of-life care on patient health outcomes and resource utilization.
Patients with advanced illness who have died in the past year; condition-specific sub-samples
2. Effects of mental health and weight loss intervention strategies on weight management outcomes
Evaluate the effects of multiple factors (change in mental health, medication regimen, etc.) on weight loss maintenance after initial weight loss success (e.g., post-bariatric surgery).
Patients who experience a defined magnitude of weight loss during a specified timeframe
3. Efficacy of post discharge follow-up programs, protocols, and/or practices
Compare the influence of post discharge follow-up and encounter patterns post-discharge (e.g., time to follow-up, method of follow-up) on patient health outcomes.
All patients; condition-specific sub-samples
Takeaways
• Events took place over 6 months (increased stakeholder buy-in, dedication, and comfort).
• Multiple types of stakeholders contributed unique perspectives, both independently (CHAB, Admin Board) and collaboratively in larger groups (dinner meetings).
• Numerous tools were used to collect and organize ideas.
• The process was worthwhile for stakeholders (e.g., meet-and-greet before dinner, proper compensation for patient partners, dinner meetings).
• Health systems leaders were engaged both directly (though the meetings, discussions) and independently via systems PIs, and they ultimately endorsed both the process and the findings.