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.