Indiana CTSI sixth annual meeting focuses on the patient role in health care
October 9, 2014
A good physician always bases their treatment recommendations on all the available evidence. But how can a doctor know they are making the right decision when they simply don't have enough evidence?
A leader of the group created to fill those evidence gaps -- and to spearhead greater efficiency in medical care and delivery in general under the U.S. health care reform law -- struck the keynote at the sixth annual meeting of the Indiana Clinical and Translational Sciences Institute, "From Academic Centers to Population Health," Sept. 26 in the Hine Hall Auditorium at IUPUI.
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The Indiana CTSI is a statewide collaboration of IU, Purdue University and the University of Notre Dame to facilitate the translation of scientific discoveries in the lab into new patient treatments in Indiana and beyond. The director of the Indiana CTSI is Anantha Shekhar, M.D., Ph.D., associate vice president for university clinical affairs at IU and associate dean for translational research and Raymond E. Houk Professor of Psychiatry at the IU School of Medicine.
"Comparative effective research emphasizes the choices that are already available to people; the options that already exist," said David Hickam, M.D., director for the Clinical Effectiveness Research Team at the Patient-Centered Outcomes Research Institute, or PCORI, a non-government institute created as part of the Patient Protection and Affordable Care Act to provide support for comparative effectiveness research and other types of research that can help patients and providers to deliver high quality medical care.
"The United State spends a lot of money on health care compared to other nations but doesn't necessarily get the desired outcomes," he added. "This raises the question: Do we truly understanding the available evidence? Are we truly working to figure out what new information might improve our evidence base so the choices people make is based upon the best possible evidence?"
The approach flips the tradition model in which a physician prescribes a treatment based upon all available evidence. Comparative effectiveness research asks physician what gaps exist in the available evidence and then designs studies to fill those spaces to improve their ability to make decisions with the greatest chance of generating positive results.
“PCORI also places a strong emphasis on the role of the patient in their own care," according to Dr. Hickam. The organization, which has distributed over $250 million since its creation in 2010, includes clinical stakeholders and patients -- as well as scientific experts -- on its review panels. All applicants are also required to explain not only the health impact and technical merits of the projects but also how the work will positively impact the lives of patients. The organization's whole philosophy revolves around the concept of "patient-centeredness."
The model represents a growing trend, according to Jay L. Hess, M.D., Ph.D., MHSA, dean of the IU School of Medicine and associate vice president for university clinical affairs at IU, who also presented. Healthcare reform is shifting the health care model from a "volume based" model rewards physicians for prescribing treatments to a "value based" model that rewards physicians for successfully keeping a group of patients healthy to the point where they don't require as many treatments in the first place. The concept of population health management is shifting the focus to greater accessibility, strong prevention, fewer unnecessary procedures, and strong care coordination -- also known the patient-centered medical home model. The ultimate goal -- and challenge -- is simultaneously strengthening patient care, improving the health of community and lowering cost.
Other presenters included Paul K. Halverson, Dr.PH, dean of the IU Richard M. Fairbanks School of Public Health at IUPUI, and Brad N. Doebbeling, Ph.D., professor and chair of biohealth informatics at the IU School of Informatics and Computing and professor of medicine at the IU School of Medicine. "We're so proud to work with the Indiana CTSI," Dr. Halverson said. "They've got so many great things going on in community engagement… it's really an interaction that recognizes the importance and value of what everyone in the community brings to the table."
Dr. Doebbling is one of two IU faculty members whose has received support from PCORI. Dr. Doebbling's project, “Improving Healthcare Systems for Access to Care and Efficiency by Underserved Patients,” aims to develop patient-centered approaches to improving access to care among the poor, uninsured or underinsured through a simulation model that takes into account the major barriers to care, such as lack of transportation, inability to get off of work, missing documents, language barriers and months-long delays in Medicaid approval. The other IU faculty to receive support from PCORI is Michelle P. Salyers, Ph.D., professor of psychology in the IU College of Arts and Sciences at IUPUI, who is testing evidence-based approaches to fight burnout and improve well-being among doctors.
Additional investigators to present at the event also put a spotlight on patient-centered research. Sarah Wiehe, M.D., co-director of the Indiana CTSI CHEP and associate professor of pediatrics, discussed the Patient Engagement Core, a new service from the Indiana CTSI that borrows the "user-centered approach" concept from the field of design to develop hands-on and interactive activities that engage patients in their own care -- as well as improve study recruitment and disseminate research findings to the public. Nitesh Chawla, Ph.D., Frank Freimann Collegiate Associate Professor of Computer Science and Engineering and Director of the Interdisciplinary Center for Network Science & Applications (iCeNSA) at the University of Notre Dame, discusses iCeNSA's mission to advanced personalized medicine through customized smartphone and web-based applications that collect relevant health data from patients. Projects examples included an obesity management program developed for high school students in South Bend and a diabetes management smartphone application receiving support from an Indiana CTSI CHEP seed grant.
A panel presentation on population health from representatives of three major research hospitals in Indiana closed the session. Presenters were Lisa Harris, M.D., CEO of Eskenazi Health and associate dean for Eskenazi Health Affairs and John F. Williams, Jr., M.D. Scholar at the IU School of Medicine; Chet Ho, M.D., director of the Population Health Office at IU Health and Michael Weiner, M.D., director of Health Services Research and Development at the Richard L. Roudebush Veterans Affairs Medical Center and associate professor of medicine and Department of Medicine Investigator in Health Services Research at the IU School of Medicine. William M. Tierney, M.D., president and CEO of the Regenstrief Institute and associate dean for clinical effectiveness research at the IU School of Medicine, served as the moderator.
The event also included a poster session with prizes for the top three posters in the both the Indiana CTSI-supported researcher and scholars and trainees categories. Each winner received $1,000.
The winners in the Indiana CTSI-supported researcher category were:
- Robin K. Fuchs, Ph.D., assistant professor of physical therapy in the IU School of Health and Rehabilitation Sciences at IUPUI, "Bone Health in Children with Cerebral Palsy."
- Laurie Littlepage, Ph.D., Campbell Family Assistant Professor of Cancer Research and a member of the Harper Cancer Research Institute at the University of Notre Dame, "The Oncogene ZNF217 Promotes Breast Cancer Chemoresistance."
- Janet E. Panoch, a research assistant in the Department of OB-GYN at the IU School of Medicine, "Patient Communication Skills Training for High School Health and Wellness Classes."
The winners in the scholars and trainees category were:
David W. McIlwain, a predoctoral researcher in the Department of Pharmacology and Toxicology at the IU School of Medicine, "APE1/Ref-1 Regulates Survivin-Mediated Drug Resistance in Prostate Cancer Cells."
- Eric Orman, M.D., a postdoctoral researcher in the Department of Medicine at the IU School of Medicine, "Delirium is Associated with Poor Outcomes in Patients with Cirrhosis."
- Emily K. Sims, M.D., a postdoctoral researcher in the Department of Pediatrics at the IU School of Medicine, "Beta Cell Derived miR-21 as an Intrinsic Protective Response and Biomarker in Type 1 Diabetes Mellitus."
McIlwain is also a recipient of the Indiana CTSI Predoctoral (Trainee) Award. Drs. Orman and Sims are also the recipients of the Indiana CTSI Postdoctoral (Young Investigator) Award. Drs. Fuchs, Littlepage and Panoch have also received support from the Indiana CTSI.