Impact of BRIC

1
Impact of BRIC

• Assessing Our Progress and Imagining Our Future
  in Health Services Research

2
Purpose of BRIC

• Provide funding for implementation of an
  Institutional Research Infrastructure Development
  Plan
• Provide funding to support this development
  centered on a nationally competitive and timely
  research project

3
Institutional Research Infrastructure Development
Plan

• Develop the skills and abilities of faculty
• Develop the infrastructure and resources for CHRP
  research faculty
• Prepare a nationally competitive application
• Develop the processes that support forming and
  maintaining an interdisciplinary health services
  research team
• Develop the processes that support timely
  dissemination of products

4
Research Project Aims

• Develop a model to explain technology acceptance
  by primary care physicians within the context of
  clinical decision support
• Describe the use and acceptance of technology by
  Nebraska and South Dakota primary care physicians
  
• Predict the likelihood of voluntary
  implementation of technology and clinical
  decision support
• Explore how the findings may be used with MEPS
  data to predict the potential impact on
  prescribing safety
• Translate the findings back to office-based
  practitioners for consideration in practice
  improvement decisions.
• Develop an external research grant proposal (R01)

5
Past, Present and Future

• Phase I - Formed of Creighton Health Services
  Research Program (CHRP)
• Phase II Building Research Infrastructure
  Capacity (BRIC) Funding - development of CHRP
  Research Fellow Mentees, CHRP Leadership,
  Community Partnerships, University Relationships
  to build sustainable health services research
• Phase III Contribution of the university to a
  sustainable CHRP infrastructure organization post
  BRIC award

6
Source Phase Development Grid
7
CU In Kind Sources of Infrastructure and
Development Support

• Health Futures Foundation launch monies
• School of Pharmacy and Health Professions (SPAHP)
• Data Management/Analyst Position 75
• CHRP Administrator 10
• CHRP Administrative Assistant 10
• In kind salary/time for 2 faculty (Galt,Paschal)
• School of Nursing (SON)
• In kind salary/time for 1 faculty (Abbott)
• Development expenses shared with CHRP

8
CHRP Foundation BRIC Build Capacity 18 month
Progress

• Faculty Research Scientist Development

• Skills
• Performance
• Focus
• Direction

9
CHRP Foundation BRIC Build Capacity 18 month
Progress Research Scientist Development
10
CHRP Foundation BRIC Build Capacity 18 month
Progress

• Research Team Development

11
CHRP Foundation BRIC Build Capacity 18 month
ProgressResearch Team Development

• Intra-team communication
• Weekly meetings of prime importance
• Shared mental models
• Shared resource access
• Structured roles and responsibilities
• Alignment of individual and group goals
• Individual leadership mutually respected
• Unique expertise of individuals respected

12
CHRP Foundation BRIC Build Capacity 18 month
ProgressResearch Project Development

• Research Project Implementation Plan
• Complex research questions complex project
• Roles and Responsibilities of research scientists
  delineated, refined as progressed through skill
  development and external influences on research
  itself
• Roles and Responsibilities of support staff
  professionals
• Deadlines, revised deadlines, revised deadlines!
• Integration of emerging opportunities onto the
  project roadmapmore revised deadlines.

13
CHRP Foundation BRIC Build Capacity 18 month
Progress Product Dissemination

• Presentations, publications shared products
• Technical reports
• News releases and publicity
• Additional funding sources to extend research -
  more opportunities
• Progress in community and organizational
  partnerships more opportunities
• Federal study section and special emphasis panel
  service more opportunities
• State council and committee appointments more
  opportunities

14
CHRP Foundation BRIC Build Capacity 18 month
Progress

• Engagement and Dissemination

Scientific Leadership Relationship
Leadership Translating Research to Service
This project is being supported in part by the
grant "Enhancing Clinical Practices through the
Adoption of Health Information Technology in
Nebraska" through the Nebraska Medical
Association and the Creighton Health Services
Research Program grant no. 1P20 HS015816 Building
Research Infrastructure Capacity from the Agency
for Healthcare Research and Quality (AHRQ).
15
Relationships Within the University -
institutionalization?

• School of Nursing
• School of Medicine
• Within School of Pharmacy and Health Professions
• School of Dentistry
• College of Arts and Sciences
• College of Business Administration
• School of Law

16
Community and Government Relationships 18 month
Progress
Uninet
UNMC School of Allied Health
UNL BUROS Institute
17
CHRP Foundation BRIC Build Capacity Where we
are at now

• Research Scientist Advancement
• Expanding our External Engagement with Partners
  and Scientist Network
• Identifying Research Streams for Individuals
• Identifying Research Platform for Research Team
• Developing Sustainability Plan
• Future Vision
• Infrastructure Discussion and Plan
• Internal and External Visit Consultants

18
CHRP Foundation BRIC Build Capacity Where we
are at now Infrastructure Impact and Needs

• We may be at the Tipping Point
• HFF ends this spring of 2008
• BRIC I ends this spring of 2008
• Core group of Scientists Developing
• Content expertise
• Research methods expertise
• Research leadership with influence in and outside
  of Creighton University forming

19
BRIC Mentee Scientists
20
J.D. Bramble

• Associate Professor
• Creighton Health Service Research Program
• School of Pharmacy and Health Professions
• Creighton University

21
Background

• Degrees
• Ph.D. in Health Services Organizations Research
• MPH in Health Administration and Policy
• Research Interest
• Influence of organizational issues on patient
  outcomes
• Teaching
• Research Methods and Biostatistics
• Patient Safety Course
• Health Care Management

22
BRIC Accomplishments

• Research Team/Network
• Publications
• Peer reviewed, book chapters and non-peer
  reviewed.
• Grantsmanship
• Participation in AHRQ Special Emphasis Panel
• Patient Safety Grant
• California Health Care Foundation Grant
• Presentations
• Skills
• Mixed Methods
• Grant Management

23
Future Needs

• Continued Skill to Development
• Intermediate/Advanced mixed methodology
• Survey design
• SAS/SPSS programming
• Funding/Research Support Opportunities
• BRIC II
• R03
• R01
• and anyone else that will give me money

24
Karen A. Paschal, PT, DPT, MS

• Associate Professor
• Department of Physical Therapy
• School of Pharmacy and Health Professions

25
Background

• Physical Therapist
• BS (Biology), University of South Dakota
• MS (Physical Therapy), Duke University
• DPT (Physical Therapy), Creighton University
• Research Training
• Doctoral level coursework in research methods
  with a focus on qualitative methodology
• Interdisciplinary Team Experience
• VA Geriatric Evaluation and Management Program
• Clinical Assessment and Research
• IPE 410 Foundation in Patient Safety
• Expertise in curriculum design, implementation,
  assessment

26
BRIC as a Process

• Teamwork in research
• Development of content knowledge
• Health services orientation
• Health information technology
• Model to predict adoption of HIT by PCPs in
  ambulatory care
• Consumer adoption
• Development of research skills in practice
• Start to finish
• Development of external relationships
• EHR Nebraska
• HISPC (NE HHS)

27
BRIC Products

• Presentations (10)
• Publications (7)
• Grants/contract submissions (2)

28
Next Steps

• Enhance qualitative research skills
• Mentorship in the context of ongoing project(s)
• Consumer security and privacy
• Consumer acceptance
• HIT adoption/interoperability across health care
  providers
• Interprofessional team member pursuing endeavors
  in mixed methods initially explored in BRIC I
• Contribute to building a culture of research
• Participate on a Special Emphasis Panel as a
  reviewer
• Funding opportunities (BRIC II K02)

29
Mark Siracuse, PharmD, PhD

• Assistant Professor
• Creighton University
• School of Pharmacy and Health Professions

30
Background

• Clinician Training and Experience
• B.S. in Pharmacy _at_ U. of Connecticut (1984)
• Pharm.D. _at_ U. of Michigan (1994)
• Professional career roles
• Community/retail pharmacy practice (primary)
• Home infusion practice

31
Background (cont.)

• Research training/development (U. of Minnesota)
• Fellowship in Pharmacoeconomics (1996)
• Aetna Pharmacy Management
• Hoechst Marion Roussel
• M.S. in Social Administrative Pharmacy (1997)
• Thesis Impact of Restrictive Drug Formularies
  in a Large Managed Care Organization
• Ph.D. in Social Administrative Pharmacy (2002)
• Dissertation Your Pharmacy Future Factors
  influencing the career aspirations of pharmacy
  students

32
What I bring to BRIC

• Faculty member _at_ Creighton for 5 years
• Research skills (Quantitative)
• Research design
• Statistical analysis skills
• Multiple linear regression
• Factor analysis
• Path modeling
• SEM using SIMPLIS command language (LISREL)
• Background in Economics Management
• Experience in Community Pharmacy

33
Accomplishments during BRIC

• Professional Presentations (16)
• Lead author on 12 presentations
• Five BRIC related (2 directly)
• Manuscripts/ Publications (10)
• Four published
• Four accepted
• Two under review likely to be accepted
• Published Abstracts (6)
• Grants/contracts submissions (4)

34
Accomplishments during BRIC

• Teaching
• PHA442 Pharmacy Practice Management
• PHA452 Pharmacoeconomics
• PHA334 Parenteral Drug products
• PHA486 Dispensing Pharm Care (2006 only)
• PHA535 Academic Rotation (2006 only)
• PHA399 Independent Research (2007only)
• Course developed PHA452 (2006)

35
Personal Outcomes from BRIC

• Skills Developed
• Further development of SEM knowledge
• Basic understanding of Mixed Methodology
• Patient Safety course (IPE410)
• Participation in AHRQ Review Panel (June 2007)
• Ambulatory Safety and Quality Enabling
  Patient-Centered Care Through HIT
• PI on Grant submission to CHCF with BRIC team for
  support (175,000)
• Evaluation of the ePrescribing Pilot project
• Competitive application
• Appreciation of Multi-disciplinary Research Team

36
Future Needs

• Tenure Promotion at Creighton
• Submit dossier by October 31, 2008
• Receive final decision by April 1, 2009
• Skills to Develop and Enhance
• Survey design (advanced)
• Mixed Methodology (beginner to advanced)
• External Funding Opportunities to Explore
• BRIC II (continuation of current BRIC effort)
• K02 or K08 with AHRQ
• R01 or R03 with AHRQ

37
Amy A. Abbott Ph.D. (c), RN

• Assistant ProfessorCreighton UniversitySchool
  of Nursing
• Launching of My Research Career

38
About Me

• BSN (1992) and MS in Nursing (1998) from CU
• ICU RN for 15 years at Level I Trauma Center
• Teaching in the SON since spring 1996
• Expert witness consulting
• Attained tenure Spring 2007
• Clinical focus adult critical care and complex
  medical-surgical nursing
• Ph.D. candidate at University of Nebraska Medical
  Center College of Nursing with focus in
  cardiovascular symptom management
• Limited research experience

39
BRIC Influences

• Multidisciplinary team experiences
• Manuscript preparation
• Manuscript reviews
• Presentations
• Qualitative research
• New knowledge-base
• Patient safety
• Electronic health records
• Health information technology
• Patient-physician relationship
• Mixed methods research
• Networking and consultation

40
Development from BRIC

• CHRP membership
• Faculty for IPE Patient Safety Course in 2008
• Publication on privacy in health information
  exchange
• Survey development
• Qualitative research exposure

41
Research Trajectory Goals

• Obtain promotion at CU
• Continue with BRIC team to address additional
  patient safety concerns and extend into nursing
• Cardiovascular patient safety avenues and other
  needs related to symptom management
• Disseminate research
• Obtain external funding (BRIC II, K02 or K08)
• Serve on review panel

42
Kevin Fuji, Pharm.D.

• Research Fellow
• Creighton Health Service Research Program
• School of Pharmacy and Health Professions
• Creighton University

43
Life Before BRIC

• Graduated in May 2007 from Creighton SPAHP
• No formal research training
• Only prior research experience was during 4th
  year clinical clerkships
• Academic and research clerkships
• Wanted to pursue a career in research and
  academia

44
Personal Development during BRIC

• CHRP Research Fellow (June 2007 July 2009)
• BRIC Project Coordinator
• A lot of progress in a short period of time
• Piggyback on existing projects
• Community infrastructure
• Pharmacists for Patient Safety
• What to do with ideas
• Authorship guidelines for multidisciplinary teams
• Research skills in pharmacy curriculum
• Submitted a small grant application to ACCP
• Related to BRIC grant work
• Review panel (Perspectives in Health Information
  Management)
• Teamwork and multidisciplinary interaction
• Co-Coordinator of IPE 410 Patient Safety Elective
  Course (2008)

45
Future Development

• Continued progress toward career in research and
  academia
• BRIC team and CHRP
• K08 award
• Mentored Clinical Scientist Development Award
• Goal of an independent health services researcher
• Research development support provided
• Pursue a graduate degree
• Institution must show commitment to the candidate
• Research infrastructure is needed
• Strength of CHRP as a multidisciplinary program

46
Andjela Drincic, M.D.

• BRIC is more than survey work !

47
Background Life Before BRIC

• Clinical endocrinologist (2 years of clinical
  fellowship)
• No formal research training
• At Creighton University for 2 years before
  entering BRIC
• Assistant Professor of Medicine, Clinical
  educator track
• Developed busy clinical practice
• As director of Clinical Diabetes Program
  developed experience working within large
  administrative systems, outpatient and inpatient
• Limited academic activity resulting in a few
  abstracts, posters and two book chapters and a
  with a few research ideas

48
BRIC needs - basic stuff

• Learn basics of grant proposal planning and
  writing
• Understand principles of research methodology
  (all new terms)
• quantitative
• qualitative
• mixed methods

49
BRIC life

• Learning the basics of research
• Survey methodology
• Quantitative data analysis
• Basic understanding of qualitative research
• Learning to productively work together with other
  team members
• Gaining new core knowledge
• Patient safety
• RCA
• Patient physician relationship
• Translating gained knowledge
• Published paper in patient safety field
• Teach in patient safety course (RCA)
• Working on a review paper in HIT/patient
  physician relationship
• Taking Basic Statistics Course (UNL)

50
BRIC influences

• Successful grant application (PI) in investigator
  initiated grant, clinical research
• Co-PI on two other multidisciplinary grants
  (clinical research in diabetes and asthma field)
• Grant submission to CHCF with BRIC team for
  support (175,000)
• Evaluation of the ePrescribing Pilot project

51
Life outside of BRIC

• Teamwork influence
• Associate Program Director, Endocrinology
  Fellowship Program
• Complete revision of the whole fellowship
• Developed new education curriculum with strong
  interdisciplinary approach to education
• Paper accepted
• Currently working on two more papers

52
BRIC wants/hopes

• BRIC 2
• Need further education in research methodology
• To develop a sustainable and protracted research
  activity with other BRIC members with ties to
  clinical endocrinology
• Patient safety
• HIT
• Patientphysician relationship
• Foundation for further professional/personal
  growth
• Where to go next?
• KO8 ?

53
Kimberly A. Galt, PharmD

• Final Thoughts

54
Personal Observations

• From Individual to Group to Team
• Characteristics of Our Research Community
  Stronger than Individual
• Team Essential to Advancing Research on Complex
  Questions
• Reconciling Team Needs with
• Individuals
• larger CHRP network
• Community Partner Needs
• Team addresses Isolation with Integration

55
Critical Relationships

• Kay Anderson - AHRQ
• Consultants
• John Creswell
• Margaret Love
• Steven Fleming
• Dennis Berens NHHS Office of Rural Health

56
Value of this Health Services Research Scientist
Core

• Note the personal viewpoints of each core
  scientist today
• They see differently and with greater vision
• Other leaders relate and want to have a solid
  support system for the important research work
  (Drs. McQuillan, Gorby, others?)

57
Source Phase Development Grid
58
How to Include?

• How do we sustain what we have developed?
• How do we accommodate those who want and need
  this support?
• How do we provide others these opportunities?

59
Moving Forward What Should our Future Look Like?

• Imagination is the only key to the future.
  Without it none exists with it all things are
  possible. Ida M. Tarbell, American journalist
  (1857 1944)
• A sustainable health services research program
• What should BRIC II look like?
• What forms of involvement would you want to have
  with this effort?
• What research related needs might you want to
  have furthered with this effort?