clinical outcomes

October 2, 2020: Driving Toward Health Impact: Our Journey and Path Forward (Nakela Cook, MD, MPH)

Posted on by Gina Uhlenbrauck

Speaker

Nakela L. Cook, MD, MPH
Executive Director
Patient-Centered Outcomes Research Institute (PCORI)

Topic

Driving Toward Health Impact: Our Journey and Path Forward

Keywords

PCORI; Health outcomes; Health disparities; Patient-centered research; Comparative clinical effectiveness; COVID-19; Maternal health

Key Points

  • Despite improvements in health, disparities and variation in care remain—especially underscored by the unprecedented COVID-19 pandemic.
  • PCORI funds studies that can help patients and those who care for them make better informed healthcare choices.
  • PCORI has funded the HERO Registry to assess COVID-19 exposure responses and outcomes within the community of healthcare workers. Other research support is targeted toward vulnerable populations, healthcare delivery, and emerging health trends.
  • With PCORI 2.0, new funding will be available for large-scale, high-impact comparative effectiveness trials. Each study will include an initial phase to determine the feasibility and viability of the study and maximize the likelihood of success during the full-scale phase.

Discussion Themes

What are your observations regarding COVID-19’s impact on health, healthcare, and research that you think will be critical for PCORI's strategy? What will bring about the necessary innovations to the system?

Addressing maternal health disparities is a high priority in PCORI 2.0. The next phase will also expand PCORI’s role in collecting and generating relevant evidence and focusing on a deliberate and transparent process for implementation.

How will PCORI broaden its reach to reduce outcome disparities among people with disabilities?

Read more about PCORI.

Tags

#pctGR, @Collaboratory1

September 25, 2020: Accelerating the Nation’s COVID-19 Testing Capacity: An Update from the NIH’s RADx Program (Rick Bright, PhD; Rachael Fleurence, PhD)

Posted on by Gina Uhlenbrauck

Speakers

Rick Bright, PhD
Senior Advisor to the NIH Director

Rachael Fleurence, PhD
Special Assistant to the NIH Director for COVID-19 Diagnostics

Topic

Accelerating the Nation’s COVID-19 Testing Capacity: An Update from the NIH’s RADx Program

Keywords

National Institutes of Health; COVID-19; Rapid Acceleration of Diagnostics (RADx); COVID-19 testing protocols; Innovative technologies; Coronavirus testing

Key Points

  • The NIH launched the Rapid Acceleration of Diagnostics (RADx) initiative to speed innovation in the development, commercialization, and implementation of technologies for COVID-19 testing.
  • RADx is creating programs to rapidly scale-up testing across the country and enhance access to those most in need. Newer technologies offer user-friendly designs with lower cost and increased accessibility at home and at the point of care.
  • Deploying the right tests at the right time to the right people will be critical to managing the pandemic until a vaccine is available and beyond. Testing will still be necessary after the vaccine becomes available.

Discussion Themes

The supply chain continues to be a challenge in COVID-19 testing procedures, for example the availability of plastic tips and swabs. However, barriers are driving innovations such as saliva technologies and extraction-less approaches.

Are there efforts underway to link testing data from disparate sources such as EHR clinical data, administrative claims data, antibody testing, symptom trackers/COVID-19 registries?

A new goal will be implementing the real-time matching of COVID-19 hot spots with available testing.

Read more about the NIH’s RADx program and in a special report in New England Journal of Medicine.

Tags

#pctGR, @Collaboratory1

September 11, 2020: Launching CONNECTS: Collaborating Network of Networks for Evaluating COVID-19 and Therapeutic Strategies (Gordon Bernard, MD; Sonia Thomas, DrPH)

Posted on by Gina Uhlenbrauck

Speakers

Gordon R. Bernard, MD
CONNECTS ACC Science Unit P
Professor of Medicine
Executive Vice President for Research
Senior Associate Dean for Clinical Science
Vanderbilt University Medical Center

Sonia Thomas, DrPH
CONNECTS ACC Principal Investigator
Senior Research Statistician
RTI International

Topic

Launching CONNECTS: Collaborating Network of Networks for Evaluating COVID-19 and Therapeutic Strategies

Keywords

COVID-19; CONNECTS; NHLBI; Collaborative research; Data sharing; Adaptive trials; Data standardization; ACTIV; Therapeutic agent prioritization

Key Points

  • The Collaborating Network of Networks for Evaluating COVID-19 and Therapeutic Strategies (CONNECTS) is a research partnership coordinated by the Research Triangle Institute, Vanderbilt University Medical Center, and the National Heart, Lung, and Blood Institute (NHLBI) of the NIH.
  • CONNECTS aims to build on existing clinical research networks to better understand the risk of severe illness from COVID-19 and to identify therapies that will slow or halt the disease progression and speed recovery. Studies will enroll participants with health conditions that are known to increase their risk for severe complications from COVID-19.
  • The immediate goal is to design and implement master protocol-driven adaptive clinical trials, including outpatient, inpatient, and recovering master protocols.
  • CONNECTS is part of a larger ecosystem in the Department of Health and Human Services that includes the FDA, CDC, BARDA, Operation Warp Speed, and NIH. More than 34 trial networks and 1,000 sites are participating in CONNECTS.

Discussion Themes

Are the CONNECTS resources, such as the common data elements manual, draft protocols, and case report forms, publicly available?

In your effort to reach underrepresented communities, have you considered collaborating with Historically Black Colleges and Universities (HBCUs), particularly those that conduct health research?

While COVID-19 is providing you with plenty to focus on, do you see the potential for sustainability of CONNECTS beyond this pandemic?

Read more about CONNECTS.

Tags

#pctGR, @Collaboratory1

August 21, 2020: Adaptive Platform Trials: Scalable from Breast Cancer to COVID (Laura Esserman, MD, MBA)

Posted on by Gina Uhlenbrauck

Speaker

Laura Esserman, MD, MBA
Director, UCSF Carol Franc Buck Breast Care Center
Alfred A. de Lorimier Endowed Chair in General Surgery
Professor of Surgery and Radiology, UCSF

Topic

Adaptive Platform Trials: Scalable from Breast Cancer to COVID

Keywords

COVID-19; Adaptive platform trial; Study design; Learning healthcare system; Collaborative research

Key Points

  • Adaptive trial design is an innovative, collaborative approach with the potential to maximize learning about treatments so as to prioritize therapeutic agents and drive better patient outcomes.
  • Adaptive platform trials are designed to identify early endpoints that can be captured in the course of care. Multiple agents are evaluated simultaneously, and those with a potential for big impact are advanced quickly.
  • As a “learning engine,” adaptive platform trials could be used to accelerate high-impact treatments for COVID-19 and future pandemics.

Discussion Themes

Essential to an adaptive platform trial are checklists of data and nimble EHR tools that evolve as the disease evolves.

What is the process to monitor for and make the decision to modify the standard of care backbone?

Read more about adaptive platform trials at the I-SPY Trials website and a recent Grand Rounds presentation, Optimized Learning While Doing: The REMAP-CAP Adaptive Platform Trial.

Tags

#pctGR, @Collaboratory1

August 14, 2020: Learning While Sprinting: A One-Year Retrospective from the NOHARM Pragmatic Trial (Jon Tilburt, MD; Andrea Cheville, MD)

Posted on by Gina Uhlenbrauck

Speakers

Jon Tilburt, MD
Professor of Medicine and Biomedical Ethics
Mayo Clinic

Andrea Cheville, MD
Professor of Physical Medicine and Rehabilitation
Mayo Clinic

Topic

Learning While Sprinting: A One-Year Retrospective from the NOHARM Pragmatic Trial

Keywords

PRISM; NIH Heal Initiative; NOHARM; Postoperative care; Nonpharmacologic pain care (NPPC); Stepped wedge; Cluster-randomized trial; Electronic health records (EHRs); Patient engagement; Clinical decision support

Key Points

  • The Nonpharmacologic Options in Postoperative Hospital-based and Rehabilitation Pain Management (NOHARM) NIH Collaboratory Trial is completing its pilot phase. This embedded, stepped-wedge PCT will test a sustainable strategy in perioperative, nonpharmacologic pain management that preserves patient function, honors patient values, and maintains the availability of opioids as a last resort.
  • NOHARM is a pragmatic, EHR-integrated intervention that bundles a portal-based conversation guide that captures patient preferences for postsurgical pain care and a clinician-directed decision support tool.
  • Nonpharmacologic pain care management options include walking, yoga, tai chi, acupressure, massage, meditation, and relaxation.

Discussion Themes

Opioids are insufficient in postsurgical care. Guidelines recommend nonpharmacologic pain care (NPPC), but there have not been studies showing how to make NPPC more viable.

The COVID-19 pandemic caused disruption in scheduled surgeries and also air travel, which precluded on-the-ground support at two study sites. However, the team was able to adjust recruitment methods during the pilot phase.

What was the team’s proactive process in working with the IRB in order to obtain a waiver of consent?

The NOHARM intervention has sustained high-level institutional support despite the impact of COVID-19.

Read more about the NOHARM NIH Collaboratory Trial.

Tags

#pctGR, @Collaboratory1

August 11, 2020: Grand Rounds Webinar Discusses the Democratization of Medical Research

Posted on by Gina Uhlenbrauck

A recent Grand Rounds webinar presented by C. Michael Gibson, MS, MD, described how open access, patient empowerment, social media, and digital health are transforming clinical trials. Dr. Gibson is a professor of medicine at Harvard Medical School and president and CEO of Baim and PERFUSE Research Institutes.

Among the key points:

  • The COVID-19 pandemic has been a call to arms to physicians to combat not only the virus but the misinformation.
  • As the internet is replacing the printing press, “copyleft” is replacing copyright in this new open-access era. It is a participatory community with bidirectional flow of information through social media.
  • Health data does not equal health care. Patients are looking to physicians to curate health information.
  • In this new world of clinical research, patients are enrolling in virtual trials via a phone app and will be followed up online through claims data and patient-reported outcomes.
  • Patient-empowered trials have the potential to provide more generalizable study results and to lead to patient-specific predictions through use of artificial intelligence.

Watch the complete webinar and download the slides.

Read more in The Democratization of Medical Research and Education Through Social Media: The Potential and the Peril (Gibson, JAMA Cardiology, 2017) and learn about the Heartline Study as an example of a “giga trial.”

August 7, 2020: The Democratization of Medicine: Open Access, Social Media, AI, Apps, and Empowering the Patient as the Future of Clinical Research (C. Michael Gibson, MS, MD)

Posted on by Gina Uhlenbrauck

Speaker

C. Michael Gibson, MS, MD
Professor of Medicine
Harvard Medical School
President and CEO
Baim and PERFUSE Research Institutes

Topic

The Democratization of Medicine: Open Access, Social Media, AI, Apps, and Empowering the Patient as the Future of Clinical Research

Keywords

Clinical research; Open access; Social media; Artificial intelligence; Heartline study; WikiDoc; WikiPatient

Key Points

  • As the internet is replacing the printing press, “copyleft” is replacing copyright in the open-access era. It is a participatory community with bidirectional flow of information through social media.
  • Health data does not equal health care. Patients are looking to physicians to curate health information from huge volumes of data.
  • Social media and open access during the COVID-19 pandemic has meant that physicians are citizen journalists, innovators, activists, and educators.
  • In this new world, patients are enrolling in virtual trials via a phone app and will be followed up online through claims data and patient-reported outcomes.

Discussion Themes

The COVID-19 pandemic has been a call to arms to clinicians to combat not only the virus but the misinformation. As educators we must set the path and not allow uninformed people to take control.

Enabling patient-empowered trials has the potential for more generalizable study results and can lead to patient-specific predictions through use of artificial intelligence.

How do we validate the quality of open-access data and reports that are not peer-reviewed?

How can we diminish the hazards of skewed research outcomes arising from trial participant conversations on social media?

Read more from C. Michael Gibson in The Democratization of Medical Research and Education Through Social Media: The Potential and the Peril (JAMA Cardiology 2017).

Tags

#pctGR, @Collaboratory1

July 24, 2020: TENS in Fibromyalgia: From Fundamental Neurobiology to Pragmatic Trial (Leslie J. Crofford, MD; Kathleen Sluka, PT, PhD)

Posted on by Gina Uhlenbrauck

Speakers

Leslie J. Crofford, MD
Wilson Family Chair and Professor of Medicine
Vanderbilt University Medical Center

Kathleen Sluka, PT, PhD
Kate Daum Research Professor
Department of Physical Therapy and Rehabilitation Science
University of Iowa

Topic

TENS in Fibromyalgia: From Fundamental Neurobiology to Pragmatic Trial

Keywords

Fibromyalgia; Musculoskeletal pain; Neuropathic pain; Transcutaneous electrical nerve stimulation (TENS); Physical therapy; Nonpharmacologic pain treatment; PRISM; Patient-reported outcomes (PROs)

Key Points

  • Fibromyalgia (FM) is a condition of widespread pain that is worsened with physical activity. It involves chronic musculoskeletal and visceral pain and is often accompanied by fatigue, depression, or anxiety.
  • Transcutaneous electrical nerve stimulation (TENS) is a technique that uses a device to deliver an electric impulse through the skin. Treatment with TENS has been shown to improve resting and movement-evoked pain and fatigue.
  • While physical therapists generally are trained in the use of TENS, the technique remains underused in clinical practice.
  • The goal of the FM TIPS pragmatic trial is to determine, in a real-world clinical setting, whether physical therapy combined with TENS for patients with FM is more effective than physical therapy alone. The study is being piloted in 24 sites across 5 physical therapy health systems.

Discussion Themes

While COVID-19 has had an impact on piloting the FM TIPS study, some kind of physical therapy will be possible through telemedicine. Other challenges include that conducting embedded research in physical therapy clinics is new, and there are multiple different EHR systems in use across the partnering clinics.

The recently published results from Fibromyalgia Activity Study With TENS (FAST) showed that TENS can be safely used in addition to other treatments to improve pain and fatigue in women with fibromyalgia in the setting of a randomized controlled trial.

Read more about the Fibromyalgia TENS in Physical Therapy Study (FM TIPS) NIH Collaboratory Trial and watch a brief interview with the PIs of the study.

FM TIPS is one of the NIH HEAL Initiative’s PRISM (Pragmatic and Implementation Studies for the Management of Pain to Reduce Opioid Prescribing) studies.

Tags

#pctGR, @Collaboratory1

July 17, 2020: Living Textbook Grand Rounds Series: Choosing What to Measure and Making it Happen: Your Keys to Pragmatic Trial Success (Devon Check, PhD; Rachel Richesson, PhD)

Posted on by Gina Uhlenbrauck

Speakers

Rachel Richesson, PhD, MPH
Associate Professor, Informatics
Duke University School of Nursing

Devon Check, PhD
Assistant Professor, Population Health Sciences
Department of Population Health

Topic

Choosing What to Measure and Making it Happen: Your Keys to Pragmatic Trial Success

Keywords

Measuring outcomes; Phenotypes; Data quality; Data linkage; Endpoints; Patient-reported outcomes (PROs)

Key Points

  • Endpoints and outcomes for embedded pragmatic clinical trials (ePCTs) should be meaningful to providers and patients and be relatively easy to collect as part of routine care. Endpoints and outcomes also should be clearly defined and reproducible.
  • Patient-reported outcomes (PROs) are often the best way to measure quality of life, but come with challenges in that they are not routinely or consistently used in clinical care nor are regularly recorded in the EHR.
  • To fully capture all care—complete longitudinal data—it is often necessary to link research and insurance claims data.

Discussion Themes

Data in EHRs are an important component of ePCTs. While ePCTs strive for efficiency, there remain tradeoffs. Sometimes it will be necessary to collect data outside of the EHR to ensure important and compelling results.

It is also important that the endpoint that is conveniently available will also be accepted as influential for stakeholders when the trial results are disseminated.

In the future, it is essential that more meaningful data as well as more patient-reported outcomes are routinely collected and incentivized.

Developing a robust data quality assessment plan will improve the value of data and detect and address data issues. Read more about how to do this in Assessing Data Quality for Healthcare Systems Data Used in Clinical Research.

To learn more about measuring outcomes, visit these Living Textbook chapters:

Tags

#pctGR, @Collaboratory1

July 15, 2020: Living Textbook Grand Rounds Series Continues With “Choosing What to Measure and Making It Happen”

Posted on by Damon Seils

Join us Friday, July 17, for “Choosing What to Measure and Making It Happen: Your Keys to Pragmatic Trial Success,” the final session in our special 5-part Grand Rounds series focused on the Living Textbook of Pragmatic Clinical Trials. NIH Collaboratory investigators Drs. Rachel Richesson and Devon Check will discuss endpoints and outcome measures in pragmatic clinical trials embedded in healthcare systems. Topics covered will include:

  • The ins and outs of using EHR data
  • Choosing and specifying your trial’s endpoints and outcomes

See below for the full schedule of Living Textbook sessions and a special message from Dr. Kevin Weinfurt.

 

Living Textbook Grand Rounds Series
Date Title Speakers
January 31, 2020 Pragmatic Clinical Trials: How Do I Start?
  • Greg Simon, MD, MPH, Kaiser Permanente Washington Health Research Institute
  • Lesley H. Curtis, PhD, Duke University
February 28, 2020 Preparing for the Unknown: Conducting Pragmatic Research in Real-World Contexts
  • Jerry Jarvik, MD, MPH, University of Washington
  • Vince Mor, PhD, Brown University
  • Leah Tuzzio, MPH, Kaiser Permanente Washington Health Research Institute
March 27, 2020 Tips for Putting Together a Successful PCT Grant Application
  • Wendy Weber, ND, PhD, MPH, National Center for Complementary and Integrative Health
June 19, 2020 Demystifying Biostatistical Concepts for Embedded Pragmatic Clinical Trials
  • Liz Turner, PhD, Duke University
  • Patrick Heagerty, PhD, University of Washington
  • David M. Murray, PhD, National Institutes of Health
July 17, 2020 Choosing What to Measure and Making It Happen: Your Keys to Pragmatic Trial Success
  • Rachel Richesson, PhD, MPH, Duke University
  • Devon Check, PhD, Duke University