Participatory strategies for translational research
Work closely with operation leaders
Research organizations nationwide are looking for ways to improve links between health care research and health care practice. Still, translational research remains challenging.
Now one recent study has found an approach that sustains translational research and improves health care quality.1
Investigators found that applying the principles of community-based participatory research to studies involving health care clinicians and leaders could improve transitions from clinical studies to clinical practice.1
The approach was used in conjunction with PHASE (Preventing Heart Attacks and Strokes Everyday) research.
"We applied these community-based research principles to this project from the very beginning," says Julie A. Schmittdiel, PhD, a research scientist with Kaiser Permanente Division of Research in Oakland, CA.
PHASE research involved about 300,000 adults at high risk of a cardiovascular event. The goal was to find the best ways to care for these individuals and prevent a heart attack.
Researchers worked with operation leaders from the very beginning, even during the planning stage of seeking funding and plotting the study's execution, she says.
When investigators wrote a grant proposal, they included a clinical leader.
"We were thinking of the community as health plan leaders, and we'd have a patient outreach team in this community," she says. "We wanted to have a true partnership with clinical leaders and work together as much as possible."
Once the study received funding, investigators took further steps to involve the community of clinicians and clinical leaders.
"The first thing we did was create an advisory board of people doing population care outreach at our facility," Schmittdiel says. "We had a clinical leader for the program and operations folks at the regional level who were partners on the study."
Investigators used the community-based participatory approach to resolve one challenge involving the design of a cluster-randomized study.
"As soon as we started, we brought in an advisory board to learn how they were doing things correctly at the facilities and how to provide operations that work well," she says.
Front-line knowledge
Investigators worked with facilities that were not participating in the study to gain front-line knowledge that would help in the study's execution.
"This was different than how studies like this are often done," Schmittdiel says. "Typically, researchers will go to some meeting to raise hands for decisions."
Instead, investigators sought a participatory process. Through this approach, they learned that each health care facility handled the PHASE program differently, and these differences could impact the study's execution.
"We would never have realized this if we hadn't been talking with clinicians," Schmittdiel says. "We had to take these differences into account and build a study that was flexible enough to accommodate different approaches at the community level."
If they hadn't learned this through the community participatory approach, then they might have given out information that was not useful or that could not be put into practice by clinicians, she adds.
"If we had built our own data fields without any idea of how they would be used, then they wouldn't have fit into the workflow," Schmittdiel adds. "The field of health information technology is littered with things where you build fancy systems and people don't use them."
Once the participatory research system was put in place, they randomized different facilities to receive the intervention or not.
"We took the approach of this being a participatory process and a practical clinical trial where we weren't unmasking the data to see what was happening, but we were trying to get feedback from people using the information about how successful it was," Schmittdiel explains. "We thought of it as a peer support kind of thing; we were there to have them explain things to us, and we'd learn together what was working for them and what was not."
Reference
- Schmittdiel JA, Grumbach K, Selby JV. System-based participatory research in health care: an approach for sustainable translational research and quality improvement. Ann Fam Med. 2010;8(3):256-259.
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