All posts by Liz Wing

New NIH Funding Opportunity to Support Collaboratory Demonstration Projects

Cluster Randomized Trials, Comparative Effectiveness Research, Funding Opportunity Announcement (FOA), Pragmatic clinical trials, , , , , ,

A new funding opportunity announcement from the NIH solicits applications to support Demonstration Projects that include an efficient, large-scale pragmatic clinical trial. Trials must be conducted across two or more health care systems (HCS) and must be conducted as part of the NIH HCS Research Collaboratory supported through the NIH Common Fund. Awards made through this FOA will initially support a one-year milestone-driven planning phase (UG3), with possible rapid transition to the second implementation phase (UH3) for a pragmatic trial Demonstration Project.

Access the full funding announcement: RFA-RM-16-019

Important Due Dates
   Earliest submission date: May 2, 2017
   Letter of intent date: 30 days prior to application due date
   Application due date: June 2, 2017

NIH Collaboratory ABATE Infection Trial Highlighted in Wall Street Journal

Clinical outcomes, Clinical trials, Cluster Randomized Trials, Learning health systems, Pragmatic clinical trials, , , , ,
Susan Huang, MD, MPH
Dr. Susan Huang

The ABATE Infection trial, an NIH Collaboratory project led by Dr. Susan Huang, is featured in the September 12 Health section of the Wall Street Journal. The article describes several studies aimed at preventing the hospital-associated infection MRSA (methicillin-resistant Staphylococcus aureus).

In the Reduce MRSA trial, published in 2013, Dr. Huang’s team demonstrated that treating ICU patients with a germ-fighting soap plus a nasal antibiotic ointment, an approach called “universal decolonization,” was superior to standard approaches in preventing MRSA infections. The ABATE Infection trial examines similar approaches to decolonization for all patients in non–critical care medical and surgical units, comparing the use of an antiseptic bath and nasal ointment to standard bathing and showering. More than 1 million showers and baths were taken over the course of the study, which has now completed enrollment. Data from ABATE are currently being analyzed, with the results expected to inform whether this strategy is effective in reducing hospital-associated infections.

“These are preventable infections and we should be able to drive them down to zero.” Susan Huang, MD

Read The Ultimate Battle Against MRSA in the WSJ.

Read more about the ABATE Infection trial.

Watch the ABATE Infection training video.

New NIH Collaboratory resource for the transparent reporting of PCTs

Cluster Randomized Trials, Data quality, Electronic health records, Research reporting standards, Research tools, Writing and Publishing, , , ,

The NIH Collaboratory has developed a tool to assist authors in the complete and transparent reporting of their pragmatic clinical trials (PCTs). In the PCT Reporting Template, users will find descriptions of reporting elements based on CONSORT guidance as well as on expertise from the NIH Collaboratory Demonstration Projects and Core working groups.

Particularly relevant to PCTs are recommendations on how to report the use of data from electronic health records. Other elements of importance to PCTs include reporting wider stakeholder engagement, monitoring for unanticipated changes in study arms, and specific approaches to human subjects protection. The template contains numerous links to online material in the Living Textbook, CONSORT, and the Pragmatic–Explanatory Continuum Indicator Summary tool known as PRECIS-2.

This resource is intended to assist authors in developing primary journal publications. It will be updated over time as new best practices emerge for the transparent reporting of PCTs.

Download the PCT Reporting Template.

Please note: this document opens as an Adobe PDF. If you do not have software that can open a PDF, click here to download a free version of Adobe Acrobat Reader.

This work was supported by a cooperative agreement (U54 AT007748) from the NIH Common Fund for the NIH Health Care Systems Research Collaboratory. The views presented in this document are solely the responsibility of the authors and do not necessarily represent the official views of the NIH.

Originally published on September 1, 2016.

  • Questions or comments can be submitted via email. Please add “Living Textbook” to the Subject line of the email.

Collaboratory phenotypes paper published in eGEMs special issue

Clinical trials, Data standards, Electronic health records, Learning health systems, Research tools, , , ,

A recently published special issue of eGEMs explores strategic uses of evidence to transform healthcare delivery systems. In A Framework to Support the Sharing and Re-Use of Computable Phenotype Definitions Across Health Care Delivery and Clinical Research Applications, Rachel Richesson and Michelle Smerek of the NIH Collaboratory’s Phenotypes, Data Standards, and Data Quality Core, along with coauthor C. Blake Cameron, envision an infrastructure that facilitates re-use of computable phenotypes in a learning healthcare system.

The authors elaborate on four required components of the framework:

  • Searchable libraries of explicitly defined phenotype definitions
  • Knowledge bases with information and methods
  • Tools to identify, evaluate, and implement existing phenotype definitions
  • Motivated users and stakeholders

Read the entire eGEMs open access publication here. eGEMs (Generating Evidence & Methods to improve patient outcomes), a product of AcademyHealth’s Electronic Data Methods (EDM) Forum, is a peer-reviewed, open access journal that seeks to accelerate research and quality improvement using electronic health data.

Related resources:

You can find extensive information on computable phenotypes in the Living Textbook chapter and in Tools for Research.

Video Highlights the Importance of Stakeholder Advisory Boards

Clinical trials, Health outcomes, Patient engagement, , ,

The PATIENTS program at the University of Maryland has produced a brief video on the role of Stakeholder Advisory Boards. Stakeholders are anyone who cares about the outcomes of a clinical study to inform healthcare decisions. The board’s purpose is to advise the study team during the course of a trial to help ensure the results are relevant and important to all stakeholders.

A Stakeholder Advisory Board comprises a diverse and balanced collection of individuals and organizations from the following groups:

  • Patients, caregivers, and advocacy organizations
  • Clinicians, nursing staff, specialists, and healthcare system administrators
  • Academic investigators and other researchers
  • Public and private healthcare payers
  • Policy and guideline organizations
  • Industry sponsors and therapeutic product developers

The 4-minute video features Ellen Tambor, MA, Senior Research Manager at the Center for Medical Technology Policy and a member of the Collaboratory’s Stakeholder Engagement Core working group.

Watch the YouTube video here.

Trauma Survivors Outcomes and Support (TSOS) trial publishes design paper

Clinical trials, Cluster Randomized Trials, Comparative Effectiveness Research, Pragmatic clinical trials, Stepped-wedge, , , , ,

The study team for the Trauma Survivors Outcomes and Support (TSOS) trial recently published their study protocol in Implementation Science. TSOS, an NIH Health Care Systems Research Collaboratory Demonstration Project, is an effectiveness-implementation hybrid trial designed to test the delivery of screening and intervention for PTSD and comorbidities across 24 U.S. level I trauma center sites. The study employs a stepped-wedge, cluster-randomized design in which sites are randomized sequentially to initiate the intervention. The study aims to determine if injured patients receiving a collaborative care intervention demonstrate significant reductions in PTSD symptoms when compared with control patients receiving usual care. The study will also evaluate whether intervention patients demonstrate significant reductions in depressive symptoms and associated suicidal ideation, alcohol use problems, and improvements in physical function.

The open access article is available here: An effectiveness-implementation hybrid trial study protocol targeting posttraumatic stress disorder and comorbidity

NIH & FDA seek feedback on new clinical trial protocol template

Clinical trials, Institutional review boards, Randomized controlled trials, Research tools, , , ,

As part of their ongoing effort to improve the speed and efficiency of conducting clinical trials, the NIH-FDA Joint Leadership Council has created a draft clinical trial protocol template. The template contains instructional and sample text intended to assist NIH-funded investigators in writing protocols for phase 2 or 3 clinical trials that require Investigational New Drug (IND) or Investigational Device Exemption (IDE) applications. Feedback is sought from investigators, investigator-sponsors, institutional review board members, and other stakeholders involved in protocol development and review.

Our goal is to provide an organized way for creative investigators to describe their plans so that others can understand them. – Dr. Pamela McInnes, NIH

Details on the rationale and development of the protocol template are on these blog posts:

Notice Number: NOT-OD-16-043. Responses accepted through April 17, 2016.

You can access the template document as well as a template shell, comment form, and other resources at NIH’s Clinical Research Policy website.

Recent Collaboratory Publications on Research Ethics

Clinical trials, Comparative Effectiveness Research, Informed Consent, Pragmatic clinical trials, , , ,

The American Journal of Bioethics has recently published three articles authored by members of the Regulatory/Ethics core group describing various questions related to research on medical practices:

  • Is shared decision making an appropriate analytic frame for research on medical practices (Sugarman 2015) discusses the role of shared decision making (SDM) in research on medical practices. The author cautions that “while SDM is in many ways similar to informed consent, there are some important differences, especially in the research setting.” This publication is freely accessible through PubMed Central.
  • Patients’ views concerning research on medical practices: implications for consent (Weinfurt et al. 2015) describes the results of focus group sessions that elicited a range of patients’ views and opinions about different types of research on usual medical practices. The authors state that “our data suggest that effective policy and guidance will involve balancing different patients’ interests and potentially different sets of interests for different types of research studies on usual medical practices.”
  • Ethics of research in usual care settings: data on point (Sugarman 2016) introduces a special five-article supplement in the American Journal of Bioethics, stating that the “growing empirical ethics literature regarding research in usual care settings provides data to inform conceptual and policy debates regarding this research and suggests areas that require further study.”

These publications were supported by a bioethics supplement awarded to the Regulatory/Ethics Core group by the NIH’s Office of the Director.

CTSA-PCORnet Webinar: A Central IRB Approach

Informed Consent, Institutional review boards, Patient-Centered Outcomes Research, , ,

The webinar copresented on March 2, 2016, by the Clinical and Translational Science Awards (CTSA) program and PCORnet is available as a video and slideset.

Petra Kaufmann, MD, MSc
Director, Office of Rare Diseases Research and Division of Clinical Innovation
National Center for Advancing Translational Sciences
National Institutes of Health

Rachael Fleurence, PhD
Program Director, CER Methods and Infrastructure Program
Patient-Centered Outcomes Research Institute

Sabune J. Winkler, JD
Director, Regulatory Affairs Operations
Harvard Catalyst

Webinar details:
March 2, 2016
3pm - 4pm ET
To join the WebEx, click here: http://bit.ly/1TGRTFS
Call-in number: 1-855-244-8681
Access code: 737 807 582

STOP CRC Trial: Analytic Challenges and Pragmatic Solutions

Cluster Randomized Trials, Comparative Effectiveness Research, Data analysis, Pragmatic clinical trials, , , , ,

Investigators from the STOP CRC pragmatic trial, an NIH Collaboratory Demonstration Project, have recently published an article in the journal eGEMs describing solutions to issues that arose in the trial’s implementation phase. STOP CRC tests a program to improve colorectal cancer screening rates in a collaborative network of Federally Qualified Health Centers by mailing fecal immunochemical testing (FIT) kits to screen-eligible patients at clinics in the intervention arm. Clinics in the control arm provided opportunistic colorectal-cancer screening to patients at clinic visits in Year 1 and implemented the intervention in Year 2. In this cluster-randomized trial, clinics are the unit of analysis, rather than individual patients, with the primary outcome being the proportion of screen-eligible patients at each clinic who complete a FIT.

The team dealt with various challenges that threatened the validity of their primary analysis, one of which related to potential contamination of the primary outcome due to the timing of the intervention rollout: for control participants, the Year 2 intervention actively overlapped with the Year 1 control measurements. The other challenge was due to a lack of synchronization between the measurement and accrual windows. To deal with these issues, the team had to slightly modify the study design in addition to developing a few sensitivity analyses to better estimate the true impact of the intervention.

“While the nature of the challenges we encountered are not unique to pragmatic trials, we believe they are likely to be more common in such trials due to both the types of designs commonly used in such studies and the challenges of implementing system-based interventions within freestanding health clinics.” (Vollmer et al. eGEMs 2015)

The Publish EDM Forum Community publishes eGEMs (generating evidence & methods to improve patient outcomes) and provides free and open access to this methods case study. Readers can access the article here.