Collaboratory phenotypes paper published in eGEMs special issue


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


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.

NIH Issues Final Policy on Use of Single IRB


The NIH has issued a final policy requiring the use of a single institutional review board (sIRB) for multi-site non-exempt human subjects research funded by the NIH. The policy will take effect May 25, 2017.

According to the policy announcement, “while the NIH anticipates that that there will be challenges associated with implementation, we expect these to be short-lived. Once the transition to the new way of operating is made, the benefits of widespread use of sIRBs will outweigh any costs and, ultimately, reduce burdens to the research process.”

In proposals submitted to the NIH, applicants will be expected to include a plan identifying the sIRB that will serve as the IRB of record for all study sites. It will be the applicants’ responsibility to assure that the sIRB is qualified to serve. NIH acceptance of the submitted plan will be incorporated as a term and condition in the award. Awardees will be responsible for ensuring that the authorization agreements between IRBs (“reliance agreements”) are in place.

According to the policy, “The additional costs associated with sIRB review may be charged to grants or contracts as direct costs, provided that such costs are well-justified and consistently treated as either direct or indirect costs according to applicable cost principles in the NIH Grants Policy Statement and the FAR 31.202 (Direct Costs) and FAR 31.203 (Indirect Costs).”

Before the policy takes effect, the NIH will be issuing guidance and resources to assist with implementation.

Read the full policy for additional details.

LIRE Systematic Review Among Articles Most Shared & Discussed Online


A systematic review completed by the NIH Collaboratory’s Lumbar Imaging with Reporting of Epidemiology (LIRE) Demonstration Project is among the top 5% of research articles garnering attention online, according to Altmetrics. The article, “Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations,” was published in the American Journal of Neuroradiology in 2014.

In the systematic review, the researchers found that imaging findings of spine degeneration are present in high proportions of asymptomatic individuals, and these findings increase with age. Thus, many degenerative features found on spine imaging are likely part of normal aging. Given that advanced imaging is increasingly used in the evaluation of patients with lower back pain, knowing the prevalence of degenerative findings in asymptomatic individuals can help clinicians and patients when interpreting imaging findings.

The LIRE pragmatic trial is testing the insertion of these epidemiologic benchmarks into lumbar spine imaging reports with the goal of reducing subsequent tests and treatments, including MRI and CT, opioid prescriptions, spinal injections, or surgery.

View the full article for free
Learn more about the LIRE trial

FDA releases draft guidance for using electronic health records in clinical research

The FDA has released a Draft Guidance for Industry to facilitate the use of data from electronic health record (EHRs) in clinical investigations. The draft guidance provides recommendations on how to use EHRs as a source of data for research, ensure data quality and integrity, and satisfy the FDA’s inspection, recordkeeping, and record retention requirements. An additional goal of the draft guidance is to promote interoperability, or the ability to exchange and use information between EHR systems that capture information during patient care visits and electronic data capture (EDC) systems that support clinical investigations. Sponsors of clinical research must also consider whether there are any reasonably foreseeable risks involved in using the EHR for research—such as an increased risk of data breaches—that should be disclosed in the informed consent document.

Read the full draft guidance here.

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


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


Join the Ethical and Regulatory Issues of Pragmatic Clinical Trials Workshop May 10

On Tuesday, May 10, 2016, the NIH Collaboratory invites you to view a public webcast of the workshop, Ethical and Regulatory Issues of Pragmatic Clinical Trials.

This workshop will include several topics from a series of articles discussing regulatory and ethical issues related to the conduct of pragmatic clinical trials. Panelists from the NIH Collaboratory pragmatic trial Demonstration Projects, along with experts in the areas of informed consent, vulnerable populations, IRBs, data monitoring committees, and privacy issues, will participate in moderated discussion using case examples from the NIH Collaboratory.

FDA Cites Collaboratory as Part of a National System for Generating Clinical Evidence

In a recent post on the FDA’s “FDA Voice” blog, Associate Deputy Commissioner Rachel Sherman and Commissioner Robert Califf describe how to overcome barriers to data sharing and create a successful national system for medical evidence generation (or “EvGen”). To foster new approaches for creating clinical evidence the authors suggest 3 principles:

“1. There must be a common approach to how data is presented, reported and analyzed and strict methods for ensuring patient privacy and data security.

2. Rules of engagement must be transparent and developed through a process that builds consensus across the relevant ecosystem and its stakeholders.

3. To ensure support across a diverse ecosystem that often includes competing priorities and incentives, the system’s output must be intended for the public good and be readily accessible to all stakeholders.”

Drs. Sherman and Califf point to substantial pioneering work being done in secondary use of data, in which data collected for clinical care are “secondarily” used for research, including projects currently underway through the NIH Collaboratory, PCORnet, and other initiatives and networks. The experience gained from these groundbreaking efforts should provide a foundation for a national system for evidence generation.

Read the full post here.

ABATE Infection Study Team Releases Training Video

The Actiabate_fa_tag copy 2ve Bathing to Eliminate (ABATE) Infection trial was conducted in nearly 200 non-critical care hospital units across the United States. The ABATE study team developed a training video to teach nurses and nursing assistants how to approach patients to administer a bath with a topical antiseptic agent containing chlorhexidine (CHG), or help patients take a shower using the liquid CHG soap.  If the results of the trial demonstrate a reduction in unit-attributable infections or multi-drug resistant organism (MDRO) burden for the intervention units, this video could be used to train nurses and staff to implement CHG bathing in healthcare systems around the nation.

The ABATE trial (ClinicalTrials.gov #NCT02063867) is a large-scale, cluster-randomized pragmatic clinical trial (PCT) designed to assess a bathing approach for reducing multidrug-resistant organisms and hospital-associated infections (HAIs) in patients hospitalized in non-critical care units. Patients were bathed either according to the hospital unit’s usual care procedures (the control group) or bathed with a topical antiseptic agent containing chlorhexidine (CHG; the intervention group). Patients in the intervention group could shower using liquid CHG soap and a mesh sponge, or have a self-assisted or nurse-assisted bed bath using the CHG cloths. If a patient in the intervention group was colonized with, infected with, or had a recent history of methicillin-resistant Staphylococcus aureus (MRSA), the antibiotic mupirocin was additionally administered nasally for 5 days.

The investigators hypothesize that this regimen will reduce the burden of vancomycin-resistant enterococci (VRE) and Staphylococcus aureus (MRSA) in these units and translate to a reduction in overall bloodstream and urinary tract infections. They will also evaluate its ability to reduce antibiotic-resistant gram-negative bacteria and Clostridium difficile.

The ABATE Infection Trial has been conducted in hospitals in the Hospital Corporation of America (HCA) health system and is an NIH Health Care Systems Research Collaboratory UH3 Demonstration Project supported by the National Institutes of Allergy and Infectious Diseases (NIAID) and the Common Fund at the National Institutes of Health. This video was created and scripted for the trial by study investigators and filmed by Sage Products, LLC.

Watch the training video here.

American Journal of Bioethics publishes special issue on ethics of research in usual care settings


The American Journal of Bioethics has published a special issue on ethics of research in usual care settings. These publications were supported by a bioethics supplement awarded to the NIH Collaboratory’s Regulatory/Ethics Core by the NIH Office of the Director. The issue includes an introduction from Jeremy Sugarman, MD, MPH, MA, along with 5 additional articles: