Whitney Palmer

Healthcare. Politics. Family.

Under One Banner: Institutions Unite to Tackle Research Challenges

Published in the May 2010 Association of American Medical Colleges Reporter

By Whitney L.J. Howell, special to the Reporter

Every day, Robert Adams, M.D., is racing against the clock to bring new clot-busting drugs to stroke victims. But the research is not easy, and comes with big logistical and financial challenges. Working alone, Adams said, he could not hope for success. But luckily, Adams is plugged into a wide network of fellow researchers and institutions who are equally committed to his goal.
Adams, a member of the Medical University of South Carolina (MUSC) neurosciences faculty, uses telemedicine to bring his expertise to 10 rural hospitals that do not have the resources necessary to best treat patients within three hours of a stroke—the critical timeframe for minimizing permanent damage. In the past two years, Adams has consulted on 420 stroke cases in real time; his average response time is nine minutes.
This research and clinical outreach is made possible through an unusual collaboration among three South Carolina research universities—MUSC, Clemson University, and the University of South Carolina. Known as Health Sciences South Carolina (HSSC), the collaborative pools the resources of its members to tackle state-level health challenges and spur economic growth. The wide respect—and fairly considerable monetary resources—afforded by HSSC’s members allow Adams, and many other researchers and clinicians like him, to perform this sort of wide-ranging support. Adams said that, without HSSC support, he would not have had the funds to support clinician salaries.
“South Carolina has the highest number of stroke-related deaths nationwide, and a big reason for this is that hospitals are either unprepared or not confident enough to know when to use [a clot-busting drug],” said Adams. “A big part of the reason why I came to MUSC was Health Sciences South Carolina. I knew that if I were part of this type of collaboration, I could make a direct impact on how stroke affects the state.”

HSSC is in some ways similar to the National Institutes of Health Clinical and Translational Science Awards (CTSA) program, which is designed to improve local and national health care by bringing together researchers at multiple institutions to develop new treatments. In fact, HSSC received a $20 million CTSA grant, and both programs do concentrate on large-scale health challenges. CTSAs, however, bring together researchers from across the country, while HSSC is focused within one state. The result is the nation’s first public-private partnership designed to improve a state’s health status, education, workforce development, and economic well-being—all under one banner.

“One of the hopes and aspirations for the work that we do through HSSC is that it fulfills its objective of increasing the quality of care in the state,” said Ray Greenberg, M.D., Ph.D., MUSC president and an early HSSC supporter. “HSSC is positioned to do this because it connects the state’s premier institutions and allows them to share data and research information that they ordinarily could not.”

At least one other state is moving to unite academic medical institutions and other entities in this fashion. Although still in its nascent stages, Ohio’s Austen Bioinnovation Institute in Akron (ABIA) combines the Northeastern Ohio Universities Colleges of Medicine and Pharmacy (NEOUCOM), Akron Children’s Hospital, Akron General Health System, Summa Health System, and the University of Akron.

ABIA’s objective is more targeted than HSSC: it aims to produce high-quality orthopedic and wound care programs. For example, Janine Janosky, Ph.D., vice president of ABIA’s Center for Community Health Improvement, said University of Akron polymer scientists and Akron General Health System pediatric orthopedic surgeons are developing surgical devices that promote bone growth for patients with severe trauma, cancer, or birth defects. The mechanically enhanced orthopedic scaffolding offers children with segmental bone loss defects an opportunity to grow more naturally. This collaboration also enhances medical education, Janosky said, because NEOUCOM medical students have firsthand exposure to cutting-edge developments in orthopedic surgery and, over time, can see how the advancements improve patient care and long-term health.

“Involving medical students is really a paradigm shift in the way we conduct research and serve patients as academic health and medical centers,” Janosky said. “It takes willing partners who can step away from tradition, look at their new partners, take the new-found energy and will, and create an impact that will be felt in the community into the next generation.”

Organizing and operating such a large and multi-institutional effort obviously brings challenges. According to MUSC’s Greenberg, ensuring that all partners are ready to commit to the same level of engagement is the primary hurdle.

“It’s a challenge to get everyone on the same song sheet, and it takes time to negotiate for what everyone wants,” he said. “But once all the partners begin to focus on teamwork, we’ve found that they begin to work and act as something bigger and better than they could be alone.”

In addition, Greenberg said it could be more difficult to launch this type of partnership in larger states simply because longer distances can make effective collaboration and direct impact on patient care more elusive. Funding, of course, can provide another obstacle. In 2002, the South Carolina General Assembly allocated $200 million in education lottery funds to establish endowed chairs at its three main research universities. An additional 2004 bond act secured another $220 million to help these universities secure private-sector partners (Greenville Hospital System University Medical Center, Palmetto Health, and Spartanburg Regional Healthcare System) with the specific goal of expediting biomedical research and promoting economic development. HSSC was the ultimate product. HSSC hospitals now provide cash payments, and partner universities contribute $1 million in endowment funds and $1 million in expendable funds for development, laboratory costs, and recruitment. The John S. and James L. Knight Foundation provided the initial funding for ABIA along with the Ohio state government, Summit County, and the city of Akron. Additional organizations have committed approximately $80 million over the next five years to fund ABIA activities.

Leaders of both collaboratives say the investments are returned by improving health and providing economic stimulus. ABIA intends to spend $150 million on academic and clinical research and create roughly 2,400 jobs; HSSC estimates it has created 2,500 new jobs for South Carolinians.

“HSSC has been a tremendous economic boon for the state,” said Jay Moskowitz, Ph.D., HSSC’s president and CEO. “With various grants and funding, as well as partnerships with other industries, such as manufacturing and software developers, we’ve hired technicians, support staff, analysts, and other professionals. But we’ve also provided health care and research benefits by creating a network that allows the state’s big players to share clinical information needed for patient care and research efforts.”

One of the underlying factors to HSSC’s success, Moskowitz said, is a partner’s ability to reach out to a business or law school with questions regarding those areas of expertise as they relate to health care. The effect is a blended organization that brings together medical and non-medical fields to benefit the state’s population.

Each HSSC endeavor requires a lead institution that works with other partners to disseminate important information and research statewide through face-to-face and electronic avenues.

HSSC’s biggest initiatives are an effort to reduce the prevalence of infections that are contracted in health care settings, and use electronic health records (EHR) to connect the state’s hospital systems with its approximately 4,000 primary care physicians. Moskowitz said the hospital associated with the infection initiative has had no central line-associated infections since 2007. Implementing a cohesive EHR system will quickly give rural residents access to high quality health care normally available only in academic medical centers. Not only will HSSC provide funding assistance for implementing the EHR systems and provide names of potential EHR vendors, but it will also teach hospitals and private providers how to use the data to track individual patients and cohorts. No other state currently ties hospitals and primary care physicians in a care and research continuum, Moskowitz said.

HSSC also offers 50 adult and infant simulators to medical and nursing students, and is developing a prototype, Web-based delivery method for these software-driven courses that provide simulator training.

“We are in a state that is small enough where we can make a total impact,” Moskowitz said. “With this system, we’ll be able to bring these initiatives and their critical information to all hospitals and give people in rural areas a chance to participate.”

For example, one HSSC researcher from the University of South Carolina School of Medicine partnered with the Lakelands Rural Health Network to determine how health information exchanges help manage chronic conditions, and how physician perception a patient’s health status. Determining the scope, leaders, and responsibilities of such a large and complex partnership can be difficult, but can also bring big benefits, said Sharon Hull, M.D., M.P.H., chair of NEOUCOM’s behavioral and community health sciences department.

“Collaborations like this that bring together the community, academia, clinical, and the economic sector help us to dissolve the walls of the silos in health care,” she said. “Health care delivery and research are major economic engines in the community, and partnerships like this help basic science move not only from the bench to the bedside, but to the community, also.”

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August 6, 2010 - Posted by | Healthcare | , , , , , , , , , , , , , , ,

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