A New Era and Direction for Community Research
For the past year, the two acronyms that have been flying around the School of Medicine and Public Health and nationally are the CTSA (Clinical Translational Science Award) grant and the ICTR (Institute for Clinical Translational Research). This "primer" will outline the substantial role of the Department of Family Medicine in both of those and how this role will come to shape the research done in the future.
Elias A. Zerhouni, MD, shortly after he assumed the leadership of the National Institutes of Health (NIH), convened a process of looking at maximizing the "portfolio of NIH-funded research" that if realigned, might bring about change in clinical medicine and the health of communities. His efforts were unprecedented and the process has been an interesting one to watch. One result was the creation of a translational research grant program intended to encourage medical schools to look at the continuum of research:
- from bench to bedside
- to clinical practice
- to community health improvement
Many health service researchers have made a career of pointing out what we are not doing with what we already know. But the narrowly-defined areas that fund clinical research through the NIH and the lack of a robust financial mechanism to force investigators and clinicians to play together in the same sandbox, have kept important clinical interventions that save lives from ever making it to practices or communities. Similarly, wonderful ideas that come from clinical practice and observations in communities rarely, if ever, made it to the funding streams of the NIH.
The NIH created a grant program that "required" basic and clinical investigators to talk with each other and, more importantly, to talk with clinicians in community practice and communities themselves. This became the Clinical Translational Science Award (CTSA) program and offered enormous opportunities for medical research but also presented great risk. The program is an infrastructure grant that will combine many previous programs for training and research which sat on their own, along with a large boost in infrastructure support for clinical and community research. But the risk for medical schools was the loss of funding for clinical research and fellowship training if they were not successful. In essence, not getting a CTSA would put a medical school in a very difficult position to be competitive for future NIH or other clinical research.
The CTSA requires a proposal that outlines training for Type I Translational research (from basic science to clinical application) and for Type II Translational research (from clinical application to application to community practice and community health, called CAP). To be successful, a school had to be strong in both types of research.
In 2006, twelve schools received the five-year implementation awards:
- Columbia University Health Sciences
- Duke University
- Mayo Clinic College of Medicine
- Oregon Health and Science University
- Rockefeller University
- University of California, Davis
- University of California, San Francisco
- University of Pennsylvania
- University of Pittsburgh
- University of Rochester
- University of Texas Health Science Center at Houston
- Yale University
One of the first things Dean Golden did after arriving in Madison was to put his full support behind the process of the University of Wisconsin applying for a CTSA implementation grant. He named Marc Drezner, MD as associate Dean for Translational Research. Dr. Drezner approached members of the DFM to help in the process of putting the CTSA proposal together. He quickly saw that the DFM had an extraordinary record of community based research, education and relationships with health systems and hospitals statewide. This was a wonderful template on which to build a linkage with the school around the new directions for research. Mike Fleming, MD, MPH, who has been instrumental in helping the Department recruit and train the next generation of clinician investigators, was asked to help write the section on the proposal for training investigators and Craig Gjerde, PhD was also part of the training section. Paul Smith, MD, director of WREN and John Frey, MD were asked to work with Maureen Smith, MD, MPH, PhD, who has a joint appointment in Population Health and Family Medicine, to help craft the Type II Translational research section.
The Dean also showed his support for Clinical Translational Research by working with the Wisconsin Partnership Program to provide matching funds for the CTSA application. Dr. Drezner put some of those funds into the development of new community research partners through WREN and developing research partnership with the Wisconsin AHEC system.
Weekly meetings throughout the entire fall of 2006 resulted in a CTSA proposal submitted in January which had a budget of $66 million over 5 years. Dr. Drezner heard in May that the review process had found the UW application to be exceptionally strong and that our score indicated that we would be fully funded in October of 2007. This is a remarkable accomplishment and places the UW School of Medicine and Public Health in the first tier of NIH Translational Research Schools in the country.
What does it mean for the DFM??
The Institute for Clinical Translational Research (the ICTR)
The ICTR was formed to serve as a home for the CTSA proposal and with its success, now has to get programs underway that will affect all of us.
The goal of ICTR: "To create an environment that facilitates the transformation of research at the University into a continuum extending from investigation through discovery to translation into practice, thereby linking even the most basic research to practical improvements in human health."
- Mike Fleming, MD, MPH will serve as the Director of the Career Development program associated with new investigators in the medical school, with particular attention to a certificate and PhD program in clinical research - which is a new program at the school. This recognizes not only Dr. Fleming's personal record of accomplishment with the NIH but his strong contribution as a mentor and leader of fellowship training in the DFM.
- John Frey, MD will serve as Director of Community Engagement as part of Dr. Maureen Smith's arm of the grant and is responsible for working with WREN and developing the Health Extension Program. The Health Extension Program will set up statewide regional research councils to work with communities and UW investigators that should lead to joint research projects between communities, health systems and the UW SMPH.
- Craig Gjerde, PhD will work with fellows and clinical investigators in his capacity of Director of Faculty Development. His task is to help the grant participants and other UW faculty to understand and use the multidisciplinary resources available within the grant.
- Maureen Smith, MD, MPH, PhD is the Director of the Community Academic Partnership Program of the ICTR which is responsible for training and implementation of Type II Translational Research and which will relate to the DFM in very specific ways. Dr. Smith is the Director of the Health Innovations Program (HIP) that has been growing the embryonic clinical health services research activities of the school through funding by the UWMF and the Wisconsin Partnership program.
- Paul Smith, MD will continue as Director of WREN, which is growing its affiliation with both family practices and other primary care practices. Dr. Smith has been working to hire regional WREN coordinators and create a diverse set of practices that will complement the UWMF and other clinical practices that are affiliated with the UW. WREN is a story worth telling for many reasons but has been the "little engine that could" and will be much larger and a more central part of the ICTR in the future.
- The clinical data warehouse, which has served the DFM clinical, educational and research activities for over a decade, will be used as a model for clinical data management by the larger ICTR program. There may be movement of some of the functions of the warehouse to the ICTR site which will work with practice and health system based research.
The Department's historical contributions to research in communities and education of fellows has resulted in our faculty being included as central figures in one of the most exciting directions for the School of Medicine and Public Health in many years. The ICTR should serve as a prime example of how the school is transformed to work statewide in:
- Clinical care
While those three emphases are a thirty-five-year tradition for Family Medicine, our responsibility in the future will be to work with the core research functions of the school to help young investigators learn about communities and health systems and through the research they do together, to transform not just the school but the State.
If you have interest in any aspect of the ICTR, working with communities on projects or research, are looking for a partnership with a community or more basic clinical researcher, please feel free to contact the people listed in this article about how you might work with the ICTR.
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