1. Changing Practice Through Research: Role of the CTSA Initiative David O. Warner, M.D. Associate Director and co-PI, Mayo Clinic CTSA, Professor of Anesthesiology

2. Dougherty, D. et al. JAMA 2008;299:2319-2321. Current resource allocation $$$

3. Dougherty, D. et al. JAMA 2008;299:2319-2321. Future resource allocation?

4. CTSA – Approaches to Practice Research Perform research in community settings (T2)  Community-Based Participatory Research  Practice-Based Research Networks Identify problems Effectiveness and sustainability Laboratory for testing system improvements  Community practices as clinical research sites (NCRA model)

5. Example of Mayo CTSA approach… Creation of PBRN within local health system Creation of Knowledge Transfer Research Unit  “incubator” for T2/T3 Development of T2/T3 curriculum Extend Rochester Epidemiology Project (“T4”)

6. Mayo Health System PBRN

7. MHS PBRN Construction… Planning process  3 Workgroups with full MHS participation Business plan formulated and approved  Creation of network infrastructure  Significant intramural funding Planning grants for initial projects  Led by MHS clinicians, with Mayo Rochester partners

8. CTSA – Approaches to Practice Research (2) Determine how to produce sustainable changes in clinical practice (T3) ???

9. Example of Mayo CTSA approach… Creation of PBRN within local health system Creation of Knowledge Transfer Research Unit  “incubator” for T2/T3 Development of T2/T3 curriculum Extend Rochester Epidemiology Project (“T4”)

10. Olmsted County records-linkage system Minnesota Iowa Wisconsin Total = 127,277 Women = 51% (63,199) ≥ 65 = 11% (13,392)

11. “Toolkit” to Support T2/T3 evidence synthesis economics and finance organization theory qualitative research designs systems engineering informatics public policy communications behavioral science

12. CTSA – Key functions that can support T2/T3 Development of Novel Clinical and Translational Methodologies Pilot and Collaborative Translational and Clinical Studies Biomedical Informatics Research Design, Epidemiology, Biostatistics and Clinical Research Ethics Regulatory Knowledge and Support Community Engagement and Research Translational Technologies and Resources Research Education, Training and Career Development

13. Bringing together disciplines important to T2/T3…. CTSA? epidemiology sociology political science psychology economics communications social marketing IT biomedical sciences

14. Challenges to T2/T3 in CTSAs CTSA leadership may or may not value T2/T3  Politics may be complicated  Educational efforts needed Resources are limited  Internal competition from T1 and other needs Will funding from NIH and others keep pace with expanded capacity to perform T2/T3?

15. How to take advantage of the CTSAs… Get to know what is available locally Lobby your CTSA leadership regarding the importance of T2/T3  Emphasize “transformation”  Emphasize need to demonstrate actual changes in actual people’s lives  Emphasize that NCRR really, really wants to hear good stories of successful translation and transformation Take advantage of the emerging consortium

16. Changing Practice Through Research: Role of the CTSA Initiative TRANSFORMATION!

17. Changing Practice Through Research: Role of the CTSA Initiative TRANSFORMATION!