NEWS & EVENTS
Improving Care Delivery: High-Priority Implementation Research within Community Health Centers
November 7 - 8, 2017
Rockledge Two, 9th Floor, Suite 9100/9104, 6701 Rockledge Drive, Bethesda, MD, 20892
Description

Introduction: Despite progress made in delivering evidence-based interventions for heart, lung, blood, and/or sleep disorders or diseases (HLBS conditions), these conditions remain major causes of death and disability. The National Heart, Lung, and Blood Institute (NHLBI) convened management and clinicians from Community Health Centers (CHC); clinical pharmacists; HLBS specialists; community-based participatory researchers; leaders from schools of pharmacy; and Federal stakeholders, from National Institute for Nursing Research (NINR), Health Resources and Services Administration (HRSA), Centers for Disease and Control and Prevention (CDC), Centers for Medicare and Medicaid Services (CMS), National Cancer Institute (NCI). Community Health Centers, including Federally Qualified Health Centers (FQHC), are a healthcare safety net for low income and uninsured populations and  provide outpatient care for one-out-of-every-twelve Americans. A better understanding of the barriers and facilitators for CHCs to deliver evidence-based prevention and control for  HLBS disorders is needed. Recommendations from this workshop will provide NHLBI options to consider to advance late-stage translation research (T4TR) within the CHC setting.

Background: Many interventions can prevent and control HLBS conditions. However in many settings, we do not know how best to move this knowledge base into sustainable practice within diverse settings and across social ecologic levels. The workshop sought to 1) garner insights on contextual issues for delivering multi-level prevention and control interventions for HLBS conditions; 2) identify strategies for coalition building, developing culturally-informed partnerships, and providing training and technical support; 3) solicit methodological  insights on how to  use  robust scientific methods, and, 4) identify key high-priority implementation research questions. In other words, we are seeking to move advancements from “bedside to curbside.” 

Approach: Over the course of two days, experts provided their experience with successes, challenges, methodological approaches, gaps in our knowledge, and gave recommendations for an implementation research agenda for NHLBI to consider.  

Recap

Highlights of Findings:  Three thematic implementation research areas were highlighted:

  • Approaches to Advance T4TR: 
    • Sustainability includes the ability of the research site(s) to continue successful programs beyond the research funding period and to support the scalability of an adaptive approach, elsewhere. The entire T4TR research enterprise---planning, designing, managing  and reporting of findings---needs to be informed by the end-goal of enabling sustainable uptake.
    • Participants recognized the importance that CHC-based research address the needs CHC leadership and staff. 
    • A planning phase of a largescale grant, or planning grant, is recommended to design and execute a successful and sustainable multi-level program.
    • Awareness of recent and on-going quality improvement activities within  CHCs  offers insights on preparedness and learning gaps for CHC to pursue T4TR research.
    • T4TR research needs to explore  options for adaptations of approaches being studied, recognizing the contextual-nuances of different organizations.
    • Multi-level stakeholder implementation configurations which take into account stakeholder preferences and resources should be considered. Preferences and resources may vary across settings and over time at a given facility.
    • Research should be based on established care models and research frameworks, as they provide a valuable means for organizing, deploying, and enabling replication of programs, elsewhere.
    • Use of parsimonious research outcomes and quality-improvement metrics with preference for use of established metrics, when possible, are advantages. This may leverage use of current measurement and reporting practices to avoid undue burden and disruption in the workflow and within the workforce.
       
  • Healthcare Team Members and Organization  The optimal healthcare team members and their organization are high-priority research topics. .
    • What are the appropriate models to assess and support better team configurations?
    • How can research assess the different types of healthcare teams that have  the point-of-care extended beyond traditional settings?
    • How can community health workers, key elements within the CHC/FQHC healthcare setting, be  supported, trained, and engaged in healthcare delivery? 
    • How should nurses, community health workers, researchers, and pharmacists’ contributions to the inter-professional teams be measured, reported, and facilitated?
    • What addition elements in the healthcare team are needed (e.g., skillsets remote experts) to conduct T4TR research and/or sustainable implementation plan?
    • How can rebalancing of roles and responsibilities among professionals, lay people, and patients, be assessed and fostered, as needed, over time?
    • Beyond the healthcare setting, where else should healthcare teams and wellness teams be organized?
       
  •  Other Challenges:
    • Research in CHCs needs to recognize the impact of social determinants of health and seek to address social determinant barriers  through multi-level interventions.  Given the importance of medication management for HLBS conditions, what are the effects of social determinants of health on patient’s medication management?
    • What are the opportunities and challenges of using HRSA’s Uniform Data System (UDS) for FQHCs and FQHC-like CHCs to capture and report care received,  including medication use. How can the use of extant UDS data support scale-up of successful implementation strategies across FQHCs?
    • The tension between conducting research projects which utilize rigorous, high-quality scientific methods and  pragmatic, cost-efficient strategies sought in resource-challenged CHC settings.
    • What are the appropriate means to assess “costs” in order to inform scalability?
       

NHLBI Contact

Rebecca A. Roper, M.S., M.P.H., NHLBI, NIH, CTRIS
National Heart, Lung, and Blood Institute
National Institutes of Health
Rebecca.Roper@nih.gov
 

Workshop Session Co-Chairs

Hayden Barry Bosworth, Ph.D.
Nivedita Mohanty, M.D.
Brian S. Mittman, Ph.D.
Nancy Schmieder Redeker, Ph.D.
Deborah J. Cohen, Ph.D.
Matthew Quinn, M.B.A.
Barry L. Carter, Pharm.D.
Todd D. Sorenson, Pharm.D.
Tyra Bryant-Stephens, M.D.
Jonathan N. Tobin, Ph.D.
Melissa Somma McGivney, Pharm.D.
Jenny Van Amburgh, Pharm.D.

Session Moderators

Suma Nair, Ph.D.
Karen Huss, Ph.D.
Alek Sripipatana, Ph.D.
Jeffrey M. Durthaler, M.S.
Susan T. Shero, M.S.
Rebecca Roper, M.S., M.P.H.

Clinical Pharmacist Panelists

Meagan Arian Brown, Pharm.D.
Benjamin Chavez, Pharm.D.
Melissa Somma McGivney, Pharm.D.
Pamela Schweitzer, Pharm.D.
Alexa Sevin Valentino, Pharm.D.
Margie E. Snyder, Pharm.D.

Workshop Planning Committee

Anthony Crampton, M.B.A.
CAPT Michael M. Engelgau, M.D., M.S., FACP
George A. Mensah, M.D., FACC
Emmanuel Peprah, Ph.D.
Rebecca Roper, M.S., M.P.H.
Uchechukwu K. A. Sampson, M.D., M.P.H., M.B.A., M.Sc. (Oxon), M.S., FACC
Catherine M. (“Kate”) Stoney, Ph.D.
Jonathan N. Tobin, Ph.D., FAHA, FACE
Michael Jay Twery, Ph.D.
Mr. Mark E. Parker

Meeting Participants

Saul Blecker, M.D., M.H.S.
Hayden Barry Bosworth, Ph.D.
Meagan Arian Brown, Pharm.D., B.S.
Tyra Bryant-Stephens, M.D., FAAP
Arlene Manns Butz, Sc.D.
Ahmed Calvo, M.D., M.P.H.
Barry L. Carter, Pharm.D.
Benjamin Chavez, Pharm.D., BCPP, BCACP
Deborah J. Cohen, Ph.D.
Jeffrey Michael Durthaler, M.S., R.Ph.
CAPT Michael M. Engelgau, M.D., M.S., FACP
Karla Finnell, Ph.D., M.P.H.
Sonja Fuqua, Ph.D., R.N.
Rachel Gold, Ph.D., M.P.H.
Karen Huss, Ph.D., R.N., B.S.N., M.S.N.
Lindsay Satterwhite Mayberry, Ph.D., M.S.
Melissa Somma McGivney, Pharm.D., FCCP, FAPhA
George A. Mensah, M.D., FACC
Brian S. Mittman, Ph.D.
Nivedita Mohanty, M.D.
Suma Nair, Ph.D., M.S., R.D.
Wendy J. Nilsen, Ph.D.
Ifeyinwa (“Ify”) Osunkwo, M.D., M.P.H.
Emmanuel Peprah, Ph.D.

Matthew Quinn, M.B.A., B.S.
Nancy Schmieder Redeker, Ph.D., M.S.N., R.N., FAHA, FAAN
Rebecca Roper, M.S., M.P.H.
Uchechukwu K. A. Sampson, M.D., M.P.H., M.B.A., M.Sc. (Oxon), M.S., FACC
RADM Pamela Schweitzer, Pharm.D., B.S.
Alexa (Sevin) Valentino, Pharm.D., BCACP
Edward D. Shanshala, MSHSA, M.S.Ed.
Susan T. Shero, M.S., B.S.N.
Cassandra Shields, Pharm.D.
Charles (“Bart”) Smoot, M.D., M.S.
Margie E. Snyder, Pharm.D., M.P.H.
Todd D. Sorenson, Pharm.D.
Alek Sripipatana, Ph.D., M.P.H.
Mr. Mark E. Stokes
Catherine M. (“Kate”) Stoney, Ph.D.
Jonathan N. Tobin, Ph.D., FAHA, FACE
Michael Jay Twery, Ph.D.
Jenny Van Amburgh, Pharm.D., FAPhA, BCACP, CDE
Ellen M. Werner, Ph.D.

Non-Federal Workshop Participants

Saul Blecker, M.D., M.H.S.
Hayden Barry Bosworth, Ph.D.
Meagan Arian Brown, Pharm.D., B.S.
Tyra Bryant-Stephens, M.D., FAAP
Arlene Manns Butz, Sc.D.
Barry L. Carter, Pharm.D.
Benjamin Chavez, Pharm.D., BCPP, BCACP
Deborah J. Cohen, Ph.D.
Jeffrey Michael Durthaler, M.S., R.Ph.
Karla Finnell, Ph.D., M.P.H.
Sonja Fuqua, Ph.D., R.N.
Rachel Gold, Ph.D., M.P.H.
Lindsay Satterwhite Mayberry, Ph.D., M.S.
Melissa Somma McGivney, Pharm.D., FCCP, FAPhA
Brian S. Mittman, Ph.D.
Nivedita Mohanty, M.D.
Ifeyinwa (“Ify”) Osunkwo, M.D., M.P.H.
Nancy Schmieder Redeker, Ph.D., M.S.N., R.N., FAHA, FAAN
Alexa (Sevin) Valentino, Pharm.D., BCACP
Edward D. Shanshala, MSHSA, M.S.Ed.
Cassandra Shields, Pharm.D.
Charles (“Bart”) Smoot, M.D., M.S.
Margie E. Snyder, Pharm.D., M.P.H.
Todd D. Sorenson, Pharm.D.
Mr. Mark E. Stokes
Jonathan N. Tobin, Ph.D., FAHA, FACE
Jenny Van Amburgh, Pharm.D., FAPhA, BCACP, CDE

Federal Workshop Participants

CAPT Michael M. Engelgau, M.D., M.S., FACP
Karen Huss, Ph.D., R.N., B.S.N., M.S.N.
George A. Mensah, M.D., FACC
Suma Nair, Ph.D., M.S., R.D.
Emmanuel Peprah, Ph.D.
Matthew Quinn, M.B.A., B.S.
Rebecca Roper, M.S., M.P.H.
Uchechukwu K. A. Sampson, M.D., M.P.H., M.B.A., M.Sc. (Oxon), M.S., FACC
RADM Pamela Schweitzer, Pharm.D., B.S.
Susan T. Shero, M.S., B.S.N.
Alek Sripipatana, Ph.D., M.P.H.
Catherine M. (“Kate”) Stoney, Ph.D.
Michael Jay Twery, Ph.D.
Ellen M. Werner, Ph.D.

Agenda

8:00 a.m.
-
Registration

8:30 a.m.
-
SESSION 1: Opening Session / Welcome, Opening Remarks, and Introductions

Introductions

Rebecca Roper, M.S., M.P.H., Health Science Policy Analyst, Translation Research Branch (TRB), CTRIS, NHLBI

Our Mission and Rationale for the Workshop

George Mensah, M.D., FAHA, Director, CTRIS, NHLBI

8:50 a.m.
-
Presentation of Charge

Uchechukwu Sampson, M.D., M.P.H., M.B.A., M.Sc. (Oxon), M.S., FACC, Translation Research Branch (TRB) Chief, CTRIS, NHLBI

9:00 a.m.
-
Implementation Research for Improving Care Delivery: FQHCs in Context

Ahmed Calvo, M.D., Senior Fellow, Thought Leadership and Innovation Foundation

9:20 a.m.
-
Break

9:30 a.m.
-
SESSION 2: Improving Care Delivery: Identifying the Evidence Base

Session Co-Chairs:

Hayden Barry Bosworth, Ph.D., Professor and Vice Chair of Education, Department of Population Health Sciences, School of Nursing, Duke University Medical Center

Nivedita Mohanty, M.D., Chief Research Officer, Director of Evidence-Based Practice, Executive Team, AllianceChicago

Moderator:

Suma Nair, Ph.D., M.S., R.D., Office of Quality Improvement Director, Bureau of Primary Health Care, HRSA

Session 2 Discussion Questions:

1. What is the evidence for informing improvements in care delivery, medication adherence, and community wellness?

2. What is the evidence on how to leverage clinical teams to optimize inputs from nurses, medical assistants, nurse practitioners, social workers, physician assistants and other health providers?

3. What is the evidence base for facilitating patients’ access to health insurance, social services, and other resources, and addressing social determinants of disease in communities and populations served by FQHC/CHCs?

4. Do we have evidence of innovative approaches to cultural competence and CHC-based supportive services, such as health education, health literacy (including translation into other languages), or provision of physical access to healthcare that are poised for adoption, uptake, and scaling?

 

10:00 a.m.
-
5-Minute Break

11:30 a.m.
-
LUNCH

12:00 p.m.
-
SESSION 3: Gaps and Challenges In Implementation Research Evidence for Improving Care Delivery

Session Co-Chairs:

Brian S. Mittman, Ph.D., Senior Scientist, Kaiser Permanente Southern California Department of Research and Evaluation

Nancy Schmieder Redeker, Ph.D., Principal Investigator/Director, Yale Center for Sleep Disturbance in Acute and Chronic Conditions, Yale University School of Nursing


Moderator:

Karen Huss, Ph.D., R.N., B.S.N., M.S.N., Program Director, Self-Management in Acute and Chronic Conditions and Caregiving Science Areas, Division of Extramural Science Programs, NINR
 

Session 3 Discussion Questions:

1. What are the gaps in knowledge and implementation research evidence for characterizing and understanding organizational readiness for change, and sustainability?

2. What do we need to understand about multi-level systems and engaging various stakeholders?

3. What are the best research strategies to understand adaptive approaches, which balance fidelity and flexibility?

4. Given FQHC’s emphasis on cost savings and demonstration of value, how should approaches for the prevention and treatment be evaluated for value?

1:00 p.m.
-
5-Minute Break

2:00 p.m.
-
BREAK

2:10 p.m.
-
SESSION 4: Leveraging Technology, Information Systems, and Data Science

Session Co-Chairs:

Deborah J. Cohen, Ph.D., Associate Professor, Department of Family Medicine, School of Medicine, Oregon Health and Science University

Mathew Quinn, M.B.A., Senior Advisor for Health Information Technology, Health Resources and Services Administration (HRSA)


Moderator:

Alek Sripipatana, Ph.D., M.P.H., Office of Quality and Data, Bureau of Primary Health Care, HRSA


Session 4 Discussion Questions:

1. How can social networking or social marketing help patients develop community-based self-help and mitigate social determinants of health; and how can FQHC patients capitalize on resources currently available or anticipated?

2. How can FQHCs and CHCs leverage technology and information systems to improve care delivery to the elderly and other vulnerable populations in various contexts, including geography and rural-urban setting?

3. How are FQHCs and CHCs leveraging technology and information systems to provide after-hour access to care, patient portal, and home wellness visits and programs?

4. How can the data reporting requirements for value-based care, pay-for-performance, and CHC certifications such as Patient Centered Medical Home drive successful and sustainable quality improvement strategies?

5. How can data from process, clinical, or efficiency measures be used to evaluate performance and provide contextually relevant insight to foster improvement strategies?

4:10 p.m.
-
Adjourn

8:00 a.m.
-
Registration

8:30 a.m.
-
Implementation Research for Improving Medication Adherence/Evidence-Based Pharmacy-Provider Configurations for Your Community Health Center

RADM Pamela Schweitzer, Pharm.D., Chief Pharmacy Officer, United States Public Health Service (USPHS), Centers for Medicare and Medicaid Services (CMS)

8:50 a.m.
-
SESSION 5: The Critical Role of Clinical Pharmacists In Medication Management and Adherence

Session Co-Chairs:

Barry L. Carter, Pharm.D., Patrick E. Keefe Professor in Pharmacy, Department of Pharmacy Practice and Science, Division of Health Services Research, College of Pharmacy, University of Iowa

Todd D. Sorenson, Pharm.D., Professor and Associate Head, Department of Pharmaceutical Care and Health Systems, University of Minnesota College of Pharmacy


Clinical Pharmacist Panelists:

Meagan Arian Brown, Pharm.D., B.S.

Benjamin Chavez, Pharm.D., BCPP, BCACP

Melissa Somma McGivney, Pharm.D., FCCP, FAPhA

RADM Pamela Schweitzer, Pharm.D., B.S.

Alexa Sevin Valentino, Pharm.D., BCACP

Margie E. Snyder, PharmD., M.P.H.
 

Moderator:

Jeffrey M. Durthaler, M.S., R.Ph., Population Health Consultant Pharmacist, IHRC, Inc., Applied Research and Evaluation Branch, Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention
 

Session 5 Discussion Questions:

1. What are the barriers, challenges and sustainable benefits associated with increasing the responsibility of clinical pharmacists as active members of the primary care team?

2. How can clinical pharmacists provide clinical care to patients and families that can be of value to them and other members of care team?

3. What are potential strategies to support clinical pharmacists and medication management programs in FQHCs? How can they be aligned with the functional requirements of FQHCs?

4. What roles can the pharmacy itself, or the pharmacy-supported process, play in patient care improvement and overall community wellness?

10:00 a.m.
-
5-Minute Break

10:50 a.m.
-
WORKING LUNCH

11:00
-
SESSION 6: Key Partnerships and Strategies For Sustainable Implementation Research Within FQHCs and Other CHCs

Session Co-Chairs:

Tyra Bryant-Stephens, M.D., Clinical Professor of Pediatrics, Director and Founder, The Community Asthma Prevention Program, The Children’s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania

Jonathan N. Tobin, Ph.D., President and Chief Executive Officer, Clinical Directors Network, Inc. (CDN)
 

Moderator:

Susan T. Shero, M.S., B.S.N., Project Officer, Implementation Science Branch, CTRIS, NHLBI


Session 6 Discussion Questions:

1. Who are the stakeholders and how can they organize to drive implementation research to improve care delivery in order to generate sustainable approaches?

2. What partnerships are necessary to address the factors (social, environmental, political, economic, etc.) or competing responsibilities that mitigate against implementation research in these settings?

3. What are the strategies for aligning implementation research projects with real-world FQHC/CHC workflow and practices?

4. What strategies for acknowledgement or remuneration will foster active FQHC engagement and participation in implementation research?

5. What prioritized infrastructure or workflow gaps need to be addressed through strategic partnerships to improve oversight and coordination of patient care by primary care teams?

12:50 p.m.
-
BREAK

1:00 p.m.
-
SESSION 7: Stimulating Implementation Research at FQHCs/CHCs: Rationale For Training and Capacity Building

Session Co-Chairs:

Melissa Somma McGivney, Pharm.D., Associate Dean for Community Partnerships, Associate Professor, University of Pittsburgh School of Pharmacy

Jenny Van Amburgh, Pharm.D., Clinical Professor and Assistant Dean for Academic Affairs, Bouvé College of Health Sciences, School of Pharmacy, Northeastern University


Moderator:

Rebecca Roper, M.S., M.P.H., Health Science Policy Analyst, Translation Research Branch, CTRIS, NHLBI


Session 6 Discussion Questions:

1. What is the state of the science on FHQCs and CHCs research experience, infrastructure, or needs from a national perspective?

2. What research training and workforce capacity building efforts are necessary for transforming FQHCs and other CHCs into learning organizations?

3. How can we enable and develop a diverse implementation research workforce equipped with the essential resources to address high‐priority community research questions within FQHCs and other CHCs?

4. How can we encourage strong research collaboration with clinician scientists at neighboring or affiliate academic health centers in order to foster implementation research studies and the growth and development of research workforce within FQHC and CHCs?

5. What are the high-priority topics of interest for training and technical assistance related to research engagement at FQHCs and other CHCs?

3:00 p.m.
-
SESSION 8: Recap and Next Steps/Summary of Discussions and Key Points

CAPT Michael M. Engelgau, M.D., Deputy Director, CTRIS, NHLBI

3:20 p.m.
-
Future Directions and Closing Remarks

Uchechukwu Sampson, M.D., M.P.H., M.B.A., M.Sc. (Oxon), M.S., FACC, Translation Research Branch (TRB) Chief, CTRIS, NHLBI

3:30 p.m.
-
Adjourn