Scientific discoveries are essential for improving patient care. Yet, according to a paper in the Journal of the American Medical Association, it takes an average of 17 years for only 14 percent of new scientific discoveries to enter day-to-day clinical practice. In addition, Americans receive, on average, only half of recommended preventive, acute, and long-term quality health care.
The issue is prevalent across numerous diseases and conditions, from high blood pressure (where nearly half of individuals diagnosed as having hypertension don’t have their blood pressure under control despite numerous studies funded by the NHLBI that have made important contributions to the detection, prevention, treatment and control of this condition) to sickle cell disease, where children with sickle cell disease are hospitalized with influenza at 56 times the rate of children without sickle cell disease (source: Pediatrics, May 2011)
Dilemmas about the translation of science – and about health disparities and health inequities – occupy the thoughts of Dr. George Mensah, director of NHLBI’s newly created Center for Translation Research and Implementation Science (CTRIS).
“For sickle cell disease, hypertension, and other heart, lung, and blood diseases, we have compelling evidence-based strategies that can prevent these diseases or their complications,” Dr. Mensah said. “So why aren’t these strategies being widely used and what can we do to facilitate that use? Why do health disparities persist when we have compelling evidence that the disparities are preventable? These are the questions that CTRIS grantees will be asking, and, hopefully, also answering.”
If you ask Dr. Mensah, he’ll tell you that CTRIS has two big-picture goals: “We want to get the maximum bang from the dollars we’ve invested in basic, fundamental discoveries and early translational research, and we want to take fundamental discoveries from our research efforts and get them to the finish line – that is, where they yield their beneficial largest impact possible within our population.”
Indeed, Dr. Mensah emphasized that CTRIS’ research and success is contingent upon NHLBI’s continued investments in basic and fundamental discovery science and early pre-clinical translational sciences.
The center will be meeting its mission by investing in research that shows how critical discoveries made in the labs and clinical trials can best be applied in hospitals, doctors’ offices, and the community at large to benefit public health. The focus is on an area called “T4 research” where investigators study treatments and practices that influence the health of populations. T4 research happens after clinical trials determine how individual patients will benefit from particular interventions and or treatments. The research tackles questions about how and in what contexts these treatments should be used and how to ensure they are used, such as:
“Ultimately, the big question is: From a scientific research perspective, how does the real world context influence the sustained adoption and use of effective interventions?” Dr. Mensah said.
CTRIS also will look at widely used but so-called “evidence-free” practices and will work with partner organizations to eliminate their use, an issue that Dr. Mensah said is as important as adoption of evidence-based practices.
Because the possibilities are so vast, CTRIS initially will focus on three main disease areas: cardiovascular disease prevention, especially related to hypertension and other major risk factors; asthma; and sickle cell disease.
For example, CTRIS-coordinated projects may examine questions such as: How are cardiovascular disease prevention guidelines being adopted in the communities and what research can we do to accelerate that adoption? When professional organizations develop guidelines, what barriers prevent doctors and nurses from adopting them?
The center will encourage the creation of novel, non-traditional research coalitions to answer these and other questions. The coalitions ideally would have multiple and diverse partners, such as major public health schools and academic health centers, public health or state health departments, community hospitals, federally qualified health centers, health plans, and federal agencies such as the Centers for Disease Control and Prevention.
An important part of the center’s work in T4 translation research will be looking at health disparities and health inequities among populations that often don’t benefit from the dissemination and implementation of medical research.
“The root of health inequities cut across all diseases,” Dr. Mensah said. “We plan to implement a trans-institute approach that looks at the scientific questions around health inequities related to gender, socioeconomic status, geography, and education.”
Dr. Mensah emphasized that the center’s work in this area will focus on identifying effective strategies for overcoming health equity issues, and not research at the basic science level.
CTRIS also will be the focal point for NHLBI’s global health activities, examining global health issues through the lens T4 translation research and implementation science.
As an example, Dr. Mensah referenced a 2013 publication he co-authored in the Journal of the American Medical Association. The paper measured the burden of diseases, injuries, and leading health risk factors in the United States from 1990 to 2010 and compared these measurements with those of the 34 countries in the Organization for Economic Co-operation and Development (OECD) countries. Despite a large investment in biomedical research by the U.S., its position based on all mortality-based metrics declined between 1990 and 2010 to 27th or 28th among the 34 OECD countries. But that’s not all.
“Ask the question, ‘How are we doing in heart attacks?’ You’ll see that we’ve invested the most money in heart attack research; yet in terms of the summary measure of health, we rank 17th. How did that happen? If you look at chronic lung disease, we rank 16th. The only category in which we come first is in how much money we spend per person every year. It is tempting to attribute these differences to differences in healthcare system between the U.S. and the OECD countries, but we know it is more complex than that,” Dr. Mensah added.
NHLBI leadership in this arena is crucial because heart disease is the leading contributor to premature mortality in the U.S. and OECD countries; and chronic lung disease and sickle cell disease are two of the top four diseases with the greatest potential for reducing years lived with disability in these countries.
“With research, perhaps we can begin to explain what’s really driving the differences,” he added.
The End Goal
“Ultimately, we hope to accelerate all types of research that lead to increased adoption of proven, evidence-based treatments and practices that will more fully utilize scientific discoveries and result in better health for all,” Dr. Mensah said.
Creation of the new center follows on the heels of work happening at other NIH institutes and centers – such as the National Center for Advancing Translational Sciences, National Cancer Institute and National Institute of Mental Health – in this new and emerging field of translation research and implementation science. Dr. Mensah plans to heed the lessons learned by the other institutes and centers, and to form partnerships with them whenever possible.
“Ultimately, we’re here to support extramural scientific community and to help them develop the skills necessary in this space to submit successful grants to the NHLBI,” he said.
“Importantly, NHLBI support for continued investments in basic and fundamental discovery science and early pre-clinical translational sciences remains unabated because without these discoveries, there will be no research insights to translate into real world settings,” he added.