Manish N. Shah, MD, MPH
Associate Professor; Emergency Medicine, Geriatrics/Aging, Public Health Sciences, and Center for Community Health
Associate Chair for Research and Chief of the Division of Prehospital Medicine, Department of Emergency Medicine
In a funding era where universities across the nation are bracing for the possibility of significant federal cuts to research, the University of Rochester Medical Center’s Department of Emergency Medicine research program is thriving. The Emergency Medicine research program received about $1.8 million in total funding during fiscal year 2013. Manish N. Shah, MD, MPH, leads the program and says its success can be attributed to a variety of factors which all tie back to the Department’s incredible research teams.
Emergency Medicine Research
The Emergency Medicine research program conducts clinical and translational research to benefit patients with acute illnesses. The program has developed four major focus areas: traumatic brain injury (TBI), led by Dr. Jeffrey Bazarian; geriatric emergency medicine and prehospital medicine, led by Dr. Shah; and global health, led by Dr. David Adler. Dr. Shah says the program’s success is largely due to a significant interest in the research questions. According to the Centers for Disease Control and Prevention, there are at least 1.7 million traumatic brain injuries each year. These injuries are becoming increasingly common among members of the military who served in Afghanistan and Iraq, as well as among athletes in the National Football League. URMC’s Emergency Medicine research team is a national leader in TBI research and has been awarded funding for its cutting edge studies on diagnostics, interventions, and biomarkers.
The Department is also nationally renowned for its work in geriatric emergency medicine – a field which is only about five to ten-years-old. Older adults make millions of visits to the emergency department each year, and Dr. Shah says more can be done to take care of these of patients. This research also ties in with the department’s focus on prehospital medicine.
“A tremendous amount of care is provided to patients before they get to the hospital, and the question fundamentally is ‘how do we improve that care,’ both in terms of diagnostics, therapeutics, and even decision making on ‘where do you go?’” he said. “You have stroke centers, you have trauma centers, you have burn centers. Which patient has to go to which place?”
Dr. Shah says the newest area of work within the department is global health research. Dr. Adler is currently working with colleagues in South Africa to study the epidemiology of human papillomaviruses in HIV-infected and HIV-uninfected women.
“The topics themselves have been very helpful in that they’ve been high impact, high interest topics,” Dr. Shah said. “Even though we’ve had the same exact problem that everyone else has with funding being tight…we’ve been fortunate that we’ve been reasonably successful in our core areas of research.”
Powerful, Multidisciplinary Research Teams
“The fun thing about emergency medicine research is that we don’t do this in isolation. Every project we do will have many other departments on it.”
The Emergency Medicine research program has been incredibly successful in building strong, multidisciplinary research teams for its studies. In 2012, for instance, Dr. Shah, Dr. Bazarian, and Dr. Jeremy Cushman teamed up with URMC trauma surgeons, geriatricians, and the Department of Public Health Sciences for a study entitled, “Field Triage of Older Adults Who Experience Traumatic Brain Injury.” Dr. Shah says this type of collaboration sets URMC apart when applying for grant funding.
“It allows us to have incredibly strong applications, such that we’re able to go forth and say, hey, we have the smartest trauma surgeon, public health scientist, epidemiologist, health services researcher, and emergency physician to answer this question.”
Dr. Shah also credits the Saunders Research Building for inspiring teams to collaborate. The building is URMC’s physical home for clinical research, and Dr. Shah says it has significantly enhanced communication among departments.
“You walk through the lobby and you stop three times to talk to people you want to collaborate with,” he said. “Now that we’re all here together, we see each other, we’re always brainstorming ideas, and this will help us long term.”
Study teams also benefit from the Emergency Department Research Associate Program (EDRA), which is run by the Emergency Medicine research team. The EDRA program is a resource for investigators who wish to identify and enroll emergency department (ED) patients in their studies. More than 100,000 patients visit Strong Memorial Hospital’s ED each year, and the program is currently expanding to include the ED at Highland Hospital. Research Associates have enrolled more than 10,000 study volunteers since the program’s inception in 1996.
In addition to multidisciplinary studies at URMC, Dr. Shah and his team are also involved in numerous multicenter studies. Dr. Shah says collaborating with investigators on a national level has helped build the emergency medicine research pathway at URMC. Currently, the Department is one of five sites partnering with Oregon Health and Science University to derive a syncope risk stratification rule. URMC serves as the central lab and Dr. Shah serves as the site Principal Investigator.
The Impact of the CTSI
“We wouldn’t have gotten here without the CTSI.”
The Emergency Medicine Department’s research efforts have grown at an incredible rate throughout the past several years. Dr. Shah says it would not have been possible without the support of the CTSI, and especially its former Director, Dr. Thomas Pearson, who mentored almost all of the researchers in the Department, including Drs. Shah and Bazarian.
“Emergency medicine in this institution has benefited tremendously from Dr. Pearson’s vision on how to build research,” he said. “Emergency Medicine had little research before Dr. Pearson came here and started the K30 clinical research curriculum and then the CTSI.”
Dr. Shah says the Emergency Medicine research program is a “homegrown affair,” with faculty members obtaining advanced degrees, career development awards, and then independent research awards. He says this tactic of developing junior faculty members and mentoring them until they become senior has helped build such a strong program.
“We have great researchers, we have great project coordinators, we have great support staff, and those individuals working clinically are incredibly supportive of the research,” he said. “When you have all of this come together, you can be successful.”
To learn more about research in the Department of Emergency Medicine, click here.