Director’s Update – August 2014

Every month, the CTSI Stories Blog will post excerpts from ongoing conversations with the institute’s co-directors.

Below, Nana Bennett gives an overview of the CTSI’s population health pillar, which was officially established in early 2014.

Nancy M. Bennett, M.D., co-director of the CTSI.

Nancy M. Bennett, M.D., co-director of the CTSI.

On the creation of the pillar:

The genesis of the Clinical and Translational Science Awards came from the idea that clinical and translational research – all research, really – should impact the health of the public more directly and rapidly than it currently does.

The problem in the United States is that our health outcomes are not as good as other countries despite spending much more. We also, obviously, have a robust research infrastructure, so you’d think we would be doing better. So Elias Zerhouni, who was the head of NIH when the CTSA program started, was interested in that gap and tried to create a vision of how research could improve health more rapidly.

So when we started the Rochester CTSI, we wanted our research enterprise to contribute more directly to public health. One of the required elements of the CTSA program was community engagement — to provide support to investigators in working with the community.  We conceived of community engagement as a tool to improve the translation of research into the community and also to serve as a bridge to the community, so their concerns could be brought into the academic institution. So when we created our community engagement core, we worked with the community very closely and built a lot of infrastructure for that dialogue to continue. This all happened at the same time we were starting the Center for Community Health (CCH), so it was perfect timing, because it all dovetailed with the mission of the CCH.

But over time, nationally, it seemed as though community engagement became the goal rather than the way to get to the goal. When Karl Kieburtz took over the CTSI and we started to think about our strengths and the ways we could make a contribution, it appeared that population health was an area that was important on all fronts. It was important to the public health of this community. It was important to the institution. It was important to the design and focus of emerging care structures in health care reform. And it was important to the research side because we need to translate what we know immediately into health improvement, and that’s population health.

A critical part of population health is informatics.  We can only think about the health of populations if we have the data. So a central part of the transformation of the CTSI is the growing strength of our informatics capacity.

On how big data ties in to population health:

A lot of our big data efforts are focused on how we bring disparate data sets together to define the multiple determinants of the health of populations and how we approach patients as part of a population. The latter concept is nothing new — Peter Szilagyi was one of the earliest people to talk about viewing one’s patients as a population, and his immunization work is an excellent example of viewing a pediatrics practice as a population group in assessing immunization rates. But now we’re focusing on how to think about the data itself in a different and broader way.

With Tim Dye coming back to the institution, we’re taking a new look at how we’re going to use biomedical informatics with population health as a focus. A population might be the patients that come to a particular clinic, or it might be all of the people who come to URMC, or it might be the population of Monroe County, or the population of all 13 counties that we serve.

Currently, we mostly use public health data to look at larger populations — we don’t use clinical data very much because of access limitations and technical issues. Now we are preparing to be able to use clinical data to more completely define the health of a population – combining it with more traditional public health data – survey data, reportable conditions, etc – trying to think of ways that we can collaborate with the other health care systems in the area over data, and not have data be a competitive entity. That’s one of our big challenges right now: thinking about systems that enable us to share data in ways that don’t interfere with the institution’s proprietary interest. Because the future of health care is looking at population data, understanding what works, and applying those lessons directly to what we do clinically.

On what to expect in the future from the CTSI in terms of population health:

Our focus will be on improving the health of the Rochester region and helping to drive the direction of our clinical enterprise to improve the overall health of our patient population.  In some ways, we are farther along with respect to driving public health than we are in the clinical realm, because we have developed such robust partnerships throughout the community. Then, as mentioned, we want to integrate those two things: We want to think about the community as a whole and focus on what is most important to the community, but use clinical data and comparative effectiveness research to determine our directions.

In the nearer term, we have four specific objectives: 1) Develop methods  to measure and demonstrate improvements in population health; 2) Increase capacity to make use of population health data; 3) Increase the institutional capacity to conduct community-engaged population health research; and 4) Increase early-career training opportunities in population health and population research. The CTSI lecture series in Spring 2015 is going to focus on population health. Bob Holloway, the leader of the series, is working with us to plan it and we will share details as soon as they are available. We hope that the series will be a great kick-off for our ongoing efforts.

Previous director’s updates:

July 2014 – Harriet Kitzman offers her takeaways from the Mini Summer Research Institute.
June 2014 – Karl Kieburtz gives an overview of the CTSI’s six pillars.

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