The ‘Un-Meeting’ format which begins with a topic and little in the way of an agenda offers a unique opportunity to explore areas where multiple types of stakeholders with multiple perspectives can interact to focus attention on an issue for which there is no clear ownership or leadership. In this manner, areas that struggle to define themselves begin to come into focus. Recently, the CTSA Consortium held an ‘Un-Meeting, Exploring the Inclusion of Community Hospitals in Clinical Research.
Community hospitals, especially in suburban and rural areas, provide care to most Americans. Diversity in clinical research, both in terms of patient populations as well as the spectrum of medical conditions, can be enhanced with a diversity of health care settings. By expanding the network of potential hospitals, the likelihood of inclusion of appropriate participants increases. This has proven especially critical during the COVID-19 pandemic where answering critical medical questions as quickly as possible could not only save individual lives, but also prevent overburdening health care resources. So as Sutton’s Law would suggest, engaging community hospitals is wise because that’s where the patients are!
As one example, the ACTIV 1 trial successfully leveraged the CTSA network to include community and rural hospitals. Initially, the trial primarily focused on CTSA hubs, but the team quickly pivoted to include community and rural hospitals to have a more diverse study population; the ACTIV 1 trial included academic institutions (61%), non-academic institutions/community hospitals (31%), and rural hospitals (14%).
The capability to rapidly and seamlessly engage community hospitals in medical research is not only valuable during a pandemic, but potentially offers unique opportunities to address many other long standing medical conditions. The focus of the Un-Meeting was to understand the barriers and impediments and identify possible solutions to engage community hospitals in clinical research. The group quickly coalesced around four distinct areas: Building Partnerships & Network Facilitation, Providing Resources, Aligning Incentives & Increasing Engagement and Data Sharing Barriers.
Building Partnerships & Network Facilitation discussed the importance of knowing which resources are available at community hospitals. Common challenges included identifying needed expertise - for example, to address unique challenges with contracting multiple entities - and engaging and incentivizing both PIs and hospital leadership as partners. Engaging research “champions” who are at both academic centers and community hospitals and creating a clinical research community at community hospitals could facilitate opportunities to share best practices and build partnerships.
Providing Resources discussed infrastructure barriers that the CTSA Program could be poised to address, such as by using tools, like the Trial Innovation Network’s site feasibility assessment tool, to assess community hospital readiness to conduct clinical research. This group also highlighted the critical role of respectful relationships and mission alignment in partnerships: at the heart of it, community hospitals and academic centers do research for the benefit of their patients, and as such, research should be done with them, and not on them.
Aligning Incentives & Increasing Engagement remarked upon opportunities to engage by identifying what the partner needs are – for example, exploring direct funding mechanisms that may be simpler than contracts, or to support grant writing – and aligning incentives that are meaningful to partners and address the pressing health problems that may be facing their community, such as diabetes, obesity, and COVID.
Data Sharing Barriers due to concerns with data integrity and data sharing practices remain a concern, as even with a common goal of serving communities, these barriers challenge the ability of partners to work within and across institutional lines.
Building relationships informed by partner needs, assets, and interests and establishing best practices that cultivate sustained engagement were unifying themes throughout. The conversation was rich with opportunities to pursue solutions to more fully engage community hospitals in clinical research as research partners to academic centers. Successful engagement will not only provide a crucial component for pandemic preparedness, but will likely discover unique research opportunities that will pay dividends during the interpandemic period and provide for unique translational science contributions to overall health care.
This Mike's Blog was featured in June 2021's Ansible. Click here to view the newsletter.