Study Uncovers Underutilization of Services at CTSA Program Hubs

Image of an iceberg. Tip of the iceberg is labeled "Resource Usage" and the bottom of the iceberg is labeled "Missed Opportunities."

CTSA Program hubs offer a wide range of services, from bioinformatics to recruitment support, to help investigators across disciplines design, implement and report their research more rigorously and efficiently. In 2018, Julie T. Elworth, Ph.D., director of evaluation at the University of Washington Institute of Translational Health Sciences (ITHS), realized that more than 75 percent of individuals using ITHS services only used services from a single domain or module – even though ITHS offered services in 11 different modules.

Now, Elworth and evaluators at other CTSA Program hubs completed a study that found a similar pattern at two other CTSAs, suggesting researchers are missing opportunities to leverage CTSA Program services across multiple modules that could further advance their work.

Published in the Journal of Clinical and Translational Science, the study identified barriers to using services in multiple modules, including informatics, community engagement, team science and more, and recommended solutions to overcome these barriers. The effort, supported by CLIC’s Synergy Paper program, was led collaboratively by ITHS, Oregon Clinical and Translational Research Institute, and South Carolina Clinical & Translational Research Institute.

Underutilization is a concern due to the risks it presents to research investigators, to the CTSA Program hubs and to the hubs’ home institutions. Investigators may experience inefficient study design and implementation by not utilizing the full array of modules available to them. Hubs may miss research or educational opportunities. Hubs’ home institutions may experience reduced value and reduced impact in their clinical and translational funding portfolio.

Study authors interviewed investigators and surveyed module managers at small, medium and large CTSA Program hubs. Four types of barriers were identified that could affect module utilization: investigators finding it challenging to identify services offered by the hub; lack of follow up about other hub services; the cost or perception of cost of services; and service providers being unfamiliar with the “real-world” context of an investigator’s research.

Recommendations for solving some of these key barriers include:

  • Improving communication across modules and regularly reviewing changes in services offered and services retired.
  • Reviewing demand for services, and, where needed, increasing module capacity or alerting investigators of delay in supplying service.
  • Ensuring that a CTSA Program hub website is clear and easy for stakeholders to use, especially for new users, in addition to posting and regularly updating module-service webinars on the site.
  • Simplifying intake forms, such as omitting detailed questions investigators might not be able to answer before consultation.
  • Providing new users a brief introduction to the CTSA Program hub-and-services structure.
  • Better co-creating and communicating service offerings and value for investigators.
  • Providing clear information on all service costs.

While this exploratory study offers actionable recommendations, more comprehensive studies that include a larger number of CTSA Program hubs and that focus on the relationship between CTSA Program features and the rates of single-module usage are needed.

“The surprisingly high percentage of single-module service users presented a mystery that we began to uncover with our exploratory study,” Elworth said. “We are looking forward to learning if other CTSAs have this pattern of service use, if they experience the same barriers or find new ones, and if our solutions work at their CTSA or if they develop new solutions.” 


This work was funded in part by the University of Rochester Center for Leading Innovation and Collaboration (CLIC), under Grant U24TR002260 and supported by the NCATS under award numbers UL1 TR002319 (JE, MV, CEB), UL1 TR001450 (JH, RP), and UL1 TR002369 (AZ).